[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS FOR 2003
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
________
SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES,
EDUCATION, AND RELATED AGENCIES
RALPH REGULA, Ohio, Chairman
C. W. BILL YOUNG, Florida DAVID R. OBEY, Wisconsin
ERNEST J. ISTOOK, Jr., Oklahoma STENY H. HOYER, Maryland
DAN MILLER, Florida NANCY PELOSI, California
ROGER F. WICKER, Mississippi NITA M. LOWEY, New York
ANNE M. NORTHUP, Kentucky ROSA L. DeLAURO, Connecticut
RANDY ``DUKE'' CUNNINGHAM, JESSE L. JACKSON, Jr., Illinois
California PATRICK J. KENNEDY, Rhode Island
KAY GRANGER, Texas
JOHN E. PETERSON, Pennsylvania
DON SHERWOOD, Pennsylvania
NOTE: Under Committee Rules, Mr. Young, as Chairman of the Full
Committee, and Mr. Obey, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Craig Higgins, Sue Quantius, Susan Ross Firth, Meg Snyder,
and Francine Mack-Salvador, Subcommittee Staff
________
PART 7A
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER
INTERESTED INDIVIDUALS AND ORGANIZATIONS
________
Printed for the use of the Committee on Appropriations
________
U.S. GOVERNMENT PRINTING OFFICE
80-409 WASHINGTON : 2002
COMMITTEE ON APPROPRIATIONS
C. W. BILL YOUNG, Florida, Chairman
RALPH REGULA, Ohio DAVID R. OBEY, Wisconsin
JERRY LEWIS, California JOHN P. MURTHA, Pennsylvania
HAROLD ROGERS, Kentucky NORMAN D. DICKS, Washington
JOE SKEEN, New Mexico MARTIN OLAV SABO, Minnesota
FRANK R. WOLF, Virginia STENY H. HOYER, Maryland
TOM DeLAY, Texas ALAN B. MOLLOHAN, West Virginia
JIM KOLBE, Arizona MARCY KAPTUR, Ohio
SONNY CALLAHAN, Alabama NANCY PELOSI, California
JAMES T. WALSH, New York PETER J. VISCLOSKY, Indiana
CHARLES H. TAYLOR, North Carolina NITA M. LOWEY, New York
DAVID L. HOBSON, Ohio JOSE E. SERRANO, New York
ERNEST J. ISTOOK, Jr., Oklahoma ROSA L. DeLAURO, Connecticut
HENRY BONILLA, Texas JAMES P. MORAN, Virginia
JOE KNOLLENBERG, Michigan JOHN W. OLVER, Massachusetts
DAN MILLER, Florida ED PASTOR, Arizona
JACK KINGSTON, Georgia CARRIE P. MEEK, Florida
RODNEY P. FRELINGHUYSEN, New Jersey DAVID E. PRICE, North Carolina
ROGER F. WICKER, Mississippi CHET EDWARDS, Texas
GEORGE R. NETHERCUTT, Jr., ROBERT E. ``BUD'' CRAMER, Jr.,
Washington Alabama
RANDY ``DUKE'' CUNNINGHAM, PATRICK J. KENNEDY, Rhode Island
California JAMES E. CLYBURN, South Carolina
TODD TIAHRT, Kansas MAURICE D. HINCHEY, New York
ZACH WAMP, Tennessee LUCILLE ROYBAL-ALLARD, California
TOM LATHAM, Iowa SAM FARR, California
ANNE M. NORTHUP, Kentucky JESSE L. JACKSON, Jr., Illinois
ROBERT B. ADERHOLT, Alabama CAROLYN C. KILPATRICK, Michigan
JO ANN EMERSON, Missouri ALLEN BOYD, Florida
JOHN E. SUNUNU, New Hampshire CHAKA FATTAH, Pennsylvania
KAY GRANGER, Texas STEVEN R. ROTHMAN, New Jersey
JOHN E. PETERSON, Pennsylvania
JOHN T. DOOLITTLE, California
RAY LaHOOD, Illinois
JOHN E. SWEENEY, New York
DAVID VITTER, Louisiana
DON SHERWOOD, Pennsylvania
VIRGIL H. GOODE, Jr., Virginia
James W. Dyer, Clerk and Staff Director
(ii)
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2003
----------
Thursday, April 18, 2002.
EDUCATION BUDGET; TITLE I; IDEA; 21ST CENTURY COMMUNITY LEARNING
CENTERS
WITNESS
HON. ALBERT R. WYNN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MARYLAND
Mr. Regula. We will get started this morning. We have a
long morning, a lot of requests, I think. And, Mr. Wynn, you
get to lead off today.
Mr. Wynn. Well, thank you very much, Mr. Chairman. And good
morning. I will try to move quickly. I would like to divide my
testimony into two parts. First, I'll talk about three
programs, and while they are very important to my district,
they are important to every district in our country,
nationwide. That would be Title I, the IDEA special education
plan, and then the 21st Century Learning Centers.
The second part of my testimony will focus on a few
projects specific to my district that I want to apprise the
committee of. We will, of course, be submitting specific
detailed written requests, but I wanted to, as they say, get it
on the radar screen.
With that in mind, I would like to begin by talking about
Title I, which is a very important program for disadvantaged
students. About a third of the students in my school districts
have schoolwide Title I programs. In fiscal year 2003, the
House budget is $11.5 billion for 2002.
I am pleased that the increase--obviously it is a
significant increase, but nonetheless it is significantly below
the $16 billion authorized for this program in the No Child
Left Behind Act. So really what I am here to say with respect
to Title I is I hope the committee will be able to move closer
to the authorized level in the bill rather than the budget's
figure that we----
Mr. Regula. Depends on our allocation.
Mr. Wynn. Exactly.
Second, IDEA programs. Special ed, of course, is very
important. Again, there is a significant gap between our goals
and what we are currently looking at. I understand we are
looking at approximately $8.5 billion in 2003, which would
cover about 18 percent of the cost of these services. Some time
ago, Congress made a commitment to provide 40 percent of these
services. The thrust of my comments on special ed is simply
this. The less the Federal Government pays, the more local
governments have to pay, and that takes away from other
education programs. And the consequences, I think, are pretty
obvious there.
Probably one of the programs dearest to my heart is the
21st Century Learning Centers. We designated a need to provide
programs for young people after school: academic programs,
athletic programs, arts and crafts, cultural programs, personal
development programs. And the fact is, we are basically flat
funding this program. Substantially less than was authorized
again in the No Child Left Behind Act which would be about 1.25
billion as opposed to the $1 billion we are looking at.
So those are the areas of concern that I have overall. And
I realize you have great limitations. We are cutting about $90
million out of the No Child Left Behind Act, including 28
programs that deal with the problems such as drop-out
prevention, particularly of concern to Hispanic and the
African-American communities, rural education programs, as well
as civic education, which is important in terms of rebuilding
character among our young people.
Having talked about these 3 areas that are important from a
national perspective, I would like to talk specifically about
my district. The first project dealing with an allocation that
I will be requesting in writing deals with an allocation to the
Prince Georges Community College. This request is based on the
events of September 11th. Prior to that, the community college
used facilities at Andrews Air Force Base. You are probably
familiar with that.
Well, that base also housed our local community college, a
significant portion of it, not its entirety. Roughly a thousand
students attended. A third of them were military personnel. The
other two-thirds were not. And, as a result of some
restrictions, there was a disruption. Classes resumed, but it
is anticipated that given our current climate that this will
not be a hospitable location for civilian community college
classes. We will be submitting a detailed request to assist
with off-site housing for the community college programs.
Mr. Wynn. The second request is a program at Bowie State
University, which is in our colleague Mr. Hoyer's district,
adjacent to mine, which serves a large number of students from
my district. It is a historical black college in Prince Georges
County. We are looking to develop and design a bioscience
training laboratory that will teach analytical technologies
used to identify biological agents--obviously since September
11th this is a major issue, particularly important to the
Washington metropolitan area, given our location in relation to
the terrorist threat.
The university is close to Washington, D.C. And would be an
ideal location. We have been providing the committee with
details on that.
The third project I wanted to--the specific project I
wanted to bring to your attention from the Children's Rights
Council. You may be familiar. They are promoting parenthood or
parenting between divorced parents. One of the issues is the
transfer of the children when there are cases of domestic
conflict. We are going to ask for an additional 25 child
transfer centers which provide supervised settings so that one
parent can drop off a child at a neutral site and the other can
pick up at a neutral supervised site.
Actually in my law practice, I saw an unfortunate incident
where a McDonald's was used and the McDonald's ended up being
shot up because the two parents could not get along. Cars were
crashed. It was quite a situation.
But I think this is a worthwhile project. I hope you will
give it full consideration.
And, finally, we would like to secure funds for our high
school debate program. A lot of emphasis is placed on athletics
to help disadvantaged students. Academic reinforcement is
obviously very important. But we would like to promote a high
school debate program that would take a somewhat different
focus and provide young people with the opportunity to engage
in policy debate at the high school level. I think this would
be a very worthwhile activity.
Mr. Regula. Have you presented these in the order in which
they are important to you? Have you prioritized? Because you
know obviously we cannot do everything.
Mr. Wynn. I am well aware of that. I have presented them in
order of priority.
Mr. Regula. So the way you have listed them in your
presentation would be your priorities?
Mr. Wynn. That is correct, sir.
Mr. Regula. Thank you very much for coming.
Mr. Wynn. Thank you very much for your indulgence, Mr.
Chairman. Have a nice day.
[The prepared statement of Congressman Wynn follows:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
I don't think that we have another Member here. Here is--
okay. Welcome. You are on.
----------
Thursday, April 18, 2002.
TRAUMATIC BRAIN INJURY ACT--HRSA, NIH, CDC; PROJECTS
WITNESS
HON. BILL PASCRELL, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW JERSEY
Mr. Pascrell. Mr. Chairman, I want to begin by thanking you
and the Ranking Member, who is not here, for dedicating so much
time to hear public and Member testimony. I will provide the
longer version to you, and I will go quickly through this.
Mr. Regula. I appreciate that.
Mr. Pascrell. An issue of utmost importance to me and many
Members is the condition known as traumatic brain injury, Mr.
Chairman. And we have done a lot of work in the last few years
on a bipartisan basis along this line.
Every year millions of Americans experience TBI, and about
half of these cases result in at least short-term disability.
It is about 80,000 people who sustain severe brain injuries
leading to long-term disability. TBI is defined as an insult to
the brain caused by an external force that may produce
something as small as a concussion to impairing a person of
cognitive abilities, physical functioning. It even can change a
person's behavior, emotional function.
I am very committed to this issue. And we formed, myself
and Congressman Greenwood, a task force on the brain injured 2
years ago. I wanted to bring to your attention three programs
that were expanded in scope and responsibility by the TBI Act
to urge you to fully fund at $36.8 million.
The first program I would like to bring to your attention
is the State grant program administered under the Health
Resources and Services Administration. The TBI Act specifically
directs States receiving grants to develop, to change, or
enhance community-based service delivery systems for victims of
TBI. I request for the State programs and the P&I programs to
be funded at a total of 14.8 million.
The second program you should be aware of, Mr. Chairman, is
the CDC's effort to build on its work with State registries to
collect information that would help improve service delivery.
If we do not know who is out there we cannot--we do not know
the depth of the problem.
Since its inception for traumatic brain injury in 1996, the
CDC program has continuously been underfunded at $3 million.
Mr. Chairman, I am requesting a total of $3 million for CDC's
expanded activities.
NIH directs the National Center for Medical Rehab Research
to launch a cooperative multi-center traumatic brain injury
clinic trials network and fund five bench science research
centers via the National Institute for Neurological Disorders
and Strokes.
I request support for $15 million for these existing
programs at NIH. Those funds are sorely needed and will help a
great percentage of the estimated 5.3 million Americans living
with this disability as a result of traumatic brain injury.
In addition to TBI, there are also two project requests. I
will go through them quickly, Mr. Chairman. The first project I
am here to ask you to support is the 21st Century Institute for
Medical Rehabilitation Research. During the last cycle I asked
for $3 million. Congress provided $350,000 of that amount, for
which I am deeply grateful. I am here today to ask for the
remaining funds if that is at all possible. One of the areas
that could benefit from greater support is the field of
rehabilitation medicine and research.
Up until now this area has not seen the kinds of increases
that many others have enjoyed, and the need remains
substantial. One of the premier institutions in the country in
the rehab research field is in my Congressional district. It is
the Kessler Medical Rehab Research and Education Corporation.
Kessler Rehab Hospital decided to create a new and unique
effort in the United States. It is called the 21st Century for
Medical Rehab Research. State of the art, Mr. Chairman. You
would be very, very proud.
My second request is for St. Joseph's Medical Center at
Patterson for a total of $2,000,000, the first designated
children's hospital and the administrator of the largest WIC
program in the State of New Jersey. The $2,000,000 will allow
the institution to continue to serve and assist the region's
vulnerable pediatric population in 2 specific areas, pediatric
emergency department and the pediatric intensive care unit. It
is a vital urban safety net providing care for the region's
uninsured and underserved.
PICUs are crucial for the care of the region's pediatric
patients, as evidenced by its receipt of 254 transports last
year under agreements with New Jersey and New York hospitals.
The children's hospital emergency department recorded
30,000 pediatric visits last year. It is pretty outstanding.
Mr. Chairman, I really appreciate your indulgence.
Mr. Regula. I assume you have given the special requests in
the order in which they have priority with the----
Mr. Pascrell. I would be happy to answer any of your
questions.
Mr. Regula. Well, we probably will not have the ability to
fund everything.
Mr. Pascrell. Well, these are priorities, you know, and
everything is a priority, nothing is a priority. You know that
better than I do. These are three. I had about 8 or 9 of them.
I hope you can respond in some manner, shape or form. I always
trust your judgment and I will leave it at that.
Mr. Regula. Thank you. Do you have the project
questionnaire with you? If not, just get it to us.
Mr. Pascrell. I think we did.
Mr. Regula. Yes. Okay.
Mr. Pascrell. Thank you, Mr. Chairman.
Mr. Regula. Next Ms. Woolsey.
[The prepared statement of Congressman Pascrell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. LYNN WOOLSEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Ms. Woolsey. Wow, this chair is hot.
Thank you, Mr. Chairman. This is a good opportunity. I
understand that we do not have all of the money in the world.
But again I am here to ask for education and health projects
for the 6th Congressional District of California just north of
the Golden Gate Bridge.
Mr. Regula. I have been there.
Ms. Woolsey. I know you have. You are usually there on the
park stuff. Yes, and Fort Baker.
Mr. Regula. What do you think of the rehab of Fort Baker?
They are trying to get a contractor to do it.
Ms. Woolsey. Right. They are going to make a good decision.
We have gotten some good infrastructure money now from DOD for
the rehab.
Mr. Regula. I think it is a terrific asset.
Ms. Woolsey. I know. I thank you for your interest. You are
already familiar with Center Point, a nonprofit comprehensive
drug and alcohol treatment center in my district. And Center
Point is one of the very few drug and alcohol treatment centers
nationwide that provides comprehensive social, education,
vocational, medical, psychological, housing and rehabilitation
services.
Mr. Regula. We gave them a half a million last year.
Ms. Woolsey. Right. They are here asking for $350,000 this
year in order to----
Mr. Regula. That is still your number 1 priority?
Ms. Woolsey. It is my number 1 priority.
Next, Sonoma State University is in my district. It is the
only public 4-year university in the 6-county region north of
the San Francisco Bay. It is a really good school that is doing
great work.
On behalf of Sonoma State, I am asking for $1 million from
the fund for the improvement of post secondary education,
FIPSE. And they need this for laboratory equipment for their
master's program in computer engineering sciences. And it would
be very useful to them and helpful if we could give them that
funding.
And I need to brag a minute about the Yosemite National
Institute. The Yosemite National Institute conducts
educational, rigorous hands-on environmental science programs.
And they are in my district and elsewhere in California.
When I first came to this subcommittee on Yosemite's behalf
2 years ago, less than 10 percent of their students were from
low income and/or minority families. But, with the help of
Federal funds, Yosemite has been able to make these programs
available to low income minority communities that have
traditionally not had access to quality science-based
educational education.
Today almost 40 percent of Yosemite's students receive
scholarships. That is why I support their request for $1
million so that they can increase their outreach.
Now those are good statistics for Yosemite and Center Point
has got good statistics. But we have some really bad statistics
in my district. And that is about the success rate in our fight
against breast cancer in Marin County. Marin County is the
district--well, you know all of that. Patrick, you know that,
too, don't you?
But Marin County has the highest rate in the Nation of
breast cancer cases and deaths for Caucasian women. And that
figure is increasing at an alarming rate, and we have no idea
why. Half of the breast cancer cases in Marin County cannot be
explained by known risk factors, by mothers and grandmothers,
and having had breast cancer.
And that is why I am asking for $1\1/2\ million from the
Center for Disease Control to expand breast cancer research and
health outreach programs in Marin County. We have twice already
helped them, not--to almost a million dollars, but now they are
ready to go with their project to find out what is going on.
And then, finally, Mr. Chairman, we have another university
in my district. This one is a private university. It is
Dominican University. It used to be Dominican College. They are
seeking Federal assistance, and we do not know the amount yet,
for a center--to build a center for science and technology.
Their center will teach teachers and nurses who will then be
able to go into the hospitals and to the schools and expand our
access to high-tech people so we do not have to go overseas and
hire them.
So that is the 6th Congressional District, a leader in
meeting the health and education needs of the 21st Century, but
needing help along the way. Absolutely a donor district in this
country for taxes. I made a commitment to them that it is my
job to make sure that they get some of something back.
Mr. Regula. Is Center Point your number 1?
Ms. Woolsey. Center Point is my number 1, continues to be
my number 1.
Mr. Regula. Mr. Kennedy, any questions?
Mr. Kennedy. No. But thank you.
Ms. Woolsey. Thank you. Thank you both. A part of something
for all of it would be good. I mean, rather than have
everything going to one program.
Mr. Regula. You would rather divide it up?
Ms. Woolsey. I would. Thank you very much.
Mr. Regula. Well, we do not have any more members here at
the moment. Good morning.
[The prepared statement of Congresswoman Woolsey follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
CHILD ABUSE PREVENTION AND TREATMENT ACT
WITNESS
HON. JOHN B. LARSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CONNECTICUT
Mr. Larson. Thank you, Mr. Chairman. I want to thank both
you and Ranking Member Obey and the distinguished Members of
the Subcommittee and my dear colleague, Patrick Kennedy.
I am grateful for the opportunity this morning to bring to
your attention the needs of the underfunded programs in the
Child Abuse and Prevention and Treatment Act.
I join with a host of sponsors from my district who have
aligned themselves with the National Child Abuse Coalition to
ask specifically that CAPTA receive an appropriation equal to
its fully authorized amount, $70,000,000 for basic State
grants, 66,000,000 for community-based prevention grants, and
30,000,000 for research and demonstration grants.
It is my hope that with this funding, we will be one step
closer to ensuring the safety of our Nation's abused children.
As I am sure you know already, Mr. Chairman, and Members of
this committee, in 1999 the Department of Health and Human
Services reported that child prevention services agencies
received over 2.9 million reports of suspected child abuse and
neglect.
National incident studies found since 1988 all forms of
abuse and neglect, sexual, physical and emotional, have risen
at least 42 percent, while some individual types of neglect
have risen over 300 percent.
Unfortunately, funding for neither CAPTA nor the CPS
agencies has kept pace with the scope of this problem, Mr.
Chairman, which by way of anecdote, and I know that you are
inundated all of the time with the numerous amounts of data and
information, but I think for Members of Congress the most
compelling thing is when we have people visit our office and
have an opportunity to express their concerns. I was visited
most recently by a dear friend, Eva Bannell, who is a child
abuse victim herself, who like so many has only recently come
forward and acknowledged this and is dealing in her own way
with this concern. And yet she comes forward not so much for
herself, but to be an advocate on behalf of children and to
make sure that children in the future are spared the ravages
and God-awful problematic things that she encountered having
gone through what has got to be a horrific situation.
I commend her. I thank her and the coalition for bringing
this very important issue before you. I know, Mr. Chairman, you
have many weighty things that you have to balance in the course
of putting an appropriations bill together. But clearly the
concern for the abused children in this Nation I know will take
precedence in the Committee's deliberations.
I have further written testimony that I would like to
submit.
Mr. Regula. It will be made part of the record.
Mr. Larson. But I wanted for the record, especially when we
have courageous people like Eva Bannell who come forward, are
willing to both talk about their own experience, but do so not
in seeking something for themselves, but clearly in wanting to
be advocates to spare all children from what they have
experienced. Thank you very much for the opportunity to appear
before the Committee.
Mr. Kennedy. Thank you, Mr. Larson. I have had the chance
to also meet with Eva Bannell, who is an extraordinary woman,
great advocate for her cause. Thank you for your work to be an
advocate for this very important cause.
Mr. Cunningham. Just a question. In San Diego the child
protective services, we had a real bad problem. As a matter of
fact, we had a court case that almost went a year against the
Advocates Child Protective Services that they got overhanded a
little bit and they were ripping children out when they really
should not.
Now I know there is a fine line. But have you had that
problem?
Mr. Larson. No. In fact, I think the importance of the
moneys that we have been able to receive, for example, in the
State of Connecticut with child protective services, the grants
that we received have provided the moneys for the additional
kind of training. And I think that is to your point, very
important that the people that we have going in understand
there is a very fine line here. And what that means is that
they have to be trained appropriately, have the appropriate
kind of education and counseling background and work to achieve
that goal. But that has not been the experience in the State of
Connecticut. In fact, we have been benefited tremendously and
have been able to leverage the Federal dollars that we need
these in instances, Duke.
Mr. Cunningham. My daughter is up at New Haven, in Ms.
DeLauro's district. She will tell you that she is an abused
child because I do not give her enough money.
Mr. Larson. Well, we will not report that.
Mr. Cunningham. Thank you.
Mr. Larson. Thank you, Mr. Chairman.
Mr. Regula. Thank you. Mr. McNulty, we welcome your
testimony.
[The prepared statement of Congressman Larson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. MICHAEL McNULTY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. McNulty. Thank you, Mr. Chairman, Mr. Cunningham,
Members of the Committee.
Thank you not only for being on time, but being ahead of
schedule. I know your time is precious. Mr. Chairman, I would
like to submit my entire statement for the record and then
summarize it, if that is okay.
I am requesting some assistance for a variety of projects
in my district and I will just go over them briefly. The
Schenectady Family Health Services is an upstate federally-
qualified health care urban community health center. It is
located in the City of Schenectady, New York. They are seeking
to obtain a 2.1 acre property located on State Street in
Schenectady, New York, to construct a new building that would
not only house the core participants but also space for other
agencies and programs that complement their core services.
The Whitney Young Health Center, also a community health
center located in the heart of my district in Albany, New York,
is doing a massive renovation project.
Mr. Regula. This is the same one that you had last year?
Mr. McNulty. Both of those did receive some funding last
year.
On Whitney Young, Mr. Chairman, they have completed their
phase one renovation project. I have seen it. It is serving a
much larger clientele because of the fact that we have been
able to expand their services. They do need to do a phase two
expansion, and that is why I am asking for continued
consideration for their project.
Just one example, Mr. Chairman. On the HIV/AIDS program,
there has been a 62 percent growth in that program at this
particular facility from 1999 through 2001, and so I would ask
some additional help for them as well.
The Albany Medical Center in my district is not only a
tremendous health care facility providing for the health care
needs of hundreds of thousands of people, really throughout the
capital region, they employ almost 6,000 people. So they are
vital to our economy, too, and they are renovating and
modernizing their trauma emergency department, and they are
asking for some assistance in that regard. Their current
facility, that part of their facility, the trauma unit, was
originally built to accommodate 45,000 annual visits, and last
year had over 63,000 visits. So they are really taxed to the
maximum in that regard.
Also, the Albany Medical Center is the only state-
designated trauma center in the 23-county Northeast region of
New York State. So that whole portion of the State of New York
is served by that facility.
Excelsior College, which you helped us with in the past,
also is a non-profit fully accredited institution of higher
learning. It specializes in distance learning, and they are
seeking funding for the establishment of a nursing management
certificate program.
Another project, Mr. Chairman, since 1990, the Institute
for Student Achievement, commonly referred to as the ISA, has
worked to keep at-risk kids in school and get them into
college. We have a program run through ISA over in the Troy
school district that has shown tremendous success in keeping
at-risk youth in school and helping them graduate and getting
them on to college. Over 96 percent of the students who have
participated in the Troy program have graduated, and over 85
percent of them have been accepted to college. So that has been
a tremendously successful program.
Union College is an independent liberal arts college that
traces its origins back to 1779. In 1795 it became the first
college chartered by the regents of the State of New York. They
have designated a program to foster multi-disciplinary
undergraduate science and engineering learning in research by
integrating several traditional disciplines including
engineering, physics, chemistry and computer science. I would
like to help them to continue that program.
Rensselaer Polytechnic Institute in Troy was founded in
1824, was the first degree-granting technology university in
the English-speaking world. They are establishing an IT
corridor in the capital region of the State of New York
anchored by their incubator program and their technology park,
which incidentally, Mr. Chairman, has been helped before by you
on other committees.
They took a vacant tract of land in the town of North
Greenbush, just adjacent to Troy, and established the
technology park, which--so there was just nothing there 20
years ago, and today is the home of 2,500 new high-tech jobs.
So it has been the largest source of private job development in
the capital region in the State of New York in the last 20
years, so I want to help them as well.
And finally, the Sage College is also a comprehensive
institution of higher learning, has three components in my
particular area, in Troy and at University Heights in Albany.
The college has made a $12.5 million commitment to its
facilities improvement, and I would like to help them continue
in that regard.
Mr. Chairman, I would like to say to you that I know this
is a pretty comprehensive list. I know that the resources
available to you are very tight. And I would point out that
each and every one of those projects is getting funding from
other sources and from private sources and so on, and I would
like to work with the Committee to try to get some measure of
funding to help each one of them just progress.
Mr. Regula. Have you prioritized these?
Mr. McNulty. I have in my testimony. I might want to work
with the staff a little bit more, prioritizing a little bit
more.
Mr. Regula. You may want to spread it around a little, too.
Mr. McNulty. We will work with you.
Mr. Regula. Thank you for coming. Mr. Cunningham, any
questions?
Mr. Cunningham. No real questions. Like Mr. Kennedy said,
it is always good to see him. It is good to see Members come up
and fight for these kinds of programs for kids in the inner
cities.
Mr. McNulty. Thank you.
Mr. Regula. Thank Patrick for his consideration as well as
all of the Members of the Committee.
Thank you.
Mr. Sherman, we welcome you. We are looking for Members.
Since you are here, we will put you on.
[The prepared statement of Congressman NcNulty follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BRAD SHERMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Sherman. I have been in Congress 6 years. This is the
first time anything has been early. I am amazed.
Mr. Regula. Well, we start on time.
Mr. Sherman. Chairman Regula, Members of the Committee, I
am here to support two projects that are important to my
district. Both of them involve innovative programs to provide
high technology that will equip students for jobs of the
future.
The first is at a high school, the second at a college.
HighTechHigh School, Los Angeles, is seeking $750,000 for in-
school improvement programs. This is an opportunity to leverage
local funds in order to provide technology training. It is, in
effect, a high school inside of Birmingham High School. It will
serve predominantly disadvantaged and minority students.
The $750,000 in Federal funding would be used to wire the
school to accommodate powerful multi-user networked computers,
and to fund acquisition of necessary computer technologies and
provide comprehensive training to teachers and other personnel.
This high tech high school will use an innovative project-based
curriculum that I think may become a model for high-tech
education at the high school level around the country.
The local funding has already allowed us to complete
architectural facility designs. We have raised $5.2 million
from State and local and private sources. We have completed
recruitment and the organization of teams to do the work and
developed an innovative curriculum. And with these
accomplishments completed, we will be able to implement and
test curriculum perhaps as early as the fall of 2002, 2003 with
the group of 9th and 10th grade students attending Birmingham
High School and acting as a magnet bringing in students in from
all over the Los Angeles area.
The high tech enrollment will be 350 students and, as I
mentioned, will be serving as predominantly minority and
underserved students who face the greatest difficulty in
preparing themselves for the high tech jobs of the future.
We are asking, as I said, for $750,000. I am trying to hit
just the high points of my testimony and expect that the entire
testimony will be made part of the record.
The second program is an engineering technology program at
California State University, Northridge. We are seeking
$1,000,000 from the Fund for the Improvement of Post-Secondary
Education. I do not have to tell Mr. Cunningham how effective
the California State University system is. And it is indeed
well represented by its campus in my area in Northridge.
We are seeking $1 million to provide a 50 percent match in
the start-up costs of a new entertainment engineering
curriculum. People know that the entertainment industry is the
lifeblood of Los Angeles. But there is an image that it is all
glitzy Hollywood actors. No. It is the people behind the
scenes. And it is increasingly a part of the high tech industry
of this country, and we need to provide the educated people for
that industry to do the high tech, keeping in mind that this is
one of the largest export industries of the United States and
is important for creating not always beneficial, but, I think
on balance, beneficial images of this country around the world.
Clearly, if this is the American century, it will be viewed
as such because of what the entertainment industry has done and
will do.
The Federal funds are requested to assist with the
acquisition of high technology equipment, software, network
expansion, and the integration to link the expertise of the
College of Arts, Art Media and Communications, of Business
Administration and Economics and Engineering and Computer
Science, bringing together three schools at the California
State University at Northridge.
In the last decade, as I have said, the entertainment
industry has been revolutionized through technology. These are
the jobs not for the rich movie stars, but for the work-a-day
people that make this industry. We have seen this technology in
Shrek and Toy Story and in other films that do not seem to be
high tech, but have high tech special effects.
This is a one-time earmark of $1 million which would enable
the University to develop and utilize the convergence of
technologies for mechanical engineering, computer science, art
and theatre, to prepare an educated and highly trained work
force for this important industry.
The Entertainment Industry Institute that this program
would support already has more than 50 industry partners who
enthusiastically embrace the initiative and have supported this
undertaking with funding and with in-kind contributions.
I urge the subcommittee to accommodate this effort by
providing $1 million of funding. The University believes that
the total cost will approach $4,000,000, and is confident that
in addition to the funds it has already put together that it
can fund the balance of that cost.
I thank you for your consideration.
Mr. Regula. Questions?
Mr. Cunningham. Just I would say, Brad, the gentleman from
California, excuse me, my daughter is up at UCLA in graduate
school, and I would tell the Chairman that California is a
donor state both in transportation and education where you have
shortages of funds in Title I with hold harmless, these other
programs that Brad is talking about, that in the inner cities,
like many of the inner cities, we are trying to attract jobs.
This is not what he is talking about, the technology is not in
the center of Hollywood where the glitz is. This is out in the
areas where we are trying to attract jobs for different people.
And I think what he is trying to do is noteworthy, bringing
those kind of jobs, and long-lasting jobs. Also the economy in
California which is in about a $17 billion deficit right now. I
thank the gentleman.
Mr. Sherman. Thank you for your support.
Mr. Regula. Further questions? If not, thank you for
coming.
Mr. Langevin.
[The prepared statement of Congressman Sherman follows:]
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Thursday, April 18, 2002.
STEM CELL RESEARCH; DISABILITY PROGRAMS
WITNESS
HON. JIM LANGEVIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF RHODE
ISLAND
Mr. Langevin. Well, good morning. I would like to thank
Chairman Regula and Ranking Member Obey and all of the Members
of the panel, particularly if I could recognize my senior
colleague from Rhode Island, and all of the work that he is
doing for his district and our State.
Mr. Regula. You are the only two from Rhode Island, right?
Mr. Langevin. The entire delegation.
Mr. Kennedy. That makes me the dean.
Mr. Langevin. We are always proud when the entire Rhode
Island delegation can show up. It impresses a lot of people.
I also thank all of the Members of the panel for taking the
time to listen to us and discuss a range of policies and
programs deserving your consideration. I do not envy the task
before you. You are forced to choose appropriate funding levels
for countless and valuable and competing programs.
Today, I would like to address two issues, stem cell
research and disabilities programs. Since last summer, I have
championed stem cell research. I urge Congress to take the lead
in eliminating the August 9th cutoff date on embryonic stem
cell research.
Since then, numerous stem cells derived from excess frozen
embryos have been discarded when they could have been added to
the NIH stem cell registry and used to save, extend, and
improve countless lives. The decision to ignore this valuable
resource after August 9th is tying the hands of America's most
talented scientists, while unnecessarily risking the potential
loss of life.
Another untapped resource is umbilical cord blood stem
cells. 99 percent of cord blood is treated as medical waste
presently. While I applaud the work of the National Marrow
Donor Program, which is facilitating stem cell transplants to
patients, I would like to see the same vigor drive the adult
stem cell and embryonic stem cells research applied to
umbilical cord blood stem cell research as well.
Moreover, more research demonstrates the value of these
cells. The creation of a federally-supported umbilical cord
blood bank to store, register, and manage the distribution of
these stem cells may eventually be the most appropriate step to
insure their proper utilization.
In the meantime, I would like to see Congress eliminate the
August 9th cutoff date and encourage more umbilical cord blood
stem cell research. To turn what was once ignored into a
resource for lengthening and improving and enhancing life is an
option that we must embrace.
I believe this also applies to various programs for people
with disabilities. As you know, last year I advocated funding
for President Bush's New Freedom Initiative. I am back again to
advocate for more. In the written testimony that I have
submitted to the Subcommittee, I listed several programs I
would like to see funded by the Appropriations Committee.
I know my time is limited so I will just mention three that
could help better integrate the 54 million people with
disabilities into society in helping them to lead more active
and productive lives.
First, the President's budget includes $20 million for the
rehabilitation engineering research centers which conduct some
of the most innovative assistive technology research in the
Nation, helping bring those technologies to market and provide
valuable training and opportunities to individuals to become
researchers and practitioners of rehabilitation technology.
Second, while research is important, it serves little use
if people cannot afford the resulting technologies. The budget
requests $40 million for States to establish low interest loan
programs to help individuals with disabilities purchase
assistive technology, which can be prohibitively expensive.
Finally, the President's budget also attempts to break down
physical barriers. As some of you know, I have led an ADA
working group over the last year to develop ways to strengthen
Title 3 requirements that all public accommodations be
accessible when readily achievable, while also assisting small
businesses in making such adjustments easy and as inexpensively
as possible.
The budget includes $20 million in competitive grants for
improving access initiatives within the Community Development
Block Grant program to help ADA-exempt organizations, including
private clubs and religious institutions, make their facilities
accessible.
Turning challenges into opportunities is my motto for life.
Eliminating the August 9th embryonic stem cell research cutoff
date and accelerating umbilical blood bank research would save
and enhance many lives, and funding these disability programs
will enrich all of our lives.
Mr. Chairman, I want to thank you and the Members of the
Committee for your time this morning.
Mr. Regula. Thank you. These are different than you had
last year. You had cancer prevention last year, I guess you had
requested.
Mr. Langevin. That is right. Yes, sir.
Mr. Regula. Any questions?
Mr. Kennedy. None. Thank you. Thank you, Mr. Chairman. Let
me just say I am so proud to have Jim in Rhode Island's
delegation. He is a fantastic advocate on behalf of stem cell
research, as you know. He made a number of the Sunday morning
talk shows, national shows last year talking about stem cell
research, has really made this a real priority. And I am really
proud that he is in our delegation advocating for something
that is going to prove to be a real success for millions of
Americans.
Mr. Hoyer. Mr. Chairman, you were not here when Christopher
Reeve testified. But, in my opinion, if we have the courage to
allow scientists and researchers to pursue the kind of research
of which Jim Langevin is talking, in the not too distant future
Jim Langevin is going to walk into our committee room and be
able to testify.
The possibilities that exist to regenerate nerves is an
incredible breakthrough. But it will require courage for us to
stay the course. There will be some who, as they have through
history, have said, well, we ought not to go down that road. I
understand the complexity and the controversy. But Jim
Langevin, Christopher Reeve and others who have had nerve
damage and therefore cannot communicate with their legs the way
you and I can, or their other limbs the way you and I can, have
the possibility to have that restored, which is an incredible
opportunity. Not just for Jim Langevin or Christopher Reeve,
but for literally hundreds of thousands and millions of people
who will be even more productive.
Now it is hard to think, Patrick, how Jim Langevin can be
more productive than he is now, because his motto is that he
overcomes challenges, and he has done an extraordinary job.
What a compelling example he is for so many people who are
challenged in America.
Jim, we are just so proud of you, and we want to keep the
faith with you. Assistive technology. We are going to try to
reauthorize that. Jim Langevin and I will be circulating--
Patrick, I think you are on that Dear Colleague, trying to get
everybody focused on that. Buck McKeon has been helping us. But
in the final analysis, what we want to do is not need assistive
technology, and that is what we are talking about with some of
this research.
So, Jim, thank you for all you do and thank you for the
example you set for all of us in terms of your courage and
commitment and incredible good spirit. Thank you.
Mr. Regula. Thank you. Thank you for being here.
Mr. Sanders, I think that we have time to get yours in. We
have two votes. We have a 15 and a 5, the second one.
First is the journal and the second is the Ag bill
instructions.
[The prepared statement of Congressman Langevin follows:]
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Thursday, April 18, 2002.
DENTAL CARE; NATIONAL COMMUNITY HEALTH CENTER SYSTEM
WITNESS
HON. BERNARD SANDERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
VERMONT
Mr. Sanders. I will be brief. Mr. Chairman, there are two
issues that I wanted to touch on dealing with health care. A
year ago, in Montpelier, Vermont, I held a hearing on the
crisis in dental care in our State. It turns out I had not
realized it, but we are looking at a severe dental crisis all
over this country.
In the largest city in the state of Vermont, which, by the
way, does better than most States, there are kids today whose
teeth are rotting in their mouth, who are low-income kids whose
family is on Medicaid. They cannot find a dentist who will
treat them because reimbursement rates are too low.
But what I am proposing, we are going to introduce a bill,
a kind of a comprehensive bill on dental care. We are not
educating enough dentists now. For every three dentists who
retire, two dentists are graduating dental school.
The long and short of the crisis that exists rurally and in
urban areas affects minorities, affects low income people. I
think this shortcut to make care available for lower income
people is to adequately fund federally-funded health clinics
all over this country.
Okay. The FQHCs, the look-alikes, the rural health clinics,
et cetera. As a matter of fact, our new FQHCs are required to
have dental clinics. They do not have the adequate funding that
they need. So without going into all of the details, I hope--
right now if you were to call up the Government, the
administration, say who is your dental guy who will tell me the
problem in Ohio, there ain't nobody there.
So I would appreciate if you would raise the issue of the
crisis in dental care which especially affects the children,
and let's see if we can move and put some money into that. I
would put the money into dental clinics right now. There is
some thought that we can put some money into the Head Start
Program for some demonstration programs. Early hygiene for the
little kids is extremely important.
So my first message is please do something about dental
care in this country. We can talk about some of the details
later.
The second issue I want to touch on, and I know the
President actually is moving forward on this, I would move
forward more aggressively, is again the issue of community
health centers all over this country.
September 11th told us, and I think no one disagrees, that,
God forbid, think of what one letter to Senator Daschle did to
this country. What happens if 500 letters go out around this
country. Nobody believes that we have the public health
infrastructure to address that. Panic. Millions of people
needing doctors on the same day. Where do I get my antibiotics
and so forth and so on.
No one thinks that we have the capability of addressing
that. Community health centers--you tell me and I agree, more
money is going into the community health centers. Let's put
more money in there. Let's get a community health center in
every community in America. It will do two things. It will
protect us in the event of a national emergency, and also it
will go a long way to solving the crisis in primary care
access.
I would urge you to go higher than the President. Fund
these things for national security, as well as health care in
general.
[The prepared statement of Congressman Sanders follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I like those myself. Because it
relieves your emergency rooms, and it gives access to others
who may not get that.
Mr. Sanders. It is cost-effective.
Mr. Hoyer. Bernie, I agree with you on all of the points
that you raised. Number one, I have always found it--and my
wife, Judy, found it very ironic that the only dental program
we have for young people is for baby teeth. That is in Head
Start. There is a dental requirement, as you know, in Head
Start, but at no other level do we require. So if you lose your
baby teeth, you are out the door.
Secondly, I have a bill that I want you to help me co-
sponsor, and I would like to get involved with yours as well.
That deals with--and we have had it in before, medically
necessary dental expenses being covered under Medicare, because
the medical community says there is a direct nexus between lack
of dental health and myriad other physical things covered by
Medicare. So we do not involve ourselves with the cheaper, we
wait until it gets more critical.
I will talk to you about that bill. We have been fighting
that and the cost--ironically, one of the problems we have had
is the CBO's cost note on that which seems to be expensive
until you compare it with what you have prevented.
Mr. Sanders. Right. Thank you. Those are the two issues.
Mr. Kennedy. I have 25,000 kids in my State whose teeth are
rotting out, and actually one of my priorities and earmarks
this year among the Committee is to get one of those clinics
funded in one of my poor cities. So it is the same thing that
all of my people are telling me, too.
Mr. Regula. I think they are very important. One thing we
need to do is to get local officials to be more interested in
participating. I have had that problem. Of course, their
budgets are constrained, too. But I agree with you.
Thank you for coming.
----------
Thursday, April 18, 2002.
NURSE SHORTAGE; COMMUNITY ACCESS PROGRAM; CDC
WITNESS
HON. LOIS CAPPS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. We will put your full statement in the record
and in the meantime you can give us the highlights.
Mrs. Capps. Mr. Chairman, I am honored to be coming before
you.
Mr. Regula. Let me ask you. I see you are going to be
talking about nurse shortage.
Mrs. Capps. Yes, I am.
Mr. Regula. A friend of mine who is a psychologist at a
school where they educate nurses said one of the big problems
we are losing nurses is because of stress.
Mrs. Capps. That is a piece of it. It surely is.
Mr. Regula. In fact she is going to testify next week about
the impact of stress on retention of nurses.
Mrs. Capps. There are many factors in the workplace that do
affect the job, and health care is stressful at best and with
changing delivery system.
Mr. Regula. I have a suspicion that the doctors turn the
stress part over to the nurses.
Mrs. Capps. Do you think that is what happens? The nurses
would like to hear that.
Mr. Regula. Okay.
Mrs. Capps. My written statement is entered into the
record; so I will just briefly touch on some of the pieces of
it. You acknowledge that there are many factors having to do
with the shortage and anecdotes give you a good snapshot of it.
The piece that I am attending to is the aging nursing work
force and the dwindling supply of new nurses, the supply/demand
part of it and focusing on the education piece of that.
The shortage ironically, and I think adding to the stress,
if you will, is going to peak just as the baby boom generation
begins to retire. They are talking about a couple of us looking
at each other, and we need to increase the resources that the
Federal Government devotes to recruiting, educating and
retaining nurses.
Professions have cycles of supply and demand. This one has
earmarks of having a crisis attached to it if we don't address
it. The events of the September 11 and recent spate of anthrax
letters remind us that nurses are the backbone of the public
health system and we need to make sure there are enough nurses
to deal with any eventuality, and this Subcommittee can help by
increasing funds for the Nurse Education Loan Repayment Program
by $10 million and the Nurse Education Act Program by $40
million. That is our suggestion.
I hope you can set aside some funds for programs included
in the Nurse Reinvestment Act that we hope is going to be
enacted into law this year. The House bill authorizes such sums
as are necessary, the Senate bill authorizes $130 million, and
those two bills are now at the conference stage. So it would be
wonderful to have some moneys available when that is signed
into law.
Other programs, I hope you will include funding for the
Community Access Program, the CAP. This program helps
communities coordinate public and private efforts to provide
medical care to the underinsured and the uninsured. These are
big topics as well, and I hope the Subcommittee will maintain
or increase funding for the chronic disease programs at the
Centers for Disease Control and Prevention, the CDC. According
to CDC, chronic diseases account for 60 percent of our Nation's
health care cost and 70 percent of all deaths in the United
States.
So that is my testimony and I thank you very much for
allowing me the time to present it to you.
Mr. Regula. Well, I think you have touched on two
challenging problems, community access and the nurse shortage,
and now is the time when we should be thinking about addressing
these.
Mrs. Capps. Thank you very much.
Mr. Regula. Thanks for coming. Susan Davis.
[The prepared statement of Congresswoman Capps follows:]
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Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. SUSAN A. DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mrs. Davis. Good morning. Thank you, Chairman Regula. I
wanted to thank you as well for the help for San Diego in the
appropriations last year. As you know, we were able to fortify
many of those nursing programs and expand some of the services
in our emergency rooms, and I can assure you that the
communities feel well supported and are moving forward in that
area. We also had some proposals to eradicate tuberculosis in
the San Diego area as well, and that has been very helpful to
us.
The areas that I would like to focus on today revolve
around the expansion of the family health centers of San
Diego's Logan Heights Clinic. This is an area that has been
underserved for many years. It provides comprehensive care
services to low income, medically underserved population. In
1970, they began with just one clinic and that health center
serves several locations throughout San Diego and provides
medical assistance to over 600,000 uninsured individuals now.
What I am requesting is $1 million to expand the Logan
Heights Center, which has a main clinical side and
administrative offices for Family Health Centers of San Diego.
There has been major growth in utilization in that area, and
really it is bursting at the seams. This funding will help
increase its ability to serve approximately 300,000 patient
visits and it is fulfilling the commitment of the President to
expand the National Community Health Centers System.
There are other requests that we have as well. The
Children's Hospital and Health Center Regional Emergency Care
Center; I am requesting $4.5 million from the Health Research
and Service Administration Health Care Construction Program to
help expand the Regional Emergency Care Center operating rooms
and specialty clinics at Children's Hospital in San Diego. And
I know as a long timer in San Diego that our Children's
Hospital certainly has provided the most unique services for
children of the region.
Mr. Regula. Excuse me. Do they train pediatricians?
Mrs. Davis. They certainly use and have residents from UCSD
and other universities in the region.
Mr. Regula. It is a Children's Hospital?
Mrs. Davis. Yes.
Mr. Regula. You put extra money in for the Children's
Hospital that do pediatric----
Mrs. Davis. Yes, it certainly does that, and it really
serves the entire region now, which we think it is very
special, but what they need is better help and support in the
Emergency Care Center there, and that is what we would be
looking for. It really has been impossible for them to keep
pace with the demand, and that is why if we can provide this
more specialized pediatric care there and expand that, it will
be of great benefit to all of the children in the area.
The other request is in the area of education, and I know
you focused on nursing shortages and trying to increase and
certainly reach out to the community and let them know how
critical this is. Our University of San Diego's Health Service
Program in continuation with the Hahn School of Nursing there
is doing just that, and what we are requesting is additional
funding for the outreach in the nursing program but also to
provide for the kind of critical nursing skills that are needed
to help and support many of our special needs patients in the
area.
I think with these three modest proposals that we will be
able to answer some critical needs in the region and help it
serve as it has been, a beacon for communities throughout the
area.
Mr. Regula. Is the city helping the community health
centers? Are they mostly county, city----.
Mrs. Davis. The county is certainly doing that. I think we
have developed a good----.
Mr. Regula. And it serves the whole county then?
Mrs. Davis. Yes, absolutely. But these particular services
really serve as a magnet for people throughout the region,
which is from the border with Orange County and down.
Mr. Regula. Thank you very much.
Mrs. Davis. Thank you very much.
[The prepared statement of Congresswoman Davis follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
IMPACT AID; NIH
WITNESS
HON. MARK STEVEN KIRK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. Mr. Kirk.
Mr. Kirk. Mr. Chairman, good morning. It is good to see you
here following in the footsteps of my predecessor.
Mr. Regula. Big shoes to fill, but we have had an
interesting challenge.
Mr. Kirk. No, you have done it and I commend you on last
year's bill which was like a battle royale, and as I remember,
it turned out to be very, very good.
Mr. Regula. It went pretty well.
Mr. Kirk. Yes. I will be doing whatever you want me to do
to get to 218 no matter what the weather is like.
Mr. Regula. If I can just persuade Mr. Tauzin, I will be
in----
Mr. Tauzin. That is enough kissing up.
Mr. Kirk. I have come here basically on two points, and I
ask unanimous consent to include my statement in the record.
The key point that I want to raise is on two programs.
One is Impact Aid. Since our country is now at war, I can
tell you from the position of the cockpit, as you go into
combat, and there are men and women now both flying over
Afghanistan and Iraq this morning, about the quickest way to
take your head out of the shed, as they say, is to have
problems at home with your kids' schools. Everybody on these
deployments, both the four carriers we have in the Arabian Gulf
and the Incirlik deployment, those are unaccompanied tours. So
your spouse and kids are back home, and no doubt they are on
base, in housing, most likely they are in a local school.
You did a hell of a job last year for Impact Aid. I have
got to thank the Committee for what you did, and I am here
simply in support of the President's request on Impact Aid in
the future, and I want to tell you what the impact is on two
school districts that I represent. In Highland Park, Illinois,
my hometown, we have got 267 military kids in school. The
Impact Aid Program kicks in 616 bucks and the State kicks in
220 bucks, but our average cost per pupil is $10,600. So the
local taxpayers of Highland Park basically have to fund 90
percent of the cost of educating these military kids.
In our elementary school District----
Mr. Regula. Great Lakes, I assume.
Mr. Kirk. This is Great Lakes.
In our elementary school district, you have to have more
than 3 percent Impact Aid kids to get any Impact Aid funds. So
we are at 2.9 percent. So we have got 60 kids in school, each
at a cost of about ten grand, zip from the Federal Government,
and we can't tax the housing there. So that is basically a
million out the door with no resources.
So it is simply to underscore the point that not only is
this important to six school districts around the country, but
if you are sending your kid to a financially strapped school
district like District 187, North Chicago, which has about
3,000 military kids in it, about the fastest way to get my head
out of Afghanistan or Iraq is to get an e-mail from back home.
You know all the ships are loaded up with e-mail, everybody is
on hotmail accounts, saying we just had canceled PE and art and
other extracurriculars at school and I don't know what I am
doing with my kids back here. What are you doing over there?
And you know in an aircraft carrier it is four acres, probably
the most dangerous. The average age on an aircraft carrier is
20 and a half and you are dealing with high explosive ordinance
and having planes take off and land on the same little place,
and if I just got an e-mail back home saying there is chaos in
the school district--and your program funded with this bill is
a huge way we can keep people's heads focused on the mission.
That is point one.
Point two is we just founded and I am head of the Kidney
Caucus, and we have a growing crisis and I think Chairman
Tauzin can back this up. You know the End-stage Renal Disease
Program is the most expensive in Medicare. The primary focus of
this caucus is keeping people out of the ESRD Program to save
Federal money. We know that most people go into a dialysis
center and they end up in that total roller coaster, and you
know Ms. Helen in the Republican cloakroom there?
Mr. Regula. Yes.
Mr. Kirk. She is now on dialysis.
Mr. Regula. Helen.
Mr. Kirk. Yes, and this is a disease that more affects
African Americans than anyone else; so it is a particular
concern in that community. Most people on hemodialysis. Three
times a week they go on that emotional roller coaster. Ms.
Helen is in the middle of that right now.
There is another treatment, peritoneal dialysis, which is
only about 10 percent of patients, but we know that if we
properly counsel these patients as they go into this that half
of kidney patients would be in peritoneal dialysis, doing it at
home and doing it on a daily basis rather than hemodialysis. I
think it is an important point to raise.
Secondly is that the data is fairly clear that if you are
an African American hypertensive diabetic you are on the road
to kidney disease. We have got 40 million at risk, 160 million
Americans showing tendencies in that direction. Directing NIDDK
and other resources of this subcommittee for an effort to
prevent as many Americans as possible from entering the ESRD
program I think saves Federal dollars and improves the quality
of life.
Mr. Regula. What is the solution? What should we be doing.
Mr. Kirk. Probably the best, biggest solution is making
sure that we educate patients that they have a peritoneal
dialysis option which allows them to stay out of the dialysis
center, doing it at home daily. They will be in better moods,
have higher health status and at lower cost.
Mr. Regula. Is this a mechanical device or----
Mr. Kirk. Yes. Basically it uses the peritoneum to flush
the waste----
Mr. Regula. The patient can administer?
Mr. Kirk. They do. And the way Medicare is structured and
the way it pays, it dramatically encourages hemodialysis. In
Europe, where there is not a financial incentive for
hemodialysis, we have about half of patients on peritoneal
dialysis.
Mr. Regula. Would this be a statutory----
Mr. Kirk. I am more modest in just having Federal education
and encouragement. A lot of this is in the phrenology community
of not really understanding all of the benefits therein, and
everybody is basically directed towards the massive
hemodialysis.
Mr. Regula. Does a reimbursement program of Medicare,
Medicaid----
Mr. Kirk. Yes.
Mr. Regula [continuing]. Prejudice in that direction?
Mr. Kirk. Yes. So we get what we pay for.
Mr. Regula. Did you talk to Ways and Means, Bill Thomas? A
change in the statute is in order.
Mr. Kirk. It is. And I think just at NIH, the concern of
this committee is education, making sure we are getting the
word out, and then also to make sure that we are really looking
at hypertension and diabetes as precursors to kidney disease,
with the goal--and I know this doesn't save money in your bill,
but even so you are just as interested as everyone else in
saving the taxpayer money, of keeping them out of ESRD, and
that is the message here.
So with that, I thank you and thank you for your support on
Impact Aid.
[The prepared statement of Congressman Kirk follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. The President of--was it Northwest in your
district?
Mr. Kirk. That is right.
Mr. Regula. Are you strongly supportive of his request?
Mr. Kirk. I am and I think that is a good, solid proposal
that he has got.
Mr. Regula. Okay. And on the Impact Aid, is this
requirement that there be over 3 percent?
Mr. Kirk. That is an authorizing committee issue. The
program itself doesn't cover all the costs and that is not
before this committee. I am just urging you to support the
President's request. You did a great job last year and this is
a program that has not received a lot of attention but because
of the war should receive more attention because it keeps
everybody focused on the mission.
Mr. Regula. Okay. Thank you.
Mr. Kirk. Thank you, Mr. Chairman.
Mr. Regula. Mr. Evans was here.
Mr. Tauzin. No problem.
Mr. Regula. Okay.
----------
Thursday, April 18, 2002.
PARKINSON'S DISEASE RESEARCH
WITNESS
HON. LANE EVANS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Evans. Thank you, Mr. Chairman. I appreciate the
opportunity to testify before you today. I would like to start
out by saluting this committee for strong support of
Parkinson's disease research. Through funding for the Morris
Udall centers and funding for NIH's 5-year Parkinson's research
agenda, this committee has ensured advances in the treatment
and taken us closer to a cure.
The value of federally funded Parkinson's research is many
fold. Breakthroughs will not only benefit the 1 million
Americans suffering from Parkinson's disease, but it will give
researchers much greater insight into other neurological
illnesses.
The time is ripe for investments in this research.
Scientists believe that Parkinson's disease could be cured in 5
to 10 years. They have good reason to be optimistic. The pace
of discovery has been astonishing. Just last week reports of a
Parkinson's patient who nearly had all of his motor ability
restored following an adult stem cell transplant gave hope to
Parkinson's patients every year and spurred further research
into harnessing the brain natural ability to restore cells.
NIH recognizes the need to be close at hand and has
responded to developing the 5-year research agenda. This report
outlines the plan for development of more effective disease
management techniques and even a cure. With this comprehensive
plan and the expertise and science at NIH, a cure is sure to
follow. The only question is how quickly. The answer lies in
the willingness of this Congress to provide the funding
necessary for a cure.
I am requesting that this committee fully fund the third
year of the Parkinson's research agenda in fiscal year 2003,
which calls for $353 million dedicated to Parkinson's research.
The funding for the third year plan represents $197.4 million
increase over the baseline spending of $155.9 million in fiscal
year 2000. This level of funding will allow NIH to continue to
conduct research that is going to lead us to a cure, we
believe.
I thank you for this opportunity to testify. As a
Parkinson's patient, I can attest to the hope that every
discovery brings and the Parkinson's community's appreciation
for this committee's work that has been done. We know that with
a strong federal commitment, that pace of discovery will
continue at the rapid clip we have seen over the past few
years. I urge to you build on the strides made in the first 2
years of this plan, and I ask you to fully fund the third year
of the research agenda.
Thank you, Mr. Chairman.
[The prepared statement of Congressman Evans follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. And it is a difficult problem, but I
think they are making progress on it and the testimony we have
had from the NIH people would indicate that there is on the
horizon a chance for success. I know that we have had
individuals in my district who have come to testify and they
are very strongly in support of continued research.
NIH is well-funded. We will be giving them a very
substantial increase into which they in turn decide where to
put it, or they spread it over the categories. But I know a lot
of it will get into Parkinson's and I appreciate your
testimony.
Mr. Evans. Thank you, Mr. Chairman.
----------
Thursday, April 18, 2002.
FRIEDREICH'S ATAXIA
WITNESS
HON. BILLY TAUZIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
LOUISIANA
Mr. Regula. Mr. Tauzin. Are you going to bring your two
helpers along?
Mr. Tauzin. I have got two helpers. I always need a lot of
help.
Mr. Regula. I know. Are these two young men with you?
Mr. Tauzin. They are with me.
Mr. Regula. Okay. Let them come up to the table if they
would like. It is good chance to see how the system works. They
might even vote for you if you do well.
Mr. Tauzin. Thank you, Mr. Chairman. Let me, before we
begin the official reason I came here, also mention NIH with
you. I know that you are doing a marvelous job in terms of
increasing the funding. I want to congratulate you for that.
Mr. Regula. And the administration has given us and the
Chairman a good budget to work with.
Mr. Tauzin. They have. I want to thank you for that. As you
know, the Energy and Commerce Committee has jurisdiction over
NIH and we are incredibly impressed every year with the
advances being made, and you are so right. We are this close on
Parkinson's and so many other diseases.
Mr. Regula. Juvenile diabetes and others, we are getting
close.
Mr. Tauzin. We really are.
By the way, in terms of the kidney disease problems that
were referred to earlier, let me concur with the testimony you
have heard, with the caveat, however, that home health is one
of the fastest rising cost items in the Medicare budget. It is
now about 30 percent per year increase, and it is the only one
without a co-pay requirement.
So I know that Bill Thomas--we had discussions yesterday.
We are trying to make sure that home health continues to be
able to satisfy what we consider to be real attempts to lower
health care costs in the long run.
Mr. Regula. When you say home health, you are talking
generically across the board?
Mr. Tauzin. Across the board. It is about a 30 percent per
year increase. So we are seeing more and more type activities
as were described to you in the peritoneal treatments for
kidney disease at home and those numbers are going up. So we
have got to deal with that and we will be discussing that with
you and others as we go forward.
But Bill Thomas and I are going to be offering a Medicare
reform bill with prescription drug benefits in it to the House
floor----
Mr. Regula. If you want to get a picture of these young
men, come on up here.
Mr. Tauzin. That is Mom, by the way. Let me introduce them
to you. Rachel Andrus and her husband are here today with their
two sons, and Mr. and Mrs. Andrus are not only dear friends of
mine, but Rachel has been my office director. She has
controlled all of our office management systems for a long,
long time and she goes all the way back to 1976, I think, when
she served our committee that I chaired in the Louisiana
Legislature. She is of Cajun extraction. She married a young
man in this area who happened to have Cajun roots as well and,
as a result of the concurrence of their genetic compositions,
they produced some beautiful kids, two of whom are here today.
One is unfortunately afflicted with a disease that appears to
somehow be very much associated with the Acadian or Cajun
population, Friedreich's Ataxia, which Keith Andrus suffers,
who is right next to me. His brother Stuart is right next to
him, one of his best friends and helpers today.
Keith has literally been diagnosed from childhood with this
disease. It is a neurodegenerative disease. It has no known
cure. It gradually debilitates its victims, and life expectancy
is limited because of it, and Keith is aware of that. We are on
a timetable to try to find a cure in time for him and so many
other young people who are afflicted with it.
It is a disease incredibly that attacks my culture, Cajun
population, at two and a half times the rate of any other
culture in this country, much like other diseases that attack
specific races, sickle cell anemia for the black minority
population of our country, and others. It is a disease that
particularly associates with our culture for some reason. It is
in our genes, and the great genetic work that is being done at
NIH and other centers around the country is hopefully our best
chance for Keith and so many others like him.
He is an amazingly courageous young man and he and his
family have been for years coming to Washington to seek the
help of our committees and our appropriators in trying to find
some chance for his survival and others like him.
Mr. Regula. Is NIH focusing their work on this?
Mr. Tauzin. Yes. More importantly, we came before you
several years ago and asked you to create the Center for
Acadiana Genetics and Hereditary Health Care through the Rural
Health Outreach Grant Program of HRSA, and in 1999 your
Committee approved it and we have created it. The center is in
operation today because of funds you provide and funds provided
by state and private sources now.
It links school medicines with the biomedical research
centers, the hospitals, the rural clinics, with a strong
telecommunications network so we can get information out about
health care and about potential treatments and work being done
on a cure. It provides education on these genetic diseases,
research into these and, by the way, Usher Syndrome, which is
closely related we understand.
I want to thank you again and ask you for your continued
support for the center. We are asking for $1.4 million of
federal assistance to the center again.
Mr. Regula. This is the center at NIH?
Mr. Tauzin. No. It is the center in Louisiana that you
helped establish. It works through the LSU System and the
Medical School. The Governor, the President of the LSU System,
and the Dean have all sent you letters outlining the incredible
work we are doing with it. We now provide over 50 percent of
the funding from state and private donors. So we are heavily
invested at the local level into the work of the center as
well, and the work of the center has now caught national
attention.
People suffer with the disease in 50 States. We just happen
to have the greatest majority of the incidents of it in our
culture. The Discovery Health channel recently focused on the
center and Friedreich's Ataxia and the incredible damage it
does to young bodies and to young people like Keith and the
fact that it claims their lives if we don't find a cure soon.
And so I want to first of all thank you because----
Mr. Regula. I see we put a million in last year at your
request.
Mr. Tauzin. And we are asking for 1.4 million this year.
Mr. Regula. Another million this time or----
Mr. Tauzin. If you can keep this up, we are getting close.
Mr. Regula. So that is your number one priority then?
Mr. Tauzin. Absolutely. It is number one and number 1-A.
And I just learned that my chief of staff in Louisiana, the
next-door neighbor, a young 15-year-old girl, was just
diagnosed with it. We have discovered it in ages as late as 15.
With Keith we learned it early. I have watched and I know some
of you have watched as I brought him year after year to you.
You have watched the disease ravage him and you have seen him
being more limited every time he comes here. His family is so
supportive and so loving and he is such a courageous young man.
Mr. Regula. Your center works with NIH, I presume?
Mr. Tauzin. We all do. NIH works with them, the center
communicates with them and the center operates with the
communication system that reaches out nationally to assist all
those who are doing work in this area. We learned at one of
your hearings that some genetic work being done at NIH may hold
some of the answers. It looks like it is related and as they do
a study on one disease, they are finding out the relationship
to a potential cure on another. So we stay in touch with all
those studies that are going on.
I just want again to say thank you. If you can continue the
federal support for the center, I have every expectation that
we are going to come up here one day and pop some champagne and
we are all going to----
Mr. Regula. We hope so.
Mr. Tauzin. We are all going to toast and thank you for
saving not only Keith's life but so many young people like him
around the country, particularly the large number that happen
to be Acadians like myself who for some reason in their gene
code have this disease special threat. So thank you. I know
that Keith thanks you personally, his family thanks you, and
more importantly the cause of a cure thanks you.
Mr. Regula. Keith, we will do the best we can for you.
Mr. Tauzin. Thank you, Mr. Chairman.
Mr. Regula. Thank you.
[The prepared statement of Mr. Tauzin follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. CIRO D. RODRIGUEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS
Mr. Regula. Mr. Rodriguez.
Mr. Rodriguez. Thank you, Mr. Chairman, for taking the time
to listen to us and for allowing us this opportunity to testify
before you.
Mr. Regula. Your full statement will be in the record and
the staff will peruse it.
Mr. Rodriguez. Thank you very much. Let me take this
opportunity, first of all, to talk to you about three projects,
and especially two of them, that I want to mention to you. One
of the first ones is project VIDA, which is Valley Initiative
for Development and Advancement. It is in the lower part of the
Rio Grande Valley, and it basically has been helping to train
over 2,000 residents on the U.S.-Mexican border.
It is in both my district and Congressman Ortiz's and
Congressman Hinojosa's. That area has over a million people. It
is the poorest in the entire United States. In fact Starr
County that I represent there on the border is the most poor
based on the 2000 census, and Hidalgo is right next to it and
then Cameron County.
Project VIDA, which is Valley Interfaith Development and
Assistance, provides job training. 94 percent of their
participant placements are placed in high skilled job areas.
VIDA is modeled after Project Quest, which is out of San
Antonio, which has gotten nationwide recognition for their high
caliber of work, and I wouldn't be here talking about any kind
of job training program unless I know that they would do a good
job.
These people are from the community. They have been
reaching out and have been making things happen with a lot of
people and these are people that have been unemployed for a
long time and have been provided that service. So I am here to
ask for half a million dollars for Project VIDA in the valley
that encompasses part of my district and part of two other
congressional districts.
In addition to that, I am also here to ask you to consider
half a million dollars also for a unique project in San Antonio
that not only services the four Congressmen there, which is
Lamar Smith, Bonilla, Gonzalez and myself, but is going to
service four States, New Mexico, Louisiana, Oklahoma and Texas,
with a unique project that is called the American Originals.
This gives an opportunity for people in Texas in that region,
especially south Texas.
The Witte Museum right now has over 200,000 people that go
through it on an annual basis. Of that, over 75,000 come from
the lower Rio Grande Valley, and the American Originals allows
an opportunity for them to look at the Louisiana Purchase
Treaty, to look at the Emancipation Proclamation, to review a
lot of the actual documents, and along with that this
particular $500,000 will allow them to prepare these rare and
significant documents as well as educational programs that they
are hoping to develop with that and, after the project is gone,
to continue to be utilized.
It is a unique project that a lot of the young people in
south Texas will never have an opportunity to come to
Washington, D.C., to see and it is the only one of the museums
that are going to be--in fact the only one in the Southwest
that will have this particular exhibit and is for the year
2003.
Those two projects, each for half a million, I ask your
serious consideration.
In addition, there is a Boysville Home for Boys and Girls
out in Converse, but they service the entire State. This is a
school that has been there since the 1930s and 1940s. They pick
up youngsters that have been abused either physically,
sexually, and they live there, and one of the things that they
are asking for it is a total of 3 million, but there are two
programs. One of them asks after they release the youngster--
and, I apologize, Mr. Chairman, I didn't check if you have a
family but when they----
Mr. Regula. I do.
Mr. Rodriguez. When they reach 18, you don't want to let
them go either. Well, you almost have to let them go and a lot
of times at that age, you know if you have any children, they
are not ready to be let go out there without any resources,
without anything. So they want to be able to work with them and
prepare them for the jobs that are out there and be able to
make sure that they can land those jobs and follow up with
them.
So part of those resources is to follow up for those
youngsters, and there truly are youngsters throughout the
entire State of Texas and the region. And the other aspect of
it is also to provide intensive counseling and training in the
area of drug abuse, and specifically for that area we are
seeking some money to help them and assist them in those areas.
So those are the three projects I wanted to present to you
and ask for your serious consideration.
[The prepared statement of Congressman Rodriguez follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I am impressed with your placement rate from
the school you described; 94 percent is remarkable.
Mr. Rodriguez. It is a beautiful program and it is modeled
after the one out of San Antonio, which is Project Quest. It
has a different name but that one is remarkable, and one of the
things they do is they use grassroots people. So these are
people that are----
Mr. Regula. You mean to teach?
Mr. Rodriguez. Exactly. So these are people out there in
the community, and that is why I feel very confident that it is
a darn good program. You are not providing resources for
these--I shouldn't say bureaucrats to remain in their jobs. You
are really looking at providing resources to those people out
there working with those people who are in need and providing
that assistance.
We just recently heard in the Valley, not in my district
but in the region that is going to be impacted, Levi Strauss is
closing some additional facilities and is going to let go a
large number of people. So the need for job training is
extremely critical.
Mr. Regula. Well, thank you for coming and bringing this to
our attention.
Mr. Rodriguez. Thank you, Mr. Chairman, for allowing me to
be here before you.
----------
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BOB FILNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Filner.
Mr. Filner. Good morning, Mr. Chairman. Thank you for
taking the time to listen to the Members and I know it is a
long day.
Mr. Regula. It is interesting.
Mr. Filner. You learn----
Mr. Regula. You get a variety that gives you a sense of
some of the problems that confronts all of us in various ways.
Mr. Filner. Thank you for your interest and your commitment
in this case to our students and around the Nation.
I want to tell you, Mr. Chairman, about Imperial County,
California, and the needs of its schoolchildren. Imperial
County is in the extreme southeast corner of California. It
goes from San Diego to the Arizona border. It is a very
agricultural area, once in fact provided a lot or most of the
vegetables and fruits for the whole Nation, the Imperial
Valley, and it is----
Mr. Regula. It is irrigated?
Mr. Filner. From the Colorado River, which is a whole
different issue from your other Committee, I suspect.
Mr. Regula. You would be at the tail end of the River,
wouldn't you?
Mr. Filner. Well, under the law of the River Imperial
County gets an incredible amount, about 80 percent of
California's water. That is a whole different issue, if you
would like me to spend 3 hours with you. It is a very difficult
situation because the agricultural area and the urban areas,
both of which I represent and I am in middle of, have to fight
over that water. It is a large county, over 4,000 square miles,
deserts, mountains. It has several medium sized cities, several
small towns, lowest population density in California probably,
but I tell you this because there is a lot of isolation of
students and teachers in various parts of the county.
It is also a very poor county, the poorest by almost any
measure in California's counties. Unemployment rates have
reached in recent years as high as 30 percent. We go crazy with
6 or 7 percent. Imagine 30 percent. The seasonal unemployment
rate is the highest in the United States. The median income is
$14,000, lowest in the State. Seventy-one percent of all the
students in fact are on the free lunch program.
I tell you this because this kind of geographical isolation
and the relative poverty of the county makes it extremely
difficult for the basic fiber-optic networks that schools must
rely on these days. It is just not there and the students are
denied the Internet access and the communication that marks the
21st century.
The Department of Education has put together an Imperial
Valley Telecommunications Authority to provide that technology
infrastructure and to make sure all of the schools are
connected with fiber-optics. The Imperial Irrigation District,
which is one of the most powerful organizations in the county
because it controls not only the water but the power, is
working collaboratively with the school districts to try to
change the situation. In fact the IID, the Imperial Irrigation
District, is giving the schools and other public agencies
access to their fiber-optic communication network that goes
throughout the region, and the IID is providing a whole multi-
million dollar contribution to the schools to attempt to try to
end their isolation. In addition, $17 million has been
contributed by the local districts and cities and counties to
this effort.
So for every dollar that we are asking the Federal
Government for, $3 has been spent by the local agencies. In
fact, the planning for the project was completed with State of
California grants and a border link grant in the past of
$775,000. So grants have been given, cities, counties,
Irrigation District, everybody is contributing. What has to
happen is to connect all the elementary, middle and high
schools to a fiber-optic structure, backbone. That will cost an
additional $6 million and we are asking that for the Department
of Education's Fund for the Improvement of Education.
Given the geographic isolation, given the relative poverty
of this county, we need this backbone to make sure our students
can in fact compete in the 21st century. The local agencies,
school districts, cities have all taken a role and we are
asking for some help from the Federal Government to complete
the project.
Mr. Regula. Okay. I was interested, and apparently you have
sort of a public agency that not only controls water but
controls electricity?
Mr. Filner. It is very unique.
Mr. Regula. Do they buy from the producers of electricity
and resell to the people?
Mr. Filner. No. The Irrigation District has its own power
plants, hydropower mainly.
Mr. Regula. This is sort of a quasi-public board, I assume?
Mr. Filner. No. It is a public board.
Mr. Regula. Are they appointed?
Mr. Filner. Elected. It is very unique.
Mr. Regula. It is unique.
Mr. Filner. And the politics is very interesting and it is
changing over time. The election to the IID board is the most
significant election in that county.
I thank you for your interest. Mr. Cunningham is familiar
with the county, our next-door neighbor and----
Mr. Cunningham. Also, the next-door neighbor is where El
Centro is, where most of the Navy training goes, and where Top
Gun is, adversary with the Rangers, and then we go over to Yuma
and fly as well.
Mr. Regula. So there are air fields in this area?
Mr. Cunningham. Yes. Maybe, Bob, if you would vote for
defense, we would get----
Mr. Filner. Most of the training, as the pilot points out,
is done in El Centro. The one great advantage that this county
has is 363 days of sunshine each year and it is always
available for training. In fact, the Blue Angels, they train
there for 3 months before they go on their tour of the Nation.
They have just completed their training out in El Centro and
they can do it every day because of the weather. The weather is
extremely clear and sunny at all times.
Mr. Cunningham. It is their winter training area when they
move out of Pensacola and get ready. But Bob is right, the area
is dispersed. This is an area that in the BRAC belonged to
Duncan Hunter, and Duncan represented the Imperial Valley for
years and years, and Bob is telling the truth. It is kind of
out in the desert. Some of the facilities they have are
depreciated and stuff, and they do need help. I don't know if
we can put in $6 million with all of the requests we have, but
we ought to be able to help some, and, Bob, I will tell you
that New Millennium bill that President Clinton signed with
computers, where you get private companies to donate their
computers to a nonprofit, we want to expand that to the
libraries as well, but the prison system uses and upgrades
those computers and it goes into the school system. They are
eligible for that also. So if they do get the fibre wiring and
stuff, it is something that could help the Imperial Valley.
Mr. Filner. Thank you. You have led the fight for that
program. I appreciate it very much.
Mr. Regula. What is the name of the air base it serves?
Mr. Cunningham. El Centro.
Mr. Filner. Naval Air Facility, NAF El Centro.
Mr. Regula. That is a new one to me. I am not familiar with
it.
Mr. Cunningham. As you head right on Highway 8. We also
have deployments, and it is where the East Coast training
squadrons come in the winter.
Mr. Filner. It is a long well-established base, but it is
small and it plays an important training function for virtually
all of the West Coast.
Mr. Cunningham. It is an area where it is still remote to
the point where you do carrier qualification training in, say,
Miramar there are a lot of lights so you don't get the effect,
and what we do is train at Miramar these young kids and then we
go to El Centro because it is darker and simulates a carrier
deck more, and then we take them out to San Clemente Island
where there are absolutely no lights. It is a lot of military,
lot of housing, Hispanic area as well, and they do need help
out there. They are pretty remote and as in many cases rural
areas are the last to get support.
Mr. Regula. This is a big country. I keep finding out new
things about it all the time. Thank you.
Mr. Filner. Thank you, Mr. Chairman.
[The prepared statement of Congressman Filner follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BART STUPAK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MICHIGAN
Mr. Regula. We will go to Michigan, Mr. Stupak.
Mr. Stupak. Thank you, Mr. Chairman, Mr. Cunningham. Thanks
for having me appear here.
You were talking about Mr. Filner's area there. That is
actually my first request is Operation Up-Link, $1.1 million.
Basically the same thing, trying to get the last mile, if you
will, of the fiber-optics in the Upper Peninsula of Michigan,
and we are remote and all the things you could have said for
Mr. Filner would basically apply to my district also.
We are working with our universities up there in Northern
Michigan and Michigan Technological, the colleges and the
hospitals. We want to link it. Last year this committee
appropriated $300,000 towards a project, and so we got the
initial infrastructure going and we want to finish it off, and
it would be $1.1 million is what we ask for to just finalize it
all up, and no disrespect to Mr. Filner, but I am six times
less than him so we should get the nod. I am just kidding, but
we would like the nod.
Mr. Cunningham. You could do that if you would waive Davis-
Bacon.
Mr. Stupak. We have got to keep Davis-Bacon. That is the
only good wages we have, especially with our telling the other
Committee. I think our unemployment up there right now is 8, 9,
10 percent. Literally 5.8 nationwide and Michigan is now above.
Next, the Center on Gerontological Studies, something new,
again through Northern Michigan University, we would like to
have the center especially for our senior population. That is
whom it would benefit, and up there it depends on what county.
The low counties have 17 percent seniors and the high counties
are 30 percent senior citizens out there, and the State average
is only 13 percent, and the center of course, as you know, will
promote knowledge of the aging process, aging network, provide
services that apply as a mechanism to enhance their lives.
Next I have is the BJ Stupak Olympic Scholarships. I want
to thank the committee again for naming it after my son. This
past weekend I had a unique opportunity. We did some stuff at
Michigan State University. But the Olympic Education Center at
Northern Michigan was a beneficiary. We raised some money for
them. So it is just not always relating to the million dollar
Olympic scholarships that we have appropriated in the past, and
with the change that we made last year in the structure, I will
tell you how critical that structure was. Some of the athletes
came down who were receiving some of this money, and they were
telling their story how they are allowed to finish their
schooling, and we have changed the requirements. Before you had
to carry 12 credit hours. That is what the Department of
Education had, so we changed that to you have got to carry at
least three.
So Allison Baver, who was one of our Olympic speed skaters,
she will finish up now at Northern this year. She will do her
last course back home at Penn State University, but she said
without this there is no way she ever could have done it,
competed around the world. But with the changes we have made
with the help of Mr. Cunningham and you, Mr. Chairman, by
making that change, in the next two semesters they will give
out $850,000 in scholarships, your place down there, Duke, Lake
Placid and Colorado Springs.
So it has been a big success. The athletes tell it best,
how dedicated they were. They got up at 3:30 in the morning at
Marquette, drove down to Lansing. That is about 450 miles for
them, and they drove down just so they could give presentations
all day on the Olympic Education Center, what we do, and the
great help this committee was. These students are exceptional
not just as athletes but as individuals, and the program has
been a great success. Unfortunately, the President didn't put
the money in. We ask that you put it back in.
I have a number of others. Let me quickly go through one or
two more, and then I will take any questions you may have.
Crooked Tree Art Center. This is in Petoskey, Michigan.
They are doing a whole renovation of their center. It is $4
million. They have already raised $3.5 million. They have
tapped every possible resource. Petoskey, a town of only 5,000
right now, this summer it will go to 30,000.
But this art center goes around to all of the schools. They
ask the schools to kick in to help pay for the program. They
have won many awards, especially for their violin program.
Of all things, in little parts of rural Michigan they are
teaching violin, and this center does it all on their own. They
have got to the point where the program keeps expanding. And
they have done $3.5 million. They are asking if you could do
$650,000 and let them finish off.
Ft. Brady Army Museum--that is up Sault St. Marie right by
the Soo Locks there--they are going to put in to preserve the
history of the fort's existence and will exhibit the history
for education future uses.
The Aging Nutrition Program. We have led the fight. I know
a lot of you have helped me on that one to increase meals, the
money we give for senior meals, whether it is Meals on Wheels
or at the senior center. I am requesting a $20 million increase
in that one, and we have always done an amendment on the floor.
Senate usually knocks us out. But hopefully, we can do
something this year.
Maybe if it came out of the Committee instead of doing the
amendment on the floor, because once we get it on the floor it
usually passes. If we could maybe put it in the bill it would
help us out. And $20 million is only keeping the rate of
inflation. That would give an extra penny per meal, or a penny
and a half per meal. That would be about all.
Marquette General, for their emergency outpatient. Last
year this committee was good enough, gave us $250,000. It
wasn't of course enough to complete the building. As we shift
from inpatient to outpatient we are asking for $4 million to
finish off the emergency outpatient. Marquette General is the
largest hospital in the north half of the state. That includes
northern lower Michigan too, because my district covers both
peninsulas. It is the tertiary care, great facility, if you
could see to help them out.
Charlevoix Hospital. I have a request in there. I want to
mention one more. Sault St. Marie Tribe Satellite Health
Center. Sault St. Marie Indians, Chippewa Indians, are the
largest tribe in Michigan. It is about 25,000 members. And they
spread out. The original treaty of 1836, their land in Sault
St. Marie was basically intact, and the 1856 treaty shoved them
basically out of the UP to the extreme western part of the
Upper Peninsula.
So their tribe has moved. Their main place is Sault St.
Marie. Their other main place is Manistique, Michigan, which is
probably about 120 miles from there. They have a huge health
center in Sault St. Marie. They want to put one in to service
their people in Manistique. It is a $3 million project. They
have put up the first $2 million. They are hoping this
committee could help them with the last million so they could
do it quicker and get it finalized.
Other than that all of the rest of it is there. I want to
thank this Committee. They were very good to my district last
year. There is a couple of projects that you have helped us
with we would like to finish off and a couple of new ones for
consideration.
With that, I would open up for any questions you may have.
And thank you for your time and courtesy.
Mr. Regula. Thank you.
Mr. Cunningham. Isn't Sault St. Marie--their reservation is
split on them now. Is it a reservation?
Mr. Stupak. Well, in Sault St. Marie it is a reservation,
and they have some land--actually pockets all over. Some of it
has been placed in trust. But there is some original parts in
different parts of the Upper Peninsula. The first treaty had
them in Sault St. Marie. The next treaty shoved them farther
west.
Mr. Cunningham. But the area in which you want to have
funding for the hospital, is that also a reservation?
Mr. Stupak. That is on trust land. Good question. I am sure
they are going to put it off Shrunk Road there. So that would
be reservation land.
Mr. Cunningham. Because in San Diego County we have many of
the tribes. They have gaming there and they are able to----
Mr. Stupak. This tribe has gaming. That is how they can put
up the $2 million. But the gaming, the casino in Manistique,
there is a small one there, is on the highway. Their
reservation is back off, and that is where most of their
offices for health care and things like that are right now. So
it is not near the casino.
Mr. Cunningham. Do you have an idea of what kind of
population, Native American population that that does serve,
because Impact Aid and a lot of those things are important.
Mr. Stupak. Because that would service the Delta County,
Schoolcraft, Luce and Elger--well, not Luce but Elger. That
would probably be pretty close to 3 to 4,000 members in that
area. There is a big one in Manistique and in the Escanaba area
there is another group there with all of their housing.
Mr. Cunningham. I am one of the Members that think what we
have done to Native Americans in this country is atrocious.
Mr. Stupak. Well, we kept moving them around.
Mr. Regula. Thank you.
Mr. Stupak. Thank you.
Mr. Regula. I think that completes our work for the day.
[The prepared statement of Congressman Stupak follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 23, 2002.
EMOTIONAL LABOR, BURNOUT, AND THE NATIONWIDE NURSING SHORTAGE
WITNESS
REBECCA J. ERICKSON, DEPARTMENT OF SOCIOLOGY, UNIVERSITY OF AKRON,
AKRON, OHIO
Mr. Regula. Well, we will get started here today. We have a
special inducement for you to stay. Elmo is the last witness
today. [Laughter.]
I have to confess, I did not know who Elmo was, but I guess
my grandchildren probably could have educated me.
We have three nice pretty little girls, not so little, who
are going to be testifying, or at least helping their mother. I
bet they know who Elmo is. Do you girls know who Elmo is? I
will be a hero to my two grandsons when I get home and tell
them I saw Elmo.
It is a great pleasure to welcome each of you today. I look
forward to hearing your testimony. We all, on the Committee,
value your views and your participation in our process. This
really is democracy at work.
In the next several weeks, we will be hearing from 200
public witnesses and Members of Congress. That is why, of
course, we cannot give too much time to anyone.
The President's budget requests $132.2 billion. That is
``billion'' with a ``b'' for the agencies. It is the second
largest program, second only to defense, for programs and
activities within the jurisdiction of this subcommittee.
Nearly all of the increased funding recommendations in the
President's budget are in three critical areas: homeland
security, medical research, and education.
I might tell you that this is almost $10 billion more than
last year's budget. Once again, tough decisions will need to be
made in the months ahead when we consider making funding
allocations.
For many of you, this will be your first time testifying
before the Subcommittee. As we begin the hearing, I want to
remind witnesses of a provision in the rules of the House,
which states that every non-Governmental witness must submit a
statement of Federal Grants or contract funds that they or the
entity they represent have received. I am sure all of you have
heard about that.
In order to accommodate as many witnesses of the public as
possible, we have scheduled about 25 witnesses for each
session. Even at this level, we will not be able to hear from
all who want to testify.
However, we do ask everyone that wants to testify, that we
cannot hear in person, to submit their testimony, and the staff
evaluates their suggestions.
Due to the volume of witnesses, I have to enforce the rule
limiting each testimony to five minutes, and I have to be
strict about that. Francine, she is the enforcer, recognizes
the importance of staying on time.
To help keep us on schedule, we will be using the lights
that are on the table. There are three lights: green, yellow,
and red. There are no fines on red, but we will appreciate if
you can close and move down on the yellow.
Once you begin speaking, the green light will indicate that
your time has started; the yellow light will indicate that you
have one minute remaining to sum up your testimony; and we
obviously know the red light means stop.
I hate to do that, because I find these programs extremely
interesting, and sometimes I am guilty of stretching it out,
myself, because I get interested in what you, as witnesses,
have to say.
But it is extremely valuable and particularly helpful to
our staff, because they do read all the testimony. With the
responsibilities we have, it is important that we try to do the
best job possible.
I said to the members of the Committee last year, since
this is my first year as Chairman, that the Bible says there
are two things that are vitally important, two rules: love the
Lord and love your neighbor.
This is the ``love your neighbor'' Committee, because
everything we do potentially touches the lives of Americans,
either through health research, the Centers for Disease
Control, and a whole host of children's programs.
Every dollar that we spend on education from Headstart to
Pell Grants goes through this committee, and it is all
discretionary. So we have to make some very difficult judgments
in allocating resources.
While $132 billion is a lot of money, it is surprising, but
we always come up what we consider to be short, simply because
there are so many needs. But we do the best we can in
allocating.
Our first witness today will be Dr. Rebecca Erickson, the
head of the Department of Sociology at the University of Akron.
She is going to talk about stress and its impact on retention
of nurses and new teachers. With the imminent retirement of the
babyboomers, we face some real shortages in these areas.
So Dr. Erickson, we are happy to have you here today, and
you can go forward.
Ms. Erickson. Thank you and good afternoon, Mr. Chairman,
my name is Rebecca Erickson, and I am an Associate Professor of
Sociology at the University of Akron and Chair-Elect of the
American Sociological Association's Section on the Sociology of
Emotions.
I want to thank you and members of the Committee for the
opportunity to speak today about how reducing the rate of
burnout among direct care nurses is essential to the
development of sound retention polices, and to our being able
to effectively address the national nursing shortage over the
long term.
Nurses typically burn out and leave bedside nursing after
just four years of employment. My goal here today is to propose
that a systematic program of research and intervention,
focusing on the emotional stresses of nursing, and the
conditions that exacerbate them, holds particular promise for
reducing the incidents of burnout and increasing nurse
retention.
Experienced RNs are choosing to leave bedside care in large
numbers. In the year 2000, there were 500,000 licensed nurses
not employed in nursing. If only a quarter of these had been
retained or could be induced to return, a significant
percentage of the 126,000 hospital nursing vacancies might be
filled.
Solving the Nation's nursing crisis in nurse staffing
requires that we understand why nurses leave direct care and
why they choose not to return.
There are many reasons for this, but the primary force
driving nurses away is the stress in the work environment.
Today's hospital nurses face increased patient loads, increased
floating between departments, decreased support services and
frequent demands for mandatory overtime.
Given these conditions, it is hardly surprising that the
National studies have reported that 59 percent of nurses say
their job is so stressful that they often feel burned out, and
43 percent of nurses experience significantly higher rates of
burnout than is expected for medical workers.
Burnout is a unique type of stress syndrome that is
fundamentally characterized by emotional exhaustion. We can
begin to appreciate what emotional exhaustion means for a nurse
by considering the results of a national survey that asks
nurses to identify how they usually felt at the end of their
work day.
The four most frequent responses were: exhausted and
discouraged; discouraged and saddened by what I could not
provide for my patients; powerless to effect the changes
necessary for safe, quality patient care; and frightened for
patients. Exhausted, discouraged, saddened, powerless,
frightened; these are the emotions experienced by nurses on a
daily basis.
Recognizing that burnout is rooted in such intense
emotional experiences is integral to preventing its occurrence.
This is especially true in the case of nursing, where the
ability to effectively manage one's own and other's emotions is
critical for the provision of excellent care.
To reduce the incidents of burnout, we must identify the
faucets of the care environment that lead to the frequent
experience and management of intense emotion. In doing so, we
would be specifying the conditions that influence the
performance of emotional labor; for the process through which
nurses induce and suppress emotion, in an effort to make others
feel cared for and safe, is indeed work. It is work that
requires a great deal of time, energy and skill.
While there is widespread agreement that issues concerning
the environment of care must be included in any comprehensive
strategy to address the nursing shortage, there has been no
systematic research done to isolate the sources of nurse's most
intense emotional experiences, and to develop a detailed
understanding of how the management of these emotions leads to
burnout and turnover.
Consistent with the recommendations in last year's General
Accounting Office report on the nursing workforce, I propose
the initiation of a demonstration project, that will generate
the data needed to effectively disrupt the burnout process.
Such a project would require the formation of an inter-
disciplinary and inter-organizational research advisory team,
that most importantly would include nurses currently employed
in bedside care. This research team would organize and oversee
a multi-method research project aimed at reducing burnout and
increasing retention.
Our first goal would be to specify the antecedents and
consequences of performing emotional labor among direct care
nurses. Our second goal would be to use this information to
develop and evaluate preventive intervention strategies among
these nurses.
The third facet of this project would consist of surveying
nursing students before, during, and after their first year of
clinical practice. This would be done to evaluate the extent to
which they are being prepared for the emotional demands of
nursing, and to identify any changes in educational and
hospital practice that might aid in the students' transition to
the care environment.
Understanding the emotional demands of caring work may be
one of the most important steps toward retaining many of the
nurses employed in bedside care. The proposed demonstration
project will provide the means of achieving these goals.
Thank you for your consideration, and I would be happy to
answer any questions you may have.
[The prepared statement and biography of Ms. Erickson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
As I understand it, at the University of Akron, you have
done some work with the nurse education program there, along
these lines. Am I correct?
Dr. Erickson. I have not specifically. I have been working
with hospital organizations in the area; but the nursing
program has been focused on these issues.
Mr. Regula. So the University is very much aware of the
problem of stress.
Dr. Erickson. Definitely.
Mr. Regula. I think if the statistic is correct, that we
lose 50 percent of the beginning teachers in the first five
years, that much of the same thing would be applicable in the
teaching profession.
Dr. Erickson. Yes, that is part of the importance of
looking at the burnout process, per se, to see what might be
generalized to other occupations, definitely.
Mr. Regula. Well, thank you very much for coming to speak
on this important topic.
Our next witness today is Lesa Coleman. She is accompanied
by her three children: Jaclyn, Corinne, and Emily.
----------
Tuesday, April 23, 2002.
NATIONAL CAMPAIGN FOR HEARING HEALTH
WITNESS
LESA COLEMAN, ACCOMPANIED BY CORINNE COLEMAN, EMILY COLEMAN, AND JACLYN
COLEMAN
Ms. Coleman. Thank you, and Jaclyn is over there. My
husband could not join us.
Mr. Regula. We are happy to have you. Tell us your story.
Ms. Coleman. Thank you; good afternoon Mr. Chairman and
members of the subcommittee. My name is Lesa Coleman, and I am
here today with Jaclyn, Corinne, and Emily on behalf of the
National Campaign for Hearing Health; not as an expert.
Mr. Regula. Lance is your husband, I take it?
Ms. Coleman. Right, Lance is my husband, and he could not
make it.
Mr. Regula. I got a little bad information here.
Ms. Coleman. I wish he was here.
Mr. Regula. Okay, I'm sorry.
Ms. Coleman. I am a mother of five children, two of whom,
Corinne and Emily, have severe hearing impairments.
As you know, the President's 2003 budget eliminates program
funding at the Health Resources and Service Administration for
the Universal Newborn Hearing Screening, or UNHS Program.
If funding for screening is cut, children and their
families will be hurt, just as my child, who was without
newborn hearing screening in 1994.
We are currently only screening 65 percent of newborns in
this country. Unbelievably, every day, 11 babies with hearing
loss leave the hospital, and their parents have no idea that
they have this loss.
That is why I am asking Congress to provide $11 million to
HRSA, so this vital program can continue to assist States with
developing and implementing newborn hearing screening and
intervention programs. To compliment HRSA's screening program,
the Centers for Disease Control needs $12 million for critical
tracking, surveillance and research efforts.
I have a very simple message. Without early detection and
intervention, children face delayed language, delayed speech,
and delayed learning development. Early identification is
critical, because we have wonderful interventions such as
cochlear implants, hearing aids, and therapies that can
dramatically improve the opportunities for a child with a
hearing loss.
I would like to share now the experience that we have had
with my daughters Corinne, age nine, who was not diagnosed
until she was age two; and then Emily, who is now age seven and
was diagnosed at birth.
If there were ever parents who should have self-diagnosed a
hearing loss, it should have been my husband and I. My husband,
Lance, is an ear, nose, and throat physician, and I, just
shortly before Corinne was born, received my Master's Degree in
child and family development.
When Corinne was born, she looked and responded very
normally, but as months progressed, we noticed that she did not
seem to be talking. Our pediatrician encouraged us to wait up
to 12 months before Corinne was sent for ear tubes.
Finally, after no improvement and without our
pediatrician's approval, Corinne's hearing was tested. So
finally, at two years old, Corinne was finally diagnosed with a
severe hearing loss.
Soon after the diagnosis, we tried to enroll Corinne in an
early intervention program. She was finally accepted at age two
and-a-half, only to be forced to exit at age three, because
early intervention ends in this country at age three.
Corinne started preschool at age three with essentially no
expressive and very little receptive speech. To improve other
communication skills, we started speech therapy, which resulted
in hundreds of hours and thousands of dollars of third party
system costs over the course of four years.
Our Emily, on the other hand, was born when Corinne was age
two and-a-half. She was tested at birth with the appropriate
equipment, and received her hearing aids at five months. Emily
was admitted to the early intervention program at six months,
where her speech was monitored regularly. She developed speech
normally, right along with her hearing peers.
Emily has never had to have regular speech therapy. Her
vocabulary has been very expressive, confident, and dramatic,
from a young age.
The contrast, in our experiences dealing with every aspect
of essentially the same hearing loss in both girls has been
dramatic. From testing to hearing aids to hearing intervention,
speech therapy, language development, socialization, and
ongoing voicing and speaking confidence issues, our younger
daughter, Emily, has had a tremendous advantage, because of her
earlier identification.
Federal funding for newborn hearing screening is critical
to ensuring that other families will not have to suffer
needlessly as Corinne and our family have.
Now Corinne and Emily would like to make a brief statement.
Ms. Emily Coleman. Hi, my name is Emily Coleman. I am glad
I was tested when I was born. I have not had to work as hard as
Corinne. Thank you.
Ms. Corinne Coleman. Hello, my name is Corinne. When I was
born, there was no newborn screening, and I had to do lots and
lots of speech therapy. My little sister, Emily, did not have
to do all this work.
I really wish that all kids with a hearing loss could be
identified early like she was. I really hope that you put the
money back into the budgets to help the other kids. Thank you.
[Applause.]
Mr. Regula. I have got to tell all of you, since our
funding is discretionary, you have got a disadvantage.
[Laughter.]
Ms. Coleman. We will use it.
In closing, I want to thank you, Mr. Chairman and members
of the committee for providing strong leadership and support
for these programs in the past. We also greatly appreciate the
support for these programs that you displayed at the agency
hearings this year.
On behalf of the National Campaign for Hearing Health, and
my family, and thousands of other families like ours, we
request your consideration to provide $1 million to HRSA for
screening, and $12 million to CDC for surveillance tracking and
research. Thank you for the opportunity to appear here today.
[The prepared statement and biography of Ms. Coleman
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, thank you, that is good.
We have a bill in Ohio to mandate that the hospitals do
just what you are describing.
Ms. Coleman. Right.
Mr. Regula. It seems to me that that would be something
that every hospital would do routinely.
Ms. Coleman. Right, but without the funding, they cannot do
it.
Mr. Regula. No, you are right.
Ms. Coleman. They need the funding. All the States need the
funding, because they have got bills. A lot of States have
bills, but without the funding, they cannot do it.
Mr. Regula. Well, thank you for coming; and Jackie, we are
happy to have you, too. You did not get a chance to speak, but
I am sure you could do well.
Ms. Coleman. She has been a lot of support.
Mr. Regula. Okay, thank you very much for coming.
Our next witness is Dr. Gregory Chadwick, President of the
American Dental Association. We are pleased to have you.
----------
Tuesday, April 23, 2002.
AMERICAN DENTAL ASSOCIATION
WITNESS
DR. D. GREGORY CHADWICK, PRESIDENT
Dr. Chadwick. Thank you, sir.
I will have to admit, that is a hard act to follow. I am
sure everybody in this room, though, has a compelling need that
we are very grateful for the opportunity to be able to express.
Mr. Regula. Well, if you stick around, we have got Elmo, I
think, as a wrap-up. [Laughter.]
Dr. Chadwick. We may do that.
Good afternoon, Mr. Chairman, my name is Dr. Greg Chadwick.
I am President of the American Dental Association and a
practicing endodontist in Charlotte, North Carolina.
Most Americans today enjoy good oral health and have the
access to the best dental care in the world. But dental decay
remains the most prevalent, chronic infectious childhood
disease. It is five times more common than asthma, and seven
times more common than hay fever. In addition, there are
disparities to access.
However, I am pleased to say that the oral health community
has made great strides in these last few years to improve
access to oral health care for the under-served population.
Some of what we have accomplished has developed from programs
that you funded here in this committee.
Mr. Chairman, we must have adequate funding for dental
education, the dental programs within CMS and HRSA, the
Division of Oral Health at CDC, and the dental research under
NIDCR, if we are to continue this forward movement.
Because dentistry receives only a small portion of the
Federal Budget, and because there must be a critical mass, if
these programs are to be effective, we simply cannot afford to
lose any of these programs.
Therefore, the Association strongly opposes the
Administration's proposal to eliminate funding for general
practice and pediatric dental residencies.
Currently, there are only 3,800 pediatric dentists in this
country. Some states have as few as ten. There is a high demand
for these residency positions, but almost half of all
applicants are turned away, because there are no residency
positions available for them.
Unlike medicine, most dental residencies are not paid
through dental Medicare. If Title VII funding for dental
residency is eliminated, 372 dental residencies will be
discontinued. Therefore, we urge the Committee to restore the
funding for these programs at a level of $15 million.
A strong education program is essential to maintaining the
dental workforce. Currently, there is a crisis in dental
education, with over 400 open faculty positions.
If we cannot recruit the very best and brightest into
academic and research, many of the oral health care concerns
that we are going to be discussing here today simply will not
be addressed.
I know the Committee will be hearing from my colleagues
representing the American Dental Education Association. We
support their requests, particularly the increased funding for
the Ryan White HIV AIDS dental program.
The ADA is concerned that CMS grants designed to enhance
access in two of our multi-year Medicaid programs will not be
continued, and in essence will be cut off in mid-stream by the
Administration's 2003 budget.
A grant to improve access to care for 7,000 low income
children under the age of six in California will be
discontinued, as well as a demonstration program in North
Carolina. That program would help children under the age of
three receive preventive health care services.
The ADA believes these pilot projects could be beneficial
to understanding the disparities to access in the current
dental care delivery system. We hope the committee will work
with us to reinstate funding to complete these projects.
We thank the Committee for its previous support of oral
health care programs at CMS and at HRSA, and we're grateful the
Committee understands the need to maintain the Chief Dental
Officers at both agencies.
This support is critical, because oral health is one of the
top three unmet needs of mothers and children. However, less
than two percent of HRSA's maternal and child health budget is
spent on oral health care.
The CDC's Division of Oral Health supports State and
community-based programs to prevent oral disease. Last year, 24
states and tribes applied for CDC grants to improve their Oral
Health Programs and increase Fluoridation and Dental Sealant
Programs.
Unfortunately, the division was only able to fund about
half of those grants. The ADA recommends a funding level of $17
million for CDC's Oral Health Program.
There is a compelling need to reduce the incidents of oral
cancer, gum disease, and tooth decay in our society. The
National Institute of Dental Craniofacial Research is engaged
in studies to determine the underlying causes of these
diseases.
In addition, they have taken the lead to develop salivary
diagnostics, which has the potential to develop non-invasive
tests for many diseases and situations like exposure to Anthrax
poisoning. The association recommends $420 million for NIDCR.
Thank you, Mr. Chairman. This concludes my testimony. I
will be pleased to try to answer any questions for you.
[The prepared statement and biography of Dr. Chadwick
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
As you know, I have got a proposal for an oral health
project in my district.
This is clearly a huge challenge to many communities across
this country, as I have seen in my communities in the Black
Stone Valley, in the number of children that are missing out on
any kind of oral health. It is staggering, and their mouths are
rotting out. It is leading to some terrible health
consequences; let alone, you know, the other ramifications of
this.
So I congratulate you for the work that you are doing,
trying to help that out.
Dr. Chadwick. Thank you, and we are pleased to have you
help raise the level of awareness on this need; because it is
only through the level of awareness, and everybody realizing
it, that we are going to finally be able to do something about
it.
Mr. Regula. Is it not correct that bad teeth can feed other
poisons, if you will, into your system, that can infect your
general health?
Dr. Chadwick. Well, it is probably even more than that. I
mean, you know, oral health is a part of general health. But I
would not want to say that infected teeth are infecting other
parts of the body. But certainly, there is a connection between
oral health and systemic health, yes.
Mr. Regula. Well, thank you very much for your testimony.
Dr. Chadwick. Thank you.
Mr. Regula. Our next witness is Marykate Connor, the
Executive Director of the Caduceus Outreach Services; welcome.
----------
Tuesday, April 23, 2002.
CADUCEUS OUTREACH SERVICES
WITNESS
MARYKATE CONNOR, EXECUTIVE DIRECTOR
Ms. Connor. Good afternoon, Mr. Chairman, Mr. Kennedy. I am
the Executive Director and the founder of Caduceus Outreach
Services.
We are a very small nonprofit organization in San Francisco
that serves homeless people who have co-occurring psychiatric
illness and addictive disorders. I have worked with homeless
people since 1986.
I am here today to speak to the issue of substance abuse
treatment on demand, which is something that Caduceus Outreach
provides to people who have co-occurring addictive and
psychiatric disorders; but I am here on behalf of all San
Franciscans and, in fact, all cities throughout the Nation that
need this kind of service, and not specifically for Caduceus.
I was one of the founding members of the Treatment on
Demand Planning Council in San Francisco. This is a
collaborative effort between the Department of Public Health
and community activists, providers of treatment, and consumers
of treatment.
We came together in 1996, in order to create a system of
treatment that is truly responsive to those who need it and
accountable to communities who fund it.
Treatment on demand is a very simple concept. What it does
is that it allows people who need substance abuse treatment to
receive it when they ask for it, as opposed to when we are
ready to help them.
It also recognizes that treatment must be relevant to the
lives of people that it serves, in order to be effective.
Treatment on demand not only asks to increase the capacity for
people that need treatment, but it broadens the scope of
treatment modalities. Our efforts in San Francisco present an
effective treatment model, but we simply need more of it.
Most communities only have a small portion of the funds
that they need to provide any kind of substance abuse treatment
at all, and as a result, people are turned away from treatment
every day.
Often, people are screened out because they do not fit the
criteria for treatment, and usually, the standard 12 step model
is what is brought about in terms of treatment.
People who have both psychiatric disorders and addictive
disorders are especially subject to discrimination, as both
conditions are stigmatized. Providers of substance abuse
treatment want people with psychiatric illness to get treatment
for their illness first, and providers of psychiatric treatment
will not treat people who are using substances.
In San Francisco, community activists have helped the
Department of Public Health pass a dual disorder policy, so
that both branches of the treatment providers must work with
each other in a simultaneous effort, and not a sequential one.
Providers have much to learn about this, but the Department
of Public Health has taken the lead in directing this modality
of treatment. This is one example of treatment on demand.
Addictive disorders and psychiatric disorders are both
biologically-based conditions. These diseases are some of the
most under-reported, stigmatized, and devastating conditions in
this country.
I believe that the stigma of these illnesses is one of the
reasons why treatment for this population is under-funded and
punishment in the form of jails and prisons and incarcerations
of all kinds are funded to the degree that they are.
There is a greater portion of funding going into
interdiction and incarceration of drugs and alcohol than there
is for treatment for people that are suffering from addictive
disorders. It actually costs more to incarcerate somebody than
it does to treat them.
Treatment really, really works. But in order for it to be
effective, it first must be available, and it must be
specifically relevant to people's lives.
I am asking you to use the power of your office to change
the fact that there is not enough treatment for everybody. Make
treatment on demand a reality for not just, you know, one city
or another city, but everywhere in the country.
It will save lives, and it will also save money, because as
I said earlier, it is cheaper to provide treatment than it is
to incarcerate them.
I believe that every life has value. When we do not provide
lifesaving treatment for someone who is begging for it, we are
clearly saying that their life is of no value.
You can change this and restore the worth of someone's
life. Please fund all efforts to provide treatment on demand,
both in San Francisco and nationwide.
Thank you, and I will answer any questions that you may
have.
[The prepared statement and biography of Ms. Connor
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you have a problem of people refusing
treatment? Now I heard you say they ask for it.
Ms. Connor. Yes, I do not often find there is a problem of
people refusing treatment. Sadly, I am one of those providers
that, because we are so very small, have to turn people away
every day, who are asking; and I know that this is the case for
many other treatment providers. There are long waiting lists.
There may be people who, in fact, are not ready for
treatment; but there are more people waiting in line for
treatment, and cannot get the treatment that is specifically
relevant to their conditions.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. I have no questions at this time, Mr.
Chairman.
Mr. Regula. Thank you very much for coming.
Ms. Connor. Thank you.
Mr. Regula. Next is Dr. John Allegrante, President and
Chief Executive Officer of the National Center for Health
Education and Professor of Health Education, Teachers College;
welcome, Dr. Allegrante.
----------
Tuesday, April 23, 2002.
NATIONAL CENTER FOR HEALTH EDUCATION
WITNESS
JOHN P. ALLEGRANTE, PRESIDENT AND CHIEF EXECUTIVE OFFICER AND PROFESSOR
OF HEALTH EDUCATION, TEACHERS COLLEGE, COLUMBIA UNIVERSITY
Mr. Allegrante. Thank you very much, Mr. Chairman.
My name is John Allegrante, and I am indeed grateful for
the opportunity to appear before the Subcommittee. I am the
Senior Professor of Health Education, sometimes known as
``Health and Clean Hands'' at Teachers College at Columbia
University in Gotham, where I have been a member of the faculty
for over 20 years.
I am a past President of the Society for Public Health
Education; and last year, I was named the new President and
Chief Executive Officer of the National Center for Health
Education.
Mr. Chairman and Mr. Kennedy, I first want to thank you for
all the support and leadership that this subcommittee has
provided for programs and initiatives that do, indeed, invest
in our Nation's youth. But to be frank with you, I am here to
sound a wake-up call today.
Specifically, I am here to request that the Centers for
Disease Control and Prevention be funded at $35 million for
fiscal year 2003, so that CDC can provide additional States
with infrastructure grants for coordinated school health
programs.
Mr. Regula. Now you mean an increase?
Mr. Allegrante. No, they already get about $9.6 million or
$9.7 million, and we want an increase over that to bring it up
to $35 million. Let me tell you why I think we should do this.
More than 3,000 young people began smoking today; more than
3,000. Childhood obesity has doubled in the last decade, making
it now a national epidemic, and 10 to 15 percent of children
are overweight, and more than half have at least one
cardiovascular disease risk factor, such as elevated
cholesterol, hypertension, or risk for Type 2 diabetes. Mr.
Chairman, 21 percent of ninth graders in this country have been
drunk at least once.
Mr. Chairman, in your home State of Ohio, 73 percent of
young people report having smoked cigarettes; 72 percent do not
get even what I would call moderate physical activity; and 81
percent ate fewer than five servings of fruits and vegetables
daily during the past seven years.
I think the statistics are alarming. They tell me that we
are failing our young people, I think, in almost every
community around this country. The cost to the Nation of not
doing more than we are currently doing for them is, I think,
intolerable.
Moreover, the burden of the premature death, disease, and
disability that we see and that results is borne
disproportionately and dramatically so in communities where
racial minorities predominate.
To be honest, what I find so disturbing about these
statistics is that something can be done. We know already what
works. In many places, it is called coordinated school health
programming.
For example, Growing Healthy, our own organization's
programming, the comprehensive school health education
curriculum, that is part of a coordinated school health
program, can help young people acquire the knowledge and skills
they need to support healthy behavior.
Yet, despite the existence of programs like Growing
Healthy, most States do not have the resources to support
putting them or putting programs like them into their schools
as part of such a program.
Now Mr. Chairman, I know that many Federal and State
programs exist to provide schools with programs such as
immunizations, nutritious meals, and physical education
programs. However, most are uncoordinated. Funds for such
programs come from a variety of Federal agencies, including
education, agriculture, and health and human services.
Yet, fewer than half of America's schools really have the
capacity, if you will, to coordinate these many diverse
programs and services that are available. I think, personally,
that this results in costly duplication of services and a waste
of taxpayer dollars.
So funding this request would enable CDC to strengthen what
we know are cost effective coordinated school health programs
of 20 States right now currently funded through infrastructure
grants, and support an additional six to nine States nationwide
in fiscal year 2003, to develop similar programs.
These funds would be used to foster critical partnerships
between the Departments of Education and the Departments of
Health and other related agencies in States, that would allow
the high level State-directed coordination across programs.
These are programs, again, Mr. Chairman, that have been shown
to contribute to overall learning and academic success of
students.
Now I am not alone in this view. There have been
independent studies, including a Gallup poll that found that
seven out of ten adults in this country rated health
information as important for students to learn before
graduating from high school. We have got an opportunity to
reach some 53 million young people indeed in schools across
this country.
So I see this as an investment for the future. School
health programs can help limit the burden of chronic disease
for our Nation, and it will pay enormous dividends in Federal
dollars saved in the coming decades.
In closing, I want to say that I understand the constraints
with which the Committee works, with which our agencies of the
Federal Government must operate.
But I believe that when it comes to health of our children,
like these young ladies we saw a moment ago, the diagnosis is
clear and the treatment is really at hand. Expanding Federal
funding of school health programs is a prescription for the
health of our children.
I thank you, Mr. Chairman. I hope that you will write that
prescription.
[The prepared statement and biography of Mr. Allegrante
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Yes, in Rhode Island, we had a great program
that was put on by the Department of Agriculture, where
children learned how to eat healthy, and also play, and learn
how to exercise.
It was a huge event with families and children at the Rhode
Island Convention Center. It was the most mobbed exhibit or
convention you have ever seen. It was all a host of folks that
were talking about eating healthy and staying active.
Mr. Allegrante. Sir, what if we could replicate that in
communities beyond Rhode Island in America, and get that kind
of excitement going?
Mr. Kennedy. Yes.
Mr. Allegrante. I think this modest request could help us
do that.
Mr. Regula. Thank you very much.
Mr. Allegrante. Thank you.
Mr. Regula. Mr. Kennedy, I understand you will introduce
our next guest.
Mr. Kennedy. Thank you, Mr. Chairman.
I want to welcome one of our witnesses today, Sister Lapre.
You can come up, Sister, and sit right in the middle, please.
Thank you, Sister, for agreeing to testify today before the
House Appropriations Labor, Health and Human Services, and
Education Subcommittee.
I know it takes great courage for you to share your own
personal struggles and also the struggles of your neighbors and
friends, and we appreciate your willingness to speak and be an
advocate on their behalf and for all seniors.
The power of your testimony today will help impact the
progress that we make towards conquering mental illness in this
Nation, and I thank you for your great work.
Mr. Chairman, Sister Lapre has been known as the ``nun on
the run'' in Rhode Island, for her great and extensive work,
working with seniors all over the State, and particularly in
Newport, Rhode Island, at the Forest Farm Adult Day Center,
where she is involved in many activities with seniors there.
So Mr. Chairman, I thank you for the opportunity of
introducing Sister Lapre.
Mr. Regula. Welcome, Sister, and we will look forward to
your testimony.
----------
Tuesday, April 23, 2002.
NEWPORT COUNTY COMMUNITY MENTAL HEALTH CENTER, INC.
WITNESS
SISTER BERNADETTE LAPRE
Sister Lapre. Chairman Regula and members of this
subcommittee, thank you for giving me the opportunity to appear
before you and share my thoughts with you today, April 23rd,
2002, at approximately 1:00 p.m. in room 2358 on the third
floor of the Rayburn House Office Building.
I would like to address here my concern about funding for
senior citizens with mental health problems. I am here on
behalf of seniors who are homeless and depressed; seniors who
are schizophrenic and possibly a danger to themselves and
others, as well; and those who are suicidal.
We recently had someone jump from the Newport Mount Hope
Bridge in our area. Having the diagnosis of bi-polar disease
myself, I know the suffering and feeling anxious, upset, and
wanting to cry a lot. I also know how desperate people can
feel.
I ask that we get the health benefits that we need for our
mental health problems or sickness, and that the Government
gives us Federal aid to help us get therapy. It is very
important for us to get therapy, so that we can deal with our
problems. It would also help the society that we live in.
Many clients are poor, and cannot pay for the medication,
which is very important to help with our sickness? Why; because
it is so expensive.
If we have to go to the hospital, we may hesitate because
of the expense. We also avoid taking our medication for the
same reason. We would then become sick, again.
In my opinion, these seniors should also go to an adult day
care program a few times a week. This will help them to forget
about their problems, let them meet other people, make friends,
and also participate in different activities, which are so
important these days. Care centers offer nutritious meals, as
well.
Our center offers daily exercise, health promotion, a
variety of fun activities, and the support of a caring staff.
I, myself, like going to Forest Farm Adult Day Care three times
a week. It will be two years, May 1st, that I have been going.
I have been going to a psychiatrist and a therapist for
seven years now. I know that for myself, if funding resources
were not paying for it, I do not think I would keep taking my
medicine, because of the cost. What would happen is, I would
fall sick and probably be hospitalized.
Right now, I am doing very well, thanks to these programs.
But more people my age need more help. Seniors do not like to
talk about these things, because they are embarrassed. I hope
that my testimony will help other older people to talk about
their illness and get help.
Thank you for listening, and I urge you to support our plea
for funding. God Bless.
[The prepared statement and biography of Sister Lapre
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Kennedy. Thank you very much, Sister. It was great to
have you testify today. You really helped put a face with the
people out there who, like you, are talking about and, like
your own experience, have suffered tremendously from mental
illness. I congratulate you on your enormous success, working
to conquer your illness all the time.
Can you explain the difference in the quality of treatment
over the years since you have been suffering from mental
illness most of your life and how it's been?
Sister Lapre. I was in France for 26 years. I was getting
help from a psychiatrist. She followed me for 26 years. And
then I came back here to the States. I was going to say, I was
well taking my medication and I was taking care of the children
before school. And after that, I fell sick again. So I was
hospitalized at Boston, at Newport Hospital. I was there for 10
days.
Then Dr. Klein is the one that took me over. I had a
therapist for seven years. They have helped me a lot to deal
with my sickness. And now instead of going every week, I go
every three weeks, and I see Dr. Klein once every four months.
And I'm doing very well. I know I'm shaking today. But without
this help, I wouldn't be well today. And I'm getting a lot of
help.
And at the Day Fund Center, I say the rosary with them, I
go to different ones, because we have divided now our program
north and south. But it's adult day care just the same. I
should have read my biography, it would have been quicker.
[Laughter.]
Sister Lapre. So I came back to the States and I had to go
to the hospital for 10 days, as I was saying. Then after that,
Dr. Klein was there and he took over. I had taken a big amount
at the beginning. And he slowly diminished my pills. So now as
a clorozapad, I'm only taking three grams seven, instead of
ten.
Mr. Regula. Well, obviously whatever you're doing works.
Sister Lapre. Yes.
Mr. Kennedy. She is giving so much to her community, it
shows. She has so much to give. By helping her, we're really
helping the whole community. She's terrific.
Mr. Regula. Thank you. Thank you for coming and for your
testimony.
As I understand it, Mr. Kennedy, you're going to introduce
our next witness also.
----------
Tuesday, April 23, 2002.
THE PROVIDENCE CENTER
WITNESS
HAVEN MILES, SUPERVISOR OF EARLY CHILDHOOD SERVICES, THE PROVIDENCE
CENTER
Mr. Kennedy. Thank you, Mr. Chairman.
It's a great honor for me to introduce Haven Miles. Haven
is a supervisor of Early Childhood Services at the Providence
Center, which is the largest psychiatric hospital center in
Rhode Island. She works particularly with the young children
and was an instrumental help in my being able to put together
the Foundations for Learning Act, which became law last year as
part of the Elementary and Secondary Education Act.
So a lot of what I've learned about it, you know how
outspoken I've been on the Committee about it, I learned from
Haven. So I thank her for being here.
Ms. Miles. I'm really glad to be here, too. And I'd like to
thank the Subcommittee for allowing me to speak on behalf of
young children who struggle with behavioral and emotional
problems.
I'm testifying today in support of Federal funding for
programs that encourage a child's healthy social, emotional and
educational development. Traditionally, education and social-
emotional development have been considered programmatically
separate. I'm here to make the case that it is crucial for us
to shift this paradigm and begin to develop programs that
consider academics and emotional development equally and at the
same time.
I'd like to start off by telling you a couple of stories
about children who I've had the privilege to work with. I
encountered recently a little boy 18 months of age. After his
second expulsion from two separate child care settings for
biting other students, he was referred to our program. He left
in his little wake a host of frazzled child care workers and an
exasperated mother who was already stressed in her pursuit of
transitioning from welfare to work.
Was this a bad child? No. Was this a socially deviant
child? Of course not. The fact is, biting is quite normal for a
child this age. Some children bite more than others. Some
children quite naturally and with little guidance learn that
biting can't happen while others require special help in
learning non-biting behaviors.
This little boy came to our program and experienced a
structured classroom setting where we could give him more
individual attention. He also experienced success for perhaps
the first time. We stopped the biting before it happened, and
employed behavior management techniques that in essence
untaught his biting behavior. After four months we transitioned
him back to a community day care setting where he today enjoys
social success.
Not all children, however, are this easily remediated. I
also work with a three year old boy who, upon arriving on his
first day of preschool, used the length of his arm to clear off
the teacher's desk. As one might expect, this infuriated the
teacher and humiliated the parent. He threw a tantrum which
nobody, the teacher nor the parent, could control. He was
allowed back, and again, he cleared off the desk and threw
another all-out tantrum. This time he was isolated in an empty
classroom. After causing substantial damage to the room, he was
expelled from the school.
Again, this boy is not a bad child. He is a child who
missed, for a variety of reasons, crucial developmental
milestones. And he is in need of specialized remedial efforts
to prepare him to enter public school. He is also a child from
a family in which substance abuse is a major struggle.
He has been with us now for two years. We work with him in
a very structured classroom, using an approach that reflects
mental health principles combined with educational techniques.
This is not found in typical community preschool settings. And
of course, we also work quite closely with the child's family.
Our intention and goal is to help this child transition to
public kindergarten with a new set of emotional and behavioral
skills that he will use to form successful relationships with
his peers and teachers. These skills also will be crucial to
his academic success.
In addition, we will share with his new teaching staff the
techniques of this approach so they can continue his learning.
Without the specialized services this child is receiving, I
don't believe he would have a chance to experience social and
academic success in school and in society.
These examples are not isolated. In fact, they are more
typical than many of us realize. The demand for specialized
programs that address both the social-emotional and academic
needs of young children is growing. I can tell you that
enrollment at the Providence Center's early childhood program
has doubled over the past two years.
While programs like Head Start are a godsend to many
children who otherwise would not have quality preschool
experiences, they are unprepared to address the needs of young
children with behavioral and emotional problems. Head Start
staff members and the staffers of other child care and
preschool programs are in critical need of the advice and
counsel of professionals who are specially trained in early
childhood emotional development.
If we have the proper resources, we can help young children
who have emotional and social problems remain in community
settings and set them on a course toward academic success. The
Foundation for Learning Act can help provide these resources.
This Act is unlike any other Federal initiative, in that it
will help make possible the development of programs that merge
educational and emotional development principles through
service integration and professional collaboration, so that we
can have, in a typical community preschool classroom, teachers
and professionals trained in early childhood development,
working together to meet the comprehensive developmental needs
of children, putting emotional development in the daily
curriculum.
I strongly urge this Subcommittee to give the utmost
consideration to funding programs that support an integrated
approach to the educational and emotional development needs of
young children. I'm going to stop before the light goes on to
ask if there are any questions.
[The prepared statement of Ms. Miles follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
Thank you, Haven. Maybe you could explain for the Committee
how you currently, the different funding streams you might be
able to get, if you don't have enough of the developmentally
delayed child to get to early intervention services through
Part C. How is it that Foundations for Learning would allow you
in a grant program like that to get these services so that you
can address these children's problems?
Ms. Miles. We are designing at the Providence Center
programs that can address the training needs for existing child
care staff who have not been trained in their own training
programs or their own college degree programs on how to manage
behavior problems. There is ample evidence, material and
information in the mental health field to provide answers to
the immediate questions that those staff have.
And one of the things we would wish very much to be able to
do is to begin sharing immediately with folks who are working
with these youngsters every day, at their places of work, child
care centers and day care homes also, the information that they
need, for example, about how to teach a youngster who is three
years old, who has never had the experience of waiting before,
how to wait, so that it becomes a successful experience for him
rather than another failure.
So the idea is to begin a process that can be, certainly
Rhode Island wide. I would like to see it nationwide, in which
the information and materials that we already have, that have
been around for people to use for at least the last decade, to
get those right into the hands of the people who need them this
very minute.
Mr. Kennedy. And so Mr. Chairman, this would address the
problem that we were talking about in the other hearing where
the Assistant Secretary of Education was testifying last week
about moving Head Start into the Department of Education, and
the real emphasis that needs to be put on literacy. They also
acknowledged after some prodding that emotional-social
competencies were equally as important. But maybe you could
underscore how it is the case where social-emotional
competencies are directly interrelated with literacy, and why
we should be very cognizant about providing those capacities
for teachers, just as we do literacy skills.
Ms. Miles. Literacy skills are taught in steps. And one of
the very first skills leading to literacy is learning how to
play with blocks. If what a two or three year old child knows
how to do with blocks is to throw them or hit people with them,
he's really not ready yet to learn that first you put the big
ones down and then you put the medium ones on top and then you
put the little ones on top of that.
You can't teach a child who is still in the process of
chucking blocks at people how to pay attention long enough to
learn that very first building block, pun intended, about how
to begin to read. If a child is not able to tolerate a waiting
period of longer than three or four seconds, he is not going to
be able to attend to a highly trained, very skillful, very
competent teacher when she is trying to demonstrate and teach
to him and include the rest of the class in the process of
learning that it's A for apple.
Mr. Kennedy. So maybe having these people, teachers, get
the education and how to deal with these children in these
fashions may help them be better literacy teachers as well.
Ms. Miles. Absolutely. Even the most basic of information
about how much stimulation to have available in a particular
classroom for a group of children can make an enormous
difference in whether a child can sit and pay attention to a
teacher or whether he's looking at all the drawings that are up
on the wall.
Mr. Regula. Mr. Wicker.
Mr. Wicker. No questions, thank you, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. No questions, thank you, Mr. Chairman.
Mr. Regula. Thank you very much for being here.
Mr. Miles. Thank you, Mr. Chairman.
----------
Tuesday, April 23, 2002.
AMERICAN ASSOCIATION OF DENTAL RESEARCH
WITNESS
STEVEN OFFENBACHER, DIRECTOR, UNIVERSITY OF NORTH CAROLINA SCHOOL OF
DENTISTRY, CENTER FOR ORAL AND SYSTEMIC DISEASES, AND PRESIDENT,
AMERICAN ASSOCIATION FOR DENTAL RESEARCH
Mr. Regula. Dr. Steven Offenbacher, Director of the
University of North Carolina School of Dentistry Center for
Oral and Systemic Diseases. Thank you for coming.
Dr. Offenbacher. Mr. Chairman, members of the Committee, I
am Steve Offenbacher. I'm with the University of North Carolina
at Chapel Hill.
I'm here today testifying on behalf of the American
Association for Dental Research. I would like to discuss our
2003 budget recommendations for the National Institutes of
Dental and Craniofacial Research, as well as the Agency for
Health Care Research and Quality and the Centers for Disease
Control.
The American Association for Dental Research is a non-
profit organization with over 5,000 individual members and 100
institutional members within the U.S. Its mission rests on
three principal pillars. One is to advance the research and
increase knowledge for the improvement of oral health. Second
is to strengthen the oral health research community. And third
is to facilitate the communication and application of research
findings.
Mr. Chairman and members of the Committee, I want to thank
you for this opportunity to testify about the ongoing work of
the research community and that of the NIDCR. Dental research
is important because it is concerned with the prevention,
causes, diagnosis of diseases and disorders that affect the
teeth, the mouth, jaws and related systemic diseases. Dental
researchers are leaders in studies of disfiguring birth
defects, chronic pain conditions, oral cancer, infectious
diseases, including oral infections and immunity, bone and
joint diseases, the development of new diagnostics and
biomaterials and the interaction with systemic diseases that
can compromise oral, craniofacial and general well-being.
Throughout the life span, the oral cavity is continuously
challenged by both infections that may have systemic as well as
local implications for health. Through the research of dental
scientists, this field continues to demonstrate that the mouth
is truly a window to the body, and that in many ways, this is
an important portal for infection that can spread and
disseminate systemically.
Research into the causes of oral diseases and new ways to
treat and prevent these diseases is estimated to save Americans
$4 billion annually. Oral health is essential and an integral
part of health throughout the life span of an individual. Of
the 28 focus areas for Healthy People 2010, the oral health is
integrated into 20 of them. No one can truly be healthy unless
he or she is free from the burden of oral and craniofacial
diseases and conditions.
Just to mention some of the extent of the problems, dental
caries or tooth decay is one of the most common diseases among
5 to 17 year old individuals. Eighty percent of tooth decay in
permanent teeth is now found in about 25 percent of the school
age children, and minority children have more than their share
of the problem.
According to the Centers for Medicare and Medicaid
Services, approximately 500 million dental visits occur
annually in the U.S., with an estimated $60 billion currently
being spent on dental services. Yet many children and adults
needlessly suffer from oral diseases that could be prevented.
In fact, 30,000 Americans will be diagnosed with oral and
pharyngeal cancers this year with more than 8,000 deaths, many
of which could have been prevented.
I am a dentist, and I'm proud to be a dental scientist.
What's important in terms of research is that there have been
new evidences that have extended the role of oral disease and
oral infection into the mainstream of medicine. For example, we
now understand that periodontal infections are an important
risk factor for pre-term delivery, may increase the risk of a
mother having a pre-term delivery almost seven fold. In these
mothers that have pre-term delivery, we now understand that the
oral organisms can pass through the blood stream and target the
fetus in utero.
For example, a mother that has periodontal disease and has
a baby that's under 32 weeks of gestation, that premature baby
is likely to be about 400 grams smaller because of her
periodontal disease, the infection targeting the fetus and
impairing the growth of that fetus. We can understand that that
translates into a cost of approximately $30,000 in the first
two weeks of that baby's life in neonatal intensive care costs.
So research has taken us to the point where we've
identified the importance of periodontal infections, and we
need the infrastructure, we need the support to extend these
findings and translate them into clinical applications that can
affect the health of the public.
We feel that we are requesting support for the NIDCR, the
National Institute of Dental and Craniofacial Research, this
supports the research an increase of 22 percent for the fiscal
year of 2003 to a total appropriation of $420 million. The
Centers for Disease Control funded at $10,839,000, we are
recommending $17 million for fiscal year 2003. And for the
AHRQ, we are requesting an increase in funding to $390 million.
Thank you for your attention. This concludes my testimony
and thank you for this opportunity to meet with this Committee.
[The prepared statement of Dr. Offenbacher follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Wicker.
Mr. Wicker. Well, you said a lot, Doctor, in a very brief
time. Thank you for your testimony. I think your testimony is
right on target and I appreciate your being here.
Let me just ask you, in the brief time we have, about the
cavities. You say 80 percent of the cavities occur in about 25
percent of the children. I wonder if those children are in
areas where the water has fluoride, and do you know the
percentage of the drinking water in the United States that is
fluoridated, if you could comment on the effects of that?
Dr. Offenbacher. I'm sorry, I don't know the exact numbers.
But I know fluoridation has a tremendous impact. For example,
the rate of caries among non-fluoridated areas, such as in
Asian Pacific Islanders, is extremely high in areas where there
is no fluoride. So fluoride has a tremendous impact.
Access to care has another impact, in terms of the ability
of us to regulate or control the caries in these children. I
don't know the fluoride statistics.
Mr. Wicker. Well, maybe you could get that to the
Committee, submit it to the record.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. And also, just to say that I think this
Subcommittee is aware that a dentist is perhaps the only
opportunity that some people will have to see a professional
that could possibly diagnose other problems and send them to
other types of physicians that they need to see. So I, as one
member of this Subcommittee, I am very supportive of all the
dental programs, up to and including pediatric dentistry, and
also getting our dentists out to the communities where we know
that the area is under-served in other areas of medicine, so
that at least there is somebody there to take a look at them
from a professional standpoint and send them in the right
direction.
So thank you for your testimony.
Dr. Offenbacher. Thank you, sir.
Mr. Regula. Thank you very much.
----------
Tuesday, April 23, 2002.
AMERICAN DENTAL EDUCATIONAL ASSOCIATION
WITNESS
DAVID JOHNSEN, DEAN, UNIVERSITY OF IOWA COLLEGE OF DENTISTRY AND
PRESIDENT, AMERICAN DENTAL EDUCATION ASSOCIATION
Mr. Regula. Dr. David Johnsen, Dean, University of Iowa
College of Dentistry. We're getting a pretty good shot on the
dentists today. [Laughter.]
Dr. Johnsen. Good afternoon, Mr. Chairman and members of
the Subcommittee. My name is Dr. David Johnsen. I'm Dean of the
University of Iowa College of Dentistry and President of the
American Dental Education Association, representing all 55 U.S.
dental schools.
In 2000, the Surgeon General released a report entitled
Oral Health in America. The document makes clear that there are
profound disparities in the oral health of Americans amounting
to a silent epidemic of dental and oral diseases affecting our
most vulnerable populations.
And there are other significant challenges within the
infrastructure of dental education and the oral health delivery
system. For instance, the dentist to population ratio is
declining, decreasing the capability of the dental work force
to meet emerging demands of society. In one-third of the
counties in Iowa, 20 percent of the dentists are age 60 or
more.
Dental education debt has increased, limiting both career
choices and practice locations. In 2000, 45 percent of
individuals who graduated with debt over $100,000. Currently
there are 400 budgeted but vacant faculty positions in 55 U.S.
dental schools. Of dental students graduating in 2000, only one
half of 1 percent plan to seek careers in academia and
research. And lack of diversity and the number of under-
represented minorities in the oral health professions is
disproportionate to their distribution in the population at
large.
We urge the following. Number one, for general dentistry
and pediatric dentistry training programs, ADEA recommends that
the Subcommittee adequately fund the Primary Care Cluster to
ensure an appropriation of $15 million for these two primary
care dental programs. These two programs provide dentists with
the skills and clinical experiences needed to deliver a broad
array of oral health services to the full community of
patients. Post-doctoral general dentistry training programs
increase access to care while training dental residents to
treat geriatric, special needs and economically disadvantaged
patients.
The pediatric dentistry program began to expand after 20
years of little change. Preventive oral health care for
children is one of the great successes in public health. But 25
percent of the pediatric population still experiences 80
percent of the dental cavities. Two-thirds are Medicaid
recipients.
Number two, for the Health Professions Education and
Training Programs for Minority and Disadvantaged Students, ADEA
recommends $135 million, including $3 million for the faculty
loan repayment program. Two programs, the Centers of Excellence
and the Health Careers Opportunity Program, are key in
assisting health professions schools prepare disadvantaged and
minority students for entry into dental, medical pharmacy and
other health professions. The faculty loan repayment program is
the only Federal program that endeavors to increase the number
of economically disadvantaged faculty members.
Number three, for the Ryan White HIV-AIDS reimbursement
program, ADEA recommends an appropriation of $19 million. This
program increases access to oral health services for HIV-AIDS
patients and provides dental students and residents with
education and training. In 2001, 85 dental programs treated
more than 66,000 patients who could not pay for services
rendered.
Number four, for the National Health Service Corps
Scholarship and Loan Repayment Program, ADEA supports the
President's recommended funding level of $191 million. Programs
assist students with the rising costs of financing their health
professions education while promoting primary care, access to
under-served areas. NHSC should open the scholarship program to
all dental students and increase the number for dental hygiene
students.
Number five, for the National Institute for Dental and
Craniofacial Research, NIDCR, ADEA joins the American
Association for Dental Research in requesting an appropriation
of $420 million for NIDCR. Likewise, ADEA urges the
Subcommittee to encourage NIDCR to expand loan forgiveness
programs to researchers. Through collaborative efforts with
NIDCR, oral health researchers in U.S. dental schools have
built a base of scientific and clinical knowledge that has been
used to dramatically improve oral health in this country.
In conclusion, Mr. Chairman, I thank you again for the
opportunity to present fiscal year 2003 budget requests for
dental education and research programs, and urge the
Committee's support. Thank you.
[The prepared statement of Dr. Johnsen follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. No questions, thank you, Mr. Chairman.
Mr. Regula. Mr. Wicker.
Mr. Wicker. Nothing, thank you.
Mr. Regula. Thank you for being here.
----------
Tuesday, April 23, 2002.
COALITION FOR INTERNATIONAL EDUCATION
WITNESS
DAVID WARD, PRESIDENT, AMERICAN COUNCIL ON EDUCATION ON BEHALF OF THE
COALITION FOR INTERNATIONAL EDUCATION
Mr. Regula. Mr. David Ward, President of the American
Council on Education.
Mr. Ward. Mr. Chairman and members of the Subcommittee, my
name is David Ward, and I am President of the American Council
on Education, an association representing 1,800 public and
private two and four year colleges and universities. Prior to
that, I was Chancellor of the University of Wisconsin-Madison,
in the same State as the Ranking Member.
One of our top priorities is Federal student aid. Before I
address today's topic, I would like to thank the Chairman, the
Ranking Member and the rest of the Subcommittee for their
support of the Pell Grant program and campus-based student aid
programs. In addition, we thank the Committee for its support
of scientific research, specifically a longstanding commitment
to double the budget of the National Institutes of Health.
Today I am here to present testimony on behalf of the
Coalition for International Education on the fiscal year 2003
appropriations for the Title VI programs in the Higher
Education Act and the Mutual Educational and Cultural Exchange
Act, commonly known as Fulbright-Hays. The Coalition is an ad
hoc group of 28 national higher education organizations, with a
focus on international education, foreign language and exchange
programs. We express deep appreciation for the Subcommittee's
long-time support for these programs, especially for the
significant infusion of funding in fiscal year 2002.
The recent terrorist threats we're being forced to address
only underscore the importance of training specialists in
foreign languages, cultures and international business.
Developing the international expertise of the U.S. will need in
the 21st century sustained financing. At the top of the list is
adequate support for Title VI and Fulbright-Hays.
Just as the Federal Government maintains military reserves
to be called upon when needed, it must invest in an educational
infrastructure that steadily trains a sufficient number and
diversity of American students. International expertise cannot
be produced quickly. It must be cultivated and maintained.
Moreover, we cannot continue to prepare for yesterday's
problems, but we must build upon our existing knowledge base to
equip our Nation to meet tomorrow's challenges in international
matters.
Responding to demands to protect national security in a
broad range of arenas throughout the U.S. and the world,
virtually every Federal agency is engaged globally. One
estimate is that over 80 Federal agencies and offices rely on
human resources with foreign language proficiency and
international experience. Despite their own language training
programs, several agencies are now scrambling to address
deficiencies in the less commonly taught and difficult to learn
languages, such as those of central Eurasia, south Asia, and
the Middle East. Faced with shortages of language experts after
September 11th, the FBI sought U.S. citizens fluent in Arabic,
Persian and Pashto to help with the Nation's probe into the
terrorism attack. One Federal agency estimated its total needs
to be 30,000 employees dealing with more than 80 languages.
Title VI and Fulbright-Hays are among the few programs the
Federal Government supports that provide the necessary long
term investment in building language and foreign area capacity
that responds to national strategic priorities. At roughly $100
million, this is one of the smallest investments the Government
makes in national security, but it pays extraordinary
dividends.
National security is also linked to commerce, and U.S.
business is widely engaged around the world in joint ventures,
partnerships and other linkages that require employees to have
international expertise. A recent study on the
internationalization of American business education found that
knowledge of other cultures, cross cultural communications
skills, international business experience and foreign language
fluency rank among the top skills sought by corporations
involved in international business.
Title VI supports important programs that internationalize
business education and help small and medium size U.S.
businesses access emerging markets, a boost toward reducing the
trade deficit and creating more U.S. jobs. The U.S. Department
of Commerce reports that 97 percent of all U.S. export growth
in the 1990s was contributed by small and medium size
companies. Yet, only 10 percent of these companies are
exporting. The most common reasons cited by U.S. businesses for
not pursuing these export opportunities is a lack of knowledge
and understanding of how to function in the global business
environment.
Research is needed to identify specific policy measures and
avenues of public and private sector cooperation that will make
possible both homeland security and continued economic growth.
The Centers of International Business Education Research
supported by Title VI have made great strides in
internationalizing U.S. business education. Globalization is
also driving new demands for globally competent citizens, and
international knowledge in almost all fields of endeavor,
including health, the environment, journalism and the law.
Although funding has increased over the last three years in
constant dollars, these programs are below the fiscal year 1967
levels. The overall erosion of funding, combined with expanding
needs and rising costs, have contributed to the shortfall in
international expertise that our Nation requires.
Last year's funding increase was an important step towards
accomplishing our Nation's strategic objective in Title VI and
Fulbright-Hays funding. As a next step for fiscal year 2003,
the Coalition recommends $122.5 million, a total increase of
$24 million for Title VI and Fulbright-Hays programs, to be
allocated as outlined in my written testimony.
That is the end of my testimony. I would be happy to take
questions.
[The prepared statement of Mr. Ward follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Mr. Chairman, let me simply say that in my
judgement, we can usually say that the need to fund programs in
education and science is usually inversely proportional to the
degree of political power demonstrated by their advocates, or
the political sexiness of the programs. Not many members of
Congress are going to get gold stars going home bragging about
what they've done to promote international education.
But I think events such as September 11th demonstrate the
wisdom of doing that. I was struck by the fact that,
Chancellor, in your statement you have this sentence: fiscal
year 1967, Title VI funded three programs that still exist, the
National Resource Centers, FLAS fellowships and Research and
Studies. Their combined estimated funding for fiscal year 2002
is about $58 million, or 32 percent below fiscal year 1967,
high point of $87 million in constant dollars.
It seems to me that our national interest in supporting
these kinds of programs has not declined since that time,
although the public interest and the political interest
certainly had, until September 11th. But I'm glad to see that
you're here supporting these programs. I must also say, I
confess I'm not objecting. Because I wouldn't be here if it
weren't for those programs. After Sputnik hit the newspapers in
1958, I received one of those three year fellowships in the
Russian area studies program. If I hadn't, I wouldn't be here
today. That might be regarded by some as a good reason not to
support the program. [Laughter.]
Mr. Obey. Nonetheless, I think it's an important program. I
thank you for being here today and support it.
Mr. Ward. I appreciate that.
Mr. Regula. Mr. Wicker, you're going to introduce the next
witness.
Thank you very much for coming.
Tuesday, April 23, 2002.
COUNCIL FOR OPPORTUNITY IN EDUCATION
WITNESS
REVEREND CLARENCE E. SMITH, REGISTRAR, RUST COLLEGE, HOLLY SPRINGS,
MISSISSIPPI
Mr. Wicker. Mr. Chairman, and my colleagues on the
Subcommittee, I am delighted to introduce Reverend Clarence
Smith. The record will show that he is Registrar at Rust
College in Holly Springs, Mississippi, that previously he was
Director of the Upward Bound program at Rust College. But he is
also my very good friend and neighbor. He works in Holly
Springs, but commutes back and forth to my home town of Tupelo,
Mississippi. Our children are in school together, and he is a
valuable member of our community.
I have but one concern, and that is that Mr. Smith recently
surrendered to the ministry and is going to seminary also. To
limit a Baptist minister to five minutes----
[Laughter.]
Mr. Wicker. I don't know if it's humanly possible, Mr.
Chairman. But Reverend Smith is here, and we're delighted to
have him here. I will yield and then I'll reclaim my time.
The first person to ever tell me about the TRIO program was
our next witness, and I appreciate that. We're delighted to
have you here, Clarence.
Rev. Smith. Mr. Chairman and members of the Subcommittee,
my name is Reverend Clarence E. Smith, and I am presently the
Registrar at Rust College in Holly Springs, Mississippi. Prior
to this position I was the Director of the TRIO program at Rust
College for about 11 years, and I'm still very involved in the
three TRIO programs that are currently on the campus.
I am testifying today on behalf of the Council for
Opportunity in Education, which represents administrators and
counselors working in TRIO programs nationally. Chairman
Regula, before I proceed with my testimony, I would like to
thank you and other members of the Subcommittee for your strong
commitment to the TRIO programs over the past few years, and
for expanding student access to these programs.
In particular, I would like to acknowledge my Congressman,
Congressman Roger Wicker, whom I have known for about eight
years and who has been a great supporter of TRIO programs and
Rust College. I have also had the privilege of presenting a
regional award to him for his outstanding support of TRIO
programs.
As you know, the TRIO programs are a complement to the
student financial aid programs and help students to overcome
the class and academic barriers that prevent many low income
first generation college students from enrolling in or
graduating from college. The five TRIO programs work with young
people and adults from sixth grade through college graduation.
Currently, there are almost 2,600 TRIO projects serving some
823,000 needy students.
Now, I would like to tell you a little about the programs
at Rust College. Rust College is a four year liberal arts
institution, and it is the oldest historically black
institution in the State of Mississippi. For over 30 years,
Rust College has been the host for three TRIO programs, Student
Support Services, Talent Search and Upward Bound.
The Rust College Upward Bound programs help eligible high
school students prepare for, pursue and complete post-secondary
education. As an incentive, Rust College also provides a $2,400
scholarship for each Upward Bound student who graduates from
high school and enrolls at Rust College. The Rust College
Education Talent Search Scholars Program also helps students
complete high school and enroll in post-secondary education.
But this program begins serving students at the middle school.
For both the Upward Bound and Talent Search programs, Rust
College serves four school districts located in rural counties
such as Benton, Marshall and Tate, which are economically
disadvantaged regions of the State. Rust College feels strongly
that providing services to the students in the target areas
through Talent Search and Upward Bound tremendously helps level
the playing field for those students, and also gives them equal
access to post-secondary education.
The Rust College Student Support Services program helps to
increase the retention and graduation rate of eligible college
students and tries to promote an institutional climate that
enhances the success of these students. I have been able to
witness first-hand the effectiveness of TRIO, and now I would
like to share with you the success story of one of my students
who benefitted from the TRIO programs at Rust College.
Charles LeSure came from a single parent family where his
mother had a meager income but had a desire for her children to
be successful. He entered the Upward Bound program at Rust
College after being referred by a counselor, because he had
academic need. While he thought about going to college, he did
not have extra support needed to help him prepare for college.
And he needed the Upward Bound program to help him stay
focused.
Of course, coming from a rural area, he also needed the
cultural experience and exposure that Upward Bound brings. He
graduated from high school and entered Rust College in the fall
of 1992. With the help of the Student Support Services program
at Rust, he graduated in 1996. Currently, he is a math teacher
in the Memphis City School System and an associate minister at
Anderson Chapel C.M.E. Church.
Current funding levels seriously limit the ability of TRIO
to serve more students and to strengthen the quality of program
services. There are almost 9.6 million low income students,
from middle school to college, currently eligible for TRIO. And
the demographics will show that.
For these reasons, the Council is recommending an
appropriation of $1 billion for TRIO in the fiscal year 2003,
an increase of $200 million. At this level of funding, the TRIO
programs will be able to serve almost 100,000 additional
students and strengthen existing services.
The Council also supports the Student Aid Alliance fiscal
year 2003 funding request, which includes a $500 increase for
the minimum Pell Grant award, to $4,500.
Mr. Chairman, Committee, we deeply appreciate and pray that
you will consider our views. I will be happy to entertain any
questions that you may have.
[The prepared statement and biography of Rev. Smith
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Wicker. Mr. Obey.
Mr. Obey. I do have just one comment. I have been a strong
supporter of TRIO ever since I have had a chance to deal with
that on the Subcommittee. But I would simply ask one thing of
the folks who are for TRIO and the folks who are for GEAR UP.
That is that they not fight each other.
I don't think the needs of the students who are served are
going to be very well met if we have a lot of time spent with
TRIO people begrudging what is appropriated for GEAR UP and
vice versa. So to the extent that you can deliver that message
to both organizations, I would appreciate it.
----------
Tuesday, April 23, 2002.
COALITION FOR COMMUNITY SCHOOLS
WITNESS
MARTIN J. BLANK, STAFF DIRECTOR, COALITION FOR COMMUNITY SCHOOLS,
INSTITUTE FOR EDUCATIONAL LEADERSHIP
Mr. Regula. Okay, Mr. Hoyer, thank you for coming and
introducing our next witness.
Mr. Hoyer. Thank you, Mr. Chairman.
I'm glad to welcome at this point in time Mr. Martin Blank,
who is the Staff Director of the Coalition for Community
Schools, Institute for Educational Leadership. Mr. Chairman,
the Coalition is an alliance that brings together leaders and
networks and education family support, youth development,
community development, government and philanthropy behind a
shared vision of full service community schools, where
community resources and capacity are mobilized around children
in public schools to support student learning. As you know, Mr.
Chairman, that's something I've been talking about for well
over a decade.
Marty Blank has extensive experience in research, practice
and policy related to full service community schools. Now,
that's his CV. He is also married to a very extraordinary
woman, Helen Blank, who is the Executive Director of the
Children's Defense Fund, and with whom I have worked for more
than a decade on issues related to children and families. She
does an extraordinary job herself.
So Marty and Helen are two extraordinary Americans serving
children in our country. And we welcome him here today.
Mr. Blank. Thank you, Mr. Hoyer. It's always a privilege to
follow in your footsteps and particularly in my wife's.
Mr. Hoyer. I had the same experience.
Mr. Blank. I know you have, and that's why we've been so
pleased with your support of full service community schools.
Mr. Chairman, I am Marty Blank, Staff Director of the
Coalition for Community Schools. My thanks to you, Mr. Chairman
and the Subcommittee, for the opportunity to testify today.
Research and common sense tell us that children from all
income groups experience barriers to learning. We've heard
about some of them today, the health, the mental health, the
dental issues that young people experience. In addition, there
are other barriers, unstructured time after school, lack of
engagement in learning, poverty in absence of family support,
student mobility, risky behavior, violence, absenteeism. These
all affect student learning. And full service community schools
address these needs in an intentional and strategic way.
Full service community schools are public schools open to
students, families and community members before, during and
after school, all year long. They have high standards and
expectations, qualified teachers, rigorous curriculum. At a
typical full service community school, the family support
center helps with early childhood development, parent
involvement in education. Employment and other services,
medical, dental, mental health and other services are readily
available. Before and after school programs build on classroom
experiences and help students expand their horizons. Parents
and community residents participate in adult education and job
training. The school curriculum uses the community as a
resource to engage students in learning and service, and
prepares them for adult civic responsibility.
Educators, families, students and community agencies and
organizations decide together what services and opportunities
are necessary to support student learning. No model is imposed
upon them. Research based strategies are applied.
You may be asking yourself, do we expect schools to do all
of this work? The answer is no. Rather, a full time
coordinator, in many instances hired by a partner community
organization, works with the principal to link the school to
the community and manage the additional supports and
opportunities available at a community school. Working with a
partner organization helps take the burden off principals and
teachers, so they can focus on teaching and learning.
Who pays for this? Financing is a shared responsibility.
the school funds the core instructional program and facilities
costs, obviously, but together the school and its community
partners fund the various services by coordinating and
integrating Federal, State, local and private funding streams
from Education, Health and Human Services, Justice, many of the
programs this Committee funds, as well as private sources.
Community partners include every sector of the community,
parks and recreation, child and family agencies, youth
organizations like the Ys, the Boys Clubs, United Way, small
and large business, museums, hospitals, the Forest Service,
police and fire departments are all involved in this effort in
communities across the country.
Do full service community schools work? Evaluation data
from 49 different initiatives compiled by leading authority Joy
Dreyfuss demonstrates their positive impact on student
learning, on healthy youth development, on family well being
and on community life. Moreover, community schools have strong
community support, strong public support. A recent poll by the
Knowledge Works Foundation in Ohio found that two-thirds or
more of Ohioans support community use of school facilities for
the kinds of programs envisioned in a full service community
school.
How can this Committee help to promote this promising
approach? At the present time, various agencies of the Federal
Government fund programs that should be integrated in a full
service community school. Too often, however, these programs
are fragmented and not focused on our key national priority:
improving student learning. The No Child Left Behind Act
requires States and local education agencies to coordinate and
integrate Federal, State and local services to help support
student learning.
We believe that to ensure the effective implementation of
this provision and to create full service community schools,
States and local education agencies need incentives and
technical assistance. Therefore, we ask this Committee to do
the following.
First, support a State full services community schools
incentive program that provides willing States with flexible
funds to create an infrastructure for full service community
schools. Support a similar program for local education agencies
that work in partnership with other organizations. Support a
national full service community schools support center where
research on this issue, coordination of training and technical
assistance and recognition programs can be implemented. And
finally, support the core underlying programs that must be
integrated at a full service community school, particularly
those where educators and community agencies must work
together, such as the 21st Century Community Learning Program,
the Safe Schools Healthy Students Program, and Learn and Serve
America.
In conclusion, Mr. Chairman, the Coalition believes that
bringing schools together with the assets of organizations and
individuals in our communities and with our families to improve
student learning is a common sense policy approach. Full
service schools help ensure that schools have support from
families and communities for the education enterprise that is
so vital to the future of our democratic society.
Thank you very much, and I'd be pleased to answer any
questions you may have.
[The prepared statement of Mr. Blank follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. If I understand you correctly, any school could
become a full service school, depending on its willingness?
Mr. Blank. That's correct, Mr. Chairman.
Mr. Regula. Your group's function is to encourage the
development of these kinds of units across the country?
Mr. Blank. That's quite correct, sir.
Mr. Regula. Thank you.
Mr. Hoyer.
Mr. Hoyer. Mr. Chairman, I don't have a question, but I
want to thank Marty for his testimony. The points that he has
made with respect to grant programs to fund the full service
community school grant program and the State full service
program as well as a support center funding, all of these I
think tie into what we need to do on this Committee, and what
I've urged in particular three Departments under our aegis to
do, and that is, obviously Health and Human Services that has
Head Start, in some respects now fully integrated at about a
quarter of the schools across the Nation, but not integrated in
about three quarters, and the President has spoken about that,
as you know. As well as educational health services that come
under both Department of Education and HHS. But also programs
for work incentive programs, worker training programs, adult
education programs which come under both Education and Labor.
In addition to that, of course, we have six or seven other
Departments including HUD, Agriculture and Nutritional
Services. The point is, Mr. Chairman, the full services school
concept is, as you know, that we have invested a lot of money
in a central, the only central facility that every community
has. Perhaps a fire hall or fire service is the other one. But
the only one that every community has, that is an elementary
school. If we fully utilize and coordinate these services, we
can get more bang for the buck that we appropriate, because
they will be coordinated and made much more efficient in terms
of delivery to those people who need them. That's the whole
concept of full service schools.
Mr. Chairman, I want to work with you over the next coming
months before we mark up the bill to see if we might start,
I've talked about this for a long time, and we're going to
introduce a piece of legislation, hopefully within the next
month. We've been working with Congressional Research Service.
Before we introduce it, I'm going to show it to you. I'd love
to have you look at it and if you think it's a good idea, to
co-sponsor it with me, along with others, but to see if we can
in effect energize this effort of utilizing our resources more
efficiently in this bill that we're going to mark up shortly.
Again, Marty, thank you very much for not only your
testimony but for the work that both you and Helen do.
Mr. Regula. How many units are there across the Nation that
do this?
Mr. Blank. It's a challenging question, Mr. Chairman. We
think there are several thousand schools that reflect this full
vision that I articulated. Many have pieces of this, and as you
correctly pointed out earlier, we are trying to get people to
see and understand this notion, this idea, and the kind of
support that we're seeking from this Committee will help us to
move that idea forward into implementation. And in addition to
all the goals that Mr. Hoyer articulated, we believe this
approach has a real connection to the student learning
objectives that are so important to this Committee, to the
President and the country.
Mr. Regula. That's an interesting thing. I have a couple in
my district that are headed that way, they're open 18 hours a
day and the community is involved. One of them has the YMCA
right in the building. That's the newest thing.
Mr. Blank. Right. Ohio is building many new schools, as you
are probably aware, because of the age of its facilities. We
would like to see them built in this way, because we believe
that it really engages all Americans in educating all our
children.
Mr. Regula. Makes a lot of sense. Thank you for coming.
Mr. Blank. Thank you so much.
Mr. Hoyer. Marty, if I can, before you leave, because the
Chairman asked the question how many there are, as you know,
Mr. Chairman, because we've had some conversations, we're going
to try to coordinate a schedule for you to go out to Eva Turner
in Charles County, which is a partially full service school.
We're not exactly where we want to be, but it's certainly a
multi-service school.
Marty, do you remember the school that I visited in New
York, whatever the number was?
Mr. Blank. Yes, IS 218, a school that's been a partnership
between the Children's Aid Society and the Community School
District Number 6.
Mr. Hoyer. It is an extraordinary school, Mr. Chairman.
When you're up in New York, this is north of the GW Bridge,
large Latino population in that area. They are doing some
extraordinary work with multi-service----
Mr. Blank. Right. They also have a site here in the
District of Columbia which might be another possibility for a
visit as well, Mr. Hoyer.
Mr. Hoyer. Obviously, yes. Thank you.
Mr. Regula. Thank you.
----------
Tuesday, April 23, 2002.
ASSOCIATION OF TECH ACT PROJECTS
WITNESS
PAUL RASINSKI, EXECUTIVE DIRECTOR AND CONSUMER, MARYLAND TECHNOLOGY
ASSISTANCE PROGRAM
Mr. Regula. Mr. Hoyer, I understand you want to introduce
our next witness.
Mr. Hoyer. Mr. Chairman, I've been very involved in
assistive technology, and you have been very helpful as last
year, as you recall, we cooperated with the authorizing
committee to preclude the assisted technology grant from
lapsing, as it would have happened under the legislation.
I'm pleased to welcome to the Committee Mr. Paul Rasinski,
who is the Executive Director of the Maryland Technology
Assistance Program, otherwise known as MTAP. Born and raised in
Baltimore, Mr. Rasinski takes pride in assisting individuals
with disabilities in our community, and we thank him for that.
He graduated from Coppin State College, began his career in
education as an industrial arts instructor in the Baltimore
City School System. He sustained a spinal cord injury in a
sports accident, and spent many years rehabilitating his
physical health and endeavoring to develop a new career. He
has, out of adversity, given great, positive effect to his own
injury and imparted great, positive wisdom to others. He joined
the staff of the Maryland Technology Assistance Program as the
Education Liaison. The position entailed, among other
responsibilities, assisting parents and educators in the proper
selection and use of assistive technology for the individual
education plans of children with disabilities.
He was promoted assistant director in 1996 and on July 1st,
1997, assumed the position of executive director. He testified
last month before the Education and Work Force Subcommittee on
21st Century Preparedness on this subject. Mr. Chairman, I am
hopeful that the authorizing committee will move legislation. I
have had discussions, I know you have talked to them as well.
Mr. Rasinski gave very compelling testimony there. And I
welcome him before our Committee today. Thank you for being
here, Paul.
Mr. Rasinski. Good afternoon, Mr. Regula, and the rest of
the members of the Subcommittee. Thank you for this opportunity
to share with you my thoughts about State programs funded by
the Assistive Technology Act. I want to especially thank our
Maryland representative, Mr. Hoyer, and the rest of the
Committee for your efforts last year, and throughout the years,
to assure that assistive technology projects have continued to
be funded.
The Assistive Technology Act of 1998 will be considered for
reauthorization next year, but without your support in this
legislative session, many of the projects will be terminated.
Before this year, and the activities of the House Subcommittee
on 21st Century Competitiveness, it had been almost a decade
since the House of Representatives had held a hearing on this
law. So much has happened over that decade, both in terms of
the accomplishments of the State grant programs, and in the
advances we have seen in technology. Remember that only a
decade ago, none of us used e-mail.
I am here today representing the Association of Tech Act
Projects, and to enlist your support in including an amendment
to the Assistive Technology as part of fiscal year 2003 Labor,
Health, Human Services, Education Appropriations bill again
this year as you did last year. As you said earlier today when
I met you, you said this was quite an important topic, and I
believe you. Last year, the amendment saved nine States from
being terminated from this important program that ensures that
people with disabilities will have access to assistive
technology that they need.
This year, we need your help again, as without an attached
amendment, 23 States will be eliminated from funding. The
States which will be eliminated are Arkansas, Alaska, Colorado,
Illinois, Indiana, Iowa, Kentucky, Maine, Maryland,
Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New
Mexico, New York, North Carolina, Oregon, Tennessee, Utah,
Vermont, Virginia and Wisconsin. As you can see, many of your
members here today represent those States. We would enlist your
help to continue our services in those States.
We request that the funding for Title I of the Assistive
Technology Act be provided at a $34 million level. This would
return us to the level of funding we received in fiscal year
2000. In addition, we request that you include the following
amendment, which would ensure that no State would be eliminated
from the program:
Provided that funding provided for Title I of the Assistive
Technology Act of 1998, the AT Act, shall be allocated
notwithstanding Section 105(b) of the AT Act; provided further
that Section 101(f) of the AT Act shall not limit the award of
an extension grant to three years; and provided further that no
State or underlying area awarded funds under Section 101 shall
receive less than the amount received for fiscal year 2002 and
funds available for increases over the fiscal year 2002
allocations shall be distributed to States on a formula basis.
I'm going to kind of go away from my written speech for a
few moments, and tell you what the $34 million provides. Each
State has a Tech Act project, and there are also six
territories. Each program takes the dollars that we get from
the Federal Government and coordinates efforts throughout each
State, along with other programs, to have the commission on
aging, education departments, anyone that has any dealings with
persons with disabilities. We enhance their programs by
educating them as to what assistive technology does for the
people, the students in school, workers on the sites, seniors
who are going home now and finding out that the houses that
they have lived in for many, many years are inadequate for
their needs. Ramps have to be built, stair lifts added, and we
do a lot of coordinating of the efforts that the person with a
disability just has to have within their lifestyle.
In conclusion, I'd like to say that in 2004, the Assistive
Technology Act is scheduled for reauthorization by Congress. I
and my colleagues around the country look forward to working
with you to develop new ways to support access to technology
for people with disabilities. We hope that you will ensure
continued support for programs in the 56 States and
territories, including the amendment to the Assistive
Technology Act as part of fiscal year 2003 Labor, Health, Human
Services, Education appropriations bill again this year as you
did last year.
We request that the funding for Title I of the Assistive
Technology Act be provided at the $34 million level. We believe
that this Federal leadership role provides the infrastructure
and seed money that leverages a great range of programs and
services that are critical to people with disabilities. For
example, all the Title III loan programs are administered by
Title I State programs. If there were no Title I program
infrastructure, there would be no Title III loan programs.
We are most grateful to you for your leadership on behalf
of Americans with disabilities who depend on assistive
technology for their independence and their full participation
in society. Thank you very much, and I welcome any questions
you might have.
[The prepared statement of Mr. Rasinski follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hoyer. I don't have any questions, but I thank Mr.
Rasinski for his testimony, and we'll certainly work toward the
objective that he seeks. I think it is so critically important,
for as he points out, a lot of States that are represented on
this panel. But much, much more importantly for thousands of
people who are enabled and empowered to participate in our
society through the use of assistive technology. Thank you.
Mr. Rasinski. Thank you.
----------
Tuesday, April 23, 2002.
UNITED NEGRO COLLEGE FUND
WITNESS
JOHN HENDERSON, PRESIDENT, WILBERFORCE UNIVERSITY
Mr. Regula. Next is Dr. John Henderson, President of the
Wilberforce University. Dr. Henderson.
Mr. Henderson. Good afternoon, Mr. Chairman and Mr. Hoyer.
My name is John Henderson, the President of Wilberforce
University in Wilberforce, Ohio. But today I appear on behalf
of the United Negro College Fund, UNCF, the Nation's oldest and
most successful African-American higher education assistance
organization. Since 1944, UNCF has been committed to increasing
and improving access to college for African-Americans, and
remains steadfast in its commitment to enroll, nurture and
graduate students who often do not have the social and
educational advantages of other college going populations.
This Subcommittee has attentively listened and responded to
our concerns in the past, and for this we gratefully thank you.
There is no more important partner in the HBCU's mission to
provide excellence and equal opportunity in higher education
than the Federal Government.
Mr. Chairman, the Labor, Health and Human Services
Education Appropriations Subcommittee can play a major role in
enhancing the capacity of HBCUs. Allow me to highlight the key
points of UNCF's recommendations in order to convey to the
Committee the importance and the value of American's HBCUs. The
primary support for low income first generation students at
HBCUs and all college campuses has been the Department of
Education's Title IV student financial assistance programs, in
particular, the Pell Grant and Federal Supplemental Educational
Opportunity grants.
With increasing numbers of low income first generation
students on our UNCF campuses, even with the longstanding
efforts to keep costs down, an increasing number of students
face a gap between the cost of education and the combination of
Federal aid, State and institutional assistance for which they
qualify and their families' capacity to meet college costs.
All institutions across the Nation, especially those like
UNCF members, and other HBCUs that enroll large numbers of poor
students, are extremely concerned about how Congress will
address the Pell Grant shortfall. Under your leadership, Mr.
Chairman, Congress provided the necessary funds to increase the
Pell Grant maximum award to a record level $4,000. And I can
personally attest to you the impact that this has had in
assisting some of our most low-risk disadvantaged students on
the Wilberforce University campus.
For this reason, UNCF supports a $4,500 Pell Grant maximum
award in fiscal year 2003. Moreover, as both a member of the
student aid alliance and a representative of 39 of the Nation's
HBCUs whose very mission and purpose is the education of
disadvantaged and poor students, UNCF urges Congress to include
funds to eliminate the shortfall in the fiscal year 2002
supplemental.
UNCF also appeals to Congress to not offset the necessary
funds needed to eliminate this shortfall by cutting fiscal year
2002 appropriations for other programs in the Labor, Health and
Human Services Education Bill. Since student enrollment at
Wilberforce and other historically black colleges and
universities is directly related to the increased demand for
Pell Grants, your support of the supplemental fiscal year 2003
appropriations is important.
In ensuring low income students access to college, we must
make sure that these students are receiving quality, early
information about college and that we are providing the
necessary student support services to truly ensure their
retention and graduation. In this regard, UNCF endorses the
student aid alliance request for TRIO as well as continued
funding of the supplemental to TRIO's student services support
program.
Members of the Committee, not only do we need your support
for increased funding for the Title IV programs, we also need
you to further your investment in HBCUs through the Title
III(B) Strengthening Historically Black Colleges and
Universities Program. These programs have been very
instrumental in enhancing the survival of HBCUs.
In the wake of September 11th, under this Subcommittee's
leadership, there was a dramatic increase in Title VI
international education programs. UNCF applauds this action and
urges you this year to further expand HBCU and minority student
participation in Title VI programs through affirmative outreach
and technical assistance efforts for both the overseas and
domestic programs and the international business programs, and
to provide increased funding for the Institute for
International Public Policy.
Mr. Chairman, UNCF also supports an increase to minority
science and engineering improvements programs, and the Thurgood
Marshall Legal Opportunities Program, that addresses access and
opportunity for under-represented minorities in law.
As I conclude my testimony, I ask that you consider
increased funding also for programs at the Department of Health
and Human Services that educate many African-Americans in the
health professions and that support research activities on HBCU
campuses.
Mr. Chairman and members of the Subcommittee, I appreciate
the time that you have given me to represent the views and
representations of the United Negro College Fund.
[The prepared statement and biography of Mr. Henderson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you, Mr. Henderson. Thank you for coming.
----------
Tuesday, April 23, 2002.
NATIONAL COUNCIL FOR COMMUNITY AND EDUCATION PARTNERSHIPS
WITNESS
HECTOR GARZA, PRESIDENT, NATIONAL COUNCIL FOR COMMUNITY AND EDUCATION
PARTNERSHIPS
Mr. Regula. Mr. Hector Garza, President of the National
Council for Community and Education Partnerships.
Mr. Garza. Good afternoon, Mr. Chairman, members of the
Subcommittee. My name is Dr. Hector Garza, I serve as President
of the National Council for Community and Education
Partnerships.
Today Ms. Corey Barber, representing the U.S. Student
Association, is present with me to signal the support on behalf
of GEAR UP, on behalf of America's college and university
students as well.
Additionally, I also have with me written letters of
support from several other education organizations, Mr.
Chairman, who also wish to be recognized as supporters for GEAR
UP. I do hope that you will allow me to enter these as part of
the official record.
NCCEP is an non-profit organization founded by the Ford
Foundation and the W.K. Kellogg Foundation to help schools,
colleges, universities and communities to improve public
education, to promote student achievement, and above all, to
increase access to college for all students, Mr. Chairman.
Today I will be talking to you about the Gaining Early
Awareness and Readiness for Undergraduate Programs, the GEAR UP
program, the program that Mr. Obey previously talked about. A
program designed to make sure that no child gets left behind in
areas of education.
I'm also here today to advocate for a significant increase
in the appropriations for GEAR UP for a total sum of $425
million. GEAR UP, as you know, is a unique Federal program that
offers a very effective approach to helping low income students
and their families prepare for success in college. It is
important for me to mention that GEAR UP is not a minority
program. It is a program for all low income students, Mr.
Chairman. Research studies have shown that the college going
rates for low income students remains substantially below those
of more affluent counterparts.
Millions of young people, especially those from poor,
minority and rural communities, still find the door to college
all but shut for them. Eighty-six percent of high income, high
achieving secondary school students go on to college, while
only 50 percent of low income high achievers enroll in post
secondary education. Young people whose family income is under
$25,000 have less than a 6 percent chance of earning a four
year college degree. High income students, on the other hand,
are seven times more likely than low income students to
graduate from college.
The students face barriers, such as under-funded public
schools and overburdened teachers. Students receive poor
academic preparation in our public K-12 schools. They have
little access to information about what it takes to be admitted
and be successful in college, little or no guidance on applying
to college, limited information about available grants and
scholarships, and in short, low income students face a
pervasive climate of despair rather than hope for a better
future in schools and at home.
Through GEAR UP, Mr. Chairman, our schools and GEAR UP
partners are working hard to change all of that. GEAR UP is a
Federal program that goes beyond serving individual students
with a primary emphasis to systemically reform whole schools
and school districts. Through GEAR UP we are changing outdated
educational practices and making lasting changes within schools
and systems so that they can have a lasting effect on the
communities.
In a recent poll, 77 percent of Americans agree that the
Federal Government should increase its education spending to
allow more people to enter and complete college. Eighty-eight
percent of Americans favored an increase in Federal funding to
improve educational opportunities for poor students in
particular. We have also discovered that through GEAR UP, all
students benefit, since GEAR UP is designed to revamp the
system, so that it works for all children.
GEAR UP helps low income students to stay in school, to
study hard, to take the right college prep courses, and to
learn about the requirements to pursue a college education.
GEAR UP is designed to transform entire schools to engage
parents and families, and to mobilize local communities to
support student achievement. The programs include mentoring
programs, tutoring, college visits, academic and career
advising programs, professional development for teachers, and
summer and after school academic enrichment programs. GEAR UP
allows students and schools to better coordinate their academic
support programs to align their curriculum to facilitate
student achievement and to provide more and better
opportunities for success in these students.
Research studies have suggested that parental and family
involvement is critical and GEAR UP achieves that. GEAR UP
prepares parents for active, productive roles in guiding their
children to educational excellence and bright futures. Because
we know that GEAR UP is a program that works, we are asking
this Congress to appropriate the required money to make this
program available to more students.
You may also be interested in knowing, Mr. Chairman, that
GEAR UP serves an extremely diverse group of students. Thirty-
four percent of students are Hispanic, 31 percent African-
American, 27 percent white, 4 percent Asian American and 4
percent American Indian. That is why low income students
deserve your support.
[The prepared statement of Mr. Garza follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I'm familiar with the program, we have it in
our largest city.
Mr. Garza. Yes, you do.
Mr. Regula. I have visited the program.
So thank you for bringing the emphasis. It is a needed
program. Thank you.
Mr. Garza. Wonderful.
----------
Tuesday, April 23, 2002.
PUBLIC/PRIVATE VENTURES
WITNESS
GARY WALKER, PRESIDENT, PUBLIC/PRIVATE VENTURES
Mr. Regula. Mr. Gary Walker, President, Public/Private
Ventures.
Mr. Walker. Thank you, Chairman Regula, for having me here
today. My name is Gary Walker, I'm President of an organization
called Public/Private Ventures, that was set up in the late
1970s with a combination of Federal funding from what was then
HEW and several philanthropies. The mission of the organization
was to search the country for what looked like promising
approaches to assisting very high risk children, doing the
research on them to see if they worked, and then reporting back
to the various Congressional committees and philanthropic
funders as to whether or not they worked.
The issue that I wanted to report to the Committee on today
is one that does not make up a large part of your upcoming
budget considerations, but one which does generate more
discussion than perhaps the portion of the budget, and that is,
faith-based programming. We became interested in faith-based
programming in 1997, not because we are a faith-based
organization, but because it was becoming clear over the years
that the capacity of the not for profit and public sectors to
deal with high risk children was simply not adequate, even if
there was an enormous amount of additional funding by Congress.
And that the number of faith institutions out there might be
one way to go to deal with these problems at scale.
We decided at that point to focus on three issues, older
high risk youth who had been involved with juvenile justice,
younger children who had parents in prison and needed
mentoring, and youth who were already two to three years behind
in literacy and needed help but could not get it within the
cities that they lived.
At this point, we're five years along in collecting data
and looking at programs around the country. As you consider the
budget, I simply wanted to lay out the things that we have
learned to date. One, we're involved in 16 cities at this point
in these three programs. The very first issue was to see if
small and moderate size faith based organizations would really
be interested in undertaking these kinds of challenges.
We actually had to close down the major demonstration
because of the clamor to get into it by these small and medium
sized organizations. There are now 700 faith-based
organizations, Christian, mosques, synagogues, on the west
coast there are also Buddhist and Hindu temples involved in all
three of these efforts. So one of the first things we've
learned is that there is an interest out there in doing this.
The second is, they generate a level of volunteers beyond
anything we've seen in any of the other sectors. In
Philadelphia itself, within six months, the faith-based
community was able to generate 500 volunteers for mentoring for
children who had parents in prison, which was equal to the
largest mentoring program in all of Philadelphia that had been
around for 70 years.
Thirdly, what we're seeing so far at least in the research
is that we are able to get results, or the faith community is
getting results. The literacy program has gotten on average of
1.9 grade level improvement in six months of students who have
stayed within that program.
Fourthly, and perhaps equally important as the good news,
is the things that those who are most worried about in faith-
based programming, namely, do they actually have the capacity
to do anything, and is there too much proselytizing, we have at
this point seen that both those issues are very manageable. The
capacity issue is an important one. Assistance is needed in
order to carry out these programs. If Congress were merely to
appropriate money, it would probably not be adequately used all
around the country.
Proselytizing is the more interesting issue. In looking it
over, 600 faith-based organizations in 16 cities, we have not
in 5 years documented one instance of proselytizing to any
degree where either the youth, their parents or anyone was
bothered. Evidence of faith was all around these programs,
there's lots of praying and lots of symbols. But proselytizing
was not a part of any of them. Actually, faith was the reason
that these volunteers wanted to help these youth, not to get
them to become members in their church.
So I guess we've concluded, as ourselves a non-faith based
organization, that if the country is really interested in
dealing with larger numbers of the highest risk youth, this is
a sector that probably is the greatest untapped resource out
there right now. It needs careful working with, but it's
something, as you look at the compassionate capital bill and
the mentoring bill really deserves attention for its potential
for the future.
Thank you.
[The prepared statement and biography of Mr. Walker
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
----------
Tuesday, April 23, 2002.
NATIONAL ASSOCIATION OF STATE STUDENT GRANT AND AID PROGRAMS
WITNESS
JIM GARCIA, PRESIDENT, NATIONAL ASSOCIATION OF STATE STUDENT GRANT AND
AID PROGRAMS
Mr. Cunningham [assuming chair]. Thank you, Mr. Chairman.
The Chairman has asked me to sit in for a while, he's got
another meeting. I always look forward to being Chairman.
Jim Garcia, President, National Association of State
Student Grant and Aid Programs. Is Jim here? Mr. Garcia. And
the clock, if you would be diligent in monitoring the clock,
because we've got a lot of witnesses. You don't want to take
their time, because they'd get mad at you.
Mr. Garcia. Thank you, Mr. Chairman.
My name is Jim Garcia, I'm the Chief of the Grant Services
Division for the California Student Aid Commission. But I am
here today in my role as President of the National Association
of State Student Grant and Aid Programs, otherwise referred to
as NASSGAP.
We greatly appreciate the opportunity you are providing for
us here today to address the future of a higher education grant
program vitally important to States, the Leveraging Educational
Assistance Partnership program, LEAP for short.
Let me first briefly discuss the group I represent. NASSGAP
is an organization comprised of individuals who operate State-
based student aid programs in the 50 States, including the
District of Columbia and Puerto Rico. Our organization does not
employ Washington based staff, relying instead on our members'
continuous grass roots efforts to advocate for strong student
aid programs. We are proud to represent over 3 million students
and their families to whom our members provide over $4.68
billion in State student aid.
I'm here to talk about why LEAP is such a worthy program to
fund at a time when our Nation's budget is already strained by
the demands of a war-time economy. To help explain, I have a
little story which I believe illustrates the value of LEAP. Not
too long ago, NASSGAP invited a senior staff person from the
Office of Management and Budget to speak at our spring
conference in Washington. At the end of his formal comments, a
member of the audience asked him how he would describe the
ideal college financial aid program of the future.
The OMB representative replied that the ideal program would
be a need-based program, would provide a grant to students,
would have a shared funding responsibility between States and
the Federal Government, and would be integrated within the
Title IV delivery system. The program would also be designed to
serve the poorest students and would have no administrative
funds.
Members of the audience began to laugh, because the program
that he had just described is the LEAP program. That year, OMB
had recommended not funding the program.
Mr. Chairman, that has been the general experience of
NASSGAP members, that people don't fully understand the
characteristics of the program. The more people learn about the
LEAP program, the more they realize that it is an excellent
resource to equalize college costs between the poor and the
wealthy. Currently, this highly successful partnership between
the States and the Federal Government is helping our Nation's
neediest students achieve their dream of post-secondary
education. These students not only qualify for and receive
Federal Pell Grants, but they must demonstrate exceptional need
to qualify for additional funds available through LEAP and also
through its component, referred to as the Special LEAP program.
Our purpose before your Committee today is to urge you to
fund $100 million to support LEAP for fiscal year 2003, a
funding level that is recommended by the National Student Aid
Alliance. Because of the unique matching requirements of the
program, that level of funding would result in an estimated
$270 million in need based student grants. By Congressional
design, every dollar for LEAP/SLEAP will go directly to
students, since neither these funds nor the State matching
funds may be used by States to cover administrative costs.
In addition, and this is key, the States must meet
maintenance of effort requirements which ensure that Federal
funds would not supplant existing State grant funds. States
have positively responded to the challenge and strongly support
the program.
States are struggling to deal with the economic
ramifications of the past year. Trends in the Nation's economy
which were further aggravated by the events of September 11th
have heavily strained States' budgets, many of which are
operating under a severe deficit. Many States are not in a
position to absorb the loss of the Federal portion of LEAP, and
some States will lose their entire need based grant programs.
With the current economic status of our Nation, now is the
best time for the Federal and State Governments to work
together to improve college access and degree of achievement.
No Child Left Behind is a wonderful national policy and LEAP is
a vital partnership program which enables the most needy of
these students to continue on and pursue their post-secondary
education goals.
Mr. Chairman, should the Federal budget be signed without
funding for the LEAP program, an estimated 61,000 financially
needy post-secondary students throughout the Nation will lose a
major source of their financial aid. This would leave many,
many children behind.
Thank you, sir.
[The prepared statement and biography of Mr. Garcia
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. We believe also that if a child excels
enough to be able to go to college or, not necessarily
academic, but even a work program, that they ought to have that
right. My wife is Special Assistant to the Secretary of
Education and Management, but you're going through the
Department of Education. Last year, the student direct program
had $50 million in student loans they couldn't even account
for, another $12 million that went to the wrong students, so
they had to reissue.
So I know that within the Department of Education, they're
going through to make sure that those dollars go to the
accurate finances. And I'm not going to smoke you, $100 million
is a lot of money when you have a limited budget in the first
place.
Mr. Garcia. Yes, sir.
Mr. Cunningham. And there's a lot of different loan
programs out there. I know the Chairman will take a look at it,
and we'll discuss it within the Committee.
Mr. Garcia. Thank you very much.
Mr. Cunningham. Thank you, Jim.
----------
Tuesday, April 23, 2002.
NATIONAL EDUCATION KNOWLEDGE INDUSTRY ASSOCIATION
WITNESS
GINA BURKHARDT, BOARD CHAIRMAN, NATIONAL EDUCATION KNOWLEDGE INDUSTRY
ASSOCIATION
Mr. Cunningham. Gina Burkhardt, Board Chairman, National
Education Knowledge Industry Association. Gina?
Ms. Burkhardt. Good afternoon, Mr. Cunningham.
Mr. Cunningham. If you would keep your comments within the
five minutes, we would appreciate it.
Ms. Burkhardt. My name is Gina Burkhardt, and I am the
Executive Director of NCREL, the regional education laboratory
that specializes in educational technology. We serve the States
of Ohio, Illinois, Indiana, Iowa, Wisconsin, Michigan and
Minnesota.
Today I'm speaking on behalf of the National Education
Knowledge Industry Association. NEKIA's members are dedicated
to expanding quality education research, development,
dissemination and technical assistance. I'm here to talk with
you about how we can together help schools successfully
implement the No Child Left Behind legislation.
I have three points to make, and I bet you can guess what
the fist one is. I'm here to request increased funding for
educational research development, dissemination and technical
assistance. Education R&D is severely under-funded, and that
needs to change, especially when you consider this is a
realized investment of dollars. We know there is a direct link
between scientifically based education research and development
and its application to proven results for students. Certainly
corporations get this. They invest up to 3 and a half percent
of their annual budget in R&D. Just imagine the health
profession without R&D behind drug and diagnostic testing.
In fact, this Subcommittee recognized the importance of
research and development when it decided some years ago to take
the aggressive step of doubling the far larger support for the
National Institutes of Health. Currently, R&D represents only
.03 percent of the education budget. That's three one-
hundredths of 1 percent. That's a pathetic statement.
We're asking the Subcommittee to apply the same approach
for educational research and double its funding over the next
three years. This is a solid and significant statement that
will take far fewer dollars than the NIH initiative.
Specifically, we propose that Congress increase funds for OERI
R&D by $82 million this year, or almost 33 percent, and commit
to similar increases over the next three years.
We are pleased to see that the Administration has proposed
increases in some programs that support research. But I am
extremely disappointed that you've decided to level fund
organizations like mine, the Regional Education Laboratories,
and eliminated funding for those research based technical
assistance programs.
My second point, an investment in education research,
development and technical assistance will get you a bang for
your buck, the bang the American people are demanding and our
students deserve. Reform that works is based on research taken
out of the controlled experimental setting and put to practical
use by all teachers for all our kids. When we do this
systematically, we learn about and can make what works
available to schools. Then we see all our children achieve to
world class standards.
My third point, for education research to make a difference
for all kids, you have to make it available and usable by all
teachers. Just imagine your fifth grade teacher reading an
article in the American Education Research Journal and going
into her classroom the next day with a new instructional
practice. That's an unreasonable expectation for our teachers.
It might help to give an example from the Chairman's State
of Ohio of how R&D has worked. Manchester High School is in the
southernmost portion of Adams County along the Ohio River. The
school district is one in the rural Appalachian region
designated as academic emergency and in danger of takeover by
that State. My lab, NCREL, worked with six of the districts to
improve the math and science learning of these students. We
found that teaching in schools covered only three of the seven
areas that were emphasized on the Ohio proficiency test. The
data showed that although six districts exceeded State averages
in three areas, they scored extremely poorly in the other four.
Once we knew this, we stepped in with significant
resources, provided 13 days of math and science professional
development to 115 teachers during the summer and the following
year. After one year, student achievement rose significantly in
four of the six districts. After two years, all six districts
were achieving, or had significantly increased their scores.
Congress created the No Child Left Behind Act that holds
schools to a higher standards of accountability than ever
before. To put these stringent requirements in place without
anteing up the funds that provide schools access to
scientifically based R&D, and the technical assistance that's
required to help them with the implementation is a real recipe
for failure. The good news is that you currently have an
infrastructure in place that can provide all schools, even the
most troubled ones, with knowledge and procedures.
My organization and the other federally funded research
development and technical organizations are ready to serve. We
believe that without a significant investment in R&D, an
increase of 33 percent each year over the next three years,
Congress will be back to ask, what went wrong, instead of
applauding your wisdom and foresight. Thank you.
[The prepared statement and biography of Ms. Burkhardt
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Thank you. And I'd say, Ms. Burkhardt, I
was a teacher and a coach at Hinsdale, Illinois, outside
Chicago.
Ms. Burkhardt. And your regional education laboratory is
West End. Thank you.
----------
Tuesday, April 23, 2002.
COALITION OF HIGHER EDUCATION ASSISTANCE ORGANIZATIONS
WITNESS
JEANNE DOTSON, PRESIDENT, COALITION OF HIGHER EDUCATION ASSISTANCE
ORGANIZATIONS
Mr. Cunningham. Jeanne Dotson, President, Coalition of
Higher Education Assistance Educations and Director of Student
Loan Account Repayment, Concordia College. Where is Concordia?
Ms. Dotson. Moorehead, Minnesota.
Mr. Cunningham. It gets cold up there.
Ms. Dotson. Good afternoon, Mr. Chairman, and thank you for
inviting me to testify today on behalf of the Coalition of
Higher Education Assistance Organizations regarding the fiscal
year 2003 appropriations for the Perkins Loan program, a
student aid program that has made a critical difference in the
lives of so many of our college students.
I am Jeanne Dotson, and I currently work as the Director of
Student Loan Accounts Repayment at Concordia College in
Moorehead, Minnesota. I've served in this capacity for 28
years. I also serve as the President of COHEAO, a unique
coalition composed of over 350 colleges and universities and
commercial organizations with a shared interest in this 40 year
old Perkins loan program. A student who attended Concordia for
four years was loaned the maximum amount allowed under the
Federal Perkins loan program. He happened to be a Native
American student. And he did graduate with the qualifications
to teach.
He told me that his dream was to go back and teach at his
high school, which is operated by the Bureau of Indian Affairs.
After graduation, he was able to secure employment at his
former high school. And he was very diligent in filing his
forms in a timely manner. And this past spring, I'm happy to
tell you that he submitted his final form allowing him to
cancel his entire Perkins loan.
He wrote me a letter to thank me for helping him attain his
dream and also to tell me how important it was that he canceled
his loan. Because as we would know, his salary was very low,
and he needed every penny just to pay his rent and just to
live. As a COHEAO member, Concordia College knows that the
Perkins loan program is critical to providing low income
students with access to higher education. Perkins loans provide
the lowest interest rate of all the Federal loan programs at a
5 percent fixed rate. In addition, borrowers find that Perkins
loans provide reasonable repayment terms, including a nine
month grace period, flexible deferment options, and
furthermore, Perkins loans are recycled. The schools
redistribute the funds to new borrowers that have been
collected from borrowers in repayment.
Significantly, the Perkins loan program also promotes
community service by offering loan forgiveness options for
students choosing work that benefits the community, such as
teaching and law enforcement. Of critical importance to the
success of the loan program is the risk sharing. This sits at
the core of the program structure. Participating schools are
required to match their allocated FCC or Federal Capital
Contribution by 25 percent, which is a substantial amount of
money for schools in this era of tightening State budgets and
dwindling non-Federal resources. In addition to the Federal
school partnership that is forged through this risk sharing,
students benefit because Perkins schools are given latitude in
which to operate this program on their respective campuses.
Since the inception of the program, Concordia College has
provided approximately $32 million in Perkins loans to 17,000
students. Last year, approximately 645 Concordia College
students received $1.3 million of which only $4,000 came from
FCC. Last year our Perkins loan borrowers who were eligible
received the benefit of over $116,000 in loan cancellations.
On behalf of all of the COHEAO members who are also
committed to this critical program, COHEAO is urging Congress
to increase funding in fiscal year 2003 for the FCC for Perkins
loans from $100 million to $140 million. And also to increase
from $67.5 million to $100 million the Federal Perkins loan
cancellation fund.
While the Perkins loan program has proven its worth, it has
been woefully under-funded. Over the last decade, funding for
new loan capital has decreased by over 75 percent and the
current FCC is now worth just 22 percent of its 1980 value in
constant dollars. In addition, the loan cancellation fund has
not been fully funded, leaving schools without the benefit of
full Federal reimbursement.
COHEAO works with other groups such as the Student Aid
Alliance to help ensure that all higher education funding is
sufficient to meet the needs of our Nation's students. Under
President Bush's fiscal year 2003 budget, most of the student
aid programs were level funded at fiscal year 2002 levels.
Campus based aid programs must grow if Congress and the
Administration intend to keep their promise to put students
first and ensure all students have access to higher education.
Thank you again for providing me with this opportunity. I
would be happy to answer any questions you might have.
[The prepared statement and biography of Ms. Dotson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Ms. Dotson, one of the things that keys me
is when people say that something is level funded; quite often
we increase each year the amount of education dollars, Pell
Grants, Eisenhower Grants for teachers and so on. So a lot of
times when something is level funded it's because it had been
increased. We have a lot, if you see the people in here, we
have a lot of different areas where people need additional
dollars.
We are doubling education dollars over the next five years,
just like we kept our promise in medical research. And we're
going to do that. I don't know how we meet the needs of all the
programs. But I know I support Perkins and I support Pell and
Eisenhower grants and those things as well. When it breaks out,
I don't know how many dollars will be given to each thing, but
I know they're good programs.
Ms. Dotson. Thank you very much, and thank you for inviting
me here.
----------
Tuesday, April 23, 2002.
NATIONAL NUTRITIONAL FOODS ASSOCIATION
WITNESS
R. MARK STOWE, PRESIDENT, NATIONAL NUTRITIONAL FOODS ASSOCIATION
Mr. Cunningham. Next we have R. Mark Stowe, President,
National Nutritional Foods Association.
Mr. Stowe. Mr. Chairman and members of the Subcommittee,
thanks for the opportunity of being here today, it is my
pleasure. My name is Mark Stowe, and I am President of the
National Nutritional Foods Association, NNFA. We're a trade
association representing some 3,000 natural foods stores and
1,000 manufacturers and distributors and suppliers of natural
health products, including dietary supplements.
NNFA supports increased funding levels for both the
National Institutes of Health, the Office of Dietary
Supplements and the National Center for Complementary and
Alternative Medicine in the 2003 fiscal year. National interest
and access to and reliable information on safe, effective
vitamins, minerals, herbs and other dietary supplements has
grown steadily since the Dietary Supplement Health and
Education Act unanimously passed the House and Senate in 1994.
Americans are obviously looking toward safe, natural
alternatives to maintain good health by supplementing
inadequate diets with vitamins and minerals.
It is estimated that nearly three-quarters of the U.S.
population are taking dietary supplements, spending by some
estimates as much as $17 billion a year. Dietary supplements
are only beginning to get the research and attention that they
deserve. Each year, major medical journals publish studies that
support the use of supplements for the treatment of specific
conditions, prevention of disease, offer general nutritional
enhancement. Studies sponsored by the National Institutes of
Health are also being conducted and published. I have included
several samples of these in my written testimony and would be
happy to arrange to have them provided to the Subcommittee if
they are interested in receiving them.
NNFA believes these studies are only the tip of the iceberg
of potential benefits such as reduced health care costs, that
additional research into dietary supplements can bring to the
American public. It is critical that Government sponsored
research levels continue to expand so that more is learned
about these natural pathways to good health and wellness.
This is especially true in light of reports from the
National Center for Health Statistics, showing that only 9
percent of American adults consume enough healthy foods to
reach even their minimum recommended daily intake. Supporting
additional research can reduce health care costs by billions.
For instance, a study in the Western Journal of Medicine
reported that increased intakes of vitamin E, folic acid and
zinc alone could save at least $20 billion in hospital costs by
reducing the instance of heart disease, birth defects and
premature death.
The Office of Dietary Supplements, ODS, was established at
the National Institutes of Health in 1995 under DSHEA to
stimulate, coordinate and disseminate the results of research
on the benefits and safety of dietary supplements and the
treatment and prevention of chronic diseases. To meet its
strategic goals, ODS has held conferences on dietary supplement
use in children, metals in medicine, and identifying and
qualifying botanicals, among others.
In fiscal year 2002, Congress approved $17 million for ODS.
This was a $7 million increase over the previous year's funding
level, and a $16 million increase over its first appropriation
in 1995. The President's budget request for the ODS in 2003 is
$18.5 million. NNFA members not only support this funding
level, but would urge the Subcommittee to increase that funding
level to at least $25 million.
In 1992, also, Congress directed NIH to establish the
Office of Alternative Medicine, with the express task of
assuring objective, rigorous review of alternative therapies to
provide consumers with safe and reliable information. Funding
for this office, now known as the National Center for
Complementary and Alternative Medicine, or NCCAM, is an
infinitesimal percentage of the overall NIH budget.
Furthermore, the Center's budget is insignificant in comparison
to the dramatic growth of the American public's interest in and
use of complementary and alternative therapies, including
supplementation.
Keeping with its strategic plan in 2003, NCCAM will expand
investigations into some of the most complex and sought after
applications of alternative therapies to human health. This
includes such areas as neurosciences, cancer, HIV-AIDS,
international health, and women's health at mid-life. We're
pleased to see that the President asked for $113.8 million for
NCCAM in 2003 to help meet its goals. This represents an
increase of $9.2 million in fiscal year 2002.
Science and experience ably demonstrate a wealth of
benefits attendant to the regular use of dietary supplements.
They allow millions of Americans to take charge of their own
good health by safely and effectively using them in preventing
and treating a host of illnesses and other conditions. The body
of research supporting the use of products like this is very
impressive, but sorely requires Government support to ensure
its expansion. Members of the National Nutritional Foods
Association urge the Subcommittee to fulfill the Congressional
mandate expressed in DSHEA by investing in the scientific
research which holds the key to our knowledge of the remarkable
importance and value of dietary supplements.
Mr. Chairman, thank you very much.
[The prepared statement and biography of Mr. Stowe follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. As I mentioned, we've doubled the medical
research, a lot of that in NIH. And I know a lot of it, I'm a
cancer survivor, so I understand lycopene and cooked tomatoes
and cook books and so on.
One of the concerns I have, I visited some of the lunch
rooms of our children. When I interview the children, they say,
well, these healthy foods don't taste good, so what they do is
go down and get a double egg, double cheese, double fry burger.
I think that's one of the things we have to do, is come up with
some kind of nutritional basis for our students today that
they'll eat.
Then secondly, these supplements are very, very important.
Just look at diabetes, look at cancer, look at the other things
that you said. With the genome program, and the research that's
going on, I think it's going to be the way of the future.
Mr. Stowe. Absolutely. Particularly if we're concerned
about controlling health care costs. This is a good way to be
able to do it.
Mr. Cunningham. That's right.
Mr. Stowe. Thank you, Mr. Chairman.
----------
Tuesday, April 23, 2002.
COLLEGE ON PROBLEMS OF DRUG DEPENDENCE
WITNESS
WARREN BICKEL, PUBLIC POLICY OFFICER, COLLEGE ON PROBLEMS OF DRUG
DEPENDENCE, AND PROFESSOR, PSYCHIATRY AND PSYCHOLOGY, INTERIM-CHAIR
OF THE DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF VERMONT
Mr. Cunningham. Dr. Warren Bickel, Policy Officer, College
on Problems of Drug Dependence. Mine is coffee.
Dr. Bickel. Good afternoon, Mr. Chairman.
My name is Warren Bickel, and I am the Public Policy
Officer of the College on Problems of Drug Dependence,
otherwise known as CPDD. The CPDD has been in existence since
1929, and is the longest standing group in the United States
addressing problems of drug dependence and abuse. Presently,
CPDD functions as an independent scientific organization
representing a broad range of scientific disciplines concerned
with researching and understanding the causes and consequences
of drug abuse and developing effective prevention and treatment
interventions.
Mr. Chairman, the College on Problems of Drug Dependence
respectfully seeks yours and your Subcommittee's strong support
for the President's fiscal year 2003 budget request for the
National Institutes of Health totaling $27.3 billion. This
level represents a $3.7 billion increase over current year
levels, which is the increase necessary to complete the
national campaign to double the NIH budget by fiscal year 2003.
Within that overall increase, we are specifically requesting a
19.8 percent increase for the National Institute on Drug Abuse,
for a total of $1,063,702,000. This figure would keep NIDA on
track to double its budget, consistent with the doubling of the
overall NIH budget.
NIDA is the Federal Government's lead agency for research
on all drugs of abuse, both legal and illegal, with the
exception of a primary focus on alcohol. NIDA's mission of
bringing the power of science to bear on drug abuse and
addiction is accomplished through a dedicated cadre of
scientists who are working to understand and find solutions to
the Nation's drug abuse problem.
Full funding of NIDA would yield scientific advances in
knowledge that will have impact on everyone and ease the
financial health and social burden of drug abuse. A 19.8
percent increase would allow NIDA first to continue to expand
the clinical trials network, or CTN, to become a truly national
research and dissemination infrastructure. The CTN is helping
to dramatically improve the quality of drug addiction treatment
throughout this country, enabling rapid concurrent testing of a
wide range of promising science based treatments across
community environments.
Second, to move ahead with NIDA's national prevention
research initiative, NIDA will call upon a broad range of
disciplines to inform the development of innovative and proved
prevention interventions. NIDA will establish community multi-
site prevention trials similar to the CTNs to enhance the
Nation's prevention efforts.
Third, to continue to have a pipeline of safe and effective
medication through NIDA's medication development program.
NIDA's role in testing medications for substance abuse is
critical, because few pharmaceutical companies are willing to
develop medications for such indications.
Fourth, to increase NIDA's research portfolio on stress as
well as its research on post-traumatic stress disorder and
substance abuse. Stress plays a major role in the initiation of
drug use, its continued use and relapse to addiction. This
research area is even more crucial given the increase in stress
that Americans have experienced in the aftermath of September
11th.
Fifth, to continue NIDA's support of a comprehensive
research portfolio in nicotine addiction. Tobacco accounts for
20 percent of all U.S. deaths. To address this public health
problem, NIDA has formed a partnership with the National Cancer
Institute and the Robert Wood Johnson Foundation. Supporting
research such as we have outlined here will further improve our
ability to prevent and treat the problems of drug abuse and
will pay handsome dividends both financially and for the morale
of our country. Thank you.
[The prepared statement and biography of Dr. Bickel
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Did I hear you right, Dr. Bickel, tobacco
accounts for 20 percent of all U.S. deaths?
Dr. Bickel. That's my understanding, sir.
Mr. Cunningham. I know it does a lot, but that seems awful
high when you look at all the other. I'd like to see
documentation on that.
Dr. Bickel. Sure, we can provide that for you.
Mr. Cunningham. I empathize with the problem. My own son,
who is adopted, was on drug dependence. Hopefully, he's doing
well now.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 23, 2002.
NATIONAL ASSOCIATION OF CHAIN DRUG STORES
WITNESS
CARLOS ORTIZ, VICE PRESIDENT, GOVERNMENT AFFAIRS, CVS CORPORATION
Mr. Cunningham. Finally, we got an Irish guy to testify.
Carlos Ortiz----
[Laughter.]
Mr. Cunningham. Vice President of Government Affairs for
CVS Corporation, Woonsocket, Rhode Island. Thank you, Mr.
Ortiz.
Mr. Ortiz. Good afternoon, Mr. Cunningham. As you said, my
name is Carlos Ortiz, and I'm Vice President of Government
Affairs for CVS Pharmacy. I'm here to testify on behalf of the
National Association of Chain Drug Stores and CVS Pharmacy. CVS
operates approximately 4,000 pharmacies in 31 States.
I want to also express my thanks to Chairman Regula for
this opportunity to testify. I'm especially thankful that I'm
going before Elmo, because I certainly don't want to go after
him, he's going to be a tough act to follow.
I'm here specifically to talk about two issues. I am a
pharmacist, and I'm very proud of my profession. Community
pharmacists operate in every State and every community in the
United States. We're open, the most successful member of
America's health care team, available 7 days a week, 365 days a
year often 24 hours a day without an appointment.
However, in delivering those pharmacy services, we're
facing two major issues. The first is the explosion in
prescriptions and prescription services that has occurred in
the United States because of the aging of the American
population, mainly. And that's that in the last 10 years, we've
seen an increase from 2 billion outpatient prescriptions to 3
billion in 2001. That's a 50 percent increase in the last 10
years. It's expected that that increase is going to go to 4
billion by 2004, another huge increase.
At the same time that that's happening, we have a
significant shortage of pharmacists in the United States. A
study that was done by HRSA at the request of Congress and was
issued in December of 2000 showed at that time that there were
7,000 unfilled pharmacist positions in the United States, an
increase from 2,800 in just 1998. It's estimated today that 11
to 29 percent of hospital pharmacist positions are unfilled,
and in community chain pharmacies, there are 6,000 unfilled
pharmacist positions.
With that in mind, to try and combat the shortage, NACDS
and the community pharmacy has endorsed House Bill 2173. This
is a bipartisan bill entitled the Pharmacists Education Aid
Act. In fact, two of the members of your Subcommittee are co-
sponsors on that bill, Representatives Kennedy and Peterson are
both on that piece of legislation.
This legislation would do four things. One, it would
provide student loan programs for the education of pharmacists.
It would provide funding for pharmacy school modernization. It
would provide incentives to place pharmacists in rural and
under-served areas. And finally, it would provide faculty loan
repayment to help with the shortage in pharmacy school
faculties. We have urged the House Energy and Commerce
Committee to pass this important legislation, and I would also
urge the Labor HHS Subcommittee to co-sponsor this important
piece of legislation.
However, because it is going to be some time before this
legislation can be enacted, we would urge you to increase the
funding, continue and increase the funding for the current
programs that are available for student loans for pharmacists,
one, the scholarships for disadvantaged students, loans for
disadvantaged students, health profession student loans, the
faculty loan repayment program, and health career opportunity
grants.
I would also urge the Committee to look at the immigration
status of pharmacists and urge you to move pharmacy to a
schedule A group one shortage occupation. We think that would
be important in addressing the shortage of pharmacists.
The second issue I would like to urge the Committee to take
some action on is the prescription, Medicaid prescription drug
co-payments. Many of the States are facing fiscal crisis.
Toward that end, they have implemented or are increasing co-
payments for Medicaid prescriptions. Those co-payments can
range from 50 cents to $3 and are a way of both controlling the
costs and encouraging prudent purchasing on the part of
Medicaid recipients of prescription drugs.
However, there is a Federal regulation, not statute, but a
regulation, that says that a pharmacy cannot deny a Medicaid
recipient service because of their ability to pay a co-payment.
Additionally, this regulation prohibits the States from making
pharmacists whole or reimbursing pharmacists for any refusal by
a Medicaid beneficiary to pay their co-payment, or inability of
the Medicaid beneficiary to pay their co-payment. So basically
what the implementation of co-payments for Medicaid
prescriptions results in is a reduction in reimbursement to
pharmacies in the community.
In the State of New York, we have a situation where 35
percent of the people who have Medicaid co-payments on
prescriptions are refusing to honor or are unable to honor
their co-pay obligation. What we would like you to do is urge
CMS to change this regulation prohibiting the States from
making pharmacists, or reimbursing pharmacists. It would not
require the States to reimburse pharmacies. It would simply
allow them to. We would then lobby or take a petition to the
States for reimbursement. If the States were economically
unable to reimburse pharmacists or providers for the co-
payment, then they would not have to. In and of itself, our
proposal would have no budgetary implications.
Thank you very much for this opportunity to testify.
[The prepared statement and biography of Mr. Ortiz follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Just a quick question. What's the main
reason you have such a low number of pharmacists? Is it pay? Is
it lawsuits? Is it schools?
Mr. Ortiz. Certainly it's not the pay. Fresh out of
pharmacy school, at CVS they'll probably be earning $80,000 to
$85,000 a year. So it's not pay.
What's happened is that pharmacy has gone from a five year
entry level degree to a six year entry level degree. That's the
entry level for pharmacy. That's happening at this time. So
many schools have missed the class. There was one year that
every school, as they converted from a five year to a six year
program, missed the class.
There's also been a significant increase in the number of
opportunities for pharmacists because of the explosion in the
number of outpatient prescriptions that has occurred. So those
are the two main reasons.
Mr. Cunningham. There are members on this Committee, if you
would bad mouth insurance companies, the only thing left is
Government health care. If you bad mouth biotech communities,
the only thing left for prescription drugs is Government
controlled prescription drugs, which I do not believe in either
one of the two.
But we do plan on bringing up a prescription drug program
prior to the Memorial recess, which I think you owe you
livelihood to prescription drugs, and we owe our health to them
as well.
Mr. Ortiz. Absolutely.
Mr. Cunningham. But we will do it, we'll do it efficiently
and we'll do it so that it makes it affordable for more people.
I didn't listen to President Clinton very much, but he did
say one thing in one of his speeches that struck me. First of
all, he told a story about a young girl that told her mother
that she was sorry for being sick, because she knew her mother
couldn't afford the doctor's visit nor the prescription drugs.
No child should have to apologize for being sick.
Thank you.
Mr. Ortiz. I agree. I can tell you, as a pharmacist, I hear
stories every day of people who are making tough decisions
between whether they were going to buy food or buy
prescriptions or whether they were going to cut their
prescriptions in half or how are they going to pay for their
prescriptions. Representative Cunningham, I agree with you
totally on that. Thank you.
Mr. Cunningham. Thank you.
Mr. Regula [resuming chair]. A question. You mentioned
about the fact that the reimbursement doesn't always cover the
total costs. But isn't that also true of hospital bills,
physicians' bills, where the reimbursement for Medicare and I
assume Medicaid does not equal what the charge is? In most
cases the hospital and/or the physician accepts whatever
Medicare pays.
Mr. Ortiz. You're absolutely right. I don't know that----
Mr. Regula. Why should drugs be different, is what I'm
saying?
Mr. Ortiz. Well, I guess there's two things. One is that
often, well, and I can't speak for hospitals or other
physicians' services. But we have a product that we have to buy
and pay for. It's not just our time that's involved, if in fact
the reimbursement from Medicaid or Medicare doesn't equal the
product cost of what we're actually paying money to buy.
It's more than our time. We have to be able to buy that
product in order to be able to dispense that product. And if
the coverage of the prescription repayment doesn't cover the
product cost, we can't replenish that product.
Mr. Regula. Well, probably if you take out your profit, you
get the cost paid. Medicare and Medicaid must have some yard
stick that they use to determine what they're willing to pay.
Mr. Ortiz. And I can tell you that we most often, I'm not
saying that we lose money on Medicaid, that's not what I'm
saying. I'm saying that we operate on a pretty razor thin net
margin. The average net margin for our industry is 2 percent
net margin. And it doesn't take a lot of prescriptions where
you lose money on to throw that 2 percent over into the
negative.
Mr. Regula. Well, I was just curious as to how Medicare and
Medicaid arrived at the amount they're going to pay you.
They're reimbursed, the same thing is true of physicians' fees.
I'm not sure how they arrive at saying, we'll only pay this
much money for that service.
Mr. Ortiz. And we're not asking for any increase in
reimbursement. What we're saying is, on the co-payment amount,
which is currently, if somebody refuses to pay, we have to
deduct that from the reimbursement. If it's a $3 reimbursement
and you're getting a $4 dispensing fee, it means that you're
losing money on that particular prescription.
Mr. Regula. Do I understand you to say that you're mandated
by law to deliver the service even though you may not get paid?
Mr. Ortiz. Even though they may not pay the co-payment. I
want to stress, there is still, there is payment above and
beyond the co-payment that the Government, State Medicaid
program reimburses us. But if the end pay is a $3 co-payment,
that co-payment and if somebody says, I can't afford to pay
that co-payment, we have to provide the service. We cannot deny
service to a Medicaid recipient simply because they cannot pay.
And the State right now under CMS regulations is prohibited
from reimbursing us for that $3 co-payment that they refuse to
pay.
Mr. Regula. So if somebody walks in that does not have
Medicaid nor Medicare or any type of insurance, can you refuse
to fill a prescription for them?
Mr. Ortiz. We can refuse. I can tell you that at CVS, if
someone comes in and says they need a prescription and they
can't afford to pay, we're going to work with them and see if
there's some way we can make sure that they don't go without.
Mr. Regula. Would that be true of a lot of seniors? They're
not being reimbursed under Medicare.
Mr. Ortiz. Of all our business, uninsured senior citizens
represent about 4 percent of our total business.
Mr. Regula. In other words, they're insured by other than
Medicare?
Mr. Ortiz. Yes, retired General Motors, retirees program or
some other program like that.
Mr. Regula. I'm surprised it's such a small percentage.
Mr. Ortiz. It's down to 4 percent of our business now. It
might be higher in some other areas of the country, where there
isn't a--we operate mainly in the northeast and the midwest
where you have a lot of unions that cover their retirees as
part of their pension package.
Mr. Regula. I know in the case of LTV in Cleveland, their
retirees are not covered any longer for their medical. So they
fit in the category probably of having to pay themselves.
Mr. Ortiz. That's happening, in some of the companies that
had lucrative pension plans, when retirees coverages are
dropping.
Mr. Regula. Gone.
Mr. Ortiz. Yes.
Mr. Regula. Okay. Thank you for coming. I think this covers
witnesses. We're going to go into recess while we set up here
for Elmo. The only instruction I have is no cameras while they
set up. While Elmo is testifying, no flash. So turn it off,
fellows.
Mr. Regula. Mr. Cunningham, you're going to introduce
Elmo's friend.
----------
Tuesday, April 23, 2002.
NAMM: INTERNATIONAL MUSIC PRODUCTS ASSOCIATION
WITNESS
JOE LAMOND, PRESIDENT AND CEO, NAMM: THE INTERNATIONAL MUSIC PRODUCTS
ASSOCIATION AND ELMO MONSTER, SESAME STREET MUPPET
Mr. Regula. Okay, Mr. Cunningham, I understand you'll
introduce our next witness.
Mr. Cunningham. Well, I'm going to introduce the friend of
Elmo. Mr. Joe Lamond is President and Chief Executive Officer
of International Music Products Association. What do they do?
They basically create more music makers worldwide. Mr. Lamond
oversaw a number of innovative programs including Sesame Street
Music Works, a joint initiative with Sesame Workshop that
focuses on music among children.
The Einstein Advocacy kit, which is an extraordinary
information package that brings music and brain research
together to show how music does help with children. The
expansion of the Weekend Warrior program which is designed to
bring baby boomers--I don't know what effectiveness that has,
Joe--but back to active music making. He's got a partnership
with the Smithsonian Institute, lasting partnerships with
Disney, Miramax, Proctor and Gamble, Texaco, VH1 Save The
Music, Grammy Foundation, Carnation as well as a host of
others.
And they're here to bring the message that music plays a
role in intelligence and wellness, not only of children but
everyone else. I know all of us have our own personal stories.
I listened to music before every mission when I went into
combat in Vietnam, just to learn how to focus.
Mr. Monster. Wow. [Laughter.]
Mr. Cunningham. Music has brought tears and laughter to all
of us. Joe and Elmo, we welcome you to the Committee. You can
have more than the traditional five minutes if the Chairman
will let you.
Mr. Monster. Well, thank you.
Mr. Cunningham. I yield back, Mr. Chairman.
Mr. Lamond. Thank you, Mr. Cunningham. Thank you, Mr.
Chairman and members of the Subcommittee.
I am Joe Lamond from NAMM: The International Music Products
Association. I'd like to first introduce my co-witness, Elmo
Monster.
Mr. Monster. Elmo's testifying on Capitol Hill. Elmo's so
nervous. What does Elmo do?
Mr. Lamond. Why don't you start by introducing yourself,
Elmo?
Mr. Monster. Okay. Elmo is Elmo. Thank you.
Mr. Lamond. Very good job, Elmo.
Mr. Monster. Elmo's been practicing all morning. And all
day, too.
Mr. Lamond. Elmo and I met through a music education
outreach program with Sesame Workshop.
Mr. Monster. That's right. Mr. Joe taught Elmo lots of
stuff about music.
Mr. Lamond. Why don't you show us some of the things you've
learned?
Mr. Monster. Elmo learned all kinds of things about music,
like anyone can make music. The whole world is full of music.
And best of all, Elmo learned how to dance to music like this.
[Demonstrating.]
Mr. Monster. This is Elmo's favorite. [Laughter.]
Mr. Lamond. We also learned that Elmo looks pretty darned
good in Armani, don't you think?
Mr. Monster. Yes. Elmo got this from Barney's.
Mr. Lamond. Thank you, Elmo.
NAMM is an international, not for profit organization made
up of nearly 8,000 manufacturers and retailers of musical
instruments and music products. NAMM members range from small,
family owned music stores that you can find in every town to
large instrument manufacturing companies and publishing houses.
These companies make and sell the instruments that allow people
to make music.
And just like any other in the business community, NAMM
members understand that a quality education is the primary
means of preparing our young people in the business world and
success in life. Like parents everywhere, we are committed to
making sure no child is left behind.
Mr. Monster. And no monsters.
Mr. Lamond. And no monsters left behind either, Elmo.
Mr. Monster. Good.
Mr. Lamond. We have the best education system in the world,
but we all know that there are some serious challenges. Our
part of the solution is based on what we know best and were our
passion lies, which is in music. In our own lives and in the
experiences of the children we reach every day, NAMM members
have seen first hand the power of music to touch the soul and
lift a struggling child to great heights. There is a growing
body of scientific research that attests to this power. Study
after study is demonstrating an unmistakable connection between
music education and success in school.
Mr. Monster. Yes, music helped Elmo learn the alphabet. If
it wasn't for the ABC song, Elmo would be lost, people. Hello.
Mr. Lamond. Research indicates that music education
dramatically enhances a child's ability to solve complex math
and science problems. Scientists believe that there is a link
to literacy skills as well. Students who participate in music
programs score significantly higher on standardized tests,
while at the same time developing self-discipline,
communication and teamwork skills. They are also less likely to
be involved in gangs, drugs or alcohol abuse, and have better
attendance in school.
Mr. Monster. Elmo is in the music program, and Elmo isn't
in a gang. No. Elmo's not in a gang.
Mr. Lamond. Let's keep it that way.
In addition to controlled scientific settings, this effect
is replicated in classrooms all over the country. For example,
in 1999, Public School 96 in East Harlem was one of the lowest
performing schools in the State of New York. Only 13 percent of
the students were performing at grade level in reading or math.
Eighteen months after the music program was restored, 71
percent of the students were performing at grade level.
Attendance is sky high, and the school is now a model
turnaround school for the city of New York. The principal,
Victor Lopez, attributes this astounding success to the
restoration of the music programs through the efforts of one of
our partners, VH1's Save The Music Foundation.
We were able to save the music in PS 96. But what about the
other schools? We are very concerned about the loss of school
music programs throughout the country. Only 25 percent of all
eighth graders have the opportunity to participate in a music
class, according to the most recent Department of Ed studies.
When we were in school, that figure was close to 100 percent.
We must make certain that all children, especially those at
risk, will be given opportunities to reap the benefit of music
education. For these children, if music education is not
offered in school, they will likely never receive it and will
be at a disadvantage throughout their academic lives.
Mr. Monster. Boy, that would be terrible, Mr. Joe.
Mr. Lamond. Yes.
Mr. Monster. Elmo doesn't know what he'd do without music.
Mr. Lamond. Well, NAMM and its partners are working on a
two-pronged approach to give every child a chance to make
music.
Mr. Monster. Oh, good.
Mr. Lamond. First, since education is essentially a local
issue, we need to help inform local decision making. We intend
to do this with more science based research on the link between
music education and learning, so that parents, teachers and
local officials can make the best case for funding school music
programs. We are seeking $1 million for the International
Foundation for Music Research for the purpose of funding this
research.
The second part seeks to provide immediate help to
children. We are seeking $1 million to support VH1 Save The
Music Foundation's efforts to provide instruments to schools
where there is no access to music learning. In the education
arena, I can think of no other initiative that can do so much
for so many children with so small an investment.
So how will you measure the success of this investment? You
will know the answer when you look into the eyes of one of your
littlest constituents playing their violin with pure joy,
devotion and a sense of accomplishment.
Mr. Monster. Elmo plays the violin.
Mr. Lamond. And you will know it when you see their parents
swell with pride during their first orchestra concert.
Mr. Monster. Elmo's parents swell with pride when they hear
Elmo sing.
Mr. Lamond. And mark my words, you will see it in the
soaring test results and attendance records of the schools to
whom you have given the simple gift of music.
Mr. Monster. Elmo scored a 1550 on his SATs. All because of
music, yeah! Oh, okay, Elmo made up that one. [Laughter.]
Elmo just wants you nice Congress people to please, please,
please, oh, please give the kids the gift of music, please?
Mr. Lamond. I hope the Subcommittee will support our modest
request. Thank you very, very much for your time and
consideration.
Mr. Monster. Yes, thanks, House Labor Subcommittee. Elmo
loves you. Thank you. Thank you.
[The prepared statement and biography of Mr. Lamond
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Elmo, why is music so important that you came
all the way here from Sesame Street to talk to our Committee
today?
Mr. Monster. Music is a big part of Elmo's life. Elmo uses
music all the time to sing and dance and learn and even to
remember stuff. Like the time Elmo had to remember what to buy
at the store. Elmo remembers it with music like this, ``Elmo
needs a little Swiss cheese, needs some frozen broccoli, and he
needs a jar of pickles now.'' See, that's why music is so
important to Elmo. [Laughter.]
Elmo's not making a mockery of this place, no. It's very
important.
Mr. Cunningham. We've got a hostile witness. [Laughter.]
Mr. Monster. No, Elmo's not hostile, he's just a monster.
[Laughter.]
Mr. Regula. Elmo, what is the best part about making and
listening to music?
Mr. Monster. Well, music really helps Elmo express how Elmo
feels. Like if Elmo's happy, Elmo plays hip-hop. If Elmo's sad,
Elmo plays the blues. And if Elmo's feeling extra saucy, Elmo
likes that word, saucy, Elmo plays show tunes like this:
``Elmo's pretty, oh, so pretty, that the city gave Elmo this
key, House Committee, can't you see how Elmo be. La, la. la,
la.'' That was terrible. But Elmo loves music.
Mr. Regula. Elmo, if you could be any musical instrument,
which one would you be?
Mr. Monster. Boy, that's a hard question. Elmo loves all
kinds of musical instruments. Maybe a harpsichord, a
glockenspiel. Wait, wait, Elmo got it--Elmo would be a drum
set. Because then Elmo could lay down his fat beats like this,
phhtt, phhhtt, phhtt. Oops. Elmo just got spittle all over the
House floor. [Laughter.]
Mr. Regula. That's why we have those white cloths on the
table today.
Mr. Monster. It doesn't help.
Mr. Regula. Elmo, how can Congress help you and all your
friends?
Mr. Monster. Boy, you have a really bassy voice. It's nice.
[Laughter.]
It's nice. That's not funny. Elmo spent all his life
listening to and playing and loving music. That's because music
is in Elmo. Music is Elmo. And Elmo knows that there is music
in Elmo's friends all over the country. But some of them just
don't know it yet. They don't know how to find their music.
So that's why Elmo needs Congress to help. Please,
Congress, help Elmo's friends find the music inside them. Thank
you. And Elmo loves you very much.
Mr. Regula. And my grandchildren love you, too, Elmo.
Mr. Monster. Ah, get out of here. [Laughter.]
Mr. Regula. Mr. Cunningham, do you have any questions for
our witness today?
Mr. Cunningham. Elmo, you have one person I think I'd be
remiss, actually, two. Mrs. Bell in San Diego, California, her
husband started Taco Bell.
Mr. Monster. Really? You mean that little chihuahua?
Mr. Cunningham. Yes. It should have been a Jack Russell.
But they have donated scores of money through their
foundation to enhance music in the Encinido Union School
District in San Diego. There's groups like that. We want to
thank you on this Committee, as well as Mr. Lamond, who's a
musician himself, for appearing before us.
Music does have an important part in life. All of us have
cried at funerals, we get tears in our eyes at the Star
Spangled Banner. I do believe that it enhances a child's
education.
When I mentioned I flew in combat, I listened to music.
Music has a rhythm to it. And whether you're flying an airplane
or what, that rhythm helps in the functions. So I think if they
even did some studies on outside of education, athletes, things
like that, I think they'd find it very rewarding.
Thank you, Mr. Lamond.
Mr. Monster. Thank you very much. From all of us at Sesame
Street, we thank you. You're very important to us.
Mr. Regula. Well, thank you for coming, Elmo. You have an
important message, and I know you have a great friend here in
Mr. Cunningham.
Mr. Monster. Yes. Thank you.
Mr. Regula. Thank you, Mr. Lamond.
Okay, the Committee is adjourned.
Tuesday, April 30, 2002.
NATIONAL MINORITY AIDS COUNCIL
WITNESS
MIGUELINA ILEANA LEON, DIRECTOR OF GOVERNMENT RELATIONS AND PUBLIC
POLICY, NATIONAL MINORITY AIDS COUNCIL
Mr. Regula. Well, we will get the hearing started. We have
a long list of those who want to be heard, and that is what it
should be. That is what the system is all about. Regrettably I
have to limit you to 5 minutes, and I say regrettably because a
lot of times I would like to ask a lot more questions, but I
simply can't get through the list. And obviously, you all won
the lottery, because we have triple the requests that we can
see or hear, so we have a lottery to decide which ones we will
have for the public hearings. And I might tell you that we are
the only Subcommittee that does public hearings, and I think it
is important that we get that information. And all of your
statements will be made part of the record and be available to
the staff as they put together this bill.
As I told the members of the Committee, the Bible says
there are two great commandments, love the Lord, and love your
neighbor, and this is the love your neighbor committee because
we touch the life of every American. We do the education
funding or health research, the Centers for Disease Control,
the Department of Labor on job training, people that are laid
off, factory closings. I have had four factories in my district
close, and that is tough business. People work 30 years at a
job, and suddenly they go there and the door is locked, and it
is not easy to start over again.
So it does give us quite a challenge to try to deal with
all these matters. Fortunately, we have a good size budget,
$125 billion, but it funds many needs, and we do the best we
can in allocating money for research in hopes that we can get
breakthroughs in a lot of different things.
This morning I was out and spoke to the breakfast group of
the MS Society, and I spoke last week three families who had
little children with juvenile diabetes, and there are
challenges, to say the least. We have a conscientious Committee
and staff, and we do the best we can to work through whatever
it is.
This country is far and away the leader in the research,
and the rest of the world looks to us, and we are blessed in
that respect. Although we haven't solved everything, we are
doing a better job than anybody else in terms of the needs of
people, and I think we can all take some pride in what our
country stands for.
Our first witness today is Miguelina Ileana Leon, Director
of Governmental Relations for the National Minority AIDS
Council. And all of you, if you can summarize your written
testimony, it will help with time. And if we get done in 4
minutes, it gives me a chance to ask a question or two.
Ms. Leon. Good afternoon, Mr. Chairman. I would like to
thank you and the members of the Subcommittee for giving us the
opportunity to testify today. On behalf of the National
Minority AIDS Council, I would like to take this opportunity to
testify regarding the devastating impact of HIV/AIDS on ethnic
and racial minority communities throughout this country and the
persistent HIV-related health disparities experienced by this
community. We would also like to share our views on Federal
funding that is necessary to assure a targeted and effective
response.
Established in 1987, NMAC is the oldest national minority
organization, representing more than 600 minority-led,
community-based HIV health and social service organizations
throughout the Nation.
We would like to especially thank you for your efforts to
assure the expansion of the Minority HIV/AIDS Initiative in
fiscal year 2002 through your appropriation of $381 million and
we commend the Congressional Black Caucus, the Congressional
Hispanic Caucus and the Congressional Asian and Pacific
Islander Caucus, Representative Jackson, Jr., who is a member
of this Committee, and Representative Pelosi for their
leadership and unwavering support for this crucial effort.
We recognize that this Nation must dedicate substantial
resources to the fight against terrorism abroad and to protect
our homeland security. However, the war against HIV/AIDS has
not been won, and now more than ever we must renew our
commitment to fortify our defenses and build the armamentarium
against the relentless attacks of HIV/AIDS in ethnic and racial
minority communities. NMAC, therefore, calls upon you, Mr.
Chairman and the members of the Subcommittee, to provide a
total of $540 million in fiscal year 2003 for funding for the
Minority HIV/AIDS Initiative.
The report of the Institute of Medicine, which was recently
released in March, ``Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care,'' and the Commonwealth Fund
report on ``Diverse Communities, Common Concerns,''
unequivocally document the persistence of serious health
disparities among ethnic and racial minorities in this Nation.
The persistence of these disparities in access to and quality
of HIV care services is particularly disturbing to NMAC. Nearly
two-thirds of the estimated 300,000 persons living with AIDS in
the United States are ethnic and racial minorities. African
Americans make up 41 percent and Latinos 20 percent of this
number. Moreover, close to 67 percent of adult/adolescent HIV
cases reported between July 2000 and 2001 were among ethnic and
racial minorities.
The Minority HIV/AIDS Initiative was specifically designed
by the Congressional Black Caucus together with the
Congressional Hispanic and Asian and Pacific American Caucus to
address disparities in access and health outcomes experienced
by minorities impacted by the epidemic. The cornerstone of this
initiative focuses on strengthening the infrastructure and the
capacity of minority community-based organizations and minority
providers to deliver quality HIV services to people of color
within their own communities.
The findings of the IOM report and the Commonwealth Fund
report underscore the need to develop and support strong,
culturally competent and language-appropriate services through
capacity-building and expansion of this component within the
Minority HIV/AIDS Initiative. NMAC, therefore, urges the
Subcommittee to sustain the commitment and to expand the
Minority HIV/AIDS Initiative by providing $440 million in
funding in fiscal year 2003.
We also urge you to fund all domestic and global HIV and
AIDS programs at the highest possible level in fiscal year 2003
because we recognize that the fight against HIV and AIDS that
we must confront is both a domestic and a global fight.
We thank you for your leadership and your commitment to
eliminate ethnic and racial health disparities and to fight
HIV/AIDS both domestically and globally. Thank you.
[The prepared statement of Ms. Leon follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Question: Are we making progress?
Ms. Leon. We are definitely making progress, but we still
have a long way to go, and we have been fighting hard and long
to address and to eliminate ethnic and racial health
disparities in this country, and the IOM report clearly
addresses the persistence of them. So I think we need to
reinforce our troops and really focus on delivering culturally
competent services.
Mr. Regula. Thank you very much for coming and bringing
this information for us.
----------
Tuesday, April 30, 2002.
NATIONAL NETWORK TO END DOMESTIC VIOLENCE
WITNESS
LYNN ROSENTHAL, EXECUTIVE DIRECTOR, NATIONAL NETWORK TO END DOMESTIC
VIOLENCE
Mr. Regula. Lynn Rosenthal, Executive Director of National
Network to End Domestic Violence. Welcome.
Ms. Rosenthal. Thank you Chairman Regula, members of the
Committee. Thank you for the opportunity to appear before you
today to talk about the funding needs for domestic violence
services, and I particularly want to thank you, Mr. Chairman,
for your ongoing support for these very important programs.
Imagine yourself fleeing for your life and leaving
everything you care about behind. Imagine standing alone and
cold at a pay phone in the middle of the night with your
children in the car crying. Now imagine that you hear a warm
and supportive voice on the other end of that line. Imagine
that somebody says to you, yes, you can come here now. We have
a safe place for you. And imagine that when you get there, you
talk to someone who believes and supports you and does not
blame or judge you.
If you can imagine this, then you can imagine the important
role that the programs you support play in the lives of
battered women and their children. The National Domestic
Violence Hotline is really the frontline response. Since 1994,
they have answered over 700,000 calls, urgent calls for help
for victims of domestic violence. Every time the hotline number
appears on a national public service campaign, every time the
hotline number appears in a newspaper article or a national
magazine or you hear that number on the radio, calls to the
hotline increase dramatically. Last month when Lifetime
Television featured that hotline number in their Week Against
Violence, hotline calls spiked by more than 900 percent in just
1 day.
And even more disturbingly, 13 percent of the calls now go
unanswered. That means more than 25,000 callers each year wait
on the line and don't receive a live voice because of
inadequate staffing.
The National Domestic Violence Hotline is an excellent
example of a public/private partnership. In addition to the $2
million appropriation that you provide each year, the hotline
raises more than $1 million in private funding. But they just
cannot continue to meet----
Mr. Regula. What is the hotline response? Do they counsel
those who call in? How do they--how does it help people,
because they are in the Los Angeles and maybe the answering
person is here.
Ms. Rosenthal. The hotline is actually situated in Austin,
Texas, and somebody may call from a small town in Ohio, and
they call an 800 number and get a live person, and that person
then can connect them to the services in their local community
and also spend time with them on the phone providing safety
planning and counseling and information and education.
Mr. Regula. Okay. I wanted to get the format for how this
would actually work because telephone to telephone has some
limitations.
Ms. Rosenthal. Here is a great example of how this works,
because the National Domestic Violence Hotline also work very
closely with the battered women's shelter and services program.
Consider this woman. A woman called from a phone booth. Her
partner had beaten her, stolen her vehicle and then left her
stranded on the side of the road. Though covered in blood, she
did not want to call the police or go to the hospital. She just
wanted to go somewhere safe. The hotline advocate was able to
find a shelter and connect her immediately. The shelter then
was able to figure out where she was located and go and pick
her up.
Mr. Regula. You have a list of the shelters around the
Nation?
Ms. Rosenthal. Absolutely. The National Hotline has a
shelter database so they can pull up the area that the caller
is calling from and connect her with a local program. So it is
a seamless delivery system.
The National Hotline works closely with battered women
shelters and services. This particular caller said that the
only people who helped her were the National Hotline worker and
the shelter advocate, and she was standing at a pay phone
covered in blood, and nobody stopped to ask her what was wrong
and what help she needed except that voice on the phone.
You can see the critical importance of these life-saving
services; however, there is a crisis looming in service
delivery. A combination of factors, the most critical being the
decrease in private giving at the local level, threatens to
pull the safety net out from under the lives of battered women.
Not a week goes by that I don't get a call that a domestic
violence shelter is cutting services, laying off staff or
closing programs. And this is at a time when there is a
tremendous need that is growing.
Kentucky reports the number of women and children on
waiting lists for shelters increased by 50 percent in the year
2000. Florida reports that 1,800 women and children were on the
waiting list for shelter in 2001. And Pennsylvania reports that
3,000 women were on a waiting list for emergency shelter. After
decades of encouraging victims to come forward, we cannot allow
this to happen. So we encourage you to fully fund the battered
women's shelter and services program at $175 million.
And finally, we know that responding to domestic violence
is about more than addressing the immediate crisis. We know it
is about providing victims the resources to rebuild their
lives. Victims cite the lack of safe and affordable housing as
the number one barrier to providing economic independence and
safety.
Mr. Regula. Thank you very much, and I appreciate that
additional information.
[The prepared statement of Ms. Rosenthal follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I might say to all of you I may interrupt you
with questions, but that is what we are here for. And I am
always afraid we are going to run out of the 5 minutes, and we
won't get a chance, but that is the purpose of this hearing,
and it is very useful, and thank you.
----------
Tuesday, April 30, 2002.
THE SAN FRANCISCO AIDS FOUNDATION
WITNESS
ERNEST C. HOPKINS, DIRECTOR OF FEDERAL AFFAIRS, THE SAN FRANCISCO AIDS
FOUNDATION
Mr. Regula. Ernest Hopkins, Director of Federal Affairs,
San Francisco AIDS Foundation.
Mr. Hopkins. Good afternoon, Chairman Regula, and thank you
very much for the opportunity to testify this afternoon. The
San Francisco AIDS Foundation has been providing----
Mr. Regula. Is it privately funded?
Mr. Hopkins. Seventy-three percent privately funded, and we
have resources from other sources, both our city funds as well
as State funds and Federal funds that provide the----
Mr. Regula. Does the State and city department of health
help with these problems?
Mr. Hopkins. Exactly. So the Federal, State and local
dollars are dramatically leveraged.
Mr. Regula. Are the Federal dollars funneled through the
State?
Mr. Hopkins. Some of them. The majority of them are
provided to the city and County of San Francisco.
Mr. Regula. The Federal program is not running the program
directly, it is the city, State and county; am I correct?
Mr. Hopkins. Indeed. The Federal program dollars we receive
are funneled to us from the city and County of San Francisco.
Mr. Regula. Are you making progress?
Mr. Hopkins. The City of San Francisco, of course, is one
of the first places that the AIDS epidemic really presented
itself. So we have made dramatic progress over time and
actually are considered a model for the world in how to provide
community-based health care to people with AIDS.
Mr. Regula. You also educate people? Do you go into the
schools and try to warn these kids of what potentially lies out
there?
Mr. Hopkins. There are more educational provisions in our
schools than in most, Congressman, because the community norms
in San Francisco allow for it. However, what I would say to you
is that across the country we have really significant and
persistent problems in actually getting into schools to have
these really necessary conversations.
Mr. Regula. That is where you have to start.
Mr. Hopkins. Absolutely.
Mr. Regula. And you had some success with education.
Mr. Hopkins. Dramatic success. We are currently
experiencing a problem in San Francisco that I would like to
tell you about since you raised the issue of education. We have
for over 10 years seen a dramatic decrease in the number of
people infected with HIV. In the last several years we have
seen increases at the same time we are seeing more and more
people living with AIDS in need of the publicly funded
services. And what our predicament continues to be, and it is
replicated across the country, is that we have more and more
people living with HIV and AIDS in need of publicly funded
services at a time when the budget----
Mr. Regula. You are talking about services such as food,
shelter, medical care?
Mr. Hopkins. Primary medical care. Talking about the case
management services that allow people to connect to medical
care, talking about the other kinds of support services that
allow people to remain in medical care. All of those services
we have been able to provide in a comprehensive set of services
through the title 1 of the CARE Act.
We are asking for $43 million in additional service funding
this year. We are able to provide the medical care through
title 3 of the CARE Act. We are asking for $14 million in
additional funding for that program. We are able to provide the
HIV prevention education to people at risk for HIV as well as
people living with HIV so they do not continue to spread the
disease, and for those resources we are asking for an
additional $303 million.
We have a big problem, and it is going to require
significant resources. And then we at the Foundation are also
attempting to make a difference globally, we are currently
engaged in dealing with the global pandemic as well, and so for
those efforts through this Committee, we ask that you consider
providing $143,800,000 in additional resources to the global
prevention efforts that we currently engage in through a
variety of sources.
Mr. Regula. Are you satisfied with the President's budget?
Mr. Hopkins. I am very dissatisfied with the President's
budget. I believe the President and the people who advise him
truly do understand that we are in a crisis, that we have a
dramatic problem here in the United States and a dramatic
problem across the world, and I am disturbed that for the
second year in a row he has flat-funded the domestic AIDS
portfolio. That makes your job more difficult to identify the
resources because it is not identified as a priority, which I
truly believe he believes it is. And it makes our job difficult
because then we have just that much less money in the pipeline.
Mr. Regula. If you stay for the rest of the day, you'll
understand why our job is difficult, too.
Mr. Hopkins. I had the benefit, Chairman, of actually being
here when you had the Department of Health and Human Services
testify before you, so I heard very dramatic testimony about
the entire portfolio, and, in fact, we are benefited to the
extent that you are able to provide resources to those other
programs. So we don't envy your job at all, but we are here to
ask----
Mr. Regula. That is your job, and you should be an advocate
for those that depend on you.
Mr. Hopkins. And thank you for all that you do with my
Congresswoman, Congresswoman Pelosi.
Mr. Regula. Nancy is very aggressive on that program.
Mr. Hopkins. We know that they keep your ear on this issue.
Mr. Regula. You are well represented. Thank you for coming.
[The prepared statement of Mr. Hopkins follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
NATIONAL COUNCIL ON INDEPENDENT LIVING
WITNESS
KELLY J. BUCKLAND, MEMBER, GOVERNING BOARD, NATIONAL COUNCIL ON
INDEPENDENT LIVING
Mr. Regula. Kelly Buckland, member of the Governing Board,
National Council on Independent Living.
Mr. Buckland. Good afternoon, Mr. Chairman and members of
the Committee. My name is Kelly Buckland, and I would like to
start this afternoon by thanking this Committee for its
commitment to independent living in the last 2 years'
appropriations. Because of your investment, the Freedom Center
was funded in Maryland and began providing services last
December. The Center has already assisted 50 people with
disabilities towards independence, and several of the Center's
staff, including the Director, Ms. Jamey George, are here today
to show their support and appreciation.
No two services are more critical to moving from
institutions to the community than housing and personal
assistance. Since we first appeared before you 2 years ago, the
number of people who have received housing assistance increased
41 percent, and the number of people who received personal
assistance services increased a whopping 150 percent. Your
investment is making a difference. Unfortunately, because of
the way the Federal funds are distributed, several States,
including my home State of Idaho, saw no increase in Federal
funding. Today I am requesting that you increase your
commitment to Centers for Independent Living by $22 million.
Mr. Regula. Is this the fault of the formula rather than
the amount of money we appropriate?
Mr. Buckland. Yes, sir.
Mr. Regula. So you really need to talk to the authorizing
committee, because they write the formula.
Mr. Buckland. And I am aware of that, and we are in those
discussions with the authorizing committee.
Mr. Regula. We do as much as we can in the gross amount,
which helps you, of course, even with the formula. But the
formula may be a little disjointed. I don't know for sure.
Mr. Buckland. We think it is unfair the way the formula
distributes it. But we do have a national consensus on a change
to the formula, so even our industry----
Mr. Regula. Do you have the attention of the authorizers?
Mr. Buckland. Mr. Chairman, we have the attention of some
of them. We have the attention of others outside the
authorizing committee.
Mr. Regula. Then they should help you with that, because we
can only deal with macronumbers. The formula distribution is
another committee, as you understand.
Mr. Buckland. And we do.
And one advantage is that the Vocational Rehabilitation Act
is up for reauthorization this year.
Mr. Regula. Gives you an opportunity to bring your case.
Mr. Buckland. Gives us an opportunity to bring it up during
the authorization.
Currently there are 368 Centers for Independent Living,
with more than 207 satellite locations, and of these 265
centers and 44 satellites are funded with Federal dollars.
Mr. Regula. What are the centers? Does this mean these are
places where--there must be more than that where you can have
independent living. I have people in my district that do
independent living. Are there more opportunities than just the
centers?
Mr. Buckland. Mr. Chairman, there are some other
opportunities, but really the way centers are operated is quite
unique from any other service provider, which was going to my
next point. Seventy percent of the staff of Centers for
Independent Living are people with disabilities, so really this
is people with disabilities who understand the barriers that
people with disabilities are dealing with, working with people
with disabilities to overcome the barriers.
Mr. Regula. So the centers would be where people with
disabilities would live independently?
Mr. Buckland. No, Mr. Chairman. We help to get them into
homes of their own.
Mr. Regula. So you give them help.
Mr. Buckland. We do stuff like peer counseling and hooking
them up with other services to give them the same level of
control over their lives.
Mr. Regula. I understand, which they are entitled to.
Absolutely.
Mr. Buckland. Our request this year, Mr. Chairman, is that
you make an additional $25 million appropriation to the Centers
for Independent Living budget, which is in the Vocational
Rehabilitation Act.
A couple of other points that I wanted to make before I run
out of the time is the President has issued his New Freedom
Initiative, and the Supreme Court has issued the Olmstead
decision, which says that provision of services to people with
disabilities in institutional settings is discrimination. And
so we need to confront that challenge, and we think that
Centers for Independent Living are in a unique position to take
on that challenge, but they don't have the infrastructure right
now to do that, and it would take an increase in appropriations
to do that. So we are asking that you take the initiative and
invest in freedom for people with disabilities and fund
centers.
Mr. Regula. Well, thank you.
[The prepared statement of Mr. Buckland follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. And I understand we all want to feel
independent, and that is really a constitutional right, as the
Court has said. So we are very sympathetic. There are some
limits as to how much we can do dollarwise, but I thank you and
all those that came with you to support your cause.
Tell me what the buttons say.
Mr. Buckland. Take the initiative, invest in freedom.
Mr. Regula. Pretty good slogan.
Mr. Buckland. Mr. Chairman, if I could just add we have
people here from nine different States, and some people came
from as far away as California, Kansas, Illinois, Tennessee.
Mr. Regula. It seems like a long way, but your efforts are
noted. You have the staff here, and they are listening to what
you have to say, to all of you, and they do a lot of the work
in putting a bill together, and they are very important in this
process, as much so as the Members. And so the effort is well
worth it, that is what I am trying to say to you, and we
appreciate the fact that many of you made an unusually great
effort to be here today, and we want you to know we do
appreciate it.
Mr. Buckland. We thank you for the opportunity, Mr.
Chairman.
Mr. Regula. We made a lot of progress, really, when I was
young and you isolated people with disabilities and stayed at
home; didn't have a chance to have independent living in any
way, shape or form. And our society has made a lot of progress.
Attitudes have changed.
Mr. Buckland. We have, Mr. Chairman--as somebody else said
before me, we got a long ways to go, but we made a lot of
progress.
Mr. Regula. You made a lot of progress, but I can remember
the difference, and it is because of people like yourselves. If
you and your predecessors hadn't spoken out, it wouldn't have
happened.
Well, we have got to move on.
----------
Tuesday, April 30, 2002.
ASSOCIATION OF SCHOOLS OF ALLIED HEALTH PROFESSIONS
WITNESS
DR. STEPHEN L. WILSON, DIRECTOR AND ASSOCIATE DEAN OF THE SCHOOL OF
ALLIED MEDICAL PROFESSIONS, OHIO STATE UNIVERSITY
Mr. Regula. Dr. Stephen Wilson, Director and Associate Dean
of the School of Allied Medical Professions, Ohio State
University. Going to beat Michigan this year?
Dr. Wilson. We beat them this last year.
Mr. Regula. I will advise them.
Dr. Wilson. Good afternoon, Mr. Chairman and members of the
Subcommittee. I am Stephen Wilson, Director of the School of
Allied Medical Professions at the Ohio State University. I am
also President of the Association of Schools of Allied Health
Professions, a not-for-profit organization representing 105
higher educational institutions and hundreds of individual
members who are deans, other administrators and faculty of
allied health units at four-year colleges. I am testifying on
behalf of that organization today.
Allied health professionals provide numerous health
services ranging from primary care to the most advanced
tertiary care, and they work in every type of healthcare
setting in both rural and urban locations. Their
responsibilities include delivery of health or related services
involving the identification, evaluation and prevention of
diseases and disorders; dietary and nutrition services;
rehabilitation; and health systems management. Among the more
than 100 professional groups are physical therapists,
occupational therapists, medical technologists, speech
pathologists, audiologists and respiratory care therapists.
While some practice independently, they generally are engaged
as members of the healthcare team with colleagues in medicine
and nursing.
Our association believes that the Federal Government has a
central role to play in ensuring that the Nation has an
adequate supply of competently prepared faculty and
practitioners in the allied health professions. This role
should encompass attracting students, especially those from
minority and underserved populations, and ensuring that there
is an adequate supply of faculty to educate them. A number of
significant documented shortages currently exist in professions
such as radiologic technology and medical technology, a
situation that threatens the ability to provide diagnostic and
treatment services to those in need of them.
On behalf of my allied health colleagues around the Nation,
I would like to express our enormous appreciation for the
Federal funds that have been awarded under section 755 Allied
Health Grants and Other Disciplines Program under Title VII of
the Public Health Service Act. President Bush proposed zero
funding for allied health in fiscal year 2002, but Congress saw
the wisdom of maintaining support of this program. These funds
have made it possible to carry out a wide variety of important
endeavors.
Unfortunately, of the more than 1,000 applications received
by the U.S. Public Health Service since fiscal year 1990, funds
have been available to support only about 11 percent of these
proposals. The appropriation for the current fiscal year is
$9.5 million, of which only $5.5 million is apportioned for
allied health, a small amount for a group of professions that
constitutes about 30 percent of the healthcare workforce. The
remainder goes to chiropractic, podiatric medicine and clinical
psychology, the other components of the section 755 program
cluster.
Mr. Chairman, let me provide you with some examples of what
has been accomplished by allied health professionals using this
relatively small amount of money and offer some justification
for our request to increase the overall amount to $21 million
in fiscal year 2003. In one example, the majority of physical
therapy and occupational therapy students at the Medical
College of Ohio at Toledo participated in a project--and
ultimately they obtained employment in rural underserved areas
or urban underserved areas in which they reported that they
were caring for a high percentage of older adults in their
clinical caseloads, and all reported an increased ability to
function as an effective member of an interdisciplinary care
team all as a result of this funded project in allied health.
Another project, 95 occupational therapy students at
Western Michigan University completed clinical rotations
serving at-risk children in the Kalamazoo public school system,
an experience that was designed to encourage them to seek
careers working with this particular population.
Another one, recognizing the need for students to be
familiar with the cultural and religious expectations of
patients from many different cultures in order to provide
satisfactory health care, the Worldwide Health Information
System Simulation Linkage Website was developed at the
University of Texas Medical Branch at Galveston. It was
designed to allow faculty members anywhere in the country to
incorporate sophisticated case-based learning into their
courses. The most direct beneficiaries for this include
patients who live in communities along the Rio Grande River
from Brownsville to Rio Grand City.
Mr. Chairman, I believe this brief account demonstrates
that the goals and objectives of section 755 have been met and,
we believe, exceeded. More importantly, activities under this
program have made it possible to advance important goals
established by Congress to increase the number of
underrepresented minorities in the health professions, enhance
quality of health care provided to the aged, and to add to the
number of practitioners who serve in rural areas.
We urge congressional support of $21 million to achieve the
recommendations specified in the legislation that authorized
the section 755 program. Surveys conducted by our association
indicate recent dramatic decreases in student applications to
both allied health academic programs accompanied by a
subsequent decline in enrollment. Professions such as medical
technology and radiologic technology already have personnel
shortages that are more acute than in nursing.
In summary, I would like to say that we are a relatively
small amount of the current 755 program. Only 57 percent of
that money is allocated to allied health. Because of its
comprehensive and diverse nature, allied health should receive
much greater attention. Federally supported initiatives that
purport to address broad health challenges must include allied
health, this vital segment of the Nation's healthcare work
force. Again, I would like to thank members for this
opportunity to testify here and see you again.
Mr. Regula. Thank you for your time.
[The prepared statement of Dr. Wilson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Is allied health out of Ohio State ?
Dr. Wilson. We run it through the College of Medicine.
Mr. Regula. Do you have different people from the College
that volunteer or participate in it?
Dr. Wilson. I was wondering if we had more here, and I
don't see any today. Usually there are.
Mr. Regula. This is a nationwide program.
Dr. Wilson. Uh-huh.
Mr. Regula. Okay. We appreciate your sharing this with us.
Get services to underserved areas, I take it.
Dr. Wilson. We have been pretty successful at that.
Mr. Regula. That is terrific.
----------
Tuesday, April 30, 2002.
AMERICAN PSYCHIATRIC NURSES ASSOCIATION
WITNESS
DR. BARBARA WOLFE, ASSISTANT PROFESSOR OF PSYCHIATRY, HARVARD MEDICAL
SCHOOL
Mr. Regula. Okay. Dr. Barbara Wolfe, Professor of
psychiatry, Harvard Medical School.
Dr. Wolfe. Mr. Chairman, as a member of the American
Psychiatric Nurses Association, also known as APNA, I
appreciate the opportunity to testify before your Subcommittee.
The psychiatric nurses that APNA represents strongly believe
that there is a need for awareness of funding for mental health
research and education.
Mr. Regula. Tell me what does a psychiatric nurse do? What
is different than being a psychiatrist or being a nurse, or is
it a little of both?
Dr. Wolfe. We serve a wide variety of populations who have
mental health illnesses or problems. Psychiatrists are trained
in medicine. Nurses are trained in nursing. By and large,
traditionally medicine has focused on the disease aspect, where
nursing has focused on looking at the health of these people
and the continuum in terms of health prevention as well as
health promotion.
Mr. Regula. You get a medical degree or an associate degree
for this, for psychiatric nursing?
Dr. Wolfe. You can be prepared at a number of different
levels, including a baccalaureate degree or master's degree,
which is what is required in terms of doing therapy, or
certainly a doctorate.
Mr. Regula. Do you practice alone, or do you practice as
part of a doctor's office? Where are your services given?
Dr. Wolfe. Our services are given in inpatient
institutions, could be general hospitals, could be psychiatric
hospitals, State facilities that focus specifically on the
mental health, also in the community. We have a wide variety of
folks who are based out in the community and particularly in
rural areas.
Mr. Regula. I assume you support parity.
Dr. Wolfe. Yes.
Mr. Regula. Figured that one out.
Dr. Wolfe. I would like to provide you with some background
information and recommendations that APNA has for the
Appropriations Committee with regard to the areas of research
and education related to mental health. Founded in 1987, the
APNA is comprised of over 4,000 members nationally. It provides
leadership to promote psychiatric-mental health nursing and
improved mental health care. APNA represents a large group of
direct care providers, investigators, educators and
administrators.
Mr. Regula. Do you treat your patients in a hospital
setting, or at home, or in an office?
Dr. Wolfe. Could be any of those settings.
Mr. Regula. Covers a wide range.
Dr. Wolfe. Exactly.
The majority of our members specialize in adult mental
health, and many are involved in subspecialties including
substance abuse, geriatrics and child and adolescent mental
health. As nurses working in this specialty, we are acutely
aware of the significant personal and family suffering as well
as the economic burden associated with mental illness.
Consider the following: 18.8 million American adults
suffered from depressive disorders in 1998 alone. Although 80
percent of depressed people can be effectively treated, nearly
two out of three do not seek or receive appropriate treatment.
Major depression ranks second only to heart disease in
magnitude of disease burden. Approximately two-thirds of
elderly nursing home residents have a diagnosis of mental
health disorders. One in five children and adolescents have a
mental health disorder affecting an estimated 7 to 12 million
youths. Total estimated costs to society related to alcohol and
drug abuse in 1995 were $276 billion.
These statistics are certainly compelling, but alone do not
paint the entire picture. We need to remember that real people
across the country face mental health disorders. Our Nation's
homeless suffer from disproportionately high rates of mental
illness and addiction. Mental illness reaches far beyond our
poor and urban streets, extending into the living rooms of all
types of communities, impacting people of all ages, from all
economic, racial and ethnic backgrounds. Particularly
distressing is the fact that mental illness is associated with
significant stigma, having devastating effects on early
detection and treatment, access to care, and perhaps even
funding of mental health research.
With this in mind one of my goals here today is to continue
our efforts to combat stigmatization of people with mental
health disorders. As noted in the 1999 Surgeon General's Report
on Mental Health, we have learned that much more must be done
to educate Americans about key findings in this report,
including, one, that mental health is fundamental in terms of
overall health; two, that mental disorders are real biological
conditions; three, that effective treatment exists for most
mental health disorders; and four, that a majority of those in
need of such services do not seek them and, therefore, do not
get the needed healthcare.
Mr. Regula. Do you agree that a lot of times people fail to
take their medicine?
Dr. Wolfe. Adherence and compliance can be a challenge,
yes.
Mr. Regula. The answer is probably yes.
Dr. Wolfe. There are a lot of factors that play a role into
why people don't take their medications.
These seemingly straightforward findings cannot be
underestimated and remain vital in our battle against the
stigma associated with mental illness.
Mr. Chairman, APNA is respectfully asking that the
Appropriations Committee support psychiatric nursing and
quality patient care by providing the following:
$27,300,000,000 to the National Institutes of Health, which is
a 16.5 percent increase, particularly to the National Institute
of Mental Health, the National Institute of Nursing Research
and the National Institute of Aging.
Health Resources and Services Administration: That $550
million be allocated to the Health Professions and Nursing
Education Program, Title VII and VIII of the Public Health
Service Act, and this does not include GME for children's
hospitals; also $15 million to the Nursing Education Loan
Repayment Program.
We likewise support full funding of the Center for Mental
Health Services and the Substance Abuse and Mental Health
Services Administration.
Mr. Regula. I am going to have to cut you off here.
Dr. Wolfe. Can I summarize?
Mr. Regula. Yes. Quickly.
Dr. Wolfe. We have report language that has been submitted,
and we hope that you support that.
In closing, psychiatric nurses are valued and have been an
integral component to mental health, and we bring a unique
perspective to the research. We are particularly happy with
your previous support regarding the combined NINR/NIMH program
that was part of the 1998/1999 language, and that has led to
the mentorship program which currently includes 16 folks who
are in that nationwide at the moment.
I would like to thank you for your support in nursing and
the work with mental health populations.
Mr. Regula. Thank you for coming.
[The prepared statement of Dr. Wolfe follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC.
WITNESS
JOHN MENGENHAUSEN, CHIEF EXECUTIVE OFFICER, HORIZON HEALTH CARE, INC.
Mr. Regula. Dr. John Mengenhausen, Horizon Health Care.
Mr. Mengenhausen. Thank you for taking the time to hear our
request in person. I know you have my written statement before
you, so I will quickly touch on the highlights, and then I
would like to bring up a couple more issues in detail beyond my
written statement.
As you stated, my name is John Mengenhausen. I am the CEO
for Horizon Health Care in South Dakota. Horizon Health Care is
a federally qualified health center, and I am the current board
chair for the National Association of Community Health Centers,
or NACHC.
First of all, let me say thank you for all the support this
committee has shown the health center programs and the patients
we serve across the country. Since 1999, the help you have
given our program allows us to serve nearly 5 million more
patients. We are now serving more than 12 million people across
the country, including nearly 5 million underinsured.
Unfortunately there are still 50 million people who have no
regular source of primary care in the country today. This
places a tremendous burden on hospital emergency rooms, charity
care providers, and even the private practice physicians.
In order to fill this gap, NACHC has promoted the goal of
doubling the number of patients served by health centers by
2006. Starting with the increases this committee enacted last
year, health centers stand ready to expand from just over 10
million patients in 2000 to more than 20 million patients in
2006. An increase in funding of $200 million next year, which
would bring the total program funding to just over $1.5 billion
would, keep the health centers on track to meet this goal.
We realize this is a very ambitious plan, yet we believe it
is reasonable and achievable. We applaud the President's plan
to expand the health center program by 1,200 new and expanded
sites, and be sure it will take every last one of those to
reach our goal. However, the President's initiative envision
only 6 million new patients by 2006. With the incredible demand
for services that we see every day, we strongly support a more
ambitious goal of 10 million more patients in the same time
frame, which explains the difference between our requests.
I would like to turn to two other topics, if I might, with
the help of this committee to support. The first is the
mechanism used by HHS to distribute the funding increases for
this year, and the second has to do with the payment of claims
under the Federal Tort Claims Act for health centers. As I
mentioned before, we wholeheartedly support the President's
plan to fund 1,200 new and expanded sites in the coming year.
The unintended consequences of this has been that all funding
increases have been contingent upon patient growth. In years
past, HHS has examined the specific performance criteria of
existing health centers and increased funding where needed.
Unfortunately health centers that have seen no growth in
patients but a dramatic rise in uninsured patients, not to
mention the general increase in costs of furnishing care that
all providers across the Nation are seeing, are ineligible for
funding increases. Therefore, we strongly recommend and urge
this committee to encourage HHS to establish a mechanism to
stabilize the existing health centers regardless of patient
growth.
And our final request to this committee is to ensure that
FTCA judgment fund for health centers is adequately funded.
Unfortunately this is a little more difficult than it sounds.
When Congress first established FTCA coverage for health
centers in 1992, the program was estimated to be $30 million
per year. While we have only yet to see annual claims nearing
the $30 million level, health centers now serve more than twice
as many patients, and unfortunately malpractice claims in
general have grown considerably across the country. Instead of
asking for specific funding levels to be set aside in the
judgment fund as in past years, we would ask this committee to
ensure some measure of flexibility in the amount set aside for
claims in the coming year.
I do want to underscore for the Committee that over the
past 10 years, the experience of FTCA coverage or the existence
of FTCA coverage for health centers has saved more than $500
million in unnecessary malpractice insurance premiums,
including more than $100 million last year. This is an
extremely important program, and we need to ensure its
continued viability.
Thank you, Mr. Chairman, for taking the time to listen to
our concerns.
Mr. Regula. Thank you. I think they are very important
because they relieve the emergency rooms that provide care for
people who are otherwise denied any kind of access, and I am
hopeful we can do as much as possible for these centers. So a
very useful thing.
[The prepared statement of Dr. Mengenhausen follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Now, do you get fairly good support from local
communities?
Mr. Mengenhausen. We do, Mr. Chairman.
Mr. Regula. I think that is part of the key; not only
money, but leadership.
Mr. Mengenhausen. Leadership is very key as we have a
community-based board of directors.
Mr. Regula. Thank you very much.
----------
Tuesday, April 30, 2002.
LIFEBEAT
WITNESS
ALAN R. FIELDS, EXECUTIVE DIRECTOR, LIFEBEAT, THE MUSIC INDUSTRY FIGHTS
AIDS
Mr. Regula. Mr. Allen Fields, Executive Director of
LIFEbeat.
Mr. Fields. Good afternoon, Mr. Chairman and staff members
of this committee. My name is Alan Fields, and I serve as
Executive Director of LIFEbeat, the Music Industry Fights AIDS.
Thank you for providing this opportunity to speak briefly about
the very critical issue of youth HIV awareness and prevention.
I would also like to thank the Committee. And in particular
Nancy Pelosi and Jesse Jackson, Jr., for the inclusion of
language as part of the minority AIDS initiative to encourage
the CDC to target at-risk populations. It is our request that
similar language be adopted this year as part of the
proceedings.
We have recently marked the 20th anniversary of the first
official report of the disease that would later become known as
AIDS. Since 1981, over 21 million people worldwide have died
from the disease. In the United States, the Centers for Disease
Control reports that nearly half a million persons have died of
AIDS. Between 800- and 950,000 persons are living with HIV
infection, with roughly 40,000 new infections each year, half
of which are occurring in young people under the age of 25,
with a disproportionate number affecting African Americans and
Latinos.
Mr. Regula. Does your group do education? Seems to me that
is----
Mr. Fields. We agree.
Mr. Regula. Prevention is worth a pound of cure.
Mr. Fields. A recent report by the AIDS Action Council
cited the following: HIV/AIDS poses a serious threat to youth
both in the United States and throughout the world. Research
has cited an adolescent tendency towards high-risk behavior
coupled with insufficient education efforts as the primary
reason for the recent increase in the transmission of HIV and
other sexually transmitted diseases in young people.
In order to stave off the growing complacency surrounding
HIV/AIDS, the tremendous strides in treatment must be matched
by an aggressive awareness and prevention campaign targeting
youth. In targeting youth, special consideration must be given
to nontraditional methods and venues of reaching those
populations most at risk for HIV/AIDS. Although African
American and Latino youth account for 13 percent of the
population of teenagers ages 13 through 19, African American
teens represent 60 percent of new AIDS cases in that group,
while Latino teens represents 24 percent of new AIDS cases.
LIFEbeat recently held focus groups with young people ages
13 to 23, African American and Latino, on issues surrounding
AIDS prevention messages. The majority of the group
participants stated that there was not much targeted HIV
messaging that was directed towards them. They all cited the
number of antismoking messages they received, but were
surprised at the lack of spots that promoted HIV prevention.
All participants spoke of their desire to receive increased
information about HIV and AIDS, but stated they needed to hear
it in direct and straightforward ways, and it needed to relate
to the truthfulness of their world.
LIFEbeat was formed in response to trends that reveal that
adolescence and young adults have a particularly high risk of
contracting HIV. Recognizing that music has always played a
significant role in the lives of young people, LIFEbeat carved
out a unique niche by effectively using the power of music to
reach this population directly. Through our Urban Aid project,
LIFEbeat is exploring different and unique ways to reach the
young African American, Latino community. Our recent Urban Aid
concert featured some of the biggest names in hip-hop and R&B
speaking to young people about HIV/AIDS, abstinence and self-
esteem issues. The positive response from the young people in
attendance reenforced the notion that if the messages and
methods are tailored and targeted, they will be successful in
reaching the designated audience. Broadcast partners MTV and
BET will simulcast the show in May, helping to ensure that
these AIDS issues are put in front of millions of young people.
We have an opportunity to curb the rising rates of
infection, but we must be willing to explore all avenues at our
disposal. Nontraditional approaches must be taken with the
development of HIV prevention materials and program efforts.
These materials and programs must be culturally and
linguistically appropriate for those most at risk. Private-
public partnerships will be paramount to any successful
outreach.
A recent report on youth and HIV and AIDS prepared by the
Office of National AIDS Policy stated that although young
people account for half of the new HIV infections, less than a
quarter of all HIV prevention funding is directed towards this
age group. If we are to ensure that we do not lose a generation
of these people, we need help in appropriating funds for these
HIV initiatives, especially those targeting youth at the
highest risk for HIV infections. We request that language is
included in the fiscal 2003 report for the continuation of this
vital HIV prevention effort that targets youth, especially
minority youth. Thank you.
[The prepared statement of Mr. Fields follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I think the entertainment industry could
probably do something in lifestyles to serve as role models
that might help.
Mr. Fields. I think some are trying more than before.
----------
Tuesday, April 30, 2002.
AMERICAN PSYCHOLOGICAL SOCIETY
WITNESS
DR. ALAN G. KRAUT, EXECUTIVE DIRECTOR, AMERICAN PSYCHOLOGICAL SOCIETY
Mr. Regula. Dr. Alan Kraut, Executive Director, American
Psychological Society. Welcome.
Dr. Kraut. I just want to begin by saying thank you for
your leadership in the effort to double the NIH budget. We in
the scientific community appreciate it very much.
As an organizational member for the Ad Hoc Group for
Medical Research Funding, the American Psychological Society
recommends $27,300,000,000 for NIH as the fifth installment of
the 5-year doubling plan.
My testimony today, and I will try to be brief, focuses on
behavioral science at NIH. The effects of behavior are
indisputable. Cancer, heart and lung disease, diabetes,
developmental disabilities, brain injury, addiction, these and
so many more are linked to behavior. They may originate in
behavior, or be manifested in behavior, or may be prevented
through behavior change. So understanding behavior is as
important as mapping a gene or diagnosing a biological
disorder.
In fact, the lines that once separated the behavioral and
the biological sciences are becoming blurred. Whether it is the
behavioral scientists using imaging technology to better
understand depression or the biological scientist using a
cognitive test to see the impact of Alzheimer's disease,
behavior is a key to health.
Almost every NIH institute supports psychological science.
It might be the effects of stress on the immune system in
people with AIDS or in heart and cancer patients, research into
how children learn and grow, studying how to manage
debilitating chronic illnesses like diabetes and arthritis, new
treatments for obesity, or the basic and applied science of
brain and behavior aimed at understanding schizophrenia. One
leading NIH supporter of behavioral science is the National
Institute of Mental Health. But today let me focus on their
efforts to strengthen clinical science.
For the past few years, in part on this Committee's
recommendation, NIMH is engaged in efforts to better translate
basic laboratory behavioral science into the clinical setting;
for example, to use what we know about the regulation of
emotion to help us better understand depression. Most recently
NIMH began working with the Academy of Psychological and
Clinical Science to develop new training methods for clinical
scientists that are grounded in basic research. The results
should be a generation of clinical scientists who will go on to
create new, more effective approaches for diagnosing, measuring
and treating mental disorders. This is exactly the kind of
outcome that Congress was looking for when it chose to double
the NIH budget.
Another supporter is the National Institute on Alcohol
Abuse and Alcoholism. You may have noticed the nationwide media
attention in recent weeks given to NIAAA's college drinking
initiative and the release of NIAAA's report outlining what
science has to say about changing the culture of drinking at
U.S. Colleges. It is a science-based assessment, and it
outlines a research agenda to improve campus prevention and
treatment activities. I am pleased to note that this initiative
is cochaired by APS member and distinguished scientist Mark
Goldman from the University of South Florida.
One more institute bringing behavioral science to bear on
public health is the National Cancer Institute. NCI's
behavioral research program begins with methodological
innovations from psychological science and applies these
concepts to cancer-related issues. It is a comprehensive
program, and it ranges from basic behavioral science to
research on the development, testing and dissemination of
disease prevention and health promotion strategies in areas as
diverse as tobacco use, diet and sun protection.
Let me raise a different issue. The National Institute of
General Medical Science is the only NIH institute specifically
mandated to support research not targeted to specific diseases
or disorders. It also has a statutory mandate to support
behavioral science. Unfortunately, NIGMS does not now support
behavior despite the statutory mandate, despite the scientific
need for such research, and despite urging from Congress,
including this Committee. That is why we are asking this
Committee to again encourage NIGMS to develop a plan for
establishing a basic behavioral research program.
Let me close with one final point. The outcomes of research
are unpredictable, but I submit that investment in one aspect
of science is guaranteed to pay off, and that is the training
of our future researchers. It is support for young
investigators now that will mean well-trained, highly qualified
scientists down the road. But without that training, we will
not have an adequate pool of researchers to pick up where
preceding generations leave off. This is a serious issue in
behavioral science at NIH where demand for behavioral
investigators outpaces the current supply. So I ask the
Committee to support the development of the comprehensive
training strategy for all research areas, including behavioral
science research. Thank you.
[The prepared statement of Dr. Kraut follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Stress important?
Dr. Kraut. Very important. There is a whole field called
psychoneuroimmunology, the interaction of behavior and the
endocrine system on the immune system. And what we are finding
is that although you think about stress in terms of workplace
stress or stress in the school, that it actually has a physical
impact on the body that can be translated, that you can see in
visual images, or that you can measure in terms of blood
reactions.
Mr. Regula. There is a specialist at the University of
Nebraska, Dr. Robert--specialized in stress as a result of a
heart attack, but it is something we don't think about enough.
Dr. Kraut. That is right. It is one of those things that
seems like everybody knows something about, but it is actually
a researchable scientific problem.
Mr. Regula. Thank you very much.
----------
Tuesday, April 30, 2002.
MICHIGAN GOVERNOR'S COUNCIL ON PHYSICAL FITNESS, HEALTH AND SPORTS
WITNESS
DR. CHARLES T. KUNTZLEMAN, CHAIRMAN, MICHIGAN GOVERNOR'S COUNCIL ON
PHYSICAL FITNESS, HEALTH AND SPORTS
Mr. Regula. Dr. Charles Kuntzleman, Chairman of Michigan's
Governor's Council on Physical Fitness. We are going to help
you catch your airplane, if you are going to help us catch up
on our schedule.
Mr. Kuntzleman. Chairman Regula and support staff, thank
you for this opportunity to share our concerns, vision and
solutions to the problems of obesity and sedentary health
risks. My name is Charles Kuntzleman, and I am Chair of the
Michigan Governor's Council on Physical Fitness and the
Michigan Fitness Foundation, and I want to describe how these
organizations are working to promote health benefits of
physical activity and creating behavior-changing programs that
equip citizens to lead physically active lives and prevent
chronic disease and reverse the trend towards sedentary living;
in short, a cost-effective best practices model.
These behavior-changing initiatives stimulated by Governor
John Engler's 1992 charge to the Council are: One, the award-
winning Exemplary Physical Education Curriculum, or EPEC as I
will describe it, is a nationally acclaimed K-through-12
physical education curriculum developed by the Council and a
consortium of 19 of Michigan colleges and universities, the
departments of education and community health, and also
numerous school districts. EPEC changes the way physical
education is taught and equips children for a lifetime of
physical activity. We focus on a variety of activities such as
motor skill development, fitness, and also personal social
characteristics such as best effort, following directions,
respect for property and others.
To date well over 2,000 physical education teachers have
been trained in 60 percent of Michigan's school districts, and
teachers in 22 States have purchased EPEC. Research and
effectiveness studies show that this voluntary program in the
State of Michigan works.
Another school-based program, ACE, All Children Exercising,
is a behavior change program, but it is an identified program
to stimulate interest and enthusiasm in EPEC and tomorrow will
involve over 400,000 Michigan participants in over 1,000
Michigan schools. Each year a different critical health message
is delivered to the student participants and their families.
The Governor's Council Awards Program is a statewide awards
program promoting recognition of exemplary initiatives in
physical education, healthy workplaces, active Michigan
communities and lifetime achievement. In 2001, 220
organizations and individuals were honored for their work. This
program works because it represents the crowning achievement of
many people who never receive recognition.
Active Community Environments is the fourth focus, and it
is a new focus of the Centers of Disease Control and the Robert
Wood Johnson Foundation and the National Governors Association.
The Michigan Governor's Council has just hired its first
statewide director of active community environment to work with
Michigan communities to make them more walkable and to
encourage nonmotorized transportation. The Council has
developed a new community assessment/inventory tool for the
promoting of active communities award. Retrofitting our
existing communities and designing new communities to make them
walkable will provide our children with safe routes for schools
and engineer physical activity back into our lifestyles.
Our regional councils represent all 83 Michigan counties,
collaborate with over 200 organizations, and implement council
and regional programs and events in our communities. This
funding also leverages another $400,000 in cash with in-kind
support for their local regional councils.
Sixth and final is the advocacy, awareness and promotion of
health benefits through position papers and publications and
Websites. Statewide physical activity, health, wellness and
sports events are formally endorsed and promoted through
communication vehicles. Behavior-changing strategies combined
with effective public awareness events and focused media
relations have proven effective in Michigan, and we have been
recognized as a Gold Star State Council of the Year and been
notified by the Centers for Disease Control as an exemplary
program in the area of translating research to the public.
Sedentary lifestyles and poor nutrition are annually
responsible for up to 580,000 deaths. Tragically we spend about
$1,400 per person by Federal and State governments to treat the
disease, yet only $1.20 is spent to prevent them. Acting now to
promote healthy eating and physical activity would protect not
only the physical health of the country, but also its financial
health by reducing disabilities, lost productivity and the
like.
We have become a cost-effective best practices model for
other States. In Michigan we have created innovative approaches
and specific strategies and numerous collaborative partners.
All of this is accomplished with only $1 million allocated from
the tobacco tax revenue through the Healthy Michigan Fund. We
have also leveraged another million in gifts, grants and
sponsorship and in-kind support. Our programs and strategies
now reach over 1.2 million Michigan citizens at an annual cost
to the State of about 85 cents per person. More can be
accomplished by increasing Federal funding to the Department of
Education and Centers for Disease Control to replicate our
Council and its initiatives in other States to address the
obesity epidemic and curb the sedentary death syndrome.
Thank you for this opportunity to testify.
Mr. Regula. Thank you. It is an important topic, and CDC is
working aggressively along the same lines.
[The prepared statement of Dr. Kuntzleman follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
NATIONAL AREA HEALTH CENTERS ORGANIZATION
WITNESS
KATHLEEN VASQUEZ, MEMBER, NATIONAL AREA HEALTH CENTERS ORGANIZATION
Mr. Regula. Kathleen Vasquez, Member, National Area Health
Centers Organization.
Ms. Vasquez. Mr. Chairman, members of the Subcommittee, I
am pleased to present testimony on behalf of the National AHEC
Organization. I am Director of the Ohio statewide AHEC program,
and the Medical College of Ohio AHEC program, and a member of
the National AHEC Organization. Together, we enhance access to
quality health care by improving the supply and distribution of
health care professionals through community and academic
partnerships.
Mr. Chairman, the AHEC HETC network is the Federal
Government's most flexible and efficient mechanism for
addressing a wide and evolving variety of health care issues on
a local level. Since our inception almost 30 years ago, AHECs
have partnered with local, State and Federal initiatives and
educational institutions in providing clinical training
opportunities to health professionals and nursing students in
rural and underserved communities.
Currently, there are 45 AHEC programs and 170 centers
located in 43 States. AHEC programs perform four basic
functions, the first of which is to develop and support
community-based training of health-profession students,
particularly in underserved rural and urban areas. Last year,
Ohio AHEC supported the clinical education of 845 nursing
students and 1,400 medical students and residents at community-
based rural and underserved sites.
Second, AHECs provide continuing education and other
services that improve the quality of community-based health
care. Last year, nearly 12,000 Ohio health professionals did
not have to leave their communities or arrange practice
coverage to attend education programs because the programs were
brought to them in their local communities by Ohio AHECs.
Mr. Regula. Were they brought by television or fiber-
optics?
Ms. Vasquez. Both. We do distance learning and in-person
lectures.
Mr. Regula. Some of both.
Ms. Vasquez. Third, AHECs recruit underrepresented minority
students into health professions through a wide variety of
programs targeted at elementary through high schools. Our Ohio
AHECs are providing school children with classroom education on
health careers; school counselors with updates on opportunities
in health careers; and summer science and medicine camps.
And last, AHECs facilitate and support practitioners,
facilities and community-based organizations in addressing
critical local health issues in a timely and efficient manner.
One example is in rural and underserved Tuscarawas County,
where the AHEC, in collaboration with a faith-based Hispanic
organization, has brought together health and social service
agencies and the local hospital to address the compounding
needs of a large influx of Guatemalan workers to that area.
More recently, the HETC programs were created to focus on
community health education and health provider training
programs in areas with severely underserved populations in
border and nonborder areas.
Currently, HETC programs exist in nine States and are also
supported by a combination of Federal, State and local funding,
the majority of which comes from non-Federal sources. Virtually
all AHEC and HETC programs are collaborative in nature. These
collaborations include health professions, schools, primary
care residency programs, community health centers, the National
Health Service Corps, public health, health career opportunity
programs and schools.
Additionally, AHECs and HETCs go beyond their core
functions to address specific health issues affecting the
communities that they serve, such as with the nursing shortage.
For example, the Lima AHEC began an RN to BSN program several
years ago. By providing preadmission counseling, arranging
local and on-line course work and instructors, RNs can remain
on the job in the community while obtaining a BSN degree. In
the past 8 years, nearly 400 nurses have completed the program.
On bioterrorism education, Ohio's AHECs have stepped in to
provide health professionals with the latest updates on
bioterrorism. In rural areas of Ohio, AHECs have downlinked
satellite broadcasts and sponsored bioterrorism preparedness
programs.
With the National Health Service Corps, the Ohio University
AHEC has supported the Corps's search program by interviewing
prospective students, recommending community preceptors and
monitoring placements of 15 students each summer in rural and
Appalachian sites.
On expansion of community health centers, at a community
health center in Fremont, for example, medical and physician
assistant students travel in a mobile health unit to work
alongside the physician preceptor in providing care at migrant
farm worker camps.
Mr. Chairman, I respectfully ask the Subcommittee to
support our recommendations to increase funding for these
programs under Title VII and Title VIII of the Public Health
Service Act to at least $550 million.
Mr. Chairman, AHECs and HETCs have not yet fully realized
their potential to be a nationwide infrastructure for local
training and information dissemination. That is why we are
requesting an increase in funding to $40 million in fiscal year
2003 from $33.4 million in fiscal year 2002 for AHECs, and $10
million in fiscal year 2003 for HETCs.
Thank you for the opportunity to present the view of the
National AHEC Organization.
Mr. Regula. You have a center at NEO UCOM?
Ms. Vasquez. We have a program at NEO UCOM, and they
operate three local regional AHEC centers.
Mr. Regula. I think we provided some funds for that
building.
[The prepared statement of Ms. Vasquez follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
AMERICAN ACADEMY OF FAMILY PHYSICIANS
WITNESS
JAMES MARTIN, M.D., PRESIDENT-ELECT, AMERICAN ACADEMY OF FAMILY
PHYSICIANS
Mr. Regula. Okay. Dr. James Martin, President-Elect,
American Academy of Family Physicians. Welcome.
Dr. Martin. Thank you, Mr. Chairman, Congressman. My name
is James Martin. I am a family physician from San Antonio,
Texas. I am the President-Elect of the 93,500-member American
Academy of Family Physicians.
Mr. Regula. Are you growing or shrinking? Hard to find you.
Dr. Martin. We are growing. We will address that.
I come to you today in support of HRSA's Section 747 of the
Title VII health profession grants. I want to thank you for the
opportunity that we have of coming here publicly in support of
that program, and also personally wanted to thank you for the
courtesy extended to me last year when I came before you and
for your obvious commitment to this through your support of our
program in last year's budget.
The American Academy of Family Physicians asks you to
support Section 747 with the amount of $169 million. Contrary
to statements from the Office of Management and Budget that
assess--their perceptions are that the program has failed to
retain rural physicians, I would remind you that the purpose of
this program was to develop and enhance departments of family
medicine within medical schools and to allow the development of
creative and innovative strategies to improve the health care
of all of our citizens.
Now, in that aspect, I also want to take a few moments and
discuss the value and role of the American family physician. We
are the doctors for 100 million Americans. We provide 65
million more office visits per year than any other specialty.
We are the only specialty that distributes itself to the
population. Five percent of our population is extremely rural;
5 percent of our physicians are extremely rural.
The Graham Center studies last year on Primary Health Care
Professions Shortage Areas demonstrated that if the family
physician goes away, 70 percent of all of the counties in the
United States become health professions shortage areas.
A Commonwealth study recently on health care disparities
for minorities made it very clear that better outcomes would be
obtained if minorities had a primary care continuity physician.
We have been very successful, and Title VII has demonstrated
very well that where it goes, family physicians soon follow.
Programs that receive Title VII funding are more likely to
produce family physicians, and the family physicians in those
programs are also more likely to go into the rural and
underserved areas. But we are concerned about the environment
for the future. We are worried that medical schools tell us
that their budgets are shrinking, and they are finding it more
difficult to provide care for the underserved in their areas.
Studies show that one-third of all of the practicing rural
primary care physicians and family care physicians are at or
approaching retirement age; and our survey suggests that with
the hassles facing them in practice, they are leaning toward
retirement rather than continuing on.
While that is going on, the needs of our patients are
increasing. Knowing west central Texas, I know that
Congresswoman Granger would know about my mother and appreciate
her, a 75-year-old, having to drive 30 miles for health care.
If Title VII programs go away, she will have to drive--she will
be 77 by then, and probably have to drive 50 to 70 miles to get
that care.
Mrs. Granger can also talk to my brother who is a family
physician in Brownwood, Texas, who works 80 hours a week. And
she can ask him if the physician workforce objectives have been
met in this country and if there is a surplus of family
physicians.
Section 747 really makes a difference to them. It will
affect my mother's health care. It will determine my brother's
ability to find a partner or someone to replace him when he is
too tired to go on.
We feel like we are preaching to the choir when we come to
you. We have watched your success. We know how concerned you
are about our health care system. And I wonder if you share our
frustration in having to come back and perform this ritual
annual event of trying to restore this money back in 747, when
we have a broken health care system.
I would much rather be talking to you today about
developing a program of affordability and accessibility and
quality of care for all Americans. But until we can do that, we
need Section 747. It is very important to us to get that. But I
ask you, in your leadership role, to look forward to the time
when we can address an issue of much more importance. That is
the development of a just and merciful health care system.
[The prepared statement of Dr. Martin follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Sherwood, your brother, is he a family
physician?
Mr. Sherwood. He certainly is----
Mr. Regula. You are from rural Pennsylvania, so you get to
question.
Mr. Sherwood [continuing]. A country doctor in rural
Pennsylvania for 25 years. And I am very familiar with the
problems you speak of. But we have had pretty good luck
recently recruiting doctors, as our doctors retire. But rural
health care is, as my colleague Mr. Peterson says, Medicare-
light. You know, we all need help.
Mr. Regula. Is insurance a problem?
Dr. Martin. Insured patients versus uninsured?
Mr. Regula. For primary care physicians and so on, that--
the cost of medical malpractice and early retirements?
Dr. Martin. Yes, sir. All over the country we are seeing
that. But especially in areas of Pennsylvania, West Virginia,
it has become a problem to the point where physicians are not
taking new patients and actually leaving the States in order to
protect themselves.
Mr. Regula. Do you concur?
Mr. Sherwood. Our product liability and malpractice
situation in Pennsylvania is bad. The legislature has been
working on it, but so far we haven't got a fix.
Dr. Martin. Another issue for another time.
Mr. Regula. I am familiar, because my family and myself
were all dealt with by the family physician. Sort of the whole
thing--took care of us, delivered our children, et cetera. I
think it is an important dimension to the field of medicine.
Dr. Martin. Thank you, sir.
Mr. Regula. As a lawyer--I was a family lawyer; I practiced
alone--so I have some empathy with you.
Dr. Martin. Some good. Thank you
----------
Tuesday, April 30, 2002.
FAIRLEIGH DICKINSON UNIVERSITY
WITNESS
J. MICHAEL ADAMS, Ph.D., PRESIDENT, FAIRLEIGH DICKINSON UNIVERSITY
Mr. Regula. Our next witness will be introduced by my
colleague, Mr. Sherwood.
Mr. Sherwood. Thank you, Mr. Chairman.
It is with great pleasure that I can introduce to you Dr.
J. Michael Adams, the President of Fairleigh Dickinson
University. He came to Fairleigh Dickinson from Drexel, and he
came to Drexel from the State system in New York State. And all
three of these great institutions have had a profound influence
on my congressional district. And so I--we are very happy to
welcome a distinguished educator.
We are interested in your programs.
Dr. Adams. Thank you. My name is Michael Adams. And I have
the pleasure of serving as the President of Fairleigh Dickinson
University.
To begin with, I would like to thank the entire
Subcommittee, especially Chairman Regula and Congressman Obey
for this, which is my first opportunity, to testify before
Congress. And I also appreciate your adjusting the schedule to
allow me to speak on educational issues in the midst of the
testimony on critical health issues. I appreciate that.
But I would also like to comment that I am proud to
represent a university with campuses in districts of two of
your distinguished colleagues from the Appropriations
Committee, Congressmen Frelinghuysen and Rothman.
And, in addition, Mr. Chairman, I am making a brief oral
presentation, but I have a more detailed written statement.
With your permission, I ask that that be entered into the
written record.
Mr. Regula. Without objection.
Dr. Adams. I wish to focus on four issues:
First, the ongoing need for federally supported programs to
assist and support the success of minority and low-income
students;
Secondly, the need for ever-increasing assistance to
incorporate distance learning and educational technology into
the learning process;
Three, the need to expand the Federal role in advancing
international education and understanding through a global
approach to problem solving; and
Finally, I believe I share your concern about the need for
our Nation to focus more resources on the professional
development of educational leaders.
I believe these concerns are aligned and consistent with
both the national and congressional agendas. Moreover, I
believe it is the responsibility of higher education to work
together with the Federal Government to advance these shared
missions.
I am proud that my university has contributed in certain
ways. Fairleigh Dickinson has a documented history of action
and achievement in these areas. We have invested millions of
dollars, without Federal assistance, in educational and public
service program efforts. For more than 20 years, FDU has
spearheaded a program to ensure both access and success for
underserved minority students in higher education.
We have developed and supported a model program called
Minority Student Support and Achievement--the Enhanced Freshman
Experience. This intensive one-year transitional program offers
students extensive support during the first critical year of
college. The program includes peer tutoring, career counseling,
one-on-one faculty mentoring, technology-enhanced instruction
and what we call ``Removing the Barriers'' strategy instruction
and guidance.
In another area, our Center for Interdisciplinary,
Distributed and Global Learning is revolutionizing the way
higher education looks at distance or on-line learning. We have
taken the unique position that if the Internet can reach out to
the world, it also be used to bring the world to our campus.
We also see the Internet as a fundamental learning,
research, communication and collaboration tool. In fact, we
have become the first university in the world to require all
undergraduates to take one distance learning course each year
during his or her undergraduate career.
Perhaps the most innovative part of our approach is the
creation of a new category of faculty called Global Virtual
Faculty, experts from around the world who link with our
campus-based colleagues to bring to young people different
views of the world and understandings that they can't have in
their traditional community. No other university has taken this
transformational initiative. And we have been recognized by
other universities, the State of New Jersey, and foundations
and corporate entities like AT&T.
In the area of Public Education Reform, our ALPS Academy
for Educational Leadership was hoping to work to solve a crisis
by increasing, improving and diversifying the pool of qualified
school leaders and teachers.
This crisis is nationwide; 50 percent of our teachers and
administrators will retire in the next 10 years. That means our
Nation needs to replace over 2 million teachers in the next
decade. Moreover, minority representation among school leaders
remains dismally low.
My university's Academy for Educational Leadership
collaborates with the New Jersey Department of Education and
state and national professional organizations to help develop
educational reform models, and we hope to dramatically improve
the number of qualified teachers and school leaders.
Mr. Regula. You have a college of education?
Dr. Adams. We do, sir, yes.
At the Federal level, we applaud you for the leadership
Congress has played at nurturing key programs that advance
these kinds of initiatives; programs, again, like the Fund for
the Improvement of Post-Secondary Education; The Fund on
Education and for Local Innovations in Education, programs
which support and make possible truly cutting-edge, national
and model programs utilizing educational technology; and,
finally last, but certainly not least, the Department of
Education's programs in support of undergraduate and graduate
international education and global studies.
The focus of my statement this afternoon is on the
importance of several of the national programs and accounts
that can provide critical support in these high areas.
Thank you, sir. I appreciate it.
[The prepared statement of Dr. Adams follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
Mr. Sherwood.
Mr. Sherwood. Well, thank you very much. I particularly am
interested in your Global Virtual Faculty.
Dr. Adams. Entirely new paradigm, Congressman; no other
university has approached that. We are seeking out individuals
who are experts in commerce, in education, in economics, in the
corporate community and bringing views of the world to these
young people on line, 24 hours a day.
Mr. Sherwood. It seems to me that you can get the best
experts in the world in one virtual classroom.
Dr. Adams. We are attempting to do that.
Mr. Sherwood. Thank you.
Mr. Regula. What is your enrollment?
Dr. Adams. We have 10,000 students at Fairleigh Dickinson,
four campuses, two in New Jersey one in----
Mr. Regula. Do you have a graduate school?
Dr. Adams [continuing]. We are private, nondenominational.
Mr. Regula. Do you have a Tom McDonald on your faculty?
Doesn't ring a bell?
Dr. Adams. No, sir.
Mr. Regula. What percent of your students are in the
College of Education?
Dr. Adams. About 4 percent, sir.
Mr. Regula. It is not big?
Dr. Adams. Well, yes, it is large in New Jersey. But that
is at the undergraduate level, we probably have 300 to 400 more
in our graduate program.
Mr. Regula. Thank you.
----------
Tuesday, April 30, 2002.
ADAP WORKING GROUP
WITNESS
WILLIAM E. ARNOLD, CHAIR, ADAP WORKING GROUP
Mr. Regula. Mr. William Arnold, Chair of the ADAP Working
Group.
You are going to familiarize me with the acronym.
Mr. Arnold. Chairman Regula, the AIDS Drug Assistance
Program.
My name is Bill Arnold. I am the Chair of the ADAP Working
Group, which is a coalition of AIDS organizations and
pharmaceutical companies and other interested organizations
that works at the Federal level for adequate funding for the
AIDS Drugs Assistance Program.
State AIDS Drug Assistance Programs are funded under Title
II of the Ryan White CARE Act, and provide medications to treat
HIV disease and prevent and treat AIDS-related opportunistic
infections to low-income and uninsured and uninsurable
individuals living with HIV/AIDS in all 50 States, the District
of Columbia, Puerto Rico, Guam and the American Virgin Islands.
I would like to thank the Subcommittee, before I say
another word, for the support we have had on this issue in the
last 6 years. Since the FDA approved protease inhibitors,
several hundred thousand people have passed through the ADAP
program since then. And this committee made it possible for
that to happen.
The data that the ADAP Working Group bases its calculations
of need on each year will also appear shortly, after we are
through with it in the ADAP monitoring report, which is
financed by the Kaiser Family Foundation's Web site. It is a
wealth of information on every single ADAP program for those of
you who feel that you may need to get down to the nitty-gritty.
In the fiscal year 2001 budget cycle, the final ADAP
increase in funding was not agreed upon until December of 2000.
Then it was short of what the ADAP Working Group had projected
by about $60 million
In the fiscal year 2002 budget cycle, the administration
budget proposed flat funding, which Congress and this committee
did increase by almost $60,000,000. But the calculated need for
ADAP in that year was $124 million.
The President's 2003 budget again proposes flat funding.
For a program driven by people continuing to live amidst the
health care system with many gaps, this is a life-threatening
crisis. The accumulated shortfalls of two budget cycles now
leave us in a structural deficit as of 1 April, 2002--that is,
this month--of about $82 million, which is actually needed as
an emergency supplemental appropriation right now, today, as I
speak here.
Additionally, ADAP will need another $80 million in the
fiscal year 2003 appropriation. This a total increase of $162
million and it will have to carry ADAP programs through March
31, 2004. The ADAP program is 6 months behind the Federal
budget year. I say all of this, mindful of the fiscal
pressures, but also very mindful of the medical costs and the
human life costs of not providing the treatments.
The ADAP need is being driven by simple factors. We all
know that highly active antiretroviral treatments have dropped
the U.S. AIDS rate from somewhere around 40,000 a year down to
less than 15,000 and even less than that in areas with
particularly good health care. The dramatic improvements in
lifespan and quality of life are almost miraculous--these
treatments must continue for ADAP patients--and therefore
patients will live longer and will tend to stay on ADAP longer.
Additionally, we have a pool of up to 300,000 HIV-positive
people in the U.S. that everybody and their brother is
outreaching to. By that I mean, the CDC is financing it,
private entities are financing it, AIDS organizations are
financing it, churches are financing it. And when these people
are identified, particularly in the overall current demographic
of the epidemic, they tend to be communities of color, they
tend to be rural, they tend to be women of childbearing age.
And all of these people tend not to have jobs that have
decent health care, so disproportionately, when they come in
for treatment, they are not going to be eligible for Medicaid,
they are not going to have adequate private insurance. They
have to knock on the ADAP door.
The only other way to qualify is to get so sick that you
have full-blown AIDS. Then you qualify for Medicaid, when you
should have been taking medicine so that you didn't get full-
blown AIDS. And we are hoping that Congress will pass the Early
Treatment for HIV Act, which will enable us to argue at the
State level for letting people get eligibility for Medicare
based on just testing HIV positive.
I will wrap up in case there are questions.
In sum, our modeling projects the following ADAP budget
requirements, or we will literally have waiting lists for each
of the AIDS drug assistance programs in all 50 States plus the
territories and the District of Columbia and Puerto Rico:
The current $82 million ``structural deficit'' is actually
needed right now, and if we don't get it, we will see waiting
lists in a whole bunch of States. In fact, the State of Florida
may actually have to close to new enrollments before elections
this year. We had--just as little as 4 months ago, we had 11
States that had closed programs or had programs with
restrictions, Texas being one of them. And, the Texas
Department of Health just advised everybody involved in ADAP
that they anticipate severe difficulties between now and the
year 2005.
Thank you for the opportunity. I wish I had brought better
news. I do bring good news in the sense that people are living.
Unfortunately, in living, they need additional access to
medications, and that is what ADAP is for.
[The prepared statement of Mr. Arnold follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. So there is progress.
Mr. Sherwood.
Mr. Sherwood. I am fine.
Mr. Regula. Thank you.
----------
Tuesday, April 30, 2002.
NATIONAL NETWORK FOR YOUTH
WITNESSES
AMANDA NICOLE (NIKKI) HAUTER, ST. PETERSBURG, FLORIDA
ACCOMPANIED BY JANE HARPER, DIRECTOR, FAMILY RESOURCES, ST. PETERSBURG,
FLORIDA
Mr. Regula. Amanda Hauter, you are Chairman Young's
constituent. And I think Jane Harper is accompanying you, and
you are going to tell us about the National Network for Youth.
Where is Jane? Come on up to the table. Okay.
The network to do what?
Ms. Hauter. That is the National Network for Youth.
Mr. Regula. Are you a college student? High school?
Ms. Hauter. High school. I am a junior in high school.
Mr. Regula. Junior in high school. Okay. It will be
interesting.
Ms. Hauter. My name is Nikki Hauter. I am a high school
junior. I live in St. Petersburg, Florida. I am testifying
today on behalf of the National Network for Youth. My testimony
will focus mainly on the funding for the Runaway and Homeless
Youth Act programs of the Department of Health and Human
Services.
The National Network supports the dozens of programs in the
Departments of Health and Human Services, Labor and Education
that reach young people. Funding is needed for each of the
following programs: the Child Abuse Prevention and Treatment
Act, CDC's HIV and AIDS Prevention Program, the Ryan White CARE
Act Title IV Program, and the 21st Century Community Learning
Centers Program.
President Bush has requested healthy increases for the
Chafee, Safe and Stable Families and Job Corps programs in his
budget request. I urge Congress to adopt the President's
recommended funding levels for these programs. However, I am
concerned about the President's proposed reductions to the
Youth Employment and Youth Opportunities Grant programs, and I
urge you not to make those program cuts.
I am also grateful to Chairman Young for being such a
strong champion for the Education for Homeless Children and
Youth program. I am confident Congress will follow through on
its pledge to leave no child behind and to provide the $70
million needed to fund this program.
I am one of the many youths who are directly benefiting
from those programs. For the last 5 months I have been staying
in the Transitional Living Program at Family Resources in St.
Petersburg, Florida. I would not be here today if this program
didn't receive a good deal of funding through the Runaway and
Homeless Youth Act. In this program I am working to put my life
back on track.
I suppose you might be wondering how a kid like me ends up
needing a program like the TLP. So let me tell you how I ended
up there. I was born in Arizona, but I spent most of my life in
Sarasota, Florida. My older brother passed away in 1995 when I
was 9 years old.
After his death, I lost all of my ambition, and I didn't
want to go to school anymore, so I skipped school a lot. By the
time I finished my second year in high school, I was behind
more than half of the required credits. I had also managed to
find myself in a, quote, ``bad crowd'' and I began to head down
a path of complete destruction. On top of that I felt
completely alienated from my father and stepmother, seeing
there was no relationship left between my father and I.
One day, instead of driving me to an appointment, my father
dropped me off at the YMCA Youth Shelter in Sarasota, where
counselors had been waiting for me. And this is another place
that receives funding.
This was not the first time that I had been dropped off at
the youth shelter, I had been placed there for various reasons
over the previous years, but I had always returned home. But
this time was different, and I desperately needed an
alternative place to go. There is a TLP in Sarasota. There was
no opening at that time, so the counselors at the shelter
helped me find the living arrangement that I am in now which is
in St. Pete.
One of the counselors, she drove all of the way down to
Sarasota, about a 45-minute drive, to interview me for the
program, and I actually moved in the next day. I was really
fortunate that there was another Transitional Living Program
that was around my area, because, in some States, there aren't
any programs like that at all. So it was really good, and the
first day at Family Resources, I could see how involved the
staff was in each teenager's life.
I have received a lot of counseling and help in this
program. I have also started attending a new school where I
have made many new friends and I have pulled up my grade point
average to a 3.17. I am active in extracurricular activities
and I help produce the daily television show at my school.
I am happy to say that I have steadily come to a halt on
that path of destruction I told you about earlier, and I am not
only learning about substance abuse, I am also learning life
skills in the Transitional Living Program.
The program has helped me in many ways. I am beginning to
be able to pull myself together and turn my life around. I feel
positive about my future, and I never used to think about
college after high school, but now I am planning on applying
for the Bright Futures Scholarship.
Without the Transitional Living Program, I would not be
standing here today, I would be a statistic, not a
congressional witness. And I just want to say that teenagers
today more than ever need programs like the ones I have been
in, the YMCA Youth Shelter and the TLP, because, you know, they
give us stability and structure in our lives; you know,
programs, they do help. And so I just ask everyone to really
know that--that from a kid's point of view, who has been in
these programs, they do help.
So, in closing, I would like to say, please provide at
least the $150 million this year for the Runaway and Homeless
Youth Act. Without these programs, I wouldn't be where I am
today.
There are other youths that are facing the same
circumstances I did, who are not able to get the help due to
inadequate funding. When you vote for the funding for the
Runway and Homeless Youth Act, remember one very important
thing: Children are our future.
And thank you very much for this opportunity to testify
today.
Mr. Regula. Jane, would you like to comment?
Ms. Harper. Well, just in summary, Nikki has been with us
for about 5 months now. She has done remarkably well. Like she
said, there are many young people out there that don't have a
place to go to get this kind of help. And it does provide her
an opportunity that she might--the alternative might be living
out on the streets.
Mr. Regula. She is with you full time?
Ms. Harper. She lives with us in our Transitional Living
Program. She goes to school. She works part-time. She is saving
money for her future. And she didn't think about going to
college, but now she is thinking about it.
She might want to be--like, a U.S. Senator or something
like that?
Ms. Hauter. After my experiences in D.C.
Mr. Regula. Start at the top. Do you have any contact with
your father?
Ms. Hauter. I do from time to time. He is involved, as far
as the program goes and, you know, things that he needs to be
involved in.
Mr. Regula. So he is interested in what is happening to
you?
Ms. Hauter. Uh-huh. And he supports everything that I do
with the program. He is very proud of me for this opportunity.
Mr. Regula. Great. Thank you.
Mr. Sherwood.
Mr. Sherwood. Well, he should be proud Nikki. And you did a
wonderful job. Thank you very much.
Mr. Regula. What are you, a junior?
Ms. Hauter. Yes.
Mr. Regula. Now, what would you like to do when you go on
to college?
Ms. Hauter. Actually, I am thinking about law school now.
Mr. Regula. Before you become a Senator, right? Thank you
very much.
[The prepared statement of the National Network for Youth
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
ASSOCIATION OF MATERNAL AND CHILD HEALTH PROGRAMS
WITNESS
CHRISTOPHER KUS, M.D., PRESIDENT, ASSOCIATION OF MATERNAL AND CHILD
HEALTH PROGRAMS
Mr. Regula. Okay. Christopher Kus, President of the
Association of Maternal and Child Health Programs. You are
going to have a tough time following that one.
Dr. Kus. In a way, it makes some of the case that I am
going to present to you, so I think that is pretty important.
You have heard from a family practitioner. I am a pediatrician.
Good afternoon, Mr. Chairman and members.
Mr. Regula. Are you a pediatrician or a general
pediatrician?
Dr. Kus. I am a public health pediatrician, but I am also
by training a developmental pediatrician. And as you said, I am
Chris Kus, the President of the Association of Maternal and
Child Health Programs. AMCHP is what we are called, and AMCHP
is a national nonprofit organization principally made up of the
directors and staff of State Public Health Agency programs for
maternal and child health and children with special health care
needs in all 50 States, the District of Columbia, and 8
additional jurisdictions. In addition to these State public
health leaders, we have members that include academia, advocacy
and community-based maternal and child health professionals, as
well as families.
I am a pediatrician and I work in the New York State
Department of Health. I am the Pediatric Director of the
Division of Family Health. The Division of Family Health
administers New York's maternal and child health program, which
includes programs for adolescents' health and youth development
programs.
Thank you for opportunity to testify. We at the Association
of Maternal and Child Health Programs appreciate the
Subcommittee's interest in and support of the Maternal and
Child Health Services Block Grant program. For over 66 years,
programs authorized under Title V of the Social Security Act,
now the Maternal and Child Health Services Block Grant, have
helped fulfill our Nation's strong commitment to improving the
health of all mothers and children. In fact, the Maternal and
Child Health Services Block Grant is a cornerstone of our
Nation's public health system.
The Maternal and Child Health Services Block Grant is a
source of flexible funding for States and territories to
address their unique needs. Each year more than 26 million
women, infants, children and adolescents, including those with
special health care needs, are served by a maternal and child
health program. Of the nearly 4 million mothers who give birth
annually, almost half receive some prenatal or postnatal
services from a maternal and child health-funded program.
Maternal and child health programs help to increase
immunization and newborn screening rates----
Mr. Regula. Are these dispensed through public health
systems?
Dr. Kus. Yes. The Federal money comes to the States. Then
the States match--in fact overmatch it.
Mr. Regula. Are these individuals that do not have access
to private health care?
Dr. Kus. It is. We serve those. And we also make sure that
people who have access to health insurance, we help them get
access to health insurance so that they become served. So we
take advantage of the systems that are in place.
We are very pleased that the Maternal and Child Health
Services Block Grant received a $17,500,000 increase after
several years of flat funding. Current events have highlighted
the importance of strong public health services. Strong
maternal and child health programs will need healthy financial
support to meet the challenges ahead. Recently our organization
stressed the acute and long-term needs of children in a letter
to the President requesting increased support for State and
local public health response efforts to bioterrorism, knowing
that children are more vulnerable to a release of chemical and
biological toxins, and their mental health can be affected
profoundly by acts of terrorism.
State maternal and child health programs are an important
point of accountability in our health care system. MCH programs
report annually on national and State-specific performance
measures. These measures include newborn screening rates,
immunization rates, teenage birth rates, health insurance
coverage in children, prenatal care, and asthma
hospitalizations.
State programs utilize this data when completing a
comprehensive needs assessment every 5 years, and States use
the needs assessment to help design their program.
Now, I want to give you a couple of examples of State
programs. How does this play out? We will start with Ohio. In
Ohio, 26 percent of Ohio's third grade students have an obvious
need for dental care. 75 percent of tooth decay is found in 17
percent of the children, so a small group of children have most
of the tooth decay.
Title V of the block grant supports the Ohio Bureau of Oral
Health Services, which supports local agencies with grant
funding to provide dental care services; that is, primary care
and dental sealants to high-risk children and women of child-
bearing age. 6,610 high-risk women and children were provided
prevention and basic restorative care through 7 locally funded
dental safety net programs.
Through the Ohio Partnership to Improve Oral Health, access
to services, working with the Dental Society, was provided to
approximately 2,627 people who would have gone without dental
care. Title V in Ohio also supports school-based dental
programs in 32 counties.
Infant mortality rates in Ohio have risen, most noticeably
in blacks. Title V funds support the Ohio Infant Mortality
Reduction Initiative which provides care management services to
make sure that women of child-bearing age have access to
prenatal services as they need them.
How about Rhode Island? In Rhode Island, children's mental
health remains a widely recognized, frustrating gap in
services.
I would like to just mention New York State's effort,
because this has been a tough year for us. September 11th
called for quick and coordinated action by public agencies. The
New York State Department of Health worked closely with the New
York City Department of Health responding to the World Trade
disaster. We have about 111 school-based health centers in New
York City. We gave them increased funding to strengthen their
mental health services and also to provide respiratory care
services because asthma was a concern.
So I think that the strong message is that the funding that
is provided by the Maternal and Child Health Block Grant takes
advantage of other funding sources, brings the service
together, but then also evaluates how we are doing in terms of
the health of women and children.
Thank you.
Mr. Regula. You work with Planned Parenthood on prenatal
care?
Dr. Kus. Absolutely.
Mr. Regula. They are an important corollary to what you do.
Dr. Kus. Absolutely. Part of the program--the prenatal care
services we fund specifically, and then we also set standards
for the care that is provided in these services.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. No.
Mr. Regula. Thank you very much.
[The prepared statement of Dr. Kus follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
COMMUNITIES ADVOCATING EMERGENCY AIDS RELIEF COALITION
WITNESSES
PATRICIA BASS, CHAIR, COMMUNITIES ADVOCATING EMERGENCY AIDS RELIEF
COALITION; CO-DIRECTOR, AIDS ACTIVITIES COORDINATING OFFICE, CITY
OF PHILADELPHIA, ACCOMPANIED BY DR. MARLA J. GOLD, DIVISION CHIEF,
HIV/AIDS MEDICINE, MCP, HAHNEMANN UNIVERSITY, PHILADELPHIA, PA, AND
MEDICAL DIRECTOR, HIV SERVICES, HEALTH PARTNERS (MEDICAID HMS)
Mr. Regula. Next is Patricia Bass, Chair, Communities
Advocating Emergency AIDS relief, Co-director AIDS Activities,
City of Philadelphia, accompanied by Dr. Gold, Medical Director
for the Hahnemann University Health Services.
Dr. Gold. Mr. Chairman, Congressman, my name is Dr. Marla
Gold, and I am chief of the Division of AIDS Medicine at MCP
Hahnemann University in Philadelphia, Pennsylvania. I am an
infectious disease expert and have both designed HIV care
programs and provided direct medical care to people with AIDS
for well over 15 years.
As mentioned earlier, for the past 2 years the President's
budget contained no increase in funding for the CARE Act; this,
despite conclusive evidence throughout the country that
programs supported by CARE Act funding save lives. Positive
patient outcomes associated with receiving health and support
services through CARE Act-supported programs have been well
described in myriad published studies.
We have seen a 70 percent reduction in AIDS mortality with
a coincident 30 percent reduction in HIV-related hospital
admissions throughout the Nation.
There have been marked reductions in perinatal HIV
transmission by over 70 percent in our country. And with
comprehensive care by experts, the risk of an HIV woman passing
the virus to her baby can now be as low as 1 percent; this,
compared to 35 percent in our country just a handful of years
ago.
Mr. Regula. You do this with drugs?
Dr. Gold. Medications, and also sometimes also with C-
section.
There is documentation that CARE Act funding has indeed
created comprehensive care systems that are accessible and
available to under- and uninsured people with AIDS,
particularly people of color and women in our country.
Articles in peer-reviewed medical journals indicate
substantial financial savings through appropriate use of
medications and implementation of national treatment guidelines
by experts staffing CARE Act-funded programs.
Today, amidst a growing epidemic, over 75 percent of people
living with AIDS in the U.S. currently reside in 51 Title I
eligible metropolitan areas.
Title I provides medical services to an estimated 200,000
people with AIDS, accounting for nearly 3 million health care
visits annually. Title III of the CARE Act provides direct
grants to 310 community-based clinics, and public health
providers in 41 States, Puerto Rico, the Virgin Islands and the
District of Columbia.
For me, I began providing medical care for people with AIDS
in the mid-1980s when there was little to medically offer
beyond support services that helped people plan for their
deaths. I never got to know my patients. They most often died
within days of admission, on a ventilator, most of them in
their twenties. Existing health care infrastructures lacked
both the expertise to provide HIV care as well as a
comprehensive service delivery system designed to meet the vast
needs of those people coming forward for care.
The Ryan White CARE Act, enacted as you know in 1990,
ultimately brought people to the planning table where we
worked--I was there endlessly--to create what we call a
continuum of HIV care. The services we needed to create had to
be accessible to all who needed them and result in positive
outcomes in terms of length and quality of life.
Today we face a new challenge. The taking of pills and
controlling of virus was and is much easier to do and
comprehend than addressing complex life issues including
poverty, homelessness, lack of food, transportation to
appointments, substance abuse treatment, mental health
counseling, and myriad specialized services for women with
AIDS, a growing field.
Take a pill. Simple. Address the life context of a patient
that enables them to take that pill. Not so simple. The CARE
Act supports a system of care. It extends way beyond the
prescription. It extends to a total commitment to provide
comprehensive care that addresses many patient needs in order
to achieve optimal outcomes.
A medical plan is not just a handful of pills; it is caring
for a person within the context of their life, understanding
their situation, and choosing with them a therapeutic life plan
that will succeed.
It is well documented that one must be 95 percent adherent
with their medication to achieve these outcomes. This equates
with not even missing more than a dose each month. The need to
take complex regimens, risk complex side effects, and do this
in a potentially fragile and vulnerable environment, created
one of our greatest medical challenges: the need to design and
implement comprehensive care systems.
This, I would suggest, is the job of the Ryan White CARE
Act. An estimated 800,000 to 900,000 Americans are living with
HIV at this moment that I am speaking to you, including 320,000
living with AIDS, the most advanced form of HIV disease. The
mortality rate with care, when you are in care, has dropped
dramatically. This results in an overall marked increase in the
total number of people who need care, and will continue to
rise. As the numbers of people in the Nation with HIV who need
care continue to rise, the critical need for comprehensive
systems will be greater than ever. And there are at least up to
300,000 HIV-infected Americans currently not on reliable care.
At a time when medication is available, there is a simple,
yet flawed assumption that simply providing drugs will solve
the problem. This couldn't be further from the truth. The truth
is that access to lifesaving medication comes through the
continuum of care offered by Ryan White CARE Act programs.
At a time when we finally have medicine to offer, it is
painful to contemplate my government pulling back on the
critical lifeline to those drugs and our system of care, and I
ask that we please don't do that.
I am here today, in summary, to strongly support the CAEAR
Coalition's request to increase Title I and III of the CARE Act
by 43,000,000 and 14,000,000 respectively in fiscal year 2003.
In my experience as a doctor, HIV expert, and public health
official, I believe CARE Act dollars translate into life; that
our systems of care should be accessible to the Nation's most
vulnerable people at this time of effective therapy for people
with AIDS.
The CARE Act is a huge piece of how we got here, how I went
from death planning to life planning with my patients and their
families, and I fervently hope that you will continue to give
us what we need to make a difference in so many lives. Thank
you.
Mr. Regula. Thank you. Ms. Bass, do you want to have one
sentence?
Ms. Bass. I am Pat Bass from the CAEAR Coalition.
Mr. Regula. You are supportive of the plan?
Ms. Bass. I am absolutely supporting her.
Mr. Regula. Mr. Sherwood.
Mr. Sherwood. Can you give us any idea statistics wise--in
other words, those of us that don't know too much about it used
to think that AIDS was a death sentence. And you are obviously
proving that that is not the case. But what kind of success
ratios are you having? When I say success, I realize that is
defined in different ways.
Dr. Gold. That is an excellent question. If we get someone
into care early--our hope is that someone is not infected in
the first place--but, once infected, when someone gets into
care early, we don't know, on the appropriate medications with
follow-up and interventions that we have to medically offer,
how long people will live.
Medical mathematical modeling suggests at least 20 years.
Some people think it could be 30 to 40 years. And, in fact, it
is sort of marvelous. I am now doing routine screening for
things like breast cancer, prostate cancer. Patients are
shocked to learn that they have high blood pressure, all of
this. And if you had asked me just a few years ago would I have
had routine health screenings and maintenance for people with
AIDS, I would have laughed, been shocked.
But, in fact, it is all before us that people can be part
of the workforce, have productive lives, and go on actually to
develop all of the other things that maybe they were going to
at one time get and work on.
Mr. Sherwood. You have made wonderful strides here in the
United States where we have the standard of living. What is the
hope for making strides in places like subSaharan Africa,
places with very low standards of living and rampant infection?
Ms. Bass. Actually I think because of the Ryan White CARE
Act, we have a model that can be used globally. But I would
like to remind you that in the United States we have areas that
very much mirror the epidemic in other parts of the world. And
to answer that would be to say that we have a very good system,
a system that could be replicated. In fact, we could teach
others how to do this because of the Ryan White CARE Act.
Dr. Gold. I would add, we are doing that. Many experts like
myself, who exist primarily because of the CARE Act and the
systems built in, are in exchange programs in places such as
Botswana where 1 in 3 individuals are infected, and the life
span will drop to something to the tune of 25 very soon.
Mr. Sherwood. Another minute?
Mr. Regula. Sure.
Mr. Sherwood. You got my attention when you said ``in some
areas of this country.'' Talk to us.
Ms. Bass. Well, I am from Philadelphia, and I have areas in
Philadelphia where I can take you and your staff to see some of
our folks who have the epidemic, who are living in conditions
that they cannot choose for care, because they are dealing with
the multiple social issues that they must deal with every day
in terms of their daily living, that they cannot choose for
their health because of other issues.
And so we can, in fact, put access in place, but unless we
are able to wrap around these clients with the system of care
and the continuum of care, we will continue to have that
problem. And so we have certainly areas, not just in
Philadelphia and New York, but other areas where we look like
some of the areas in Africa.
Mr. Sherwood. So you are talking about general conditions
and not percentage of the population.
Dr. Gold. That is right. There would be less overall
infected in terms of the percentage when you compare to it
subSaharan Africa, where 60 percent of the world's cases
reside; that is correct. But the health care infrastructure and
lack thereof, you can go to urban Philadelphia and find
problems. And certainly if you look at the whole State of
Pennsylvania, as you know, there are just rural pockets where
Title III is the lifeline to people with HIV in those areas.
And we are linked to many of those experts throughout the
rural States. That is true throughout the United States. There
are connections between Title III- and Title I-funded centers
so that we can help one another do this care that is so
important to our patients.
Mr. Sherwood. And what are our trends now with the spread
to a larger segment of the population? We had some very dismal
projections a few years ago, and then recently we thought that
projections were much better. But what is the latest
information on that?
Dr. Gold. The current information in the Centers for
Disease Control and Prevention is that for approximately the
last 2 years, if you look at the epidemic in our Nation
overall, there are approximately 40,000 new infections a year.
The bulk of those infections are impacting upon impoverished
communities of color, particularly women and the injection
drug-using population.
Nonetheless, if you then look at mini-epidemics, go into
different communities and take a look at what is happening,
there is new disease among young people, as some of the folks
earlier have testified, that we are seeing blossom again
because of lack of sustained behavioral interventions because
of lack of dollars for care. Which is why those of us who do
this work keep coming back year after year and trying to
sustain these systems and, in fact, grow them for the people
who need us the most.
With the 40,000, and with the happily, as I mentioned,
reductions in mortality, it means that every aspect of medical
care, every single subspecialty, will be impacted upon having
to care for people with HIV in this country. There is no
question about it. All of us will know at least one person, and
most of us will care for dozens.
Mr. Sherwood. Thank you both very much.
Mr. Regula. Thank you.
[The prepared statement of Dr. Gold follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH
WITNESS
R. PALMER BEASLY, M.D., DEAN, UNIVERSITY OF TEXAS, HOUSTON SCHOOL OF
PUBLIC HEALTH
Mr. Regula. Dr. Palmer Beasly, Dean, University of Texas,
Houston School of Public Health.
Dr. Beasly. Mr. Chairman, members of the Committee, thank
you very much for this opportunity. My name is Palmer Beasly. I
am the Dean of the School of Public Health at the University of
Texas. I am here today as the Chair-elect of the Association of
Schools of Public Health, ASPH, that represents the 31
accredited schools of public health in the United States.
I would like to start by--I have four issues that I would
like to highlight. The first one is the relatively new program
that funds through the cooperative agreement for money that
flows through CDC, the Centers for Public Health Preparedness;
that is, the Bioterrorism Disaster Preparedness Centers,
relatively new program. There are currently seven academic
Centers for Public Health Preparedness funded by CDC, and an
additional eight centers that have been approved, and funding
should be released for those new centers, bringing the program
total to 15.
Nineteen States do not have programs at this time,
including Ohio and Texas. They should. And our request is to
get broader coverage, increasing the funding from $20 million
to $30 million, so that each of those schools will be able to
have a program that will cover their State and region for the
areas of the country that do not have schools of public health.
This will be the primary source by which the public health
workforce will be trained to be prepared for bioterrorism.
As you probably know, there were 800 nurses trained at the
Columbia program, the School of Public Health, prior to 9/11
that were very helpful in dealing with the issues in New York
City.
The second one is the relatively old prevention research
centers that also has money that flows through CDC through the
cooperative agreement. That is money that provides for
prevention research centers that do a broad variety of
prevention research, and is the primary basis by which we work
with CDC to carry out activities that does research in a
variety of health, disease prevention, and health promotion
areas.
Texas does have one of those centers. We would like to
increase the funding to the $1 million per center that was
intended under congressional Public Law 98-551 when it was
established in 1985-86, but has fallen to as low as 580,000 per
center, rising only to about $700,000. And the request that we
have for $35 million would allow up to six new centers, plus
bringing the funding of the existing centers to the intended
1,000,000.
An example of this kind of program is called CATCH. It is a
program that was done as research to evaluate the effectiveness
of nutrition and weight and exercise programs for children in
schools. It turned out to be so successful that it has been
adopted as a nationwide program in many States to implement
nutrition and exercise programs, a program that may well help
with the national epidemic that we have of obesity and its
consequences.
The third area is extramural prevention research for CDC,
an area that CDC has not traditionally been in, analogous to
what NIH does. It is very important that we have something that
will allow transitional research to be done under investigator-
initiated, peer-reviewed research like we carry out with NIH.
The schools of public health participate substantially in NIH
research, but the kinds of research that the CDC does is more
practical, more transitional, would allow us to be more
effective in what we do.
An example of this would be the work that I have done that
showed that the Hepatitis B virus is transmitted from mothers
to infants. It was not known; HIV was not around at the time.
And this then led to the discovery that mother-to-infant
transmission leads to the chronic carriers today, not true when
adult infections occur unlike HIV, and that this sets up the
individual for development of liver cancer. And we have then
been able to show that immunization of these infants at birth
is able to eliminate up to a very small percent of these
infections, and thus we will be able to substantially eliminate
hepatocellular carcinoma from the world, an achievement that
will be of greater significance than the combined achievements
of both the Sloan-Kettering and M.D. Anderson program, because
it deals with primary prevention. So extramural research, we
would like to see it funded at $20 million.
And finally, school of public health students have careers
that they enter into because they are idealists. Most of the
jobs pay very poorly. And we need training funds in order to
sustain the public health workforce. And ASPH requests the
Congress complete the national network of public health
training centers so that all schools of public health are
involved in these activities.
This will increase the number of students that can be
trained at the 14 current HRSA public health training centers.
And ASPH requests that Congress provide $10 million in fiscal
year 2003 through the HRSA budget.
Mr. Regula. Thank you very much.
[The prepared statement of Dr. Beasly follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 30, 2002.
ASSOCIATION OF PUBLIC HEALTH LABORATORIES
WITNESS
DR. MARY GILCHRIST, DIRECTOR, UNIVERSITY HYGIENIC LABORATORY, IOWA
CITY, IOWA, AND PRESIDENT, ASSOCIATION OF PUBLIC HEALTH
LABORATORIES
Mr. Regula. Dr. Mary Gilchrist.
Dr. Gilchrist. Mr. Chairman, and I am currently serving as
the President of the Association of Public Health Laboratories,
APHL, and I am representing that organization today.
Given the critical role that public health laboratories
play in our Nation's public health system, I urge that you
adequately fund our efforts to provide bioterrorism and
chemical terrorism response to fight emerging infectious
diseases and to protect our citizens from environmental toxins.
Let me first address bioterrorism response.
During last year's anthrax attacks, our labs worked around
the clock processing specimens to ensure the health of the
public. Importantly, the testing that occurred in the public
health laboratories controlled fear and panic and reduced
excess costs to health care and our economy. I was told just
last week that our efforts in Iowa saved one corporation,
quote, millions of dollars, unquote, and that their corporate
colleagues had similar stories to tell.
The threat of bioterrorism is not over. Laboratories must
stand ready to identify organisms that could be used to
compromise food, water or air. For fiscal year 2003, we request
that you continue to fund the Emergency Supplemental Program at
the $940 million level. These funds will support the
laboratories that are part of the laboratory response network
by ensuring safe and secure facilities, trained personnel and
modern equipment. The funds will help the public health
laboratories to develop connectivity with the clinical and
hospital laboratories.
Last year the emergency supplemental fund did not contain a
section that would allow States to better prepare for chemical
terrorism. The likelihood that chemical agents will be used for
terrorist purposes is really high. Chemical agents can produce
immediate effects, are cheap and easy to use and widely
available commercially.
To prepare for chemical terrorism our States need trained
personnel and equipment to perform rapid screening for toxic
chemicals.
Let me next address the continuing threat of emerging
infectious diseases. Between 1973 and 1999, some 35 newly
infectious diseases were identified, for example AIDS,
Legionnaires' disease, Lyme disease, hantavirus pulmonary
syndrome and West Nile virus. Because we do not know what new
diseases will arise, laboratories must always be prepared for
the unexpected.
Last year a total of $354 million was appropriated for the
emerging infectious diseases program at NCID, the National
Center for Infectious Disease. For fiscal year 2003, APHL
requests that this be funded at $425 million level.
In the State of Ohio in 2001, the Ohio Department of Health
stopped an outbreak of meningitis. The work of the laboratory
in this outbreak helped stop a potential epidemic. CDC provides
guidance to the States to prepare for and respond to such
outbreaks.
Finally, let me explain the value that the environmental
health programs at CDC bring to our Nation. The Environmental
Health Laboratory Program is located at NCEH, the National
Center for Environmental Health. NCEH is recognized for its
expertise in biomonitoring and the assessment of exposure to
toxic substances by measuring them in blood and urine.
Last year $157 million was appropriated for the
environmental health programs at NCEH. For fiscal year 2003,
APHL recommends that this program be funded at the $203 million
level.
In 2001, NCEH awarded 25 planning grants totaling $5
million to 33 States to develop State-based monitoring programs
to help prevent disease from exposure to toxic substances.
Continued funding will allow these States to increase their
capacity to measure toxic substances in such vulnerable groups
as children, the elderly and women of child bearing age.
Adequate funding of NCEH will also ensure that newborn
screening programs in the States are of the highest quality.
In closing, I want to thank the members of the Committee
for this opportunity to testify and for your support of the
Nation's public health infrastructure and thus the Nation's
health.
[The prepared statement of Dr. Gilchrist follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood [presiding]. Thank you very much, Dr.
Gilchrist. I think sometimes the country at large thinks that
we have all these issues in hand and we know that sometimes we
don't. We appreciate your good work.
Dr. Gilchrist. Thanks for your understanding.
----------
Tuesday, April 30, 2002.
ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS
WITNESS
DR. GEORGE E. HARDY, JR., EXECUTIVE DIRECTOR, ASSOCIATION OF STATE AND
TERRITORIAL HEALTH OFFICIALS
Mr. Sherwood. Dr. George Hardy, State and Territorial
Health Officials.
Dr. Hardy. Yes, sir. Thank you, Mr. Sherwood. I appreciate
your tenacity hanging around to this late hour. I am very
congested.
CDC and HRSA are the Federal agencies that provide most
State health departments with essential resources to address
public health issues from terrorism through immunization,
chronic disease, HIV/AIDS, injury prevention and control, to
name just a few. ASTHO urges the committee to approve a total
CDC appropriation for 2003 of $7.9 billion and a total HRSA
appropriation of $7.5.
Let me begin by thanking the Committee for recognizing the
need in providing the critical initial funding to begin to
build the Nation's public health infrastructure. September 11
and the subsequent anthrax crisis served as a wakeup call for
us all. In responding to these events, we realize that many
health departments were not fully prepared. The overall
response was good, but resources were stretched to the limit.
Should a second major event have occurred at the same time, our
public health system response would likely have fallen far
short. We want to thank you for providing the initial resources
to strengthen our preparedness capacity.
The Administration's budget recognizes that improving
infrastructure will require a sustained investment over a
number of years and proposes a bioterrorism budget at CDC of
$1.5 billion and at HRSA of $618 million. We strongly support
those initial requests.
While the Nation is understandably focused on terrorism, we
hope this committee will not lose sight of the many other
important public health issues of the day. For example, this
year the Administration's budget proposes level funding for the
National Immunization Program. If we are to meet our goals of
immunizing 90 percent of children and appropriately immunizing
adults and adolescent populations, we must provide additional
resources. We support a $65 million increase above current
appropriations for the National Immunization Program.
As you also know, many States have been faced with severe
shortages of childhood vaccines in the past 2 years, and we
would urge this committee to ensure that a 6-month supply of
all childhood vaccines is made available through the VFC
stockpile program to address that issue.
More than 90 million Americans live with chronic diseases,
diseases characterized by a protracted course of illness
frequently associated with unnecessary pain and a decreased
quality of life. At a time when the Secretary has proclaimed a
national diabetes epidemic, only 16 States receive
comprehensive diabetes funding. Heart disease and stroke remain
leading causes of death and have even less funding, and no
States have comprehensive arthritis or physical activity and
nutrition programs.
This year, the Administration's budget proposes cutting
chronic disease funding by $57 million. We urge you to reject
that recommendation and provide instead an additional $350
million for this line.
Over the years, this committee has invested wisely in the
important work of NIH, but if the critical research findings
from that investment are just left on a shelf, they might just
as well not have been made. We sincerely hope that you will
provide the States the resources to translate existing research
findings into meaningful public health programs.
Since its inception 20 years ago, funding for the
Prevention Block Grant has been stagnant. We would urge you to
provide an increase of $75 million for this block grant.
In the interest of your time, we haven't touched on all of
the areas of CDC and HRSA budgets that deserve attention. The
Ryan White Care Program that you just heard about and the MCH
Block Grant are two such initiatives that are very important to
the States. We hope you will provide the $850 million being
requested by AMCHP for the block grant.
In conclusion, Mr. Sherwood, I want to thank you and all of
the members of this subcommittee for your commitment to public
health. With your support, we have been able to improve the
quality of life for millions of Americans. Still, we know there
is much more that can and must be done, and we respectfully
request your continued support to achieve the best health
status possible for all Americans.
I thank you for your attention, and I would be happy to
answer any questions you may have.
[The prepared statement of Dr. Hardy follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood. Thank you very much, Dr. Hardy. One of the
things we have discussed often on this Committee is the lag
between our new discoveries and getting them on the street, if
you will, and we have talked about that with the people from
NIH several times. Interesting to hear you bring it up again.
Dr. Hardy. It is absolutely critical, sir, and I mentioned
it in the area of chronic disease. As I am sure you will hear
later from Dr. Merchant, it is true in occupational health, it
is true in infectious disease. Tremendous and exciting things
have been learned, but they don't do the people any good until
they are translated into programs.
Mr. Sherwood. Thank you very much, sir.
----------
Tuesday, April 30, 2002.
NATIONAL ASSOCIATION FOR RURAL MENTAL HEALTH
WITNESS
DR. DONALD A. SAWYER, PRESIDENT, NATIONAL ASSOCIATION FOR RURAL MENTAL
HEALTH
Mr. Sherwood. Next we will have Dr. Donald Sawyer,
President of the National Association for Rural Mental Health.
Dr. Sawyer. Congressman Sherwood, Subcommittee staff, the
National Association for Rural Mental Health, or NARMH, is
pleased to be able to offer testimony to the Congressional
Subcommittee on Labor, Health and Human Services, Education and
Related Agencies.
NARMH was founded in 1977 in order to support mental health
and substance abuse providers in rural areas. NARMH is a
membership organization composed of approximately 500
organizations and individuals from across the United States.
Available national data indicates that mental illness is as
prevalent in rural areas as it is in urban locations. In
addition, it has long been reported that individuals in rural
areas are more likely to be without a source of health care,
without health insurance, in poor health and to be coping with
a chronic or serious illness than are individuals in urban
areas.
Health and mental health resources have historically been
concentrated in the urban areas of the United States. In
contrast, rural and frontier areas have fewer mental health
resources available despite sizeable populations. This limited
availability and accessibility of services creates serious
consequences for individuals, families and mental health
authorities when attempting to address the issues of mental
illness in rural areas.
The idealized myth of life in rural America has long
disregarded the substantial cultural and ethnic diversity as
well as the pervasive poverty found in these areas. One
critical area where a massive change has occurred is in the use
and abuse of substances. This upsurge has been chronicled in
many sources, but most recently an article in the New York
Times reporting a University of Michigan study which reported
that while drug use in cities has decreased, it has increased
significantly in rural areas and that crack is now more widely
used in eighth, tenth and twelfth graders in rural areas than
those in metropolitan areas, a truly significant finding.
It is important to recognize that in rural and frontier
areas mental and behavioral health services will be provided in
a variety of traditional and nontraditional settings. Most
individuals needing services will not have access to a mental
health center, and it is even less likely there will be a
private or not-for-profit program available which specializes
in the treatment of mental illness. Services will often be
delivered through the primary care system in schools, through
church-based programs or in small clinics, and while there may
be simply a single mental health generalist on staff, there are
a variety of other medical professionals.
During the past year a group comprised of several
organizations concerned with this issue met to fashion
recommendations to Congress and federal agencies. This group
included representatives from NARMH, the National Rural Health
Association, National Mental Health Association, American
Psychological Association, the private not-for-profit sector
Mental Health Liaison Group, and the Maine Rural Research
Center, and we collectively ask that you consider the six
recommendations that we developed for the Appropriations
Committee: first, that Congress increase funding for the Rural
Health Outreach Grant Program and that these funds target
behavioral health services as well as promote grass roots
community mental health; second, that Congress increase funding
for the Rural Telemedicine Grant Program and that these funds
should also focus on behavioral health care in rural areas;
third, that Congress increase funding for grants, scholarships
and/or expand loan repayments from mental health professionals
who will engage in rural practice; fourth, that funding be
increased for the Quentin Burdick Rural Interdisciplinary
Training Grant Program; fifth, that there be a funding increase
for CMHS and SAMSHA and require that 30 percent of the increase
be spent supporting both the development of consumer
organizations and the development of a document which will
provide communities and groups with a template of what can be
achieved in rural areas through the use of self-help groups and
consumer run services, and finally, that Congress provide
additional funding to the Office of Rural Health Policy to
continue the Sowing the Seeds of Hope Program, which provides
mental health services, much needed mental health services to
farm families in seven Midwest States.
I want to thank the Committee for hearing my testimony
today.
[The prepared statement of Dr. Sawyer follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood. Thank you, Dr. Sawyer. And it was interesting
data on rural--little harder to admit in rural areas that you
have a mental health problem.
Dr. Sawyer. It is true. There is significant stigma
associated with it and because of the smallness of the
community it is often hard to get services in confidential
manner so it is a difficult challenge.
Mr. Sherwood. Thank you very much.
----------
Tuesday, April 30, 2002.
NATIONAL ALLIANCE FOR NUTRITION AND ACTIVITY
WITNESS
DR. MOHAMMAD AKHTER, EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH
ASSOCIATION
Mr. Sherwood. Next we have Dr. Mohammad Akhter, Executive
Director, American Public Health Association. Welcome, Doctor.
Dr. Akhter. Thank you, Mr. Chairman. My name is Mohammad
Akhter. I am the Executive Director of the American Public
Health Association. I appreciate this opportunity to appear
before you, Mr. Chairman, today. I am representing here 200
different organizations, professional, medical, health,
industry as well as food safety organizations, and all of us
are interested in one thing and one thing alone, prevention of
chronic disease, prevention of obesity and healthy eating and
exercise, and that is why I am here representing them, to
present to you what we think we need to do.
Our Nation's greatest health threat is obesity. Over the
past 20 years obesity rates have doubled in children. During
the past decades rates among adults have increased by 60
percent. Almost two-thirds of the American adults are now
seriously overweight or obese, putting them at increased risks
for disabilities and life-threatening diseases such as heart
disease, stroke, cancer, high blood pressure and diabetes.
The negative health consequences of obesity are already
evident. The rate of diabetes increased by 50 percent between
1990 and 2000. Due to the rising rates among children, type 2
diabetes can no longer be called adult onset diabetes. Younger
children are getting that.
Heart disease is also associated with obesity. Sixty
percent of overweight children already have high cholesterol,
high blood pressure, or other early warning signs of heart
disease. Poor diet and physical activities are cross-cutting
factors for many diseases. Four out of the six leading causes
of death in our Nation, overweight, obesity and lack of
exercise, deal with those. Heart disease, cancer, stroke and
diabetes all have this in common. They contribute somewhere
between 300,000 to 600,000 deaths annually. In addition, they
lead to many disabilities, including blindness from diabetes or
hip fracture from osteoporosis or stroke leading to loss of
independence.
Mr. Chairman, poor diet and lack of physical activity costs
our Nation more than $147 billion each year. This cost could be
reduced by helping families to eat better and to be more
effective.
A federal investment now in our population-based primary
prevention to decrease the rate of chronic diseases will pay
for itself in the future reduction in Medicaid-Medicare costs.
Government programs to encourage Americans to eat a
healthier diet and to be more physically active remain
underdeveloped. The CDC's Division of Nutrition and Physical
Activity is a good start, but it reaches only a small fraction
of the American public.
Current funding of $27.6 million a year allows CDC to have
a program only in 12 States. The National Alliance for
Nutrition and Physical Activity urges the Committee to support
a fiscal 2003 funding level of 60 million for nutrition,
physical activity and obesity at CDC. This level will allow it
to have programs in at least 24 States.
Mr. Chairman, the rate of obesity is increasing too fast.
And at the current rate of increase of funding, it will take us
10 more years to be able to fund our States. So we very much
encourage the Committee to consider funding this program to a
$60 million tune because we can't afford to wait 10 years to
fund programs in each and every State.
Mr. Chairman and members of the Committee, we also want to
thank you for your support of the CDC's Youth Media Campaign.
This is the program where the media is used to educate the
youth in terms of eating right and doing physical activity. We
have learned that use of the media is the best way to reach our
children. It has been evident in smoking cessation, in drinking
low fat milk and in carrying out physical activities,
especially walking. We believe the program should be enhanced
and this program should be funded, and CDC is doing great work
in supporting this activity and we believe that funding of this
program at $125 million would go a long way in helping our
youth to grow up to be healthy adults.
In conclusion, Mr. Chairman, we are grateful for the
previous increases to the Nutrition and Physical Activities
Program at the CDC and for your additional support for the
Youth Media Campaign, but the growth must be significantly
increased this year to be able to meet the increased demand so
we can have a nationwide program. Now is the best time to
invest in our Nation's comprehensive approach to deal with this
problem. The CDC is the best agency and this investment will
continue to pay dividends over the years to come in terms of a
healthy Nation and greater productivity for our country.
Thank you, Mr. Chairman, for the opportunity.
[The prepared statement of Dr. Akhter follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood. Thank you, Doctor. And you told us what we
heard before, that so many of our health problems are
behavioral. And when you talk about reaching the young people,
I wonder what liaison you have with the American public school
system, because, you know, that is a great way to reach 80
percent of the young people.
Dr. Akhter. We have a very good working relationship with
the school system. Part of the school system, the School
Nursing Association and Nutrition Educators are members of this
coalition, 200 groups of people. We are working on all fronts,
but a little bit of resources, very small amount of money could
go a long way in terms of delivering the message to our
children all around the country.
Mr. Sherwood. I worry about the programs of the Cola
companies to give free scoreboards to a school if they will put
Coke machines or Pepsi machines in the school, because I
understand that for every second large soft drink that a child
drinks every day they increase their chances of being obese by
85 percent. That is a terrifying statistic.
Dr. Akhter. Absolutely, Mr. Chairman, and they are spending
a lot of money, $860 million a year to promote Coca-Cola
drinking. And on the other hand, we are asking $125 million to
undo some of these things that they are promoting so
rigorously. I think we have to have a counter campaign so the
youth can hear the message from the other side and could make
the right decision.
Mr. Sherwood. Your third paragraph on the second page I
think sums it up: Healthy eating, physically active and
maintaining a healthy weight are not an easy task because of
our society. Portion sizes are large, communities are designed
for driving rather than walking and physical education is being
crowded out of school curriculums. It seems like a lot of the
progress we have made since World War II is not progress in
certain respects.
Dr. Akhter. In some sense there are side effects to all the
progress, but they are fixable, they are doable things. I think
many communities are now having the sidewalks. The people walk.
But these are the kinds of things we need to take a natural
approach, working with the State and local health departments,
to make sure that every community has a program that encourages
walking rather than driving, that encourages healthy eating and
work with the food industry to have an adequate size of the
meal.
Mr. Sherwood. Number one, reduce caloric intake; number
two, exercise more.
Dr. Akhter. You said it well.
Mr. Sherwood. Thank you very much, Doctor.
----------
Tuesday, April 30, 2002.
BASSETT HEALTHCARE
WITNESS
DR. WILLIAM F. STRECK, PRESIDENT AND CHIEF EXECUTIVE OFFICER, BASSETT
HEALTHCARE
Mr. Sherwood. Now we would like to welcome Dr. William
Streck. Did I say that right, Streck?
Dr. Streck. You did, sir. Thank you, Mr. Sherwood. Thank
you, staff members. I have submitted my written testimony and I
would propose to provide a summary of the executive summary I
submitted.
I am Bill Streck, the President of Bassett Healthcare based
in Cooperstown, New York. Cooperstown is the site of the
National Baseball Hall of Fame and also privileged to be
represented by Congressman Boehlert.
Cooperstown is also the site of Bassett Healthcare, which
is celebrating its 75th year as a social experiment in health
care. It is an academic rural health center and has been since
its origin a teaching hospital with research. It actually
launched the first prepaid health plan in 1929. It was the site
of the first bone marrow transplant in the 1950s. It is more
recently a center for New York Agricultural Medicine and
Health, a research institute that is focused on population
studies and, more recently, obesity, and it is an organization
that now spans eight counties in central New York, provides
services to about half a million people a year, is based with
20 different primary care centers in rural areas, a teaching
hospital is the center, two other hospitals and all in all is a
complex delivery system that provides research and education
enterprises for a rural area.
This particular institution, in conjunction with the New
York State Department of Health, took it upon itself to look at
cardiac disease in this rural area, and we have in concurrence
with the New York State Department of Health developed the
Bassett Heart Care Initiative, an initiative that involves the
Cardiac Disease Registry that involves community intervention
and that fundamentally looks at the way health care is
delivered to patients needing cardiac care.
This arrangement is one that is unique, and we are here
seeking your support for those components of the initiative
that are necessary to continue this forward. This includes some
capital improvements on our campus. It includes the development
of the program in conjunction with the department, all of which
is detailed in the written testimony, but fundamentally we are
here offering for what, based on earlier conversation, would be
a modest sum of a million dollars, but this would be a
substantial contribution toward our effort to effectively
introduce new levels of health care in rural America and
establish a research base for ongoing policy research that
would be applicable beyond our particular locale.
So that is the purpose of our request to this Committee,
and we are appreciative of the consideration.
[The prepared statement of Dr. Streck follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood. Thank you very much. Only in Washington,
D.C., is a million dollars a modest sum. But for leather
stocking health care it would be worth it, and thank you very
much. Your organization has a wonderful reputation, you know.
My congressional district is just south of Binghamton a little
bit.
Dr. Streck. You have the Guthrie Health Center?
Mr. Sherwood. I do.
Dr. Streck. So you know Ralph Meyer. We will talk about
those people at another time, but it is a pleasure and
certainly that is another premier health system and one with
which I am very familiar.
Mr. Sherwood. Thank you very much.
----------
Tuesday, April 30, 2002.
FRIENDS OF NIOSH COALITION
WITNESS
DR. JAMES A. MERCHANT, DEAN, COLLEGE OF PUBLIC HEALTH AND PROFESSOR,
DEPARTMENT OF OCCUPATIONAL ENVIRONMENTAL HEALTH, UNIVERSITY OF IOWA
Mr. Sherwood. Dr. Merchant. You would--how do you get the
position of being last today?
Dr. Merchant. Well, Congressman Sherwood, I appreciate the
opportunity to testify and thank you for persevering and thanks
to the staff, too, for persevering to the end of this hearing.
I am here today on behalf of the Friends of NIOSH, or
National Institute for Occupational Safety and Health, a unit
of the CDC. This is a coalition of 15 organizations
representing industry, labor and scientific organizations which
are dedicated to supporting NIOSH research and prevention
programs.
Today the Friends of NIOSH requests the Subcommittee to
provide $336.5 million, or an increase of $60 million, for
fiscal year 2003 programs for NIOSH. This is a substantial
increase, but the contributions of NIOSH are enormous.
Mr. Chairman, occupational illness and injury continue to
be a significant problem in the United States. Every day an
average of 9,000 U.S. workers sustain disabling work-related
injuries, 16 will die from an injury and another 137 will die
from a work-related disease.
Despite these sobering statistics, I firmly believe that we
can and will continue to make U.S. workplaces safer for all
Americans. Through research, surveillance, education and
training, NIOSH is working with industry, labor and the
scientific community to make all workplaces safe and
productive.
Since its inception in 1996, NIOSH's National Occupational
Research Agenda, or NORA, has become an essential framework for
approaching work-related illness and injury. NORA has
identified the most important research priorities, including
high hazard industries like construction, mining and
agriculture and the health care industry, and has provided
funding in these areas. However, much more research is needed
for emerging priorities, including workplace violence
prevention and research.
In the days following September 11 and the anthrax attacks
on U.S. citizens and the U.S. Congress, it became clear that
America's workers, whether airline pilots and crew, first
responders, office workers or postal employees, are on the
front lines when the Nation faces terrorist attacks. All of
those who died on 9/11 did so while at work. In response, fire
fighters, medical personnel and other emergency responders,
construction workers and decontamination workers relied on the
know-how, technology and guidance developed through NIOSH
occupational safety health and research.
However, more research is needed, especially through
NIOSH's Personal Protective Technology Laboratory, to protect
first responders from potential biological and chemical agents
and terrorist attacks. NIOSH is also poised to work with the
extramural community to expand its research to protect
emergency responders and the workforce in general from the
threat of bioterrorism and chemical terrorism.
Mr. Chairman, the hardest problem to fix is the one that
you do not know about. That is why surveillance of workplace
injuries and illnesses is a central part of NIOSH's mission.
Accurate accounts of work-related illnesses and injuries and
reliable measures of hazardous exposures are required of
focused research and prevention activities. Establishing
occupational safety and health surveillance or tracking within
State-based public health programs is the most effective way to
build a national system for identifying and responding to
workplace conditions and risks.
While NIOSH annually responds to health hazard evaluations
of workplace illnesses and injuries, recently NIOSH has
necessarily given priority to the tragic events of 9/11 and the
ensuing anthrax attacks. NIOSH's health hazard evaluation staff
played an immediate and key role in assessing the health
problems and injuries resulting from the World Trade Center
attack and provided key expertise and hands-on assistance in
response to the anthrax emergency. Both the rise in demand of
the NIOSH Health Hazard Evaluation Program and the recent
terrorist events have severely taxed the resources of the NIOSH
Health Hazard Evaluation Program and its other prevention
efforts. Additional support for these key programs would enable
NIOSH to expand these critical activities and prepare for the
probable terrorist attacks in the future.
Mr. Chairman, reliable prevention and effective treatment
of work-related diseases and injuries require professionals who
are trained in the occupational safety and health disciplines.
A recent Institute of Medicine report identified a need for
more occupational safety and health professionals at all
levels.
Unlike most of the 24 medical specialties, occupational
medicine does not receive training through the Medicare
Graduate Medical Education Payment System. NIOSH's 16 education
and research centers at leading universities around the country
and the 35 training project grants in 22 States and Puerto Rico
are an essential resource for training occupational health
professionals. Increased support for this national training
network is also necessary for general public health
preparedness.
In conclusion, NIOSH research, health hazard response,
health tracking and training programs are vital elements of our
Nation's security. Friends of NIOSH appreciate the opportunity
to comment on these essential programs and the funding needs of
the National Institute of Occupational Safety and Health. Thank
you for hearing our views.
[The prepared statement of Dr. Merchant follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Sherwood. Thank you very much, Doctor, and you
mentioned first responders. The training of first responders is
quite important in light of our 9/11 experience. They did such
a good job in New York, but we are bound to have some things
pop up that we are not prepared for.
Dr. Merchant. An enormous training need. We have been
working with the CDC, and Palmer Beasly mentioned these
preparedness centers in working with NIOSH, and we learned a
lot from NIOSH. We developed a training video for every first
responder unit in Iowa, every police department, every fire
department, every EMS unit, because many of them had not had
the essential training in terms of how to recognize hazardous
substances and some of the basics of personal protective
equipment. This is what NIOSH specializes in, and this is the
enormous contribution they made at the time of 9/11 and with
the anthrax outbreak we had earlier this year.
Mr. Sherwood. The hearing stands adjourned. Thank you all.
Thursday, May 2, 2002.
INTERNATIONAL HYPERBARIC MEDICAL ASSOCIATION
WITNESS
DR. PAUL HARCH, PRESIDENT, INTERNATIONAL HYPERBARIC MEDICAL ASSOCIATION
Mr. Regula. Okay, we'll get started, because we have a long
list today, and we'll probably get some interruptions for
votes.
We're happy to welcome all of you. These are important
issues. I just came from my office full of people with
diabetes. And they're convinced that, maybe so, another couple
of dollars and there will be a cure. I'm sure you feel the same
way about whatever you're dealing with.
The United States has done a remarkable job in research. I
was impressed the other day, the NIH people testified that
every five years, life expectancy goes up a year. So in 50
years, that's 10 years. And that's thanks to the research
that's done and a lot of what's happening, good diet and a lot
of things that are pluses.
Well, we want to get started, because we want to give
everybody an opportunity. Our first witness will be introduced
by David Vitter, from the great State of Louisiana.
Mr. Vitter. Thank you very much, Mr. Chairman. I'm pinch
hitting today for Ernest Istook, but I'm very, very happy and
honored to introduce Dr. Paul Harch from Louisiana. He's an
emergency and hyperbaric medicine physician who graduated magna
cum laude and phi beta kappa from the University of California
Irvine in 1976 with a bachelor's degree in biology and
subsequently from Johns Hopkins Medical School in 1980. He
completed two years of general surgery training at the
University of Colorado, one year of radiology at LSU School of
Medicine, has worked 17 years in hospital based emergency
medicine and 15 years in hyperbaric and diving medicine.
His primary interests have been brain decompression
sickness and hyperbaric oxygen therapy, base-spec brain imaging
index neurorehabilitation. He is going to obviously talk more
about his work. It has been very, very promising, having
treated over 180 children and 320 adults. And he's now
recognized as one of the foremost authorities in the U.S. on
hyperbaric oxygen therapy.
In that capacity, he's been elected as the first president
of the newly formed International Hyperbaric Medical
Association. And with that, I'm very pleased to present Dr.
Harch.
Mr. Regula. Dr. Harch, thank you for coming. Let me say to
all of you, because we have 25 witnesses today, we have to
limit you to five minutes. I'm sorry, but there just isn't any
choice. And there's a little box on the desk that gives you a
warning when the time is about to expire. If I ask questions,
that's on my time.
Dr. Harch. Thank you. Chairman Regula and members of the
Committee, I first want to thank you for the opportunity to
testify today. My name is Paul Harch, and as Mr. Vitter said, I
am an emergency and hyperbaric medicine physician who is here
representing the International Hyperbaric Medical Association
and brain injured Americans. I'm not here to ask for money. I'm
here to show you how we can save money and improve the health,
welfare and outcomes of brain injured Americans.
What I'd like to say is that simply, we have a treatment
for brain injury that is----
Mr. Regula. All types of brain injury?
Dr. Harch. Almost all types. We have looked at this now in
over 500 patients over the last 12 years and 50 different brain
based neurological conditions. This is a generic treatment for
brain injury with, I believe, the capacity to revolutionize the
treatment of brain injury in the world.
Amongst these 500 patients have been 180 children. The
first five brain-injured children in the United States treated
with hyperbaric oxygen therapy were treated by me in New
Orleans. Many of these children have cerebral palsy, autism,
near-drowning, a variety of neurological disorders. And many of
them include IDEA children, who as you know, the Federal and
State Government is now spending $55 billion a year to attempt
to educate, when they don't have the capacity to learn, often
from organic brain injury.
This treatment, as we have shown in a number of these
children, can give them the capacity to learn. And the cost is
roughly about a year to a year and a half of the education
support money.
What I wanted to show you today was that this can be
applied in a variety of conditions. After presenting this in
1992 through 1995 to scientific meetings and experiencing a
fair amount of criticism, I went to an animal model. We have
now done this and replicated this in animals and have the
first-ever demonstration of improvement of chronic brain injury
in animals.
What I wanted to show you today and just mention quickly
about diabetes, this is actually the only modality that can
prevent major amputations in diabetics with foot wounds, which
as you know is a major failed target of the Healthy People 2000
initiative. What I'm going to show you here today is, there are
a few examples of what can be done.
And the patient here, whose brain scans are on the poster,
is one of Mr. Istook's constituents. This is the first
Alzheimer's patient in the United States and possibly the world
treated with hyperbaric oxygen therapy for his Alzheimer's. He
was a 58 year old architect who of course had lost his job and
now needs 24 hour supervision and accompaniment by his wife.
After a lecture I gave at the University of Oklahoma Health
Science Center, the neurology group referred him as a test
case. What you're looking at here are brain blood flow scans.
The way brain blood flow in the brain works is similar to a
gasoline engine. More gasoline, more blood flow, more RPMs to
the engine, better metabolism to the brain.
If you look at these pictures, these are three dimensional
reconstructions of the human brain blood flow. On top here is
the brain scan before treatment and this is the face view.
We're looking right at the patient. The eyes would sit here,
and wherever there are holes in the brain are significant
reductions in blood flow. This is the right side view and this
is the left side view, and here is the top view. Where the
three major arteries in the brain on each side come together is
right here, on each side. That's the most vulnerable area for
brain injury. It's the area primarily injured in Alzheimer's.
After three and a half months of treatment, 89 hyperbaric
treatments, you see how all of these damaged areas of the brain
have begun to fill in. Simultaneously, he was tested by the
neuropsychologist at University of Oklahoma----
Mr. Regula. We've got about a minute left. Tell me what the
process is.
Dr. Harch. It is putting a patient in an enclosed chamber,
decreasing the pressure and giving them pure oxygen. It
dissolves in the blood and you're able to put the oxygen in the
liquid portion of the blood, above and beyond what is bound to
hemoglobin in our red blood cells, which as you and I now have,
100 percent saturation. It's then delivered to injured areas in
the body, and by repetitive exposure, you grow new blood
vessels, you stimulate damaged cells to begin repair.
Mr. Regula. Because there's a more intense flow of oxygen
to the injured, in this case the brain area.
Dr. Harch. Exactly. And it's an ability to restore, not
dead, but damaged tissue that is not functioning.
Mr. Regula. Okay. You developed the process. It is being
used or is it still in an experimental stage?
Dr. Harch. It is being used for a variety of other
indications. And increasingly so for this, at a number of
centers in the United States.
Mr. Regula. Has NIH done any experimentation with this?
Dr. Harch. No. Well, there has been some in the past, on
senility and some other neurological disorders.
[The prepared statement of Dr. Harch follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, thank you very much. We'll read your
paper, and I know the staff will be interested. It's a
challenging idea. Because we deal with a lot of Alzheimer's, a
lot of brain injuries, it could revolutionize the treatment.
Dr. Harch. Thank you, I agree.
Mr. Regula. Thank you for coming.
----------
Thursday, May 2, 2002.
ACADEMY OF RADIOLOGY RESEARCH
WITNESS
DR. PHILIP O. ALDERSON, CHAIRMAN, DEPARTMENT OF RADIOLOGY, COLUMBIA
UNIVERSITY; PRESIDENT, ACADEMY OF RADIOLOGY RESEARCH
Mr. Regula. Our next witness is Dr. Philip Alderson,
Chairman, Department of Radiology at Columbia University,
President of the Academy of Radiology Research. Welcome, Dr.
Alderson.
Dr. Alderson. Thank you, Mr. Chairman.
I represent the Academy of Radiology Research, which
represents more than 30,000 radiologists, imaging scientists
and allied professionals, as well as over 90,000 imaging
technologists. And Mr. Chairman, I appreciate the opportunity
to speak on the fiscal year 2003 budget for the National
Institute of Biomedical Imaging and Bioengineering.
NIBIB will support research in both biomedical engineering
and in imaging. The two fields are closely related
scientifically. And we are working closely with our engineering
colleagues to take full advantage of the synergies.
In the recent words of NIH Director Nominee Elias Zerhouni,
we need to encourage cross-cutting initiatives. And also the
recent words of Acting Director Ruth Kirschstein, a cross-
cutting institute such as NIBIB is truly a reflection of where
science is today and where it will take us tomorrow. I strongly
agree with both Dr. Zerhouni and Dr. Kirschstein. A cross-
cutting technology has had and will continue to have an
enormous positive impact on clinical care and advanced
biomedical research.
Imaging science has already revolutionized medical care.
And the second revolution is already underway, a revolution in
which imaging will allow us not only to visualize diseases, but
to see and measure those diseases and find out how they
actually work, witness the display from our first witness
today.
The techniques for imaging biological activity at the
cellular and molecular levels could produce images of genetic
or molecular activity that signal disease processes much
earlier than we can now, a multitude of infectious,
degenerative immunological diseases or even cancer. So as a
result, physicians could begin disease treatment earlier, for
example, breast cancer or prostate cancer. And then do much
better for their patients.
Basic cross-cutting research in molecular imaging supported
by NIBIB could make broadly applicable new diagnostic tools
available more quickly than would be possible, if disease-
specific research in the other institutes were the only way to
accomplish these goals at the NIH. And new techniques developed
in NIBIB could be applied to studies in all the other
institutes.
The NIBIB is planning a number of promising initiatives
that are likely to result in breakthroughs in both imaging
science and biomedical engineering. Unfortunately, there is a
large gap between the science to be done and the funds
available. The budget requested for 2003 includes only a $9
million increase for NIBIB, a level that will severely reduce
its capability to fund research to develop new biosensors, to
build new and better imaging systems, to develop image guided
surgical approaches, just to name only a few of the many, many
great potential initiatives that NIBIB is exploring.
Unless something is done to change the current budget plan,
scientific opportunities will be lost. According to NIBIB
budget documents, the Institute will fund 100 new competing
research grants in the current fiscal year, but only 49 in 2003
if the budget request is enacted. We cannot build a new
institute on a shrinking research program, especially when we
begin with what is the smallest institute at the NIH.
Moreover, it's anticipated that NIBIB will be able to fund
only 14 percent of the research proposals it receives for 2003,
whereas it is currently able to fund 30 percent, which is in
line with the other institutes. If that rate is only 14 percent
next year, there surely will be widespread and severe
discouragement among researchers.
Stifling the growth of the NIBIB at this early stage would
be especially tragic because of its potential to attract new
investigators, scientists who have not previously been
supported by NIH to biomedical research. In particular, the
NIBIB provides a research home at NIH for physical, in addition
to biological, science. Investments in NIBIB will create
opportunities for closer collaborations between the physical
and biological scientists, and will unquestionably benefit both
areas.
This potential expansion of the scientific talent focused
on biomedical questions will not happen, however, unless NIBIB
has sufficient resources to meet the demand created by the many
high quality research proposals. The imaging and biomedical
engineering communities believe that an increase of $100
million for NIBIB in fiscal year 2003, over and above the
results of the current review of imaging and bioengineering
grants at the NIH, is needed. Such an increase could be managed
effectively by the NIBIB staff, would allow the institute to
begin to explore current scientific opportunities and would
provide a foundation for appropriate growth in the future.
I would be pleased to answer questions.
[The prepared statement of Dr. Alderson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for coming today, and we will discuss
this with the NIH folks. I'm not sure why the reduction, but
maybe they have a reason. In any event, we'll check with them.
Thank you.
Dr. Alderson. Thank you very much.
----------
Thursday, May 2, 2002.
HEINZ C. PRECHTER FUND FOR MANIC DEPRESSION
WITNESS
WALTRAUD E. PRECHTER, PRESIDENT, HEINZ C. PRECHTER FUND FOR MANIC
DEPRESSION
Mr. Regula. Our next witness is Waltraud Prechter, who will
be introduced by our good friend, John Dingell.
Mr. Dingell. Mr. Chairman, thank you for your courtesy to
me and to my dear friend, Waltraud Prechter. I will be brief in
my introduction. First of all, thank you. I am proud to
introduce a very good personal friend of mine, Wally Prechter.
She and her late husband have been community leaders in
southeast Michigan for over 20 years.
The family founded the World Heritage Foundation, a major
philanthropic entity dedicated to helping make a difference in
the areas of health, education, welfare, arts, culture and the
community. The Foundation also fosters innovative public and
private sector partnership, entrepreneurial development and
German-American relations. Ms. Prechter has been the President
of the World Heritage Foundation since 1985, when it was
conceived.
She has been a positive force in our community and a model
citizen. She serves in numerous leadership positions including
the University of Michigan Health Care Advisory Group, Wayne
State University's Detroit Medical Center Women's Clinical
Services Board, the Detroit Symphony Orchestra and the
Downriver Council for the Arts. She is a bright light in our
community and our country. It's a privilege to present her to
the Committee this morning. She will speak on an issue that has
great impact on families and communities across the country.
I'm proud to introduce Wally Prechter.
Ms. Prechter. Thank you, Mr. Dingell. Chairman Regula,
members of the Committee, my name is Wally Prechter, Waltraud
Prechter. I thank the Committee and also wish to thank
Representatives Dingell and Rogers for making this possible.
I am President of a foundation my children and I
established last year in my husband's memory, the Heinz C.
Prechter Fund for Manic Depression. I greatly appreciate the
opportunity to speak to you today as a wife, mother and an
individual whose life has been touched by the insidious illness
called manic depression.
I will never forget July 6th, 2001. Heinz, my husband of 24
years, seemed to feel far better than he had in months. After
struggling with his third bout of manic depression in over
three decades, the hopelessness that immobilized him seemed to
have lifted. He rose early for a workout, and I was relieved
and elated.
However, my feelings of joy were short-lived. Only minutes
later, I discovered Heinz in the guest house. He had taken his
life. He left without a word, there were no goodbyes to our
twin children, Paul and Stephanie, and there was no goodbye for
me. He was 59 years old.
He embodied the American dream. I have tried to do justice
to his life in the full testimony I submitted to the Committee.
Let me just say here that he came to this country with only $11
in his pocket, but he went on to introduce the sunroof to
America, and built a premier global supplier of specialty
vehicles and open air systems.
He also was a philanthropist and he felt a deep obligation
to give back to his community and his new country. He became a
citizen and believed deeply in the American dream.
At the height of his career, my husband fell victim to
suicide. Heinz was one of 30,000 fellow Americans who took
their lives last year. That, Mr. Chairman, represents one
person taking his or her life every 17 minutes.
Many of those individuals suffer from manic depression or
bipolar, experience extreme changes in mood, thought, energy,
behavior and productivity. It affects an estimated 2.7 million
adult Americans. As debilitating as blindness or paraplegia,
manic depression destroys the ability to reason, motivate,
communicate, share ideas and thoughts and productive
relationships. Thereby, manic depression erodes the very
foundation of America's information economy and economy of
mental performance.
Bipolar disorder contributes to billions of dollars in
economic loss due to lost productivity, absenteeism and
premature death. Mr. Chairman, it's an illness that our great
country can no longer afford. In order to prevent others from
going through what our family went through, we established the
Heinz C. Prechter Fund for Manic Depression in his memory. The
fund will engage the best and brightest researchers to advance
medical research to find cures for bipolar disorder.
But we and other similar organizations cannot do this
alone. While the Federal Government has begun to address this
problem, much more needs to be done. That is why I am here
today. My request of this Committee is three-fold.
First, I wish to thank the Congress for increasing funding
for research at the National Institutes of Health. While this
is a significant accomplishment, research funding at the
National Institute of Mental Health is lagging behind. I would
respectfully ask this Committee to ensure that funding at the
NIMH increases on a par with other institutes.
Secondly, I would ask the Committee to encourage NIMH to
provide bipolar disorder with its proportionate share of
funding increases for mental research. Even more importantly, I
would suggest for NIMH to focus its bipolar research on
unlocking the underlying genetic causes of this insidious
hereditary disease, as well as developing effective and safe
treatment options.
As in the case of cancer or AIDS, we as a Nation should
commit ourselves to finding cures for this condition that
affects millions of Americans.
Lastly, I would ask you to urge the Department of Health
and Human Services to convene a national symposium to create a
research road map to finding cures for bipolar disorder. As I
noted in my written testimony, a national strategy for suicide
prevention was successfully developed as a result of such a
conference.
That 1998 conference brought together the best and
brightest researchers and clinicians, mental health advocacy
groups, and affected individuals. Since bipolar disorder is a
significant factor in many suicides, this type of national
approach is certainly warranted.
I appreciate the Committee's consideration of these
requests. I am humbled and deeply honored to share my story
with you. Mine is just one story of thousands of untold stories
all over America. It is my hope that starting today, we will
jointly embark on a journey in pursuit of a new frontier, to
battle the illness that robs us of our loved ones and to find
cures for manic depression. I urge you, Mr. Chairman and
distinguished members of the Committee, to do whatever is in
your power to support our endeavor which will lead to a
healthier, happier and more productive America.
Thank you.
[The prepared statement of Ms. Prechter follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for coming. I knew your husband well,
he was a wonderful man. I'm on the board of the Smithsonian,
and he was on the Board of Advisors there, and was just a good
citizen in a lot of different ways. Obviously this is something
we should address. The numbers are much greater than I would
have thought from listening to your testimony.
Ms. Prechter. That's correct.
Mr. Regula. I know when I heard about Heinz, it was a real
shock to me, because he was such a dynamic personality. It's
something that's impossible to understand.
Ms. Prechter. Thank you very much.
Mr. Regula. Thank you for coming.
Mr. Dingell. Mr. Chairman, thank you for your courtesy.
----------
Thursday, May 2, 2002.
NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY
WITNESS
DR. MICHAEL D. JENSEN, M.D., PRESIDENT, NORTH AMERICAN ASSOCIATION FOR
THE STUDY OF OBESITY
Mr. Regula. Our next witness is Dr. Michael Jensen,
President of the North American Association for the Study of
Obesity.
Thank you for coming.
Dr. Michael Jensen. Thank you, Chairman Regula, members of
the Subcommittee. Thank you for the opportunity to testify
before you on behalf of NAASO, the North American Association
for the Study of Obesity. I am Dr. Michael Jensen, the
President of NAASO. NAASO is America's leading obesity
organization. Our membership is comprised of the leading
scientists and clinicians in this field.
I'm here to testify as to the importance of federally
funded programs that support obesity research and prevention.
The scientific advances we've made in the last 10 years could
not have happened without the support expressed by this
Committee. Obesity is quickly becoming the leading health care
problem in the United States. It is a complex disease that
involves genetic, metabolic, behavioral and environmental
factors. The increased prevalence and causal relationship with
serious medical complications has considerable health and
economic consequences for our country.
For example, the prevalence of obesity has doubled in the
last 20 years. Approximately 60 percent of adults and 15
percent of children are now overweight or obese. It is the
number two preventable cause of death in the United States,
resulting in more than 300,000 lost lives each year, and more
than $61 billion in obesity related health care expenses. We
are now seeing children with adult type obesity diseases, such
as type 2 diabetes.
In short, obesity is an expensive, growing epidemic that
has the potential to bankrupt our health care system. We
believe that increased research for understanding, preventing
and treating obesity will decrease the prevalence of costly
obesity related diseases, like diabetes, high blood pressure,
coronary diseases, and could ultimately result in considerable
financial savings.
Research funding supported by this Committee has led to
some remarkable advances in our understanding of obesity. It's
revolutionized how we understand how the brain regulates food
intake. We've determined the amount of physical activity
required to prevent weight re-gain, and what properties of food
promote over-eating. We've demonstrated that behavioral and
lifestyle changes that result in only a 6 percent weight loss
can result in a 58 percent decrease in the risk of developing
diabetes.
I think it's important to build on these accomplishments.
Future research should be directed at developing more effective
prevention strategies, improving obesity treatment and
improving our understanding of how excess fat impairs health.
Regarding prevention, the current obesity epidemic can be
attributed in large part to an environment that discourages
physical activity and encourages over-eating. This is
particularly true in children. To be successful, prevention
efforts are going to need to target the environment. In the
past, we thought that educating people to eat less and exercise
more would solve the problem. Thanks to research, we have
learned why this is not true. And we can now develop sound,
scientific approaches for treatment and prevention. The efforts
in the CDC in obesity prevention should be fully supported.
Regarding treatment, much of the information gained on
weight management strategies has not been effectively
translated into treatment. Additional research is needed to
identify the means to sustain long term changes in eating and
physical activity behavior. I think the most exciting new
developments in obesity therapy will probably be derived from
research that improves our understanding of how our body
regulates fat. This may lead to development of new and
effective treatments that safely mimic the body's natural
defenses against obesity.
In addition, if we can understand the links between excess
fat and other diseases, we should be able to prevent the organ
and tissue damage that relates to excess body fat. If we can
learn more about how the brain regulates energy intake,
physical activity and how it controls body fat, we may be able
to make the kind of rapid progress in prevention and treatment
that has been accomplished in other areas, such as high blood
pressure and high cholesterol. These scientific advances could
result in savings of billions of dollars in health care costs.
The NIH has a great track record of successfully addressing
health problems and could do the same for obesity. But the NIH
currently plans on allocating 1 percent of its total budget to
obesity research. NAASO feels strongly that this is
inconsistent with the scope of the problem. We urge this
Committee to double the amount spent on obesity research. Two
percent of the NIH budget for the number two health problem is
not too much to ask.
Thank you.
[The prepared statement of Dr. Michael Jensen follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. You're really trying to change, to some degree,
people's lifestyle, isn't that a factor?
Dr. Michael Jensen. And allowing the change to be made in
such a way that people can do it. We just haven't been able to
do that yet.
Mr. Regula. We need one of those things like smokers get,
they can put a patch on and it discourages it.
Dr. Michael Jensen. If we understood what regulated it,
that would be a great approach.
Mr. Regula. Thank you for coming. It is a problem, and it's
one of the factors that we have such a wide range of foods
available in our country, and plenty of it. It's not an easy
answer.
----------
Thursday, May 2, 2002.
RESEARCH SOCIETY ON ALCOHOLISM
WITNESS
STEPHANIE O'MALLEY, DIRECTOR, DIVISION OF SUBSTANCE ABUSE RESEARCH,
DEPARTMENT OF PSYCHIATRY, YALE UNIVERSITY, PRESIDENT, RESEARCH
SOCIETY ON ALCOHOLISM
Mr. Regula. Our next witness is Dr. Stephanie O'Malley,
Director, Division of Substance Abuse Research, Department of
Psychiatry, Yale University. Welcome.
Dr. O'Malley. Good morning, Mr. Chairman and members of the
Subcommittee. Thank you for the opportunity to speak today.
In addition to the credentials you mentioned, I'm here as
the President of the Research Society on Alcoholism to present
testimony on behalf of the Society. The Research Society on
Alcoholism is a professional society of over 1,400 members who
are committed to understanding and intervening in the negative
consequences of alcohol use through basic research, clinical
protocols and epidemiological studies.
I'm sure I don't need to tell you this, but the costs of
alcohol abuse and alcohol dependence in this country are
staggering, on individual lives and families. In this country,
one out of four families has an immediate family member who has
an alcohol problem. The economic cost to the Nation is
estimated to be approximately $185 billion annually.
What's surprising is a recently released report on college
drinking, sponsored by the National Institute on Alcohol Abuse
and Alcoholism, revealed that 1,400 college students between
the ages of 18 to 24 die each year from unintended alcohol
related injuries, and 500,000 other students are
unintentionally injured as a result of alcohol use. Equally
disturbing is the increasing trend of alcohol consumption among
children ages 9 to 15.
A report issued last year by the Robert Wood Johnson
Foundation states that by eighth grade, 52 percent of
adolescents have consumed alcohol. And the leadership to keep
children alcohol-free, which is a multi-year, national
initiative founded by the NIAA, the Robert Wood Johnson
Foundation and other Federal agencies, reports that almost one-
third of eighth graders and half of tenth graders have been
drunk at least once, and one-fifth of ninth graders report
binge drinking, that is five or more drinks in a row, in the
past month.
We'll only be able to intervene in these kinds of problems
with evidence based research for policies and prevention
programs.
In addition, for some sub-groups, such as American Indians,
the costs associated with alcoholism are disproportionately
high, and may be directly linked to some of the major health
problems, such as diabetes and hypertension. The Indian Health
Service, for example, estimates that the age adjusted
alcoholism mortality rate for American Indians is 63 percent
higher than for all other races in the U.S.
Despite this, or perhaps because of the widespread impacts
and effects of alcohol, it's been impossible to identify a
single cause or solution. But because of this Subcommittee's
support for biomedical research, and specifically for the NIAA,
the alcohol research community has been making important
strides in clarifying many of the factors which we now know
contribute to alcoholism and the consequences of drinking.
We've seen significant advances in disentangling the role
of genetics and environmental influences, we've begun to
identify critical components of effective treatment and to
develop new treatments. And we've begun to explore integrated
approaches for those with the most severe illness. While
recognizing these advances, however, the Federal investment in
alcohol research has been modest, given the magnitude of the
problem. There must be a strong national commitment to alcohol
research and treatment if we hope to reverse these current
trends.
I would like to just mention a few examples of promising
opportunities in the field of alcohol research which have
adequately supported and will move the field significantly
forward. One area is the NIAA's funded research, which has
successfully identified molecular targets of alcohol in the
brain, and the characterization of these targets may lead to
the discovery of compounds that block specific effects of
alcohol. These discoveries have already led to the prevention
of alcohol related birth defects in mice. So we need to have
further research to translate these findings.
We also have had sponsored research on medications
development that have proved to be effective, but not for
everyone. Additional funding is needed to aggressively pursue
the range of activities from basic to clinical research to make
sure that we have new ways of treating this disorder.
We also know, as I mentioned, that there is an increased
risk for alcoholism in certain minority groups, and we don't
really understand why this risk exists, and whether or not the
risk applies to all members. Initial studies have begun to
identify specific strengths and vulnerabilities which are
important to explore if we are to address the needs of all
Americans.
Because I'm running out of time, I want to sum up, but I do
also want to mention that I've been talking about some of the
science today. I also want to encourage you just to read the
newspapers, which I know everyone here does. And you can see
from that that this country is still dealing with the aftermath
of September 11th, and many people are increasing their alcohol
consumption in response to the events. I would predict that
many of these problems associated with alcohol could increase
in magnitude in the near future.
As a result, the RSA requests a budget of $475 million for
the NIAA in fiscal year 2003. This request represents the
professional judgment of the alcohol research community and
it's justified based on the historic under-funding of NIAA and
the promise and the opportunity in the present. Thank you.
[The prepared statement of Dr. O'Malley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for coming and bringing your message.
----------
Thursday, May 2, 2002.
FEDERATION OF AMERICAN SOCIETIES FOR EXPERIMENTAL BIOLOGY
WITNESS
DR. ROBERT R. RICH, PRESIDENT, FEDERATION OF AMERICAN SOCIETIES FOR
EXPERIMENTAL BIOLOGY
Mr. Regula. Our next witness is Dr. Robert Rich, President,
Federation of American Societies for Experimental Biology. Dr.
Rich, welcome.
Dr. Rich. Thank you, Mr. Chairman. It's my privilege today,
on behalf of the Federation of American Societies for
Experimental Biology and the biomedical research community to
thank you and the members of this Subcommittee for your past
leadership and your continuing commitment to fund the historic
five year campaign to double the budget of the National
Institutes of Health, certainly the world's leading biomedical
research organization.
FASEB is very grateful, too, to President Bush for
requesting $27.3 billion for NIH in fiscal year 2003 and to the
full House's endorsement of this request. This amount
represents the fifth and final installment in that doubling
effort.
However, Mr. Chairman, while we are very pleased with the
President's overall budget, we do have three concerns about the
details of the President's budget that I would like to raise
with the Subcommittee. The first issue that I'd like to discuss
with you is that for the first time in NIH's history, the
President's budget requests appropriations language for a
specific disease, that is to say cancer. Mr. Chairman, if this
recommendation is adopted, I predict a host of other patient
and disease advocacy groups coming before this Subcommittee
next year requesting their specific research earmarks.
Let me be clear, Mr. Chairman. FASEB is not concerned about
the amount of money recommended for cancer research in the
President's budget. But we're very concerned about a specific
earmark setting such a precedent.
Second, while the President's fiscal year 2003 budget
requests $27.3 billion for NIH, it's important to note that
this recommendation includes almost $500 million in procurement
for non-research activities and for taps and transfers to other
agencies. Additionally, the President's budget proposal allows
the Secretary of HHS to tap the budget of NIH by up to 3
percent. This could be as much as $820 million, undercutting
this Subcommittee's specific decisions regarding NIH spending.
Collectively, up to $1.3 billion could thus be subtracted
directly from the bottom line of funds available for biomedical
discovery. We believe this proposal should be rejected.
Mr. Chairman, for the past half century, our investment in
people who do research has been the secret to NIH's spectacular
advances. My third concern is therefore with two specific
proposals in the President's budget that threaten to reduce our
supply of scientists at two critical points in the research
career continuum: young investigators and senior researchers.
We're currently facing a shortage of qualified young scientists
because of high debt burdens and low salaries. The President's
budget would exacerbate this crisis by shortchanging stipends
for pre-doctoral and post-doctoral fellows under National
Research Service awards.
Last spring, NIH recommended increasing stipends by 10 to
12 percent per year over the next several years. But the
President's fiscal year 2003 budget calls for only a 4 percent
increase. FASEB believes that Congress should increase stipends
by at least 10 percent, a level that would be consistent with
last year's appropriation.
Regarding researchers at the peak of their productivity,
the Administration has again proposed reducing the maximum
salary available for performing NIH-funded research in our
Nation's universities below the level for scientists working
directly for the Government. We wish to thank you for rejecting
this same proposal last year, and we urge you to do so again.
Maintaining the higher rate will retain for university
scientists the maximum salary available to senior researchers
at NIH's Bethesda campus, and will help to ensure that the best
clinical scientists continue to be able to do NIH-funded
research.
Finally, Mr. Chairman, I'd like to thank you and the
members of the Subcommittee once again for making those really
difficult choices that have been needed to support NIH. Allow
me to conclude simply by observing that it is not too early for
us to begin discussions about funding in the post-doubling era.
Thank you very much.
[The prepared statement of Dr. Rich follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you, and it's no question that stipends
make a difference, and likewise that salaries impact the
supply. It's something of concern that you can't research
without researchers.
Dr. Rich. That's right. Thank you very much.
----------
Thursday, May 2, 2002.
CITIZENS UNITED FOR RESEARCH IN EPILEPSY
WITNESS
JIM ABRAHAMS, CO-FOUNDER, DIRECTOR OF THE CHARLIE FOUNDATION TO HELP
CURE PEDIATRIC EPILEPSY
Mr. Regula. Jim Abrahams, Co-Founder and Director of the
Charlie Foundation to Help Cure Pediatric Epilepsy.
Mr. Abrahams. Thank you for allowing me to appear before
you today. Frankly, I was asked by some other parents of
children with epilepsy to speak today, because I have had a
career in the movie business, and it was the hope of those who
in the past have seen these rooms overflow with elected
officials and media to hear testimony of celebrities and then
be virtually evacuated for others less well known that perhaps
my appearance would bring just one more Congressman or one more
journalist to hear our plea.
Because in fact, there are many parents of children with
epilepsy who have lived with the horror and agony of this God-
forsaken disease longer than I, and who would be better
qualified to testify before you about its devastating effects
on their children and families and point out the frustratingly
paltry sums our Government has appropriated to try to
understand it.
I say this because my son, Charlie, is perhaps what you
would consider a best case scenario with regard to his
epilepsy. You see, Charlie does not number among the 400,000
Americans who died of epilepsy related causes since his first
seizure 10 years ago, a number, by the way, which is equivalent
to those who have been killed by breast cancer.
Also, because his seizures are currently controlled by a
rigorous, high fat, ketogenic diet, Charlie no longer has to
deal with anti-seizure drugs and their mind and body altering
side effects, such as insomnia, diarrhea, high blood pressure,
rashes, nausea, lethargy, constipation, gum growth, suppressed
appetite, depression and on and on. Women, for instance, using
Dilantin, among the most highly prescribed of these drugs, are
told not to have babies, not because they can't conceive, but
because their doctors are afraid of what they would conceive.
But because Charlie must be considered a best case
scenario, I don't want to leave the impression that his chances
for a normal, independent life haven't been severely damaged by
epilepsy. Nor do I want you to think he doesn't use up his
share of the $12.5 billion annual cost that epilepsy reaps on
our Nation. He's mainstreamed through the public school system,
and his adaptive physical education and occupational therapy,
one-on-one tutors, social inter-active groups, special reading
groups and public school resource programs designed to help him
make up the physical and intellectual delays his seizures,
drugs and brain surgery caused him, are all subsidized by
public tax dollars.
And of course, none of us can guess how Charlie and
millions like him may have contributed to society, had their
young brains not been ravaged so horribly.
This chart behind me displays the dollar amounts allotted
by you to epilepsy research versus other diseases. I'll not
burn my time by repeating the inequity you can clearly see.
However, I will comment by saying that until you've seen your
own child's eyes go dead, fall back in his head as he drops to
the ground, until you've watched your own child slowly fade
into retardation one painstaking day at a time, until you've
seen your own child decay from a drug reaction or you bury you
own child after she drowned in her bathtub during a seizure,
you can't possibly appreciate the cruelty of this disparity.
More Americans have epilepsy than muscular dystrophy,
cerebral palsy, multiple sclerosis and Parkinson's disease
combined. Of the 181,000 new cases diagnosed this year, 75
percent will be children. Tragically, the research budget of
the national Government nowhere near reflects that.
As a matter of fact, in the last five years, you've
increased funding 3 percent per year on average. I personally
have sat through many meetings with bright, intrigued, willing,
dedicated scientists who have been unable to pursue potentially
invaluable avenues of epilepsy research literally due to an
inability to pay for technicians, lab rats or even counter
space.
I do not take lightly the honor of speaking for and
attempting to express the frustration of the 2.5 million
Americans and their families whose lives have been damaged or
destroyed by the hell of epilepsy. And I appreciate that until
this moment you, like many Americans, may have been unaware of
the devastation epilepsy causes, and the relative lack of
attention it gets from the Federal Government.
For years now, parents like myself have come before you,
hat in hand, sharing their grief and imploring you to help. But
as this chart so clearly points out, to very little avail.
It's difficult to tight rope walk the line between
expressing outrage on one hand and alienating the very people
from whom we are asking help on the other. So I hope you'll
understand my opting for candor over diplomacy. For this
Government to continue along its path of under-funding epilepsy
research when it is clear that with modern science, it is
merely a function of dollars until we can understand and cure
this centuries old agony. It is more than a mere shame. I can't
help but feel it is both callous and disheartening.
You have the power to act to save lives and spare other
children and their families the tragedy so many of us have
known. Please do so.
[The prepared statement of Mr. Abrahams follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for bringing this to our attention. I
don't know on what basis NIH makes its judgments as far as what
will be funded by way of research. I think your statement is
that it's not adequate in relationship to others.
Mr. Abrahams. The NIH budget was increased 15 percent this
year, and epilepsy got a 3 percent increase.
Mr. Regula. Thanks for coming.
----------
Thursday, May 2, 2002.
AMERICAN PUBLIC HEALTH ASSOCIATION
WITNESS
DR. MOHAMMAD AKHTER, M.D., MPH, EXECUTIVE DIRECTOR, AMERICAN PUBLIC
HEALTH ASSOCIATION
Mr. Regula. Dr. Mohammad Akhter, Executive Director,
American Public Health Association. Dr. Akhter.
Dr. Akhter. Thank you, Mr. Chairman, and good morning. My
name is Mohammad Akhter, I'm the Executive Director of the
American Public Health Association, the largest association of
public health professionals in the world.
We are very pleased to have this opportunity to appear
before you this morning to speak about the budget. Mr.
Chairman, we're grateful to you and members of your Committee
and the Congress for your support of bioterrorism preparedness.
We are really doing wonderful work all across this country
getting our Nation prepared to deal with any future attacks by
the terrorists.
This has helped a great deal for us to prepare not only for
the bioterrorism situation, but also other public health
problems, building public health infrastructure in the country.
This has been a tremendous credit to you, members of your
Committee, and members of the Congress, and we're grateful.
We're also very pleased with the President's budget that
further supports the bioterrorism preparedness. And we request
of you that preparedness must continue--we must continue to
invest to make sure that we are as prepared as we can be.
Mr. Regula. We had a panel yesterday from HHS, the top
people, and they definitely are on the move, trying to get
ready for whatever future crisis might occur.
Dr. Akhter. Thank you, Mr. Chairman. We appreciate the
support that you have shown for this particular effort.
Our membership is also concerned about the other areas that
affect the health of the American people. You already heard
about obesity and coronary diseases. Obesity is a major cause
of many coronary diseases. The four leading causes of death,
among the top six, are related to overweight and obesity. We
need to have a program nationwide that starts to deal with what
we know, so the American people could change their lifestyle,
change their eating habits and start to do exercise a little
bit more. We can get a lot of mileage out of that.
We have a very tiny program at CDC right now. We request
very much that you increase that program funding to $60 million
this year, so that we could have a program, at least in half of
the States, to provide information and education to the public.
One of the areas where we really need to pay attention is
the children. You already heard that 15 percent of our children
are obese. Over 60 percent of those obese children have high
blood cholesterol, and already have early signs of heart
diseases. And the best way to reach them is through the media.
CDC has a media campaign, and we would very much appreciate if
you would fund the media campaign at the $125 million level
that it was originally intended to do.
Finally, Mr. Chairman, there are 50,000 deaths in this
country that are called violent deaths. I am very grateful to
you all for putting some money in to set up a reporting system,
so that we can know what are the causes of suicide, who is
committing suicide, and what are the causes of other violent
deaths among our society. Once we know who these people are,
once we know what the causes are, then we can develop adequate
preventive strategies. Mr. Chairman, we request that you put
$10 million into that effort, so that we have adequate data and
that scientists could develop adequate programs.
The Health Resources and Services Administration is one of
our Nation's wonderful agencies that provides access to many
treatment programs. Mr. Chairman, one of the areas in which we
need help is professional training. We need to have people. You
already heard about researchers and I am talking about other
professionals that we need to deliver public health services to
provide support to the local health agencies. And your work on
the health professional training program will be very helpful.
Finally, within HRSA is a program that supports abstinence
education only. Mr. Chairman, that's a wonderful program. We
would very much like to see, as Secretary Powell has said, and
as previous Surgeon General David Satcher has indicated, for
those who are not sexually active, abstinence is a great thing.
And we must support that.
But for those who are sexually active, we must have an
alternate choice, of having condoms so they could not have
sexually transmitted diseases and not have hepatitis-B and
things like that. So Mr. Chairman, providing the flexibility
for the States, so the States could develop a comprehensive
program, would go a long way in having a wonderful program for
our children.
The Agency for Healthcare Research and Quality, Mr.
Chairman, this is the agency that looks at the quality of care,
particularly the medical errors. We believe this agency needs
to be funded at its full level so that it can fulfill your
Congressional mandates, have adequate resources to do that.
And in conclusion, Mr. Chairman, substance abuse and
alcoholism are major problems among our society. And to really
have good prevention programs is a must. We suggest that the
Substance Abuse and Mental Health Services Administration be
funded at $3.65 billion this year so they can have adequate
programs.
In summary, Mr. Chairman, we appreciate your support of
bioterrorism, but we should have a balanced approach, so that
we should look at the long term consequences of some of our
programs.
Thank you very much for this opportunity.
[The prepared statement of Dr. Akhter follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
----------
Thursday, May 2, 2002.
AMERICAN ACADEMY OF OPHTHALMOLOGY
WITNESS
ALLAN JENSEN, OPHTHALMOLOGIST, BALTIMORE, MARYLAND; MEMBER, BOARD OF
TRUSTEES, AMERICAN ACADEMY OF OPHTHALMOLOGY
Mr. Regula. Dr. Allan Jensen, Ophthalmologist, Baltimore,
Maryland, Member of the Board of Trustees, American Academy of
Ophthalmology. Welcome.
Dr. Allan Jensen. Thank you, Mr. Chairman.
Thanks for the opportunity to appear before you today in
support of appropriations for the National Eye Institute. My
name is Allan Jensen. I'm a practicing ophthalmologist in
Baltimore, and an Associate Professor of ophthalmology at Johns
Hopkins, and presently serve as a member of the Board of
Trustees of the American Academy of Ophthalmology. The Academy
is the world's largest organization of eye physicians and
surgeons, with over 27,000 members.
The Academy first wants to thank you for the support that
you and your colleagues have demonstrated for the NIH and the
National Eye Institute in the past. As a result of your
commitment, the NIH budget is on track to be doubled in the
five year period that ends with this budget cycle. Of
particular note, in the fiscal year 2002, the NEI budget saw a
growth that for the first time in recent memory out-paced the
budget growth of most other NIH institutes. The National Eye
Institute Congressional appropriation represented an increase
of 13.9 percent for a total budget of $581 million.
While the NEI has received many welcome and useful budget
increases over the years, historically it's fallen behind in
comparison to budget increases for other NIH institutes. The
American Academy of Ophthalmology is concerned that the
tremendous research opportunities made possible by the fiscal
year 2002 appropriation will be jeopardized by the President's
proposed 8.4 percent budget increase for this year.
The Academy believes it is essential that the commitment to
funding of the National Eye Institute be maintained, so that
vital research can be continued. Polls have shown that
Americans fear blindness more than any other condition except
cancer. And the public deserves to have these fears met with
sound research that can preserve sight.
To allow the National Eye Institute's continued pursuit of
research opportunities in areas that show great promise,
including genomics, neuroscience, bioengineering and other
clinical research, we ask that Congress appropriate $692
million for fiscal year 2003. With your support, we have made
many advances in relieving the pain and suffering from many
blinding disorders. Examples of investments in research that
have significant potential to save sight include gene therapy
studies, which will provide essential information into the many
types of vision disorders, including retinitis pigmentosa, an
inherited, now incurable form of blindness.
NEI-supported research has led to the development of
prosthetic devices that can be surgically implanted in the
brain or retina to partially restore sight. NEI-sponsored
research has led to the development of new drugs effective in
the treatment of glaucoma, the leading cause of irreversible
blindness among African-Americans.
For macular degeneration, NEI-supported research has led to
the development of a drug to inhibit the growth of abnormal
vessels that leak and bleed to cause blindness in this
disorder. And as you know, macular degeneration is the leading
cause of vision loss in older Americans, affecting more than 10
percent of Americans over age 65.
NEI-supported studies have documented important information
about how the herpes simplex virus spreads, and how physicians
can better treat it. Diabetes is the number one cause of
blindness of working age adults. NEI-supported studies have
demonstrated that blindness from diabetes can be prevented in
most patients by laser therapy, something in my career, which
was over two decades, when I first entered practice, there was
really nothing available. We really have seen a miracle. Those
at greatest risk from diabetes are Native Americans and
African-Americans.
The American Academy strongly recommends that $692 million
be directed to research conducted by the NEI on eye and vision
disorders. As the baby boomers age, it is critical that
research is targeted to find effective treatments and cures for
diseases such as glaucoma and macular degeneration, but also on
the prevention of other blinding and disabling eye diseases.
Missed opportunities in eye and vision research will translate
into increased Government dependence and a decreased quality of
life for many of our citizens.
I appreciate the opportunity to speak to you this morning,
and would be glad to take any questions.
[The prepared statement of Dr. Allan Jensen follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
I think it was Helen Keller who said that she'd rather give
up hearing than eyesight. I can understand that.
Dr. Allan Jensen. Thank you very much.
----------
Thursday, May 2, 2002.
SOCIETY FOR INVESTIGATIVE DERMATOLOGY
WITNESSES
DR. JOUNI UITTO, M.D., PRESIDENT, THE SOCIETY FOR INVESTIGATIVE
DERMATOLOGY; CHAIRMAN, DEPARTMENT OF DERMATOLOGY AND CUTANEOUS
BIOLOGY, PROFESSOR OF DERMATOLOGY AND CUTANEOUS BIOLOGY AND
BIOCHEMISTRY AND MOLECULAR PHARMACOLOGY, JEFFERSON MEDICAL COLLEGE;
DIRECTOR, JEFFERSON INSTITUTE OF MOLECULAR MEDICINE, THOMAS
JEFFERSON UNIVERSITY
VICKY WHITTEMORE, CO-CHAIR, COALITION OF PATIENT ADVOCATES FOR SKIN
DISEASE RESEARCH
Mr. Regula. Our next witness is Jouni Uitto, President, The
Society for Investigative Dermatology, accompanied by Dr. Vicky
Whittemore, Co-Chair, Coalition of Patient Advocates for Skin
Disease Research.
Welcome, Dr. Uitto.
Dr. Uitto. Mr. Chairman and members of the Committee, let
me first thank you for the opportunity to testify here today on
behalf of the Society for Investigative Dermatology, which has
as its mission the support of research in skin diseases.
Our 2000 members include researchers and physician
scientists from universities, hospitals and industry committed
to the science of dermatology. My specific purpose in being
here today is to personally emphasize the need for increased
funding for the programs of the National Institutes of
Arthritis and Musculoskeletal and Skin Diseases, or NIAMS. And
this position is also supported by the American Academy of
Dermatology.
I'm here with Dr. Vicky Whittemore, Co-Chair of the
Coalition of Patient Advocates for Skin Disease Research. She
will speak for one minute after my comments.
Mr. Chairman, before I describe some of the recent advances
in skin research, let me first thank you, you personally, for
three specific matters. First, for taking time to meet in your
district office with Dr. Jay Klemme, a dermatologist
constituent of yours, together with Dr. Kevin Cooper, who is
the Chair of Dermatology at Case Western Reserve University,
and with Ms. Angela Welsh, who is our Administrative Director.
We certainly know how busy you are, Mr. Chairman, and we
appreciate your courtesy.
Secondly, we would like to thank you for the language that
you and the Subcommittee provided for the bill report calling
for a workshop at the NIAMS to determine economic and social
costs of skin diseases in the United States. As you know, this
analysis has not been updated since 1979. I'm happy to report
that the workshop will be held in September. The Society of
Investigative Dermatologists is very pleased at the positive
way that NIAMS is developing plans for it.
Finally, we thank you for the large increase in funding you
provided last year for the NIAMS and NIH in general. We also
appreciate the Administration's proposal this year to increase
NIH's overall funding to provide for the final funds required
to double the NIH budget. We recommend to you that the Congress
agree with that proposal.
At the same time, we do recognize the concerns about
bioterrorism overshadow other matters. But we would prefer that
the same 16.5 percent increase for NIH overall include a
similar percentage increase for NIAMS.
There are more than 3,000 different diseases affecting the
skin, hair and nails, with an average each year of about 60
million Americans being affected by these conditions. With the
advent of technologies in molecular and cell biology in
general, there has been an increased sophistication in our
understanding of the mechanisms underlying many of these
disorders affecting the skin.
Important new advances in dermatology and cutaneous biology
have certainly been made over the past year, and in the
interest of time, I will refer to the full text of my testimony
for those details. Mr. Chairman, thank you for this opportunity
to discuss with you the science of dermatology. Everyone in the
field of medical research certainly understands that it was
this Committee, your Committee, which initiated the move to
double the NIH research budget over the five years, and we
congratulate you and thank you for your leadership.
I'll be happy to answer any questions, but please allow Dr.
Whittemore to say a few words.
Ms. Whittemore. Thank you, Dr. Uitto and Mr. Chairman. I'm
Vicky Whittemore, the Co-Chair of the Coalition of Patient
Advocates for Skin Disease Research.
I represent 25 different organizations who in turn advocate
on behalf of the over 60 million Americans with skin disease,
including common skin diseases like acne, psoriasis and eczema,
but also the less common skin diseases, like tuberous
sclerosis, which affects my nephew. He has benign tumors that
cover his face that bleed excessively, and that the insurance
will not pay for their removal, because they say it's cosmetic.
And these tumors would re-grow if they were removed with laser
treatments. But he does not have this treatment, because he
also suffers from epilepsy and autism, and could not undergo
the procedure.
But there is no cure for tuberous sclerosis, the skin
disease part of it or the other aspects of the disease, or for
any of the skin diseases, for that matter. So together with the
Society of Investigative Dermatology, the Coalition also
advocates and thanks you for the increase for the NIH and
similar increase for the National Institutes of Arthritis and
Musculoskeletal and Skin Disease. Thank you.
[The prepared statements of Dr. Uitto and Ms. Whittemore
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you include in the skin diseases the effects
of cancerous growths?
Ms. Whittemore. Absolutely, yes.
Dr. Uitto. Yes, sir. Skin cancer, as you know, is an
epidemic in this country which is increasing tremendously. That
is part of it.
Mr. Regula. I know. Too much sun, I guess, is part of the
problem. But that's included in all your research applications?
Dr. Uitto. Absolutely.
Mr. Regula. Well, thank you very much.
----------
Thursday, May 2, 2002.
ASSOCIATION FOR RESEARCH IN VISION AND OPHTHALMOLOGY
WITNESS
SHEILA K. WEST, PRESIDENT, ASSOCIATION FOR RESEARCH IN VISION AND
OPHTHALMOLOGY, EL MAGHRABY PROFESSOR OF PREVENTIVE OPHTHALMOLOGY,
JOHNS HOPKINS UNIVERSITY
Mr. Regula. Dr. Sheila West, President, Association for
Research in Vision and Ophthalmology. Dr. West.
Dr. West. Mr. Chairman, good morning. I'm testifying as
President of the American Association of Research in Vision and
Ophthalmology. It's the largest organization of vision
scientists in America. Specifically, though, I'm speaking as
one of the researchers in academia who has devoted a career to
the prevention and treatment of blinding disorders in our
population.
Your support for the increase in the fiscal year 2002
budget for the National Institutes of Health, and specifically
for NEI, is greatly appreciated. Today I'm adding the research
community's voice in support of the citizens' budget request
for fiscal year 2003 of $692 million for the National Eye
Institute. This amount almost completes the fulfillment of the
bipartisan goal for doubling the NEI budget since 1999.
You might question the need for increasing eye research at
this time. The answer lies in the fiscal as well as the social
responsibility to invest now against what is certain to be a
sizable increase in the numbers and the cost of visual
impairment in the United States. As you heard, most of the
blindness and visual impairments in this country are age
related eye diseases, like cataract, macular degeneration, and
glaucoma.
At present, we estimate there are more than 1 million blind
people in the U.S. and an additional 4.2 million with several
visual impairment. If nothing were to change in our ability to
take care of these eye diseases, in another 30 years those
numbers would double, due entirely just to the aging of the
U.S. population.
The growth of the age group 85 plus is of special concern.
They are the fastest growing among the elderly population and
their rate of eye disease is especially high. One in seven
Caucasians will have AMD, one in ten Hispanics and African-
Americans will have glaucoma. These 4.2 million Americans age
85 and older now include our parents. In 30 years' time, that
number is going to swell to 8.9 million, and God willing,
that's going to be you and that's going to be me.
The cost to the American people of visual loss is high.
Each year, over 1.5 million cataract surgeries are performed
and despite significant declines in reimbursement, cataract
surgery alone now accounts for 12 percent of the Medicare
budget. The annual cost to Medicare for just cataract surgery
is $3.4 billion. That's over five times the amount we request
for vision research at NEI for all the eye diseases.
And the cost is not just to Medicare. You heard Dr. Jensen
earlier talking about the treatment for diabetic retinopathy.
It's cost effective, it saves society an estimated $975 per
person with diabetes. However, recent research in the Hispanic
community suggests that of the one in five people with diabetes
in that community, 15 percent are unaware of their disease, and
a quarter of them already have eye disease. So in that
community, diabetic retinopathy is the leading cause of visual
loss in the working age population. That's the 40 to 64 year
olds. That's going to pull them out of the working group in
their most productive years.
You also heard from Al Jensen that the news from the
research community in eye disease is both exciting and hopeful.
In my research in particular, I'm convinced of the need to
prevent or delay the onset of worldwide cataract. More people
are now visually impaired from cataract worldwide, it's between
40 million and 80 million people, than are currently living
with HIV-AIDS. Research that we're doing in Maryland suggests
that there are both genetic and environmental factors that are
important, specifically smoking, ocular exposure to sunlight
are risk factors. If we can understand the interplay of those,
we have hope for enabling further specific research on anti-
cataract agents.
So we as investigators feel the urgency for the
continuation of enhanced support for vision research at this
crucial junction of exciting discovery and progress, but in a
time of an imminent explosion of the magnitude of blindness and
visual loss for the United States and worldwide. And we look to
our political leaders for the foresight to invest now the $692
million for the protection of sight for all Americans.
I'd be pleased to respond to any questions at this time.
Thank you, Mr. Chairman.
[The prepared statement of Dr. West follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Is there any single cause that
represents the greatest volume of vision problems?
Dr. West. Because macular degeneration is so common in the
Caucasian population, in the United States that's the single
leading cause. But I think it's important to look within
groups. Clearly, glaucoma is absolutely critical.
Mr. Regula. Is macular degeneration, degeneration of the
nerve?
Dr. West. Of the retinal. In fact, once you have macular
degeneration, you lose central reading vision.
Mr. Regula. What can you do to prevent it?
Dr. West. The National Eye Institute has just published a
trial suggesting that people with early signs of this disease
taking a vitamin supplement may delay the onset of visual loss.
But that's expected to be effective in about 20 percent of
people.
Mr. Regula. Part of it's just the aging process?
Dr. West. We think it's tied to the aging process, but we
also think that there are other ways that we can intervene.
Mr. Regula. Thank you very much.
----------
Thursday, May 2, 2002.
ACADEMIC HEALTH CENTERS CLINICAL RESEARCH FORUM
WITNESS
DR. WILLIAM F. CROWLEY, JR., M.D., DIRECTOR, CLINICAL RESEARCH,
MASSACHUSETTS GENERAL HOSPITAL
Mr. Regula. Dr. William Crowley, Director of Clinical
Research, Massachusetts General Hospital. Dr. Crowley.
Dr. Crowley. Thank you, Chairman Regula, for the
opportunity to participate in these hearings.
I'm a physician scientist, professor of medicine at Harvard
Medical School and Director of Clinical Research at the Mass
General Hospital. My own personal research is all NIH-funded,
and it's allowed me to take from the conceptual level to the
FDA approval process the ability to treat children with
precocious puberty and disease and infertility in women. These
therapies that I pioneered are now being used for men with
prostate cancer, women with painful endometriosis and uterine
fibroids.
But I'm not here to talk about my own research, I'm
actually here representing a group called the Academic Health
Center Clinical Research Forum. The Academic Health Centers,
the top 24 or so of these centers, are all involved in a
consortium to focus on clinical research and to drive clinical
research. Arguably, many of the people who are here asking for
more funding are actually asking for more clinical applications
of that funding. That's what clinical research does.
So my first mission is to thank you for your vision and
leadership in doubling the NIH budget. It's led to the improved
life expectancies that you talked about, the decreased
mortality from heart attacks of 30 percent, now some
improvements in cancer survival and certainly infections which
are preventable or treatable that couldn't have been done
without this doubling of the NIH budget.
You've also put in place the human genome project, which is
an enabling platform that's going to bring medical benefits
that we can't even dream of at this moment. A joint economic
commission report in May of 2000 showed that there's a 40
percent return on investment for the money you put into
research here by life expectancy improvements, functioning
improvements and biotech and pharmaceutical spinoffs for these
investments. So we're here to express our thanks and
appreciation for that.
So all this is wonderful. But there are a few speed bumps
along the road of swift transfer of basic research, as the
accelerating promise of the genomics era slams into the direct
problems of the burgeoning health care funding crisis. A lot of
those are being mediated at the Academic Health Centers and a
lot of those secondarily impact clinical research.
Two blocks to the translation of this basic science into
practice have emerged. And they are called translational
blocks. The first block is the bench to bedside transfer of
information. This is very difficult, tricky, dangerous, and
it's the first of the two blocks.
Mr. Regula. If you can't do that, it's of no value.
Dr. Crowley. I agree completely. We're on the same page.
The second block is, once clinical trials have established
something as effective, to get it into the hands of the
practitioners, where again, the public doesn't benefit until
that happens. So these are two bottlenecks which are now
emerging in the process of this wonderful advancement.
So when we talk about the public benefits that you're
concerned about, we're really talking about the national
clinical research enterprise, which is a loose term for all the
mechanisms that transfer basic science into utility for the
patient groups that are here together. In fact, Dr. Zerhouni,
his second priority is, as he said, to bring the fruits of our
research to clinical testing more rapidly and enhance our
ability to prevent and detect disease much earlier. So he's
really focused on the two translational blocks.
So the Academic Health Centers, therefore, where the
majority of this research gets done, it's a partnership between
the NIH and the Academic Health Centers dating back to Vannevar
Bush in 1945, his famous paper, ``Science: The Endless
Frontier,'' proposed putting Government money into the hands of
academic centers to do this.
We have four recommendations that we'd like you to
consider. Number one is to accelerate the ongoing clinical
research training that the NIH has undertaken. They've done a
terrific job of putting in place new mechanisms, these K23 and
K24 grants, to attract young investigators into specifically
clinical research. We'd like you to watch that as the NIH
starts to plateau its budget a little bit more to make sure
it's not the victim of tightening of the bay line.
The second thing is, we'd like to strengthen the loan
repayments. The average medical student leaving medical school
owes $115,000. That's a mortgage on a career, and they can't
even think about going into clinical research unless that loan
repayment is better. In spring of this year, they actually
instituted a program at the NIH; this clearly needs to be
broadened and widened. It's been way over-subscribed in the
spring of this year.
The third thing is to re-establish the NIH board on
clinical research. I was part of the original board during Dr.
Varmus' era, and that was abolished in 1997 and hasn't met
since. These advisory boards are very important for patient
groups, physicians and basic scientists to bring their leverage
to the NIH in an ongoing, day to day fashion.
Mr. Regula. Don't they have a voice in where the money is
going to be spent?
Dr. Crowley. Precisely.
And the final thing is to encourage the NIH to participate
in a broader and more comprehensive planning for the national
clinical research enterprise. The Institute of Medicine has set
up a clinical research roundtable to deal with this. In fact,
I'm a member of it. We recommend that the NIH be part of a
broader public-private partnership to steer this national
clinical research enterprise, which at the moment does not have
a lot of leadership.
So we really believe the value to the American public is
only going to happen when there's a balanced investment of both
basic and clinical research, and that clinical research is
emerging rapidly as the narrow neck in the bottle. It's the
vehicle by which all of this happens for the public.
So we appreciate your time and attention and we'd be happy
to answer any questions.
[The prepared statement of Dr. Crowley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you very much.
----------
Thursday, May 2, 2002.
AMERICAN FEDERATION FOR MEDICAL RESEARCH
WITNESS
DR. DAVID A. D'ALESSIO, M.D., SECRETARY-TREASURER, AMERICAN FEDERATION
FOR MEDICAL RESEARCH; ASSOCIATE PROFESSOR, DEPARTMENT OF MEDICINE,
UNIVERSITY OF CINCINNATI SCHOOL OF MEDICINE
Mr. Regula. Our next witness is Dr. David D'Alessio,
Secretary-Treasurer, American Federation for Medical Research.
Dr. D'Alessio. Good morning, Chairman Regula. Thank you
very much.
I'm pleased to be here today representing the American
Federation for Medical Research, a national organization of
over 3,000 physician scientists engaged in research, focused on
virtually every major disease and disorder. I'm a physician and
Associate Professor at the University of Cincinnati School of
Medicine. I'd like to begin by thanking the members of your
Subcommittee for your longstanding support for the National
Institutes of Health. The AFMR joins the many organizations
that have advocated a five year doubling of NIH spending.
According, we support the total budget requested by the
Administration of $27.3 billion.
In particular, AFMR would like to express its strong
support for the Administration's proposal to double the budget
for extramural tuition loan repayment programs, including the
program for clinical researchers authorized by the Clinical
Research Enhancement Act, and referred to just a few minutes
ago. We are extremely pleased that this Subcommittee provided a
$28 million budget for this purpose last year, and hope that
you will approve the Administration's request to double the
funding to $55 million for the coming year.
Loan repayment is critically important if we're going to
attract outstanding graduates of medical school into careers in
clinical investigation. With respect to tuition repayment for
clinical researchers, we share concerns expressed by members of
the Subcommittee at a recent hearing regarding the policy set
by NIH in the first year of the program, limiting access to
applicants who already have obtained NIH funding. A lot of
physician scientists in the early phases of their career have
not yet applied for or obtained NIH funding. This limitation
restricts the impact of the loan repayment program
considerably.
We are pleased that the NIH has indicated it will change
this policy in fiscal year 2003, and we hope you'll continue to
inquire about the specifics of this change to assure that the
trainees and the students enrolled in clinical research
training programs will be eligible to apply.
The AFMR urges you to make two modest adjustments within
the total fiscal year 2003 budget requested by the
Administration, both of which are responsive to concerns
frequently expressed by members of this Subcommittee, about the
need to assure that basic science discoveries are in fact
applied to new medical treatments and preventive therapies.
First, we strongly urge you to fund the Graduate Training and
Clinical Investigation awards authorized by the Clinical
Research Enhancement Act, and second, we recommend a more
substantial increase for the general clinical research centers
program of the NCRR.
Clinical research, sometimes referred to as patient-
oriented research, is the process through which basic
laboratory discovery is translated to improvements in medical
care. It was in hopes of reversing the decline in clinical
research that Congress passed the Clinical Research Enhancement
Act in 2000. Prior to passage of the legislation, the NIH went
forward to establish one of the most important programs
authorized in the bill, and that's the Clinical Research
Curriculum Awards, known as the K30 grants.
These grants enabled over 50 institutions to establish
rigorous training programs, most requiring students to pursue a
graduate degree in clinical research. What became apparent
fairly quickly was that this program was missing a critical
element: support for the students themselves for necessary
tuition and stipends to enable them to pursue the programs that
were being offered. The students are medical school graduates
who have finished their clinical training, they frequently have
a large debt burden. And to make a commitment to research
requires a financial compromise on their part.
Accordingly, the sponsors of the legislation added a
provision to create the graduate training and clinical
investigation awards. Based on discussions AFMR leaders have
had with numerous K30 program directors, it is quite clear that
the NIH investment in the K30 program simply cannot begin to
yield its potential benefit unless a companion program is
established to provide tuition and stipend support for the
student doctors themselves.
Congress authorized this program in Section 409(d) of the
Public Health Service Act as the Graduate Training and Clinical
Investigation Awards, and the AFMR urges you to provide a
budget of $24 million in fiscal year 2003, so these awards can
help fulfill the enormous potential of the curriculum
development grants. To paraphrase your comment from earlier
this morning, you can't do clinical research without clinical
researchers.
With respect to the GCRCs, the President's budget request
is totally inadequate at an increase of less than 10 percent.
This continues a trend. The budget for the National Center for
Research Resources, which funds the CRCs, has grown by 83
percent since 1999, and the GCRC budget only by 36 percent.
Clinical research centers provide the infrastructure that's
necessary if the advances in basic biomedical science are to be
applied to human disease. They're the essential laboratories of
translational research. I urge you to provide the $370 million
budget that we recommend.
In conclusion, it's been my pleasure to appear today before
this Subcommittee. I want to thank you again for your support
for the NIH and for your attention to the needs and concerns of
clinical investigators and their patients. Thank you.
[The prepared statement of Dr. D'Alessio follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for your testimony.
----------
Thursday, May 2, 2002.
WOMEN'S HEALTH RESEARCH COALITION
WITNESS
DR. CELIA MAXWELL, M.D., FACP, ASSISTANT VICE PRESIDENT FOR HEALTH
AFFAIRS, DIRECTOR, WOMEN'S HEALTH INSTITUTE AND ASSOCIATE PROFESSOR
OF MEDICINE, HOWARD UNIVERSITY
Mr. Regula. Our next witness is Dr. Celia Maxwell, Vice
President for Health Affairs, Director, Women's Health
Institute and Associate Professor of Medicine at Howard
University. That's quite a portfolio there.
Dr. Maxwell. Good morning, and thank you, Mr. Chairman, for
the promotion. But I'm actually Assistant Vice President for
Health Affairs, the Director of the Women's Health Institute,
and Associate Professor of Medicine at Howard, as you
mentioned.
Today I'm testifying on behalf of the Women's Health
Research Coalition, which was created by the Society for
Women's Health Research about three years ago. This coalition
currently has about 350 members, and these include scientists,
clinicians, representatives of voluntary health organizations,
pharmaceutical companies, as well as biotech companies. We
study women's health and the related field of sex differences
for at least three very important reasons.
First, women have historically not been included in medical
research. And when they are included, the results of the
research have often not been broken down by sex and reported as
such in the scientific literature. Second, studies prove that
women have more acute medical problems, higher hospitalization
rates, even when we control for pregnancy and child birth, and
that they use more prescription and non-prescription drugs than
men.
Finally, there are significant gaps in our knowledge about
diseases that affect women uniquely, such as ovarian cancer,
predominantly such as autoimmune diseases, or differently, such
as cardiovascular disease. I am testifying today to seek the
Subcommittee's support on the Coalition's position on all four
of these issues.
First, we join our colleagues in the field of health
research in thanking this Subcommittee for its past support of
doubling the budget of the NIH over a five year period. We urge
you to take the final step this year by reaching the
President's total funding level for the NIH. At the same time,
we hope that you will assert your legislative prerogative to
insist that women's health and sex-based research receives
nothing less than the same rate of increase as the rest of the
NIH.
Second, as you know, there are offices, advisors and
coordinators for women's health at many agencies throughout the
Department of Health and Human Services. These offices play
critical roles in bringing the appropriate levels of focus to
women's health issues at the highest level of each agency.
However, their funding is not guaranteed unless this
Subcommittee guarantees it.
With the exception of NIH and SAMHSA, there are no
authorizations. The offices or positions simply exist, making
them potentially vulnerable to shortsighted budgetary and
policy decisions. We urge you to prevent any lessening of the
roles through strong supportive language and adequate funding.
One of the most significant of these offices from our
vantage point is the Office of Research on Women's Health at
NIH. Last year, the Subcommittee supported a significant
increase in funding for that office, and this enabled that
office to create the specialized centers of research on sex and
gender factors affecting women's health. We urge the
Subcommittee to support a $10 million increase in fiscal year
2003 for this office to assure another round of peer-reviewed
center grants that can be competed for this year.
Finally, the Women's Health Research Coalition urges the
Subcommittee to include language in its fiscal year 2003
committee report that will specifically support the development
of a comprehensive research program to fully utilize the
voluminous data that has been generated by the Women's Health
Initiative. Such an effort should form the basis for a
tremendous amount of additional support and research on the
issues that concern us.
Last year, as you know, Mr. Chairman, the Institute of
Medicine, a premier scientific body that Congress itself often
turns to to help it address some of its most difficult health
care problems, issued a report that detailed the scientific
justification for the entire field of sex and gender-based
research. That outlined the opportunities that await
investigation.
This research, we feel, will fill the gaps in our
knowledge, improve the health care of every American and create
a better future for our country. This may seem like a grand
vision, but isn't that the very essence of scientific research?
Mr. Chairman, this Subcommittee has been a wonderful partner
for those of us in the health care research community for many
years. We admire your unwavering commitment to improving the
health of the Nation, through strong support of peer-reviewed
scientific research. We look forward to continuing to work with
the Subcommittee to build a better and healthier future for all
Americans.
Thank you again for the opportunity to testify. I would be
pleased to answer any questions you may have of me.
[The prepared statement of Dr. Maxwell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you have a network of people doing research
on women's health?
Dr. Maxwell. Yes, Mr. Chairman.
Mr. Regula. A flow of information sharing?
Dr. Maxwell. We do. The NIH facilitates that through
several of its programs.
Mr. Regula. And you focus on the types of things that
impact most heavily on women, is that correct?
Dr. Maxwell. Yes, sir. And we would like continued support
for these efforts.
Mr. Regula. Okay, thank you.
----------
Thursday, May 2, 2002.
NATIONAL DISEASE RESEARCH INTERCHANGE
WITNESS
DR. NOEL K. MACLAREN, M.D., PROFESSOR OF PEDIATRICS, DIRECTOR, CORNELL
JUVENILE DIABETES PROGRAM, WEILL COLLEGE OF MEDICINE, CORNELL
UNIVERSITY; CHAIRMAN OF THE BOARD OF DIRECTORS, NATIONAL DISEASE
RESEARCH INTERCHANGE
Mr. Regula. Dr. Noel Maclaren, Director, Cornell Juvenile
Diabetes Program.
Dr. Maclaren. Thank you, Mr. Regula.
On behalf of the National Disease Research Interchange, and
its founder----
Mr. Regula. You're addressing juvenile or type 2 or both?
Dr. Maclaren. I do both, sir.
Mr. Regula. You've got the whole range of diabetes?
Dr. Maclaren. Yes, sir, whole families are affected by this
disease.
And on behalf of its founder, Ms. Lee Ducat, I'd like to
thank you for the opportunity to appear here today in support
of the National Institutes of Health. I'm Noel Maclaren. In
addition to being Chairman of the Board of NDRI, I'm a
Professor of Pediatrics and Director of the Cornell Juvenile
Diabetes program in New York.
Ms. Ducat and her organization recognized the need to
provide researchers with human organs and tissues to enable
them to study human disease. Animal models, while an integral
part of the biomedical research process, only permit us to go
so far with our research analysis. Before NDRI came into
existence, organs were often incinerated when they were
considered unsuitable for transplantation.
To date, NDRI has provided to more than 2,000 researchers
more than 300,000 human tissues to study more than 80 distinct
diseases. NDRI is truly a national resource which should be
carefully nurtured and expanded by the NIH. You and your Senate
colleagues acknowledged this in last year's conference report,
and I quote, ``The conferees continue to be very interested in
matching the increased needs of researchers, particularly NIH
grantees, as well as the intramural and university-based
researchers,'' including, I might add, sir, those in the
Cleveland Clinic, ``who rely upon human tissues and organs to
study human diseases and to search for cures for them. The
conferees are aware that NIH is in the process of encouraging
the Institutes and Centers to expand support for the NDRI.''
Your Senate colleagues also recognized the NDRI, and I
quote, ``the leader in this competitive field, uniquely
positioned to serve NIH grantees as well as the intramural and
university based researchers who are finding it increasingly
difficult to obtain this valuable and effective alternative
research resource.''
NDRI fully supports President Bush's budget request of
$27.3 billion for all of the NIH. This funding level completes
the goal of doubling the NIH budget over a five year period. We
recognize, however, that the world has changed dramatically
since the attacks of September 11th. As you know, the
President's budget now includes $1.8 billion increase to
support biomedical research focused on bioterrorism prevention
and treatment. NDRI is uniquely qualified, ready, willing and
able to work with the Federal Government to obtain human
tissues and organs necessary to develop and test anti-terror
vaccines.
With the NIH support, NDRI has designed a pilot program
which has begun to collect HIV infected human tissues for
research. This tissue has not previously been available to our
researchers across the country looking for a cure for AIDS.
While the world was focused on the tragic events of September
11th, in my hometown NDRI first retrieved such an organ at the
Mount Sinai Medical Center and provided that tissue to some of
the most eminent researchers in the field at the University of
Minnesota that very day.
Such tissues are vital to the creation of vaccines to
prevent and treat this burgeoning disease, HIV. Increasing
support for the program would then be consistent with the
Administration's increased commitment to treating and curing
AIDS.
I'd like to share with the Committee three other examples
of research opportunities the NIH should pursue with the NDRI,
consistent with the Administration's funding priorities that
would enable the NIH to comply with the intent of Congress.
First, diabetes research. NDRI has for years had experience in
procuring pancreases for research. We're very concerned,
however, at this time, of significant national hope and Federal
commitment, to islet cell transplantation resources that the
Federal sources have not been committed to expanded procurement
of an additional 1,000 pancreases needed to conduct the
research.
Second, in brief, adult stem research, NDRI supports
cutting edge studies that are relevant to heart attacks,
Alzheimer's disease and Parkinson's. And third, in cancer
research, NDRI provides this vital activity too.
Thank you very much for the opportunity to testify before
you today. We look forward to working with you and the
Committee and the NIH to pursue these very important and
exciting research opportunities.
[The prepared statement of Dr. Maclaren follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Stem cell research has great potential.
Dr. Maclaren. Yes. This is adult stem cell research that I
think is an opportunity.
Mr. Regula. They would be cells that have not yet taken on
an identity that could go to various locations and, is the word
morph themselves into health----
Dr. Maclaren. We seem to have progenitor cells parked in
various parts of our body in case of damage, in which case
these cells have a potential for regeneration. This is the
excitement, to be able to pursue that regenerative capacity.
Mr. Regula. Inject the healthy cells into the damaged
organ?
Dr. Maclaren. Yes.
Mr. Regula. What would happen to the damaged cells? Would
they just be absorbed by the body?
Dr. Maclaren. In the case of Parkinson's disease, it's a
lack of cells in a particular part of the brain creating a
chemical called dopa.
Mr. Regula. What about diabetes?
Dr. Maclaren. Diabetes, the hope is that the islet cells
which are lost could be regenerated from these progenitor stem
cells.
Mr. Regula. I had a group this morning say that it's that
close.
Dr. Maclaren. We can all just about taste it, sir.
[Laughter.]
Mr. Regula. Thank you very much.
Dr. Maclaren. Thank you.
----------
Thursday, May 2, 2002.
NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION
WITNESSES
JUDI LUND PERSON, PRESIDENT AND CEO, CAROLINAS CENTER FOR HOSPICE AND
END OF LIFE CARE
DAVID J. ENGLISH, PRESIDENT AND CEO, THE HOSPICES OF THE NATIONAL
CAPITAL REGION
Mr. Regula. Judi Lund Person, President and CEO, the
Carolinas Center for Hospice and End of Life Care. You're
accompanied by David English, President and CEO, The Hospices
of the National Capital Region.
Ms. Person. Thank you, Mr. Chairman. My name is Judi Lund
Person. I'm the President and CEO of the Carolinas Center for
Hospice and End of Life Care in Raleigh, North Carolina. I'm
pleased to appear before you today with my colleague, David
English, on behalf of a critical project that will advance the
quality of hospice and palliative care for millions of
Americans.
Specifically, we are recommending or requesting the
Subcommittee's support for a national data project to be
carried out collaboratively between the Carolinas Center, The
National Hospice and Palliative Care organization, and the U.S.
Department of Health and Human Services. As the Committee may
know, hospice and palliative care are among the fastest
developing components of our health care system today. For
example, in North Carolina, every county has at least one
hospice program. Last year, we served over 18,000 patients.
Mr. Regula. Do you deal mostly with cancer patients?
Ms. Person. About 60 percent of our patients have cancer,
but we serve any disease, any age.
Mr. Regula. What would be some examples of other diseases
that have the kind of needs that hospice provides?
Ms. Person. The kinds of patients that we see are
traditionally patients who are toward the end of their life. We
see a large number of congestive heart failure patients, COPD,
chronic obstructive pulmonary disease, some Alzheimer's
patients, some stroke and coma patients, end stage renal
disease.
Mr. Regula. Any pattern or length of time spent in hospice
care?
Ms. Person. The length of time spent in hospice care is
definitely diminishing. We are working on all sorts of angles
to try and make sure that people get access to hospice care
earlier in their disease.
Mr. Regula. Some of this is done in-house, isn't it, you
can have a hospice group go to the patient, am I correct?
Ms. Person. Absolutely. Almost all of our care is provided
to patients wherever they live. That might be in their own
home, in a nursing home, in an assisted living facility.
Mr. Regula. Okay, not in a standalone facility, then?
Ms. Person. We have facilities all over the country. But
only a small percentage of our care is provided there.
Mr. Regula. Okay, go ahead.
Ms. Person. One of the challenges arising from the huge
expansion in the services that we've been providing is a very
acute need to better understand how the services are evolving,
what the most effective practices are, and how the trends are
developing over time. In North Carolina, we have been
collecting data on hospice care since the very first hospice
patient was served in 1979. We have done our data collection
through a public-private partnership between the State
Government in North Carolina and our organization.
This information and the insights that we have found from
it are invaluable to our primarily not-for-profit community
based hospice providers, as well as State legislative and State
government decision makers. Through this data, we and they can
better design and deliver services on the limited resources we
have and the fund raising that's required to do the work.
One of our challenges, however, is that we as a State have
collected the data, but we can't compare ourselves to other
States in the country.
Mr. Regula. Do some States provide funding for hospice?
Ms. Person. State governments in general provide funding
for hospice through Medicaid. There is, I think, only one State
where the State government has actually appropriated money.
Mr. Regula. Do you get some charitable contributions and
support?
Ms. Person. We receive lots of charitable contributions,
absolutely.
We're before you today because we believe our partnership
is designed to significantly impact hospice care. We believe
our partnership can and must be expanded to the national level.
With me this morning is my colleague, David English, who
will speak to our vision for an expanded effort.
Mr. English. Thank you, Judi, and thank you, Mr. Chairman.
I come here today as the Chair of the Public Policy Committee
of the National Hospice and Palliative Care Organization, whose
members serve about three-fourths of all patients and about
700,000 patients a year are served by hospice and their
families.
I also serve as the President of the Hospice of the
National Capital Region, which includes Hospice of Northern
Virginia, Hospice care of the District of Columbia and Hospice
of Prince George's County. Germane perhaps to today, I'm also a
statistician, at least by training.
Put simply, as Judi said, there is a critical void in
information regarding hospice and palliative care. The work
that Judi has done in North Carolina and South Carolina is
totally unique within the country. This is in part of a
function on the fast growth, as Judi described, and part a
function of the great variety of hospice programs around the
country.
What we're hoping for is to take the appropriate steps to
establish benchmarks and standards that will enable our sector
to continue its legacy of quality compassionate care. The
proposal we are making to the Subcommittee will build upon that
existing data that Judi spoke about. It will also combine that
with State resources, with Federal resources and really create
a unique and dynamic system.
If one looks at it in sum, what one measures one manages.
And we really need to do this at a national level, not simply
at a local level. If we can work with you and the Federal
agencies to develop a credible, comprehensive survey tool, we
will provide better care to more Americans and their families
at the end of life. Given the tremendous potential of this
proposal, the NHPCO, the National Hospice and Palliative Care
Organization, the Carolina centers are committed to co-
sponsoring with the Federal Government this project. Our
organizations will devote matching resources to leverage the
Federal investment and the credibility which comes from a joint
effort with HHS.
With the Subcommittee's support for $750,000 in fiscal year
2003, we can launch the design and implementation of this
critical tool.
Mr. Regula. A new program?
Mr. English. It is a new program, yes, sir.
Building on an existing program which is incredibly
effective, but only exists in North Carolina and South
Carolina. Thank you for the opportunity to share that.
[The prepared statement of Ms. Person and Mr. English
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
I had a staff person, Eleanor Copeland, worked there.
Mr. English. Right, Eleanor Weiss now.
Mr. Regula. Her married name is Weiss? Is she still with
you?
Mr. English. She actually left us, unfortunately, to get
married and have children. Although she still stays with us,
she was heavily involved with raising funds, which is
significant.
Mr. Regula. She was a superb staffer. I'm sure she served
you well.
Mr. English. She told me you were her second best boss,
next to me. [Laughter.]
She is a remarkable human being.
Mr. Regula. She really is terrific. Thank you very much for
coming in.
----------
Thursday, May 2, 2002.
CHRONIC FATIGUE AND IMMUNE DYSFUNCTION SYNDROME ASSOCIATION
WITNESS
K. KIMBERLY KENNEY, PRESIDENT AND CHIEF EXECUTIVE OFFICER, THE CHRONIC
FATIGUE AND IMMUNE DYSFUNCTION SYNDROME ASSOCIATION
Mr. Regula. Kimberly Kenney, President and CEO, Chronic
Fatigue and Immune Dysfunction Syndrome. It's been an
interesting morning, some of the titles are mind boggling in
terms of the scope that they must encompass. I'll be interested
in chronic fatigue, I think all of us have that at times.
Ms. Kenney. It feels like it, doesn't it?
Mr. Chairman, and members of the esteemed Committee, I come
to speak with you today about chronic fatigue syndrome, CFS,
also known as chronic fatigue and immune dysfunction syndrome.
CFS is a serious and debilitating illness that affects twice
the number of Americans as multiple sclerosis. It is
characterized by profound exhaustion, chronic pain, flu-like
symptoms and severe cognitive problems. Women are affected at
three times the rate of men, and persons of lower socioeconomic
status and ethnic minorities are at greater risk than
Caucasians.
Mr. Regula. What causes it?
Ms. Kenney. We don't know. That's why we're here this
morning.
Mr. Regula. You want to do research that hopefully will
develop the----
Ms. Kenney. Come to better understand the causes and----
Mr. Regula [continuing]. Practices and lifestyle that would
overcome it, is that----
Ms. Kenney. Yes, treatments and lifestyle adjustments are
part of what I think we'll need to have more information about,
so we can return these people to good health.
Since 1987, when CFS was first formally defined by the CDC,
we've made important strides in awareness, research and policy.
Yet there is still no marker, no diagnostic test, no treatment
and no information about long term----
Mr. Regula. How do they identify it, other than you're
tired?
Ms. Kenney. It's a symptom pattern, and the exclusion of
any other possible causes.
Mr. Regula. I see that you have immune dysfunction
syndrome. Do you think part of this is caused by the immune
system not functioning?
Ms. Kenney. There are documented abnormalities in the
immune system, the endocrine and the central nervous system.
Mr. Regula. It would be pretty difficult to do your job.
Ms. Kenney. Yes. Most people can't do their job and end up
on Social Security disability, and if they're lucky, long term
disability.
Mr. Regula. So it's severe enough to keep you from
participating in society?
Ms. Kenney. Yes. In fact, the definition itself requires
significant and severe impact on work, life, home life,
schooling, education.
Mr. Regula. Do they give Social Security disability for
this?
Ms. Kenney. Yes. There's a ruling that was passed in 1999.
Mr. Regula. That's interesting, because how do they know
people aren't faking it?
Ms. Kenney. There's not a lot of secondary gain to tell
people you have chronic fatigue syndrome. It's still very much
demeaned and belittled. And the people who have this would much
rather be back at the lives they had before they got sick.
Mr. Regula. Any age level?
Ms. Kenney. It seems to affect people in the prime of their
life, but kids get it, seniors get it. There's no boundary in
terms of age, race, or socioeconomic status.
Mr. Regula. The symptoms would just simply be inability to
function effectively?
Ms. Kenney. Most people can remember the day, the hour and
the minute at which they felt ill for the first time and have
never felt well since. This goes on for years.
Mr. Regula. So you have a sense of not feeling up to par, I
guess?
Ms. Kenney. That's right. It's almost like having
mononucleosis 24 hours a day, on top of a chronic pain
syndrome. The cognitive problems----
Mr. Regula. Skip your testimony and tell me how we should
deal with this.
Ms. Kenney. All right, I'd be pleased to. A few months ago
I met with a group of CFS patients in Canton, Ohio. Those who
braved the snow that Sunday afternoon came to ask the same
questions I asked 11 years ago, when I began my work on behalf
of the CFIDS Association of America: Where can I find a
knowledgeable doctor? What symptomatic treatments are working
for other patients? What is the latest----
Mr. Regula. Are there doctors that specialize in this?
Ms. Kenney. There are a handful. Most doctors don't know
enough about it to effectively treat people, even for the
symptoms that might relieve their suffering and improve their
quality of life.
Mr. Regula. It seems to me, if you went in complaining
about fatigue that there could be many causes, and the
diagnosis would be a challenge.
Ms. Kenney. Yes, diagnosis is very much a challenge and can
take many months or years.
Mr. Regula. What do you think we should do? Why are you
here?
Ms. Kenney. The NIH and the CDC have been studying this
since about 1987. The Centers for Disease Control has, we've
recently come through a period of great tension and stress over
a three year period, 1995 to 1998, the Inspector General
documented that there was $12.9 million in CFS research funds
that were reported to Congress to be spent on CFS that were
actually diverted to other areas.
We've been working very closely with CDC and the Congress
to restore those funds and to expand the research program at
the CDC. And now it is much more comprehensive, they're looking
at all these different----
Mr. Regula. So they are doing research at CDC?
Ms. Kenney. Yes, they're doing research at CDC and the NIH
is funding a small amount, about $6 million a year, of external
research.
Mr. Regula. You'd like to see that expanded?
Ms. Kenney. Yes, in proportion to the magnitude of the
illness, its long lasting nature, the fact that people are
disabled and taken out of their work lives and their
productivity in our society. The economic impact of this, we
don't have a figure for it yet, but it's enormous.
Mr. Regula. Do you have a nationwide organization?
Ms. Kenney. Yes. I'm President and CEO of the only national
organization fighting this illness.
Mr. Regula. How many members do you have?
Ms. Kenney. We have about 23,000 members. Many of those are
families. There are estimated to be 800,000 people who have
this, but only 10 percent of them have been diagnosed,
according to CDC studies.
Mr. Regula. What's the cure?
Ms. Kenney. There is no cure right now. The best we can do
is symptomatic treatment of the sleep disorder, or the
cognitive problems, the pain. That's often not that effective.
Mr. Regula. So it's not a drug therapy.
Ms. Kenney. There's no drug therapy. There's only been one
drug taken through the early stages of FDA approval. We
basically wait and watch for other drugs that are approved for
similar conditions like MS or lupus, to see if those drugs
might have application with this population. So far there's
very little.
Mr. Regula. So it has a relationship, in your judgment, to
these other immune deficiency diseases?
Ms. Kenney. They share many factors. They share many
similarities in terms of symptoms. They are often misdiagnosed
as some of these other things, like lupus and MS and rheumatoid
arthritis. I think chronic disease in general is an area that
needs more research because of the subtle interactions of the
immune system and the cardiac system.
Mr. Regula. I was out with the MS folks this week, and of
course they have varying impacts. Do you have the same thing
with chronic fatigue? Does it put people in a wheel chair, for
example?
Ms. Kenney. Yes, there's a very wide variety of illness
severity. Some people are able to continue with work but have
to cut out all other activities and others are bed-bound for
years.
[The prepared statement of Ms. Kenney follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for coming.
Ms. Kenney. Thank you for hearing my testimony.
Mr. Regula. We'll read it, the staff will read it.
Ms. Kenney. It was more important to converse with you,
actually. Thank you, Mr. Regula.
Mr. Regula. Thank you.
----------
Thursday, May 2, 2002.
PANCREATIC CANCER ACTION NETWORK
WITNESS
PAULA KIM, FOUNDING CEO, PANCREATIC CANCER ACTION NETWORK
Mr. Regula. Paula Kim, Founding CEO, Pancreatic Cancer
Action Network.
Ms. Kim. Good morning, Mr. Chairman. Thank you very much
for this opportunity to testify.
My name is Paula Kim, and I'm here to tell you a little bit
about one of the most feared and deadly cancers. Pancreatic
cancer has a 99 percent mortality rate, the highest of any
cancer.
Mr. Regula. That's true, I understand that.
Ms. Kim. It's the fourth leading cause of cancer death for
men and women in this country. About 30,300 Americans are going
to be diagnosed this year with pancreatic cancer and just about
the same number will die. It strikes silently, and the average
life expectancy after diagnosis with metastatic disease is
about three to six months.
Mr. Regula. Is there any way you can get ahead of that? Do
you have to wait for symptoms?
Ms. Kim. Unfortunately, most patients are very
asymptomatic. By the time symptoms present themselves, most
patients have advanced stage diseases. Sometimes people are
lucky because they're in for something else and they catch it
by accident. But that's very rare.
Mr. Regula. What is it? What would be the evidence, a mass?
Ms. Kim. Not always. Tumors don't always show up like a big
mass, unfortunately. It's very diffuse at times. Sometimes you
might have jaundice, but that's if you have biliary
obstruction. So there's a lot of variations.
Mr. Regula. Will an MRI identify it?
Ms. Kim. An MRI sometimes can catch it. Generally,
endoscopic ultrasound and a CT scan with a fine needle aspirate
biopsy. But again, to do that, generally you need to present
with symptoms and generally then it's too late.
Mr. Regula. So the patient comes in with discomfort and
then the doctor identifies this?
Ms. Kim. Sometimes. But oftentimes not. Because what
happens is that many times it gets totally overlooked and it
gets mixed in with other things, such as ulcers,
gastrointestinal disease, sometimes it's back pain, sometimes
it can be distant pain in your arm. So oftentimes the symptoms
are very similar to other ailments.
Mr. Regula. It's pretty elusive.
Ms. Kim. Very. Absolutely very.
Mr. Regula. What are you asking us to do?
Ms. Kim. What we're saying is, it's a big problem. There
are less than 10 researchers fully focused on this disease.
There's no cure, no early detection, no treatment options. I
know this first hand because my dad died from pancreatic
cancer. It took nine months to diagnose him but just 75 days
for him to die.
Mr. Regula. Does it afflict men and women equally?
Ms. Kim. Just about, almost 50-50.
Mr. Regula. No particular age?
Ms. Kim. The average age of onset is 63, although I will
tell you in my work that I've come across, and I work with many
patients who are 35, 40 years old, men and women alike, people
that are absolutely in the prime of their life, that are very,
very healthy.
Mr. Regula. Kind of a silent----
Ms. Kim. Very silent, very deadly. Just absolutely nothing
that's really going on.
Mr. Regula. There isn't a whole lot you can do to
anticipate or prevent it, is there? By the time you find out,
it's too late.
Ms. Kim. That's the problem. And that's why we need
research. And that's what we're here to talk to you about.
We have many researchers who are willing to work on this,
but they're stifled due to a lack of opportunity and resources.
Mr. Regula. Is NIH doing something in this area?
Ms. Kim. Well, what's happening is, these are the words of
the NCI. In the words of the NCI, this cancer is
disproportionately underrepresented in both clinical and basic
research. Despite a budget of over $4 billion this year, the
NCI, by their own estimates, will spend $24.6 million, that's
six-tenths of 1 percent, kind of like trying to break apart an
iceberg with an ice pick.
Pancreatic cancer research has been left on the sidelines,
totally out of the lineup, we're not even in the ballpark. This
is the background on the cancer, so what we can do is talk
about where do we go from here.
Science follows money, money creates opportunity and
opportunity gets progress. That is the bottom line. So clearly
we need some giant steps, and here's how we can get there. We
urge you to support the following key actions that will bring
forth some scientific progress. Implement the NCI pancreatic
cancer PRG's recommendations. This is the blueprint. The NCI
needs to develop a strategy and get going.
We need to increase the pool of researchers, it's really
small. As I mentioned, less than 10 full time researchers in
this country on this disease.
NCI needs to continue funding 100 percent relevant grants
at a 50 percent higher pay line in fiscal year 2003. There are
currently zero specialized programs of research, SPOR grants,
in pancreatic cancer. We urge the NCI to fund no less than five
by fiscal year 2004. Cancer registry data takes about 18 months
to get into the system. Most pancreatic cancer patients die by
then. We need to develop ultra-rapid methods that can be
implemented so data can be collected and patients can be
contacted while they're alive.
We urge the NCI and the CDC to expand education and
awareness. The entire ocean of research of cancer funding must
rise, and all ships will rise with it, even our little tugboat
of pancreatic cancer. This is why PanCAN is a proud member of
OVAC, One Voice Against Cancer.
Mr. Regula. How many die each year from pancreatic cancer?
Ms. Kim. About 29,700. Thirty-thousand three hundred are
diagnosed. Nine out of ten people die. So what we'd like to do
is tell you that PanCAN joins OVAC in urging you to include
$27.3 billion for the NIH, $5.69 billion for the NCI, $199.6
million for the NIH Center for Minority Health and Health
Disparities, and $348 million for the Centers for Disease
Control Cancer Education, Prevention and Screening.
Mr. Chairman, the Federal research enterprise has done
wonderful things in this country for diseases. Pancreatic
cancer, unfortunately, hasn't been on that ship. We look
forward to working with you.
[The prepared statement of Ms. Kim follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. You founded the Pancreatic Cancer Action
Network?
Ms. Kim. Yes, sir.
Mr. Regula. Since it's such a short-lived disease, before
it's fatal, how do you get membership? Because people don't
know that they should be members.
Ms. Kim. It's very interesting, in 1999, when I founded
this organization, we had zero dollars, we had myself
volunteering and like five people more volunteering, a handful.
I am very happy to report to you, three years later, we have a
mailing list of 17,000 people, we have a full time staff of
seven, and thousands of volunteers across this entire country
raising hope and awareness. People are angry about this
disease, and through the power of technology and the internet
and fax machines, they've come to our cause.
Mr. Regula. So you're getting probably family members as
members of your organization.
Ms. Kim. Yes, it's mostly family members and we deal with
the patients. Then unfortunately, I'll talk to the patients,
I'll help them, six months later, they're almost always dead.
Mr. Regula. Thank you for your efforts.
Ms. Kim. Thank you very much.
----------
Thursday, May 2, 2002.
OREGON HEALTH AND SCIENCES UNIVERSITY
WITNESS
PATRICIA G. ARCHBOLD, DISTINGUISHED PROFESSOR, SCHOOL OF NURSING,
OREGON HEALTH AND SCIENCES UNIVERSITY
Mr. Regula. Dr. Patricia Archbold, Distinguished Professor,
School of Nursing, Oregon Health and Sciences University.
You're a friend of Senator Hatfield, I guess.
Dr. Archbold. Yes.
Mr. Regula. How is he doing?
Dr. Archbold. He's doing great.
Mr. Regula. Is he teaching?
Dr. Archbold. He's doing some teaching and some foundation
work for us. And I'm going to tell you about some of the
projects he's involved in.
Mr. Regula. Okay.
Dr. Archbold. I'm speaking for the University at this time,
and it's an academic health center. Like many centers, we have
a four part mission that involves research, teaching----
Mr. Regula. Do you get NIH grants?
Dr. Archbold. I do. I have right now----
Mr. Regula. At this institution and you personally, then?
Dr. Archbold. Yes. We have a large number of NIH grants in
the University. They focus on everything from very basic
molecular biological research through clinical research.
I'd like to update you today on some of the work we're
doing in aging, because that's the area that I'm involved in.
And we want to thank you, first of all, for helping us get some
additional funds for training of health professionals in this
area.
Mr. Regula. Do you deal with the School of Nursing then?
Dr. Archbold. I'm in the School of Nursing.
Mr. Regula. We had testimony a couple of weeks ago that
we're losing nurses because of the impact of stress, the
inability to just deal with it. They're leaving the profession
and there is a looming shortage of nurses.
Dr. Archbold. Yes, a dramatic shortage of nurses and also
nursing faculty. The mean age of nursing faculty in Oregon is
over 50. And nurses, it's in the late 40s. So I would say the
crisis is here.
Mr. Regula. Any recruits coming in?
Dr. Archbold. We are at our school. But that's not true
nationally.
Mr. Regula. What could we do in this legislation or
expenditure of money, we're a money committee, Appropriations,
what could we do to help with the nursing profession to get
greater numbers and keep people?
Dr. Archbold. I think that one thing would be scholarship
dollars for nursing students. Nurses don't have the earning
capacity that other professionals in health care have. So
encumbering large loans is very difficult for them.
Mr. Regula. Is there a program of forgiveness in the
nursing profession?
Dr. Archbold. Yes.
Mr. Regula. I thought there was.
Dr. Archbold. But expanding the number of scholarships
would bring more people in. And then wages and working
conditions are an issue in nursing. I think we as a country
need to look at that systematically.
Mr. Regula. I'm using up your time, but if you can give me
in a nutshell what you'd like, why are you here.
Dr. Archbold. This is very important, because in addition
to needing nurses in general, we need nurses with expertise in
caring for elders. At the Oregon Health and Sciences
University, we've been looking at reconceptualizing care so
that we're working with younger people on a very highly
individualized, tailored goal setting mechanisms for making
lifestyle changes to keep people healthier longer. That's
called the Center for Healthier Aging. We have AOA funding for
that.
Mr. Regula. Nurses in many instances are probably closer to
the patient than the doctor.
Dr. Archbold. I think that's probably true in terms of time
and contact.
Mr. Regula. Right. And is your program two years, three
years, four years or a mixture, at your university?
Dr. Archbold. At our university, we have four campuses,
three in rural areas and one in Portland. It's a two-year
program on top of two years of general learning.
Mr. Regula. So they get a bachelor's degree in nursing?
Dr. Archbold. Correct. And the Oregon Nursing Leadership
Conference is now working very closely to integrate the
associate degree programs more closely with the bachelor's
degree programs.
Mr. Regula. You offer the associate, with the two year?
Dr. Archbold. We don't, but it is at the State.
Mr. Regula. So you'd like us to give some financial support
to encourage people to go into the field.
Dr. Archbold. To enter nursing, and then once they're in
it, to progress and then while in it, to develop expertise in
gerontological nursing.
Mr. Regula. Well, the demographics on the growing
population of seniors is startling, or mind boggling, because
it's going to affect so many facets of our society.
Dr. Archbold. That's right. It already has, and will expand
in the foreseeable future.
Mr. Regula. Well, we will look at it, we'll look at your
testimony. I'd be interested in programs where we can help.
Dr. Archbold. I believe this would be one place where you
could really help.
Mr. Regula. Of course, we have a limited budget, so many
needs. Yet we do a lot of good things in this country.
Dr. Archbold. Yes.
Mr. Regula. NIH testified last week, that every five years,
life expectancy goes up a year. That's a pretty good record.
Dr. Archbold. For some people.
Mr. Regula. In 50 years, you're adding 10 years.
Dr. Archbold. Yes, for some people.
Mr. Regula. Yes, I understand that, but on average. So
compared to my parents, I have theoretically 10 more years.
Dr. Archbold. That's right. And we're very interested in
creating ways that the health care system can keep people
healthy through interdisciplinary----
Mr. Regula. Well, that's part of it, if you have quality of
life it's one thing. Living long without quality of life is
another. I suppose that's one of the challenges.
Dr. Archbold. That's right.
Mr. Regula. Is to make sure people have a quality life.
Dr. Archbold. That's right.
Mr. Regula. Well, thank you for coming. Tell the Senator,
he and I collaborated on the visitor's center downtown, the
White House Visitor's Center. I don't know if you've been
there, probably not.
Dr. Archbold. Not yet.
Mr. Regula. It's down next to the White House, people can
go there when they want to go to the White House, and they can
get a lot of information and so on. You tell Mark that it's a
huge success.
Dr. Archbold. I will.
Mr. Regula. He'll remember it, because we worked together
on making it happen. Thank you for coming.
Dr. Archbold. Thank you very much. And I have some
testimony that's longer.
Mr. Regula. It will be in the record. Staff will read it,
because we're interested in the nursing problem. Retention as
well as getting young people to join, because we're going to
need these people very much as we have this aging population.
Thank you.
[The prepared statement of Dr. Kathleen Potempa, unable to
appear, and the biography of Dr. Archbold follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 2, 2002.
AMERICAN TRAUMA SOCIETY
WITNESS
HARRY TETER, EXECUTIVE DIRECTOR, AMERICAN TRAUMA SOCIETY
Mr. Regula. Harry Teter, Director of the American Trauma
Society.
Mr. Teter. Good morning, Mr. Chairman, and I thank you for
the opportunity to appear before you this morning. I have some
written testimony and I will leave that for you all to look at
and digest at another time.
Mr. Regula. The Trauma Society, tell me what your mission
is.
Mr. Teter. Our Trauma Society has basically two missions.
One is to provide the proper care for those who are injured or
in very severe episodes such as car crashes, etc., to be sure
they get to the right place, seen by the right people in a very
rapid time. The second mission is to try and prevent trauma
from ever happening in the beginning.
So we have a great deal of work that we do with the Centers
for Disease Control and Prevention, with NHTSA, with all the
agencies that look to how we prevent car crashes, how we
prevent homicides, suicides, etc. So we have two major
programs.
Mr. Regula. Do you benefit from research done by the
military? Because obviously they must have a higher than
average number of individuals that are suffering from trauma,
just by the nature of the work they do.
Mr. Teter. Yes. And we obviously look to any studies or any
work that they do that will help us to either do better care or
prevention. In fact, many of the trauma systems that we are out
there building today are designed because of the military, what
we learned in Vietnam, what we learned in Korea. In fact, they
were the examples, where we would pick people up from where
they were injured and take them to a proper place, not
necessarily to the nearest place, which led to many unnecessary
deaths.
And we're certainly learning that now across the country,
and we're implementing these systems.
Mr. Regula. Aren't more and more hospitals putting in
trauma centers, where they have the know-how and the equipment
to deal with automobile accidents, falls, a whole range of
industrial accidents?
Mr. Teter. Yes, we do have that. In fact, thanks to this
Committee, you have helped us develop what we call the Trauma
Information Exchange Program. I will be delighted to give you a
map that shows you where all the trauma centers are in this
country and what their capabilities are. It becomes very
important, as we look at responding not only to anything that
would be in a mass casualty situation, but in everyday
situations. We are painfully reminded of what happened on 9/11.
And I will tell you that if we don't have trauma systems in
place, we're not going to be able to take care of the next mass
casualty.
Mr. Regula. One of the important groups are the EMS folks
that are attached to fire departments. I live out in a rural
area, and our fire departments volunteer, and our EMS people
are volunteers. I'm always amazed, pleasantly surprised how
many individuals, at their own expense in our little rural
community, will go get EMS training because if I fall off a
ladder, they're going to be the first ones there, probably.
Mr. Teter. We owe an enormous gratitude to the EMTs in this
country who volunteer.
Mr. Regula. Do you develop information that they can use in
their training programs?
Mr. Teter. Absolutely. Absolutely. And I must say that a
great deal of good work has been done by the Department of
Transportation in training programs. We are very much
concerned, they are the entry point in our systems. They are
the ones that arrive first on the scene, and that's where
things start. But if they didn't have a procedure in place in
the community to know where to take them, whether you go to a
trauma center, and not all patients of course need to go to a
trauma center. Eighty-five percent of patients go to the
nearest hospital.
Mr. Regula. Can't they do a lot of damage if they don't
handle that patient correctly?
Mr. Teter. Absolutely. That's why they're well trained. No
question about it. We do not want to have people out there that
don't know what they're doing.
But we also want to be sure that, as I say, they get to the
right place, which is why the trauma systems are so important,
and why today, I'm here to urge three things. You always want
to know why we're here, we are here because the trauma systems
development program got no funding recommendations from the
Administration. We find that perplexing, at best. Because if
we're going to do homeland preparedness, or just care for you
and me at home, we'd better have those.
Fortunately, this Committee has always rectified that in
the past, and we ask that you do it again. We also look very
closely to the injury prevention program at CDC. We think CDC
does marvelous work. We want them to continue on their injury
prevention research. We have to develop better programs on how
to keep people out of harm's way.
Then three, we have two programs that the Trauma Society
does. One, to help families of trauma victims. Note again that
when we looked at the incident of 9/11, we saw these anguished
families before us. Well, let me tell you, that is every day in
this country at every trauma center. We have started developing
a wonderful program and we need your help on that. In our
Trauma Information Exchange Program, which thanks to this
Committee, we're ready to give you the best information we can.
Mr. Regula. Ergonomics, do you work with that?
Mr. Teter. Ergonomics is a little different issue.
Interesting and important, very high. Trauma is blunt or
penetrating injury, it is severe. It is what you can't do
anything about when it happens to you. And we need to have you
properly cared for, and me too.
[The prepared statement of Mr. Teter follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, thank you very much.
Mr. Teter. It's been a pleasure, thank you.
----------
Thursday, May 2, 2002.
INTERNATIONAL FOUNDATION FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
WITNESS
NANCY NORTON, PRESIDENT, INTERNATIONAL FOUNDATION FOR FUNCTIONAL
GASTROINTESTINAL DISORDERS
Mr. Regula. Nancy Norton, President, International
Foundation for Functional Gastrointestinal Disorders. Welcome.
Ms. Norton. Thank you, Mr. Chairman, and members of the
Subcommittee. Thank you for the opportunity to appear before
you today.
My name is Nancy Norton. I am the Founder and President of
the International Foundation for Functional Gastrointestinal
Disorders. I started the IFFGD in response to my own experience
as a patient at a time when there was little educational
information or support available to patients with bowel
disorders. I'm happy to say that 11 years later, our
organization annually serves hundreds of thousands of people,
providing information and support to patients and to
physicians.
It's the largest organization of its kind in the U.S. IFFGD
works with consumers, patients, physicians, providers and
payors to broaden understanding about gastrointestinal----
Mr. Regula. So you're an information group.
Ms. Norton. We're an information group, we're also a
research group. And we provide support.
Mr. Regula. But the doctor, or the physician, has to take
care of the actual disorder, correct?
Ms. Norton. The hope is that the doctor will take care of
the disorder, right. These are some of the things that need to
be addressed.
Mr. Regula. So your organization would dispense information
to the public? Do you have a web site?
Ms. Norton. We have a web site. Actually, we have five
different web sites. We have a home page that talks about
general gastrointestinal disorders, we have one that's about
irritable bowel syndrome, we have one that's about bowel
incontinence, and we have a kids' GI site. So we address a
number of different issues in the GI community.
Mr. Regula. So really the function of your organization is
to get the information out, give people who need to know and
get them to the proper care, is it?
Ms. Norton. Right. I think one of the important things to
take note of regarding our organization is that bowel disorders
are hidden in this society. We don't talk about it openly. I'm
here really to talk about fecal incontinence. Fecal
incontinence affects an estimated 2.2 percent of the
population. Our organization did the first prevalence study on
fecal incontinence in the United States.
We feel that that number is underreported. I think people
don't realize the level of incontinence and it's not just
something that occurs in the elderly. We tend to feel like it's
something that happens when you're frail and elderly. I'm an
incontinent person as a result of an obstetrical injury. Few
women know that an outcome of childbirth can be that you live
the rest of your life with fecal incontinence.
We don't talk about the bowel disorders associated with
multiple sclerosis or diabetes or colon cancer or uterine
cancer.
Mr. Regula. So your organization gives people a willingness
to recognize that there is a problem.
Ms. Norton. Right. We may be the first person they've ever
talked to about their incontinence.
Mr. Regula. How do they find out about you?
Ms. Norton. We have information in doctor's offices, also
through the media. We try to get a message out, but it's very
interesting, the media in the United States is very reluctant
to even talk about bowel disorders. So it's been extremely
difficult in getting this message out into the public.
Mr. Regula. But your web site would be one way.
Ms. Norton. Right. I think another point I would really
like to make is that 45 percent of nursing home residents are
incontinent. Typically maybe only 14 percent of nursing home
residents are incontinent on entry into the nursing home. So
there's something that's going on in the first year of their
stay in a nursing home and those numbers increase. This is
really an issue that needs to be pursued.
Mr. Regula. It seems like it's somewhat of a degeneration
of the system. Is there a cure?
Ms. Norton. There is no cure. And that's part of why I'm
here. Some of this is preventable. We would like to see the
NIH, NIDDK research portfolio expanded so that we can address
prevention as well as treatment.
Mr. Regula. Do they do anything on this?
Ms. Norton. They do very little. We are sponsoring a
conference in November of this year, our organization. We've
asked for support from NIDDK in particular to sponsor this
meeting. We really need to have more funds directed into this
area, in particular.
The other piece I would like to address is that of
irritable bowel syndrome. I have been here before and spoken
about IBS. But IBS affects an estimated 30 million Americans.
Many people suffer in silence, unable to speak about the
disease, even to their family members. The medical community
has been slow in recognizing IBS as a legitimate disease.
Patients must often see several doctors, sometimes searching
for several years before they are given an accurate diagnosis.
Data reveals that for many people, there are severe
consequences and a distressing level of disability, morbidity
and mortality that results from the search for an effective
treatment for unrelieved chronic symptoms of IBS. Once a
diagnosis of IBS is made, medical management is limited,
because the medical community still does not understand the
physiological mechanism of the disease.
While there is much we don't understand about the causes
and treatment of IBS, there is much we do know about the level
of suffering associated with the disease. For example, we do
know that IBS is a chronic disease affecting as many as one in
five adults. It is reported more often by women than men. It is
the most common gastrointestinal diagnosis among
gastroenterology practices in the U.S. It is a leading cause of
worker absenteeism in the United States. And total and indirect
costs associated with IBS have been estimated at $25 billion.
Mr. Chairman, much more can be done to address the needs of
millions of digestive disease patients. We urge you to continue
the effort to double the NIH budget by providing a 16 percent
increase for fiscal year 2003. Within NIH, provide proportional
increases of 16 percent to the various institutes and centers,
specifically NIDDK.
We understand the difficult budgetary constraints under
which the Subcommittee is operating. Yet, we hope you will
carefully consider the tremendous benefits to be gained by
supporting strong research and education programs for
incontinence and irritable bowel syndrome at NIDDK.
Mr. Chairman, on behalf of millions of digestive disease
sufferers, thank you for your time.
[The prepared statement of Ms. Norton follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you for taking the time to come.
* * * * * * *
Thursday, May 2, 2002.
ASSOCIATION OF ACADEMIC HEALTH CENTERS
WITNESS
DR. ROGER J. BULGER, M.D., PRESIDENT AND CEO, ASSOCIATION OF ACADEMIC
HEALTH CENTERS
Mr. Regula. Dr. Roger Bulger, President and CEO,
Association of Academic Health Centers.
Dr. Bulger. Thank you very much, Mr. Chairman. I admire
your stamina, and everybody else's, who's heard us.
Mr. Regula. We're getting down to the end, two more to go.
It's interesting, though, as part of getting an understanding.
I think that's what makes this Committee worthwhile, we can
help people in a lot of ways.
Dr. Bulger. I've learned a lot by being here, I can tell
you that.
I guess I should tell you who I represent. An academic
health center is a place that is defined as having a medical
school, either allopathic or osteopathic, and at least one
other health professional school in association with a clinical
enterprise. So the UCLAs and the Michigans and the places that
have as many as seven health professional schools----
Mr. Regula. Then you have the association.
Dr. Bulger. Then we have the association. And those
individuals who have the job of integrating what goes on.
Mr. Regula. In your testimony, what do you want to tell
this Committee?
Dr. Bulger. The reason I wanted to tell you the basis I'm
coming from, it gets to what I wanted to highlight. There are
four or five things. First of all, we celebrate the doubling.
We've worked very hard for that. I think it's wonderful. I
wanted to bring you some information. A survey that we've just
done shows that 70 percent of our members have grown their
research enterprise in response to the doubling of the NIH
budget.
Mr. Regula. Probably almost all your members participate
with NIH in a grant of some kind.
Dr. Bulger. Well, I think that's right. But you frequently
hear the criticism from friends and foes alike, or the
observation that this is only going to make the rich richer,
the top 25 research----
Mr. Regula. You mean schools when you say rich.
Dr. Bulger. Yes, the ones that are research intensive.
Mr. Regula. But not every school's got the capability.
Dr. Bulger. No, but they have, what I'm saying is that 70
of them, 70 out of 100 responding, have benefitted
significantly enough for them to advance. We know that every
dollar that comes from the Federal Government in a grant
translates into six or seven dollars for the--
Mr. Regula. How many schools in your judgment, or
facilities, I should say, in the United States, are capable of
doing research as envisioned by NIH?
Dr. Bulger. I would say that at least, when you take the
centers, which have an average of four to five schools, that
there are 100 that can do that, 110. All of them can do
something, but they're not geared up for intense laboratory
research in many instances.
What I thought would be useful is to comment on some of the
things that have not been commented on before. I know how hard
it is to juggle the dollars. But I picked out five things that
we think are very important and there are raises in each of
these five things. They address institutional, cultural and
medical problems, health problems in ways that I think people
don't think of when they think entirely in research benefits.
Let me just touch on them.
First of all is the Center for Minority Health and
Disparities. You can see the reasons for that. That could be in
a time of doubling, raising that a little bit more, even though
it's at almost a 20 percent raise here. It wouldn't be seen in
the larger sense.
The other ones are two, you just touched on it, and I was a
little surprised it didn't come up when you asked what can we
do for nursing. What we can do for nursing, one of the things
our places can do for nursing is develop the capacity for
nursing faculty. In the long term, we can't train more people
unless we have more faculty. It's not appealing. They can't get
research funds. They do different kinds of research.
And you know what, fecal incontinence is one of the kinds
of things that nurses, when they see problems, they work on
those problems. To be honest, they're not very sexy from the
point of view of the traditional thing. That institute could
stand an increase, I know they have good proposals that go
unfunded.
The other one that we haven't talked about at all is
dentistry. That institute is doing very well and it's giving
that profession, which is kind of also in need of faculty to
the same extent that nursing does. Remember, we don't talk
about dental shortages, because half the people in the United
States don't get dental care.
Mr. Regula. We've had that testimony.
Dr. Bulger. So those are the things that I would really
mention. I think the other one that doesn't take more money but
you could do with a directive, and we want to associate
ourselves with, is what the Deans of Public Health I think have
already expressed to you somewhere in the written testimony.
That is that the NIH look across the board within each
institution at enhancing the investment in population based
studies, health care outcomes. Not necessarily knowing they
can't seek the molecular basis for the disease, but how do we
change and improve the outcome with chronic diseases and other
things.
That's probably enough. Thanks a lot.
[The prepared statement of Dr. Bulger follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you very much for your testimony.
----------
Thursday, May 2, 2002.
FRIENDS OF THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
COALITION
WITNESS
KAREN STUDWELL, CO-CHAIR, FRIENDS OF THE NATIONAL INSTITUTE OF CHILD
HEALTH AND HUMAN DEVELOPMENT COALITION
Mr. Regula. Karen Studwell, Co-Chair, Friends of National
Institute of Child Health and Human Development Coalition.
Ms. Studwell. Good morning.
Mr. Regula. We're happy to welcome you here today.
Ms. Studwell. Thank you. I am here today as Co-Chair of the
Friends of the National Institute of Child Health and Human
Development, a coalition of nearly 100 organizations that
support the extraordinary work of NICHD. Our coalition is now
in its 16th year and is comprised of organizations----
Mr. Regula. You support the work out at NIH?
Ms. Studwell. Right. NICHD is one of the institutes at NIH.
Our coalition is comprised of organizations representing
scientists, health professionals and advocates for the health
and welfare of children, adults, families and people with
disabilities.
Mr. Regula. How do you get organized?
Ms. Studwell. Very haphazardly. We're actually a group,
it's a voluntary organization of people who advocate on behalf
of over 100 organizations. Some of these organizations are
small, representing Rett Syndrome or Fragile X, who aren't
represented in Washington, so they join the Coalition because
they support the research at NICHD.
Mr. Regula. So people who have an interest in child health,
they're motivated by that, I assume?
Ms. Studwell. Typically the research that NICHD does would
affect either the diseases or conditions that their
organization represents. NICHD's research doesn't focus on one
disease or two diseases, but the whole span of human
development. So they do work on maternal health, fetal
development, child health as well as behavioral health.
Anywhere from tobacco prevention to sexual behavior, as well as
autoimmune diseases, diseases that may be prevented with
treatment in utero. So it's quite a broad spectrum.
The Coalition would like to thank you for sustaining the
bipartisan commitment to doubling the Federal investment in NIH
over the past five years. As I said, we're focused specifically
on NICHD. Sustained public investment in NICHD provides a
foundation of scientific knowledge about physical,
intellectual, social and emotional development that has
profoundly improved public health and reduced human suffering.
The Friends of NICHD believe that this public investment is
poised to produce new insights into human development and
solutions to health problems for the global community, our
Nation and the families that live in your town. In the past
year alone, NICHD has made great strides in addressing its
research mission and has added impressive achievements to its
record of progress over the past 39 years.
For example, NICHD researchers have found a vaccine to
prevent staph infection, which is commonly received in
hospitals accidentally when patients go in for other surgeries.
In addition, researchers funded by NICHD discovered a new
vaccine for typhoid fever, a disease that infects 16 million
people worldwide each year, killing 600,000. Typhoid vaccines
currently on the market are ineffective for children under five
years of age, and this is the first vaccine to protect young
children against typhoid fever.
NICHD also continues to make advances in understanding the
causes and treatments for male and female infertility, pelvic
floor disorders and the risks of pregnancy itself. In this
country, 30 percent of women experience major medical
complication at some point during their pregnancy. We hope this
alarming number will decrease through additional research
focused on pregnancy related complications such as prevention
of pre-term labor, the role of genetics in pregnancy outcomes
and the causes of ethnic and racial differences in maternal
mortality, such as African-Americans, who are four times more
likely to die of pregnancy related causes than whites.
A major research body for maternal-fetal medical research
is the NICHD maternal-fetal medicine units network. The MFMU
network was established in 1986 to respond to the need for well
designed clinical trials in this specialty field. With 14
participating centers, the MFMU network is the only vehicle of
its kind that allows researchers to study a sufficiently large
number of patients so that concrete recommendations can be made
to introduce new scientific discoveries. Increased funding is
needed both for individual investigators studying pregnancy and
its complications, as well as to ensure the long term stability
of the MFMU network.
Although this impressive record of accomplishment has made
significant contributions to the well being of our children and
families, much remains to be done. I'll briefly tell you about
some of the challenges that remain and some of the projects
NICHD is working on. Currently, as part of the Child Health Act
of 2000, they are working on the national longitudinal study,
which will look at children from in utero all the way until
they are 20 years old. The study will enroll 100,000 children
and is currently being developed. So we strongly support fully
funding that initiative.
The Child Health Act of 2000 also included a new pediatric
research----
Mr. Regula. One last question, we're running out of time.
Are you pleased with what they do at that institute?
Ms. Studwell. Absolutely, yes.
Mr. Regula. Do you think that they're making progress and
contributing substantially to children's health?
Ms. Studwell. Yes.
Mr. Regula. And your group is very supportive of the
efforts that they make?
Ms. Studwell. Yes, absolutely. And we're asking for a $1.28
billion fiscal year 2003 appropriation for NICHD.
Mr. Regula. I don't know what the President's budget has in
it.
Ms. Studwell. It was a bit less than that. This would be a
15 percent increase, as opposed to the 9 percent increase
that's in his budget.
[The prepared statement of Ms. Studwell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. You're not backward about making your request.
[Laughter.]
Ms. Studwell. Thank you.
Mr. Regula. Thank you.
----------
Thursday, May 2, 2002.
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
WITNESS
NANCY CREAGHEAD, PROFESSOR AND CHAIR, DEPARTMENT OF COMMUNICATION
SCIENCES AND DISORDERS, UNIVERSITY OF CINCINNATI; PRESIDENT,
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
Mr. Regula. Our last witness today, and this is the one
we're looking for, is Dr. Nancy Creaghead, Professor and Chair
of the Department of Communication Sciences and Disorders, the
University of Cincinnati, and President of the American Speech-
Language Hearing Association.
Put in layman's language what you want to tell us.
Dr. Creaghead. All right, I will. I am coming today on
behalf of the American Speech-Language Hearing Association,
which represents 105,000 audiologists and speech-language
pathologists. I am here to urge you to continue support for
newborn hearing screening and early intervention.
Mr. Regula. We had some comment on that, I'm aware of it
because my son and daughter-in-law just had a baby, their
little girl is about 12 weeks now. And I think the hospital, I
asked them, they did give them some type of hearing check. Then
we had testimony a few weeks ago about the fact that they felt
that it should be mandatory, this person that was testifying.
Dr. Creaghead. That's correct.
Mr. Regula. A few little girls that got missed.
Dr. Creaghead. That's what I am----
Mr. Regula. It seems so rational. Why wouldn't every
hospital do this?
Dr. Creaghead. Every hospital doesn't do it because of the
cost. And so that----
Mr. Regula. How costly, what do they do, use a tuning fork
and see if the child reacts? How do you test the hearing in a
baby?
Dr. Creaghead. There are two techniques that are available
for testing a baby, who obviously can't respond overtly. One of
them is oto-acoustic emissions, which is testing what happens
in the middle ear through sound pressure, and the other one is
auditory brain stem response, which is through electrodes to
see if the brain is getting the signal from the ear. So one of
them is actually a process in the ear and one's in the brain.
Mr. Regula. So there is substantial expense connected with
it.
Dr. Creaghead. The expense----
Mr. Regula. Maybe not substantial.
Dr. Creaghead. About $25 to $60.
Mr. Regula. How many States mandate this?
Dr. Creaghead. Currently, and this is actually because of
the previous funding that's already in place, there are 37
States that mandate it, plus the District of Columbia. And
other States that have voluntary support of this. So there are
about 40 States that are doing testing.
Mr. Regula. If you catch it early, with the testing of a
baby, does that give a greater opportunity for remediation?
Dr. Creaghead. Absolutely. That is the critical thing. The
reason that we need to do this testing of infants is that
despite the fact that we have made such increases with the
current Federal funding through EHDI--we have gone from 20
percent of the children being tested to about two-thirds--we
still have 11 children leaving hospitals every day who haven't
been tested, who have hearing loss and their parents don't know
it because they didn't receive testing.
What is needed is funding, back to your question regarding
the need for early intervention. What we need funding for right
now, and the reason we're asking for an additional $11 million
for the HRSA and $12 million for the CDC, is to continue the
early testing, but really importantly, to be able to make that
connection to early services. Children need to begin to have a
hearing aid and begin services by six months of age to prevent
the incredible delay that's going to occur in their
communication, their speech and language development and
ultimately their school success in reading and writing.
Mr. Regula. So identifying them means you get remediation
early, which would be very important in speech patterns?
Dr. Creaghead. Absolutely.
Mr. Regula. That's what the mother testified to a couple of
weeks ago.
Dr. Creaghead. It's critical for speech and language
development and ultimately, school success.
Mr. Regula. Seems to me every State ought to mandate it.
Dr. Creaghead. The problem now is that with the level of
funding we have right now, and cutbacks in State funding and in
Title V, that States who would put these into place don't have
funds to make that next step, which means tracking, doing
follow-up testing to find out what the nature of the hearing
loss actually is, to track those children and be sure that they
get them into the early intervention and preschool and then
school age programs.
Mr. Regula. Would it require a specialist to administer
this test? Because in the hospitals, usually the nurses would
be the individuals that would be caring for that child the
most. Is it a specialized technique?
Dr. Creaghead. The test itself does not have to be
administered by a specialist, but it needs to be, the program
needs to be coordinated and supervised by an audiologist. Then
volunteers and other people, including nurses, can actually do
the actual testing.
The other thing that we really need that's related to this
is increases in the Part C, the preschool portion and early
intervention portion of IDEA, in order to support the services
that these children need. Also, there is a critical shortage of
special education personnel. So we're also asking for a 12
percent increase in Part C to support intervention, for early
intervention, and in Part D, to support personnel preparation.
Mr. Regula. You know, IDEA has to be reauthorized.
Dr. Creaghead. Right.
Mr. Regula. Are you going to testify?
Dr. Creaghead. Absolutely.
Mr. Regula. Good. So you represent the American Hearing
Association, is that right?
Dr. Creaghead. I'm the volunteer President of the American
Speech-Language Hearing Association.
Mr. Regula. Well, I think obviously this is very important
work. Early intervention seems to be the key.
Dr. Creaghead. It is. Increasing funds are absolutely
needed for this program to be able to--that we've already
started and made so much progress, in two years we've gone from
identifying, as I said, 20 percent, to identifying two-thirds
of them. But there's no point in identifying them if we can't
provide the intervention services.
Mr. Regula. Is Ohio mandatory?
Dr. Creaghead. Ohio actually just signed, I was just
yesterday in Maselin, Ohio, where Governor Bob Taft signed our
bill into law, and we became the 37th State.
Mr. Regula. I think Kirk Shering sponsored that.
Dr. Creaghead. That's right.
Mr. Regula. One of my Representatives.
Dr. Creaghead. He was there, and he was speaking in a group
of individuals and in Maselin, had done an incredible amount of
work. Joan Fenfrock is one of the people, she was one of the
absolute leaders of this effort in Ohio. So I had the
opportunity to fly into Cleveland yesterday and be there with
the Governor as he signed the bill.
So Ohio is finally on board, 37. I wish we had been
earlier, but we finally got there.
Mr. Regula. That's terrific. Any other points you want to
make?
Dr. Creaghead. I think those are the major things. I think
that the fact that the coordinated effort from HRSA and CDC and
the funding for IDEA is the critical package that we can put
together to be sure that these 12,000 children with hearing
loss that are born every year are able to succeed in school.
Mr. Regula. I suppose a lot of them get in the IDEA
program.
Dr. Creaghead. Yes, they do. But the problem is that if
they get there too late, if they're not identified, right now
if a child isn't identified early, it's usually like two and
three years old when they're not talking, when they're already
not talking is when they get identified. And it's too late. And
then they are going to be taking more funding throughout life
from IDEA because of the fact that they have greater problems.
[The prepared statement of Dr. Creaghead follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you very much for coming.
Dr. Creaghead. Thank you so much for allowing me to
present.
Mr. Regula. I think that completes our list today. Thank
you all. The Committee is adjourned.
Tuesday, May 7, 2002.
NATIONAL YOUTH EMPLOYMENT COALITION
WITNESSES
T.W. HUDSON, EXECUTIVE DIRECTOR, HOUSTON WORKS USA
YOLANDA FINK, ASSISTANT CORPS LEADER, OHIO DEPARTMENT OF NATURAL
RESOURCES, OHIO CIVILIAN CONSERVATION CORPS, CANTON, OHIO
Mr. Regula. Well, we will get started. Today we have a lot
of witnesses; and I guess you all know the rules, 5 minutes. We
have got a little blinker here that gives a warning. I hate to
cut it short, but just remember, you won the lottery or you
wouldn't be here at all.
We get about 350 to 400 requests to testify. And we run a
lottery with--what did we do about, Francine--about 140. We
take statements from everybody, but obviously we just don't
have the time to do 400. I think it indicates a high degree of
interest in the activities of this Committee.
I told the Members when we started--I said, the Bible says
there are two great commandments. The first is love the Lord,
and the second is love your neighbor; and you are all our
neighbors. Because we do a lot of things that touch the lives
of a lot of people, probably almost all Americans, because we
do all of the education funding, and we do the health research,
the National Institutes of Health, the Center for Disease
Control, we do the Labor Department. It is broad, broad
jurisdiction. And that is why we have so many requests.
That is okay because that is democracy. People have an
opportunity to be heard. And we are as sensitive as possible to
all of the needs of a lot of people. Even though we have a big
budget, we have to stretch it to make it fit. But we do the
best we can. So we will get started.
Mr. T.W. Hudson, accompanied by Yolanda Fink, Ohio
Department of Natural Resources--I know where that is--and the
Ohio Civilian Conservation Corps, National Youth Employment.
Welcome.
Yolanda was down in my office. She is going to go back home
and tell everybody to join that Civilian Conservation Corps.
Okay.
Mr. Hudson. Mr. Chairman, members of the Subcommittee,
thank you for the opportunity to testify today. I am here on
behalf of the National Youth Employment Coalition, and I will
focus my remarks on the Youth Opportunity Grant. However, I am
equally concerned about the funding cuts for youth dislocated
workers and adults.
And I would like to ask please if our remarks could be
included as a part of the record.
Mr. Regula. I appreciate your summarizing. Try to summarize
because 5 minutes is not long. I like a minute or so if
possible for questions for myself or other Members that come.
And your entire statement will be in the record.
Mr. Hudson. Thank you.
I am the Executive Director of Houston Works USA, a
community-based organization. Over the past 18 years, we have
served over 100,000 youth. We have been the recipient of a
Youth Opportunity Grant which targets 7,500 young people in
Houston's most impoverished areas.
A study conducted recently by Northeastern University found
that over 1 million young people in the United States between
the ages of 16 and 24 lost their jobs this past year. This
accounted for 53 percent of the total U.S. jobs lost, five
times the comparable rate for the adult population.
The Youth Opportunity program, YO, targets youth in high
poverty areas who are left behind by the traditional
educational system. It emphasizes prevocational skills,
provides academic remediations, encourages postsecondary
education, but with successful employment as its ultimate goal.
YO is a distillation of the best practices of youth programs.
It differs from the mainstream program of employment
training in two major ways. First, it concentrates funding in
high poverty areas through a holistic service delivery system.
And second it is open to all youth who live in disadvantaged
communities. YO provides a forum for youth services, so we
avoid redundancy and we have full collaboration.
The cost for a YO participant is significantly under
$10,000. Now, that is as opposed to $26 to $30,000 for a Job
Corps youth and $35,000 for a young person who would be
incarcerated. The YO program is the heart of our efforts to
build a comprehensive youth development system.
Using the YO dollars we have established four youth career
centers, four satellite centers in the high schools, which
really constitute the beginning of a self-sustaining community-
based program, and we have integrated that with the WIA One-
Stop System. A comprehensive accountability system is being
implemented so that we can continue good, sound program
management.
And, Mr. Chairman, the program is making a difference. In
Houston we have seen a 15 percent decrease in unemployment
among our youth.
Mr. Regula. How about crime?
Mr. Hudson. Crime we have also made progress with. We have
juvenile justice grants with which we have integrated. They are
completing high school, they are moving on to college, they are
beginning successful careers. And kind of a byproduct, the
parents become encouraged by the advancements of the youth, and
they go on and do things.
Your investment is giving us an early success. It is in the
best interest of all to restore the fiscal year 2003 funding
levels for the Youth Opportunity Grant program and encourage
the Department of Labor to expand this program to other needy
areas.
Our programs were recently visited by your colleague,
Representative Tom DeLay, and I would encourage any member of
your staff or yourself to visit these YO sites so you can see
the difference that you make and can make for our young people
by continuing this investment in the future.
[The prepared statement of Mr. Hudson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hudson. And now, Mr. Chairman, it is my honor to
present Ms. Yolanda Fink, who is a member of the Ohio
Conservation Corps.
Mr. Regula. It was good fortune that you found someone in
Canton, Ohio.
Mr. Hudson. Yes, sir.
Mr. Regula. Okay, Yolanda.
Ms. Fink. Hi. I would like for you guys to bear with me. I
have a learning disability, my reading. So here I go.
Chairman Regula, Ranking Member Obey, and members of the
Subcommittee. My name is Yolanda Fink and I am honored to
travel to Washington----
Mr. Regula. Take your time, Yolanda. We have got plenty. We
will give you a couple of extra minutes.
Ms. Fink [continuing]. From Chairman Regula's district, to
speak as someone who has benefited from the federally funded
work force development program.
I want to let the Subcommittee know that participating in
the Ohio CCC has given me and the Corps members I am here to
represent--many who entered the Corps as high school dropouts,
ex-offenders--hope, self-esteem, and the desire to help others
who are less fortunate.
With the support from the Corps family, I have progressed
educationally and gained marketable job skills.
I came to the Corps with an unemployed husband who is the
father of a 2-year-old from another relationship. We have a new
baby. We came to the Corps with no future. With help from the
Corps family and the Canton community, my family recently moved
into a Habitat for Humanity home. I am now a better student,
worker, decision-maker and leader thanks to the Corps.
I understand that helping others is important. I paint and
fix up houses for the elderly in Canton.
Best of all for me, I have gained confidence and life
management skills to enter college. I realize that a degree is
essential. When I leave the Corps, I will have $4,725 for
scholarship from AmeriCorps. My goal is to teach special
education.
Chairman Regula, I understand that the Subcommittee is
considering reducing training for youth and young adults.
Mr. Regula. We are not considering it. Somebody gave you
bad information, especially after you have been here today.
Ms. Fink. Thank you.
I feel that it is very important to all of us because it
means a lot to me, as well as my Corps that is here. They have
helped me a great deal with my reading, and college; and the
Corps is just a big family and we are together.
Everyone in the Nation will, like, benefit from us if they
can contribute a small amount to help us. It is an opportunity
to learn and grow for the young people today, for this program
to stay alive, because we need it. It is a lot of kids out
there, as well as young adults, that need the help that they
are providing for us. And I would love for you guys to keep it
for all of us. Thank you.
Mr. Regula. Okay, Yolanda. I have got a deal for you.
We will keep it alive if you tell your friends that they
should join, and that they should get their GEDs. Will you do
that?
Ms. Fink. Yes, they are. We keep pushing it.
Mr. Regula. You can be persuasive because you have been
there and you can make a difference in a lot of lives. So that
is our bargain. Okay. We will do our part. Thanks for coming.
Mr. Hudson. Thank you.
[The prepared statement of Ms. Fink follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
NATIONAL JOB CORPS ASSOCIATION
WITNESSES
TARA THOMAS, DIRECTOR, HUMAN RESOURCES, HCR MANOR CARE, SOUTH OGDEN,
UTAH
MAX McWASHINGTON, CERTIFIED NURSING ASSISTANT, HCR MANOR CARE
Mr. Regula. Tara Thomas, Director of Human Resources,
accompanied by Max McWashington, National Job Corps
Association.
Ms. Thomas. Mr. Chairman and members of the Committee,
thanks for the opportunity to talk about HCR Manor Care's
rewarding partnership with Job Corps. My name is Tara Thomas,
and I am the Human Resources Director with HCR Manor Care in
South Ogden, Utah. HCR Manor Care is the leading owner and
operator of long-term care centers in the United States. We
have nursing centers in 31 States and employ 59,000 people.
Our company and our industry are benefiting significantly
from Job Corps. I am sure all of you are familiar with the
severe shortage of health care professionals, particularly
registered and licensed practical nurses and certified nursing
assistants. I understand that Congressman Miller represents the
district in the U.S. with the highest number of senior
citizens, and is particularly concerned about this shortage.
I am here today to testify not only about our country's
nursing shortage, but about how we have found the solution to
identify, train, and hire qualified health care professionals.
And that solution is Job Corps.
Nursing centers have been particularly hard hit by the
shortage of qualified personnel, and this comes at a time when
the public is extremely concerned about increasing the amount
of time caregivers spend with our patients. As a human
resources professional, I have the difficult task of choosing
qualified employees to care for our elderly population. Due to
the shortage of qualified or trained applicants in health care
today, I am profoundly grateful for the Job Corps program
providing a source of highly competent workers.
Job Corps is helping us to find and train the employees we
need to provide the care deserved by our patients and our
residents. It is helping us to hire highly qualified employees
who are motivated to succeed and make long-term commitments to
the health care field.
We want to hire employees who care, who truly care, and we
are finding that our Job Corps hires have made this type of
commitment. Our South Ogden, Utah, facility has benefited
tremendously from this partnership. Since 2000 we have hired,
trained and placed over 50 qualified Job Corps graduates in
jobs that were difficult to fill with qualified candidates. We
have found that Job Corps students are dedicated, loving, and
highly competent employees.
Job Corps has truly been a blessing for our staff, for our
residents and for our community. Job Corps is win-win for all
involved. The young men and women who are graduates of the Job
Corps program are being given a wonderful opportunity to rise
above obstacles placed in their way and become productive
citizens and key members of the U.S. economy.
The young man testifying before you today is an example of
how employees benefit from Job Corps. Max McWashington has been
a source of inspiration for our employees and our residents. He
is highly skilled, a leader among his peers and valued by his
coworkers. One of our residents was so impressed with Max's
care and concern for her that she nominated him for our highest
award, our Champion of Caring Award. Due to her glowing account
of the care she was given by Max, he was the recipient of our
highest honor, he was voted the Champion of Caring for November
of 2001.
I think it is clear that the American public favors
programs that offer a helping hand instead of a handout. And
the Job Corps is offering one big and beneficial helping hand
to make that handout unnecessary. Job Corps is invaluable to
our industry as well as many others. We truly benefit from this
partnership.
We are in the business of helping others. And Job Corps has
been crucial to our success. Thank you.
Mr. Regula. Thank you.
[The prepared statement of Ms. Thomas follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Max, would you like to say something?
Mr. McWashington. My name is Maximilian McWashington. I am
pleased to be here and be able to thank you for your support of
the Job Corps program.
I am a 19-year-old certified nursing assistant at HCR Manor
Care Center in South Ogden, Utah. My seven brothers and sisters
and I were raised by my mother after my father left us when I
was 3. My mother died when I was 14, and I was sent to my
grandmother's house with three of my siblings.
My grandmother played an important part in my life. She
raised me to go to church and follow the rules. But even with
this help, by the time I got to high school I began to drift. I
started to skip school, finally began to fail my classes. Me
and my friends only went to classes when we wanted to.
I hadn't been in any serious trouble, but I was hanging out
with people who were getting in deeper with drugs and other
illegal activities. It was probably only a matter of time
before I would be in deep myself. You see, I was raised in a
good God-fearing family, but you have the streets. You have to
live the life of the streets.
People had asked me, why don't you find some new friends.
The reality of the situation is that I had to choose from
friends who were stealing cars and doing drugs or friends who
had guns and killed people.
Mr. Regula. That wasn't a very good choice, was it? But you
made a better one.
Mr. McWashington. Yeah.
Okay, through a friend I heard about Job Corps. In the 22
months I spent in the Job Corps program, I completed my high
school education and got two trades, welding and health
occupations.
I am not going to kid you. The program was tough and my
instructors had high standards, and many times I thought about
giving up and quitting. It would have been a lot easier to
quit, though my choices were Job Corps or the streets. I chose
Job Corps.
I love being a certified nursing assistant. And I work with
the elderly population. My coworkers recently recognized me as
a Champion of Caring. She recently told you guys about that.
Entering the Job Corps program was the turning point in my
life. I am not sure where I would be today if the Job Corps had
not been there, but I know I would be much worse off. It is sad
to say, but I know if I would have stayed in Oakland, I may not
have been killed but I may have been incarcerated by now.
Today, I have a future and my future includes helping
people like I have been helped. The good thing is, I am not
unique. I have met many people in the Job Corps program that
have also been helped and got a good start, you know, on a
professional career; and the Job Corps is making a tremendous
difference.
I am enrolling in community college in the fall. I am still
uncertain of what I would like to be or what I would like to do
with the rest of my life. But I have confidence that I will
succeed in whatever life has to offer me, and Job Corps has had
the biggest impact on my life and my future. Thank you.
Mr. Regula. Max, I will make you the same proposition. Tell
your friends. You can have a really important influence on some
of your peers, because you have made it and you can persuade
them that that is the way to go.
And you will have done them a great favor. Thank you for
coming. Unfortunately we have to move on.
[The prepared statement of Mr. McWashington follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
BIG BROTHERS BIG SISTERS OF AMERICA
WITNESS
AUDREY S. KEIRNS, IMMEDIATE PAST CHAIR, REGIONAL OFFICERS, BIG BROTHERS
BIG SISTERS OF AMERICA
Mr. Regula. Okay. Audrey Keirns, Immediate Past Chair, Big
Brothers Big Sisters of America.
Ms. Keirns. Good afternoon, Chairman Regula. It is truly a
privilege to appear this afternoon on behalf of Big Brothers
Big Sisters in support of fiscal year 2003 funding for
mentoring. As a 22-year veteran of a local Northwest Ohio Big
Brother Big Sister agency, and an 18-year veteran of the
national board, I have seen firsthand the difference that
mentoring makes in the lives of children.
We have 500 local affiliates throughout the Nation, at
least one in every State, and Ohio has more agencies than any
other State. Big Brother Big Sister programs have paired
volunteers with children for nearly 100 years. The purpose of
the relationship is simple: to make a significant difference in
the lives and positive development of children at risk.
Our professionally supported relationships which numbered
over----
Mr. Regula. I am sold. I have two in my district.
Ms. Keirns. Good. Ohio has more than any other State.
Mr. Regula. A few years ago we had the national young lady
who was chosen as number 1 for the whole country.
Ms. Keirns. Right, the Big Sister of the year. I remember
that. I was on the national board.
Mr. Regula. I know the program. In fact, I have helped give
them some financial help. They have an auction every year that
I participate in.
Okay, go ahead.
Ms. Keirns. We greatly appreciate that.
Mr. Regula. You are way ahead of the game now. You
understand?
Ms. Keirns. I appreciate that, too.
We had over 200,000 relationships last year for making a
potential difference in the lives of boys and girls as they
become competent and caring men and women. We offer positive,
broad-based programs that focus less on specific problems after
they occur and more on meeting childrens' basic development
needs.
We also have proof positive in a recent Public/Private
Ventures Study that we have made a difference in terms of
reducing violence, reducing the need to use alcohol and drugs,
performing better in schools, and things like that. So we have
proof positive. We are one of the first agencies that can claim
that.
Several years ago we launched a school-based program to
compliment our traditional community-based approach to
mentoring. We have found it attracts significantly more
volunteers and is even more cost-effective. One of the reasons
volunteers like it, it is in a more structured environment;
they know what they are doing.
A lot of times our volunteers say, what do I do, after they
are matched. So the school-based program really helps that. It
also helps us to meet each child's individual education goals,
that the teachers refer. We thank the Subcommittee for the
support Congress has provided in the past and we hope to see an
expansion of the school-based program.
We are eager to work with more children in the future and
have made a commitment to serve 1 million children by the year
2010.
As a result, Big Brothers Big Sisters is pleased that the
Mentoring for Success Act included a strong mentoring
component. Our per unit cost for matches is $500. At the
$17,500,000 provided last year, we could serve 35,000 more
children. For the $50 million that is being requested for
fiscal year 2003, we could serve an additional 100,000
children. On behalf of Big Brothers Big Sisters, I respectfully
request that the Subcommittee consider the benefits that $50
million would yield.
We also fully support the President's fiscal year 2003
budget request of $25 million for the ``Mentoring Children of
Prisoners'' program. This is a brand-new program. It is a pilot
program in Philadelphia, the Amachi program that has been very
successful; and we certainly would appreciate the authorization
for the full $67 million for that program.
[The prepared statement of Ms. Keirns follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, we are going to do the best we can with
all of these programs.
Ms. Keirns. I understand. There are a lot of worthwhile
programs.
Mr. Regula. That is it. We will try to make the best
judgments we can. And the real key, I am sure you use a lot of
volunteers; that is an important component of all of those
programs.
Ms. Keirns. We have one volunteer for every child that we
serve. So that is 220,000 volunteers now.
Mr. Regula. Thank you for coming.
Ms. Keirns. It is truly an honor to appear. And thank you
for your consideration.
----------
Tuesday, May 7, 2002.
FIGHT CRIME: INVEST IN KIDS
WITNESS
MARTIN FRANTZ, PROSECUTING ATTORNEY, WAYNE COUNTY, OHIO, ACCOMPANIED BY
MIRIAM ROLLIN, DIRECTOR OF FEDERAL POLICY, FIGHT CRIME: INVEST IN
KIDS
Mr. Regula. Our next witness is Martin Frantz from the 16th
District of Ohio. He is the prosecuting attorney of Wayne
County, Ohio. He is going to talk about investing in kids.
That is a better investment than in jails, isn't it?
Mr. Frantz. Yes, it is, Mr. Chairman.
Thank you for the opportunity to testify about the impact
of the decisions that you and your Committee will make on
fiscal year 2003 appropriations. My name is Martin Frantz, and
I have spent the past 23 years as prosecutor in Wayne County,
Ohio. And I am joined at the table by Miriam Rollin, the
Director of Federal Policy for Fight Crime: Invest in Kids.
I am here today on behalf of more than 1,600 police chiefs,
sheriffs, prosecutors and victims of violence who have joined
together to create this organization, Fight Crime: Invest in
Kids. Our mission: to take a hard-nosed look at the research
that shows what really works to keep kids from becoming
criminals.
First of all, we believe there is no substitute for tough
law enforcement. But those of us on the front lines also know
that we will never be able to arrest and prosecute and imprison
our way out of the problem of crime. And once a crime has been
committed, we can't undo the agony felt by the victim nor can
we repair the victim's shattered life.
We can save lives, we can save hardship and we can save
money by investing in programs that give kids the right start
in life.
Quality programs that provide early childhood education are
proven to dramatically reduce the chance that at-risk children
will grow up to become criminals. You see, when our fight
against crime starts in the high chair, it won't end in the
electric chair.
Sadly, programs that help parents send their children to
quality educational child care programs are underfunded. Head
Start, Early Head Start and the Child Care and Development
Block Grant program can serve only a fraction of those
eligible; and many of the parents who don't receive child care
assistance from programs like these are forced to make do with
child care which no member of this committee would want for
their child or grandchild.
Increases of $1 billion for Head Start and $1 billion for
the Child Care and Development Block Grant are necessary so
that we can send more kids to school ready to learn.
Of course, the opportunity to prevent crime doesn't end
when kids start school. The prime time for violent juvenile
crime is in the after-school hours from 3 to 6 p.m. These are
also the peak hours for kids to smoke, drink, use drugs and
have sex. And, not surprisingly, quality after-school programs
are proven to reduce crime, both now and down the road.
The 21st Century Community Learning Centers program helps
communities establish and run after-school activities. This
subcommittee has approved important increases for this program
over the past several years, but thousands of applications are
still turned down because of a lack of funding.
More than 10 million children and teens lack adult
supervision after school. Increased funding for the 21st
Century after-school program to its authorized level of $1.5
billion would help close this gap.
Our choice is simple. We can either send our children to
after-school programs that will teach them good values and
skills, or we can entrust them to the after-school teachings of
someone like Jerry Springer, violent video games, or worse yet,
the streets.
Because my time is limited, please refer to my written
testimony where I have discussed the crucial need for
investments in programs like the Social Services Block Grant
and the Promoting Safe and Stable Families program. These
programs fund activities which are proven to prevent child
abuse and neglect. Unfortunately, child abuse and neglect
increase the chances a child will grow up to become a criminal.
I am reminded of Rebecca, who in 1988, at the age of 11,
was sexually molested by a drunken family friend who had been
left to care for her. This year, Rebecca will begin serving her
third sentence in an Ohio prison, leaving behind a child of her
own. We cannot let this cycle go on for another generation.
I have also discussed in my written testimony an important
new school dropout prevention program that will keep kids in
the classroom, off the streets and out of trouble.
Law enforcement understands that the type of investments I
have described today really do make a difference. The National
Sheriff's Association, the Major Cities Chiefs, the Fraternal
Order of Police and the National District Attorneys Association
have all passed resolutions supporting investments in quality
child care, after-school activities and child abuse prevention
programs.
Polls of individual police chiefs and other law enforcement
officials also demonstrate widespread support for these
programs. Every day that we fail to invest adequately in
quality early childhood education and care, after-school
activities, and programs that prevent child abuse and neglect,
we increase the risk that you or someone you love will fall
victim to violence.
I am here to ask you to pay attention to this plea from the
people on the front lines. Invest in America's most vulnerable
kids now so they won't become America's most wanted adults
later.
Thank you for this opportunity. I would be happy to answer
any questions.
Mr. Regula. Well, thank you. I assume that having a high
school like you do have in Worcester, helps a great deal in
after-school programs.
Mr. Frantz. Thank you very much. Thank you.
Mr. Regula. It is a challenging problem.
[The prepared statement of Mr. Frantz follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
INTERNATIONAL READING ASSOCIATION
WITNESS
LESLEY MORROW, PH.D., PRESIDENT-ELECT, INTERNATIONAL READING
ASSOCIATION
Mr. Regula. Dr. Lesley Morrow, President-Elect of the
International Reading Association.
Dr. Morrow. Thank you, Chairman Regula and members of the
subcommittee. I am Lesley Morrow, and I am President-Elect of
the International Reading Association and a professor of early
childhood and early literacy and Chair of the Department of
Learning and Teaching of Rutgers University, in New Brunswick,
New Jersey.
The International Reading Association is a professional
association dedicated to improving reading and literacy
education in this country and around the world. We are an
organization of 80,000 members in 99 countries. I am here today
to talk with you about the importance of Reading First and
Early Reading First. The International Reading Association
supports these programs and believes that in our Nation
significant numbers of children do not have equal access to
appropriate quality reading instruction.
Reading First and Early Reading First can make a
significant difference for our Nation's young children by
providing school districts with funds needed to offer quality
reading instruction. Reading First provides funds to the States
to support local school districts and their professional
development activities around the findings of the National
Reading Panel. The panel was appointed by Congress to determine
predictors of reading success based on existing research; and
the panel found five practices that increase reading
performance. They are phonemic awareness, phonics, vocabulary
development, fluency and comprehension.
It is crucial that the findings of the report be carefully
implemented. An effective program includes all of the elements,
and all of the elements share importance. The panel also found
that programs are most successful with teachers who are well
trained in the teaching of literacy.
Many believe that reading instruction requires a technical
manual and that, if given the manual, a well-meaning person
could teach reading. That doesn't work. The Program for
Improvement of Student Achievement, PISA, completed a study of
32 nations' schools and found that the most critical element
was effective reading programs with effective teachers.
Reading First and Early Reading First provide funds for
professional development in literacy instruction that is
ongoing. This is crucial to reading success. It is particularly
important in Early Reading First, which deals with preschool
teachers who often don't hold a teaching certification. IRA is
interested in helping with the professional development and
hopes that the Department of Education will call on us.
There is a concern of the International Reading Association
and others that to receive funding for Reading First, we will
have to purchase a commercial instructional product from a
limited list. It would be helpful if the Department of
Education would issue guidance for the selection of programs
and for the development of districts' own research-based
programs. Different programs have different strengths and
weaknesses. The critical element is the proper match between
programs and schools and effective implementation by quality
teachers.
Reading First is at the $900 million funding level. Even if
all the funds are spent effectively, we will fall short of our
goals. In our Nation's urban centers, reading programs not only
lack the professional development funds only beginning to be
addressed by this initiative, they also lack funds for books.
Reading, like any other skill, benefits from extensive
practice, and if children don't have access to books, they will
not have the opportunity to practice. In addition, 50 percent
of the children in high-poverty, low-performing schools
targeted by Reading First will not be receiving instruction in
languages spoken in their homes. Those children need teachers
who know how to meet the learning needs of those students.
Early Reading First is also a critically needed program. Of
the over 12 million children between the ages of 3 to 5 in the
U.S., 20 percent, or 2,400,000, live in poverty. Some of these
students enter school with little or no exposure to books or
knowledge about the alphabet or print. This puts them at a
disadvantage when compared to the children who come from homes
full of books with parents who read to them.
Mr. Chairman, we know that you are making many decisions
about which disease to research, which education programs to
support, and that you don't have the resources for all of them.
Thank you for doing this public service. Please understand that
our desire to seek expansion of funding for Reading First and
Early Reading First is fueled by our belief that children can
come to read better in school and, as a result, can contribute
more to their communities, their families, and their society
over their lifetime.
Literacy helps to eliminate poverty and disease. A literate
society is a productive society. In funding this program, you
are not only funding the educational needs, but the health
needs of our Nation.
I want to thank you very much for the opportunity to
present, and I would also like to say that as I listened to the
four other presenters, I believe that Reading First would have
helped them if they had had such a program to begin with. Thank
you very much.
Mr. Regula. Thank you. You have a good friend in the White
House in terms of this program.
Dr. Morrow. Yes, I know. It is very important.
[The prepared statement of Dr. Morrow follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
NATIONAL COUNCIL OF MATHEMATICS
WITNESS
JAMES M. RUBILLO, EXECUTIVE DIRECTOR, NATIONAL COUNCIL OF MATHEMATICS
Mr. Regula. Mr. James Rubillo, Director of National Council
of Mathematics.
Mr. Rubillo. Thank you for the opportunity to appear before
the Subcommittee. My name is James Rubillo, and though I am now
the Executive Director of the National Council of Mathematics,
I came to this position last year with more than 35 years of
mathematics teaching experience; and I consider myself, first
and foremost, a teacher.
What we are asking for today--and I say ``we'' because a
coalition of business and education groups endorses this
request in a statement that we have included in the testimony--
is that Congress invest in math and science education. The
Math-Science Partnerships Program authorized at $450 million in
the No Child Left Behind Act was appropriated at only
$12,500,000 in fiscal year 2002.
For many years, the funding for math and science was
included in the Eisenhower Professional Development program,
and we agree with and support the need for reforms in that
program and hope the new Math-Science Partnerships program
satisfies that need.
However, the Eisenhower fund stated a Federal priority on
math and science education that is now lacking. It is our
understanding from an exchange between the Chairman and
Representative Ehlers on the House floor on December 19, 2001,
that it was the intent of the conferees that no less than $375
million be expended on math and science professional
development in the year 2002.
Currently, though Title II was generously funded at $2.8
billion, there is no requirement that any of this teacher-
quality money be spent on professional development. Now, given
the deep cuts that States have made in their budgets, the need
for hiring incentives to fill shortages in certain fields, the
desire to cut class size and to meet other important priorities
outlined in the legislation, it is unlikely that the States
will match the focus on math and science of the previous law.
If fully funded at $450 million for fiscal year 2003, the
Math-Science Partnerships program would provide grants to local
school districts to develop high-quality, ongoing professional
training programs for teachers in collaboration with business
and higher education. We must do more not less to prepare our
teachers who teach mathematics and science before they enter
the classrooms, and we must provide them with continual
professional development after they have begun teaching.
The current status is alarming. Most kindergarten through
grade 6 teachers in the United States teach mathematics and
science. But many of them have had, at most, a single course in
math content and instructional methods in their teacher
preparation program. As a result, they do not consider
themselves mathematics teachers or science teachers, but rather
teachers who have to teach math.
That situation, of course, is the same in science. With
this level of training, the knowledge of mathematics of many
teachers is not solid, and they simply don't know ways of
teaching the subject effectively to their students. So
continued professional development is a necessity, and that
requires funding beyond the State level.
I would like to describe an example of the kind of long-
term professional development program that could be more widely
implemented if the Math-Science Partnerships program were fully
funded. Now, for 5 years, I presented a year-long program for
teachers that began with 30 hours of professional development
in a 2-week summer session. These sessions focused on
integrating technology into the teaching of mathematics related
directly to the curricula that the teachers would be teaching
in the following year.
Now, during that following academic year, we held five 3-
hour follow-up meetings for those summer institute attendees.
Through the Sustain Program, these teachers grew close to each
other, they shared their lessons, discussed what worked and
what didn't work in the classroom. They learned from the
program, from each other, and were better teachers as a result.
We need to make a significant investment in math and
science educators. Today's math and science teachers are
preparing our next generation of scientists, engineers,
explorers, inventors and workers as well as an informed
citizenry. Reforming math and science teaching through the
establishment of these new partnerships is not a complete
solution, but it is certainly a start.
Thank you.
[The prepared statement of Mr. Rubillo follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Would you agree that a prerequisite to math and
science is the ability to read?
Mr. Rubillo. Absolutely. We support the initiatives in that
regard.
Mr. Regula. We have to start with the base, which is
reading, and then build on what you are saying.
Mr. Rubillo. But the key, as well, is to make sure that the
teachers at those levels have a solid base in both their
content and in methodology.
Mr. Regula. That is what the CEO of a major dot.com company
recently has said, who is very much in favor of this, because
they are having difficulty getting engineers and employees--
well, thank you very much for your testimony.
Mr. Rubillo. Thank you.
----------
Tuesday, May 7, 2002.
ST. JOSEPH'S INDIAN SCHOOL OF SOUTH DAKOTA
WITNESS
BROTHER DAVID NAGEL, EXECUTIVE DIRECTOR, ST. JOSEPH'S INDIAN SCHOOL OF
SOUTH DAKOTA
Mr. Regula. Our next witness will be introduced by our
colleague, Mr. Thune.
Mr. Thune. Thank you, Mr. Chairman.
I appreciate very much the opportunity to introduce to you
and to this committee a distinguished South Dakotan, Brother
David Nagel. Brother Dave is the Executive Director of St.
Joseph's Indian School in Chamberlain, South Dakota.
Mr. Chairman, if you have never had the occasion to visit
Chamberlain, it is a great place and consider yourself
officially invited.
Mr. Regula. How big is it?
Mr. Thune. It is a couple of thousand people. But it is
right on the Missouri River. It beats spending the night in the
Chicago airport, which you and I have done together before.
Mr. Regula. I agree with that.
Mr. Thune. Since you have many other witnesses to hear from
this afternoon, I would simply like to say that Brother Dave
has been associated with St. Joseph's for more than 20 years.
He was named Executive Director there in 1996. He and his team
at St. Joseph's are transforming the lives of young Native
Americans every day through its residential care program.
Specifically, the school is addressing serious issues
related to high rates of alcoholism, abuse, neglect and lack of
education among Native American youth and their families.
It is a program that has produced and is producing solid
results. Unfortunately, the problem is widespread and more
individuals need help. And, so, Mr. Chairman, I know that you
and the Subcommittee will show Brother Dave and St. Joseph's
Indian School, its request, every consideration; and I want to
welcome Brother Dave to your panel.
Thank you again for the opportunity to be here today.
Mr. Regula. We welcome you. A couple of questions. Is this
a grade or high school, or both?
Brother Nagel. Grade school and high school. We have our
own grade school, and our high school students attend the local
high school in Chamberlain.
Mr. Regula. In the public school?
Brother Nagel. In the public school. It is residential
care, first grade through high school.
Mr. Regula. These students live there then?
Brother Nagel. We have 18 homes with 12 children in a home
with house parents.
Mr. Regula. I was Chairman of the Committee that did the
Bureau of Indian Affairs funding for many years. We also do it
in here. So I have visited Indian schools. I know the
challenges. They are many.
Brother Nagel. I appreciate this opportunity.
Since 1927, St. Joseph's Indian School has provided
nationally recognized educational and supportive services to
needy Lakota children from all of the various tribes in South
Dakota. In fact, St. Joseph's is the only accredited
residential care program exclusively serving Native American
youth in the United States. We provide residential care,
academic programs, counseling and psychological services,
health care, recreational programs and college scholarships.
St. Joseph's raises 90 percent of its funds from private
sources. We have more than 500,000 active donors in all 50
States. I am here today because there is an urgent need among
Native American youth in the State of South Dakota.
Please let me tell you a little bit about our students. I
recall with pride a recent high school graduate who graduated
from our program. This young man was the first member of his
family to graduate from high school. St. Joseph's gave him the
confidence and the tools that he needed to complete high school
and to beat the odds. In South Dakota, 60 percent of freshman
will not complete high school.
Here are just a handful of statistics that would give you a
better sense of our typical student. Native Americans suffer
from a lack of education, unemployment, alcoholism, chronic and
severe health problems, and dysfunctional family situations at
alarmingly higher rates than the rest of population in the
United States. The high school graduation rate for Sioux Indian
population in South Dakota is only 23 percent.
This poor educational statistic results from low
expectations, instability in the home and family, and the poor
socioeconomic status of reservations in South Dakota. Only 8
percent of our students live with both of their biological
parents. The average household income for students is $10,488,
well below the national poverty level. An astonishing 63
percent of St. Joseph's students have suffered from domestic
abuse and violence. Most come from families that suffer from
substance abuse.
Obviously, these are high-need, at-risk children. It should
not surprise anyone that St. Joseph's has discovered during our
75 years of experience that providing services that deal with a
multitude of health, mental and physical issues enables Native
American youth to succeed academically, emotionally and
economically.
A moment ago I gave you some statistics that ought to
concern all of us, but let me give you a few statistics that
will give us all hope. The attendance rate at St. Joseph's
Indian School last year was a wonderful 96 percent. Of the high
school students in our high school program, 100 percent
graduated. The majority of our students earned a B average or
better, and St. Joseph's students that took the SAT exams last
year scored well above the Native American average on both the
math and the verbal portions of that test.
I could go on with many other positive facts and figures,
but I simply want to say that these numbers reflect a learning
environment where students are given the tools to excel. And it
works. Many of our school's alumni are now successful tribal
leaders, business people, educators and ranchers in South
Dakota.
St. Joseph's objective now is to expand its supportive
services so that we can provide additional critical programs to
our students, their families and individuals from the
surrounding reservations. Specifically, St. Joseph's plans to
build a family counseling center, expand its staff and provide
additional supportive programs. These services include
individual and family counseling, drug and alcohol counseling,
health care, parenting skills development, workshops addressing
domestic violence and abuse and other follow-up services.
Therefore, St. Joseph's is requesting a Federal investment
of $650,000 from the Health Resources and Services
Administration account. This Federal investment will accomplish
exactly what these funds are intended to do, to open the door
to health care services for those who are in need. On the
reservations these individuals are often neglected, have little
or no access to health care counseling and treatment, but
through our programming, we can address this desperate
situation.
Mr. Chairman, members of the Subcommittee, on behalf of St.
Joseph's Indian School, I greatly appreciate your thoughtful
consideration of this request. Thank you.
God bless you and guide your work. Thank you.
[The prepared statement of Brother Nagel follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. God bless you. You are doing the work of the
Lord there. What is your enrollment?
Brother Nagel. We have 210 students in residence. And we
serve about 20 to 25 students through college scholarships.
Mr. Regula. You bring in students from a wide range and
they go to high school.
Does the local school district take responsibility for them
in the high school programs since they are not residents?
Brother Nagel. Funding follows them for the educational
component from their home districts.
Mr. Regula. So they can stay in that locale?
Brother Nagel. Yes. And the school district is happy to
take our students, because there is a need for more enrollment,
and our numbers help fill their needs. So we have a mutual
working relationship.
Mr. Regula. It is not quite as densely populated as Ohio.
Brother Nagel. There are probably a few less people.
Mr. Regula. But we don't have any Indian reservations
either.
Brother Nagel. Well, we have seven in South Dakota.
Mr. Regula. Thank you.
----------
Tuesday, May 7, 2002.
AMERICAN ELECTRONIC ASSOCIATION AND THE MATH/SCIENCE PARTNERSHIP
WORKING GROUP
WITNESS
RICHARD J. SCHAAR, PRESIDENT, EDUCATIONAL AND PRODUCTIVITY SOLUTIONS,
AND SENIOR VICE PRESIDENT, TEXAS INSTRUMENTS
Mr. Regula. Our next witness is Richard Schaar, President,
Educational and Productivity Solutions, and Senior Vice
President of Texas Instruments.
Thank you for coming.
Mr. Schaar. Good afternoon, Mr. Chairman, and members of
the Subcommittee. My name is Richard Schaar, Senior Vice
President of Texas Instruments and President of TI's
Educational and Productivity Solutions business.
I am also chairman of the American Electronics
Association's Human Resources and Workforce Committee, on whose
behalf I am appearing to urge the Subcommittee to support full
funding for the Math-Science Partnerships authorized under the
Title II, Part B, of the No Child Left Behind Act of 2001.
The partnerships established among local education
agencies, colleges and other groups, including business, will
support teacher training and professional development,
curricula development, recruiting and distance learning all
based on needs assessments in local school districts.
Here are a few key points: one, the business community
cares deeply about math and science education. We vigorously
promoted passage of the No Child Left Behind Act last year.
Increased investments in math and science education was one of
our priorities.
Although Congress authorized $450 million for the Math-
Science Partnerships program, it appropriated only $12,500,000.
This represents a 97 percent decrease from the roughly $375
million in dedicated Federal funding previously available for
math and science at the Department of Education. It is far
below the increased investment envisioned under the new law.
Two, proficiency in math and science is critical to the
Nation's economic growth, national security and technological
leadership. In this technology-driven economy, there is no
question that the Americans who can master math and science
concepts will have more opportunities than those who cannot.
Unskilled, entry-level jobs are increasingly a relic of the
past. More than ever a college degree is necessary for greater
job mobility, security and earning power.
Three, we are not measuring up. Despite real world demands
for math and science proficiency, results from the NAEP and
TIMSS test demonstrate just how far we must go to prepare
students in those core disciplines. For example, roughly three-
quarters of American students are not proficient in math and
science in grades 4, 8 or 12; roughly a third do not possess
basic-level skills.
Four, poor preparation in those subjects has consequences.
There is a declining number of math, science and engineering
degrees awarded to students graduating from U.S. universities.
Under-representation among women and minorities is particularly
alarming. This has led many companies, including Texas
Instruments, to meet hiring needs by recruiting foreign
nationals for specialized engineering jobs.
Five, there are no easy answers. Indeed, these trends are
so disturbing that it prompted the National Commission on
Mathematics and Science Teaching for the 21st Century, the
Glenn Commission to recommend both significant funding
increases and clear action steps to address the need.
Activities authorized under the Math-Science Partnerships in No
Child Left Behind include many of the best recommendations of
that report.
Six, the pressure is on. As you know, the No Child Left
Behind Act requires that students be tested annually in math,
beginning with the 2005-2006 school year, and periodically in
science by 2007-2008.
In addition, the bill requires that all teachers be highly
qualified by the end of the 2006-2007 school year. The number
of teachers teaching out of the field, especially in math and
science, is a challenge across the country. The problem is
particularly acute in high-poverty schools where students have
less than a 50 percent chance of getting math or science
teachers who hold a license or degree in the field being
taught.
Teacher quality is one of the most important determinants
of student success. Funds provided under the Math-Science
Partnerships program would help districts address these
concerns.
Seven, support for math and science excellence must be a
national priority. Only the Federal Government can elevate it
to that level. The Department of Education partnerships, if
funded at a level over $100 million, would be formula-based and
available to every State. They are specifically designed to
focus on high-need school districts. They also require a needs
assessment be done in every district to help ensure that the
money be spent effectively on that community's particular
shortfall. The business community urges to you provide full
funding for this program.
Thank you for allowing me to speak. I am happy to answer
any questions that you might have.
[The prepared statement of Mr. Schaar follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, as you heard me ask before. Is reading a
key to the ability to understand math and science?
Mr. Schaar. Certainly, you have to have reading skills.
That has to be built up over time. But without the mathematics,
existing in the society today will become ever more difficult
for the citizens of the United States.
Mr. Regula. Interesting.
You said that you have to import people to fill your slots?
Mr. Schaar. We do at that this point. That will continue
unless we can change the paradigm.
Mr. Regula. Aren't you a major chip manufacturer?
Mr. Schaar. Yes, we are. If you have a cell phone, it is a
digital phone, it probably has a TI chip inside.
Mr. Regula. So when it fades out on me now and then I
should----
Mr. Schaar. When it fades out on you, you will have to talk
to your local carrier.
Mr. Regula. Good evasive answer.
Mr. Schaar. Thank you.
Mr. Regula. Thank you for coming. We have heard----people
have come to see me about this, too, Intel for one. It is a
real problem.
Mr. Schaar. It is a significant problem.
Mr. Regula. We have to get the reading, too.
Mr. Schaar. It is, unfortunately, almost like bread and
water. You have to have them both.
Mr. Regula. Thank you.
----------
Tuesday, May 7, 2002.
JEFFREY MODELL FOUNDATION
WITNESS
VICKI MODELL, CO-FOUNDER AND VICE PRESIDENT, JEFFREY MODELL FOUNDATION
Mr. Regula. Vicki Modell, Co-Founder and Vice President of
the Jeffrey Modell Foundation. And for you Buckeyes, she did
not own the Cleveland Browns.
Ms. Modell. Well, good afternoon, Mr. Chairman and staff.
Thank you for the opportunity to testify. It is without a doubt
a singular honor for me as a private citizen to speak directly
to the decision-makers of our government to share our thoughts,
our hopes, our dreams, and our needs with you.
Mr. Chairman, your support, and that of the Subcommittee
for the past 5 years, and especially in this last year, has
been something that has moved us in ways that I can hardly
express.
By way of background for those who don't know me, I am
Vicki Modell, Vice President and Co-Founder of the Jeffrey
Modell Foundation. The foundation was named for our son
Jeffrey, who passed away at the age of 15 from a condition
known as primary immunodeficiency.
When my husband Fred and I began this journey 16 years ago,
we never could have imagined where it would take us and the joy
it would bring and the privilege, such as sitting here today.
When we thought a few years ago that it might be a good idea to
collaborate with the Child Health Institute and the Allergy and
Infectious Disease Institute----
Mr. Regula. This is in NIH?
Ms. Modell. At NIH, in research, this committee said, ``Go
do it.'' and you wrote strong report language to encourage our
foundation and the Institutes to work together. The result was
$5 million in important research that never would have
occurred.
When we recognized the importance of the estimated 500,000
Americans who go undiagnosed, you again told us to go out and
tackle the problem. Again, you wrote strong report language,
and we involved the Child Health Institute the Allergy and
Infectious Diseases Institute and the Cancer Institute, the
American Red Cross and the pharmaceutical industry; and
together, we have forged a physician education and public
awareness campaign that has achieved a remarkable amount on--I
might say, on a rather limited budget.
And when we came to this committee and reported that
African American and Hispanic children are chronically
undiagnosed and were conspicuously missing from our patient
population, you again wrote strong support language, and we
received a $1.3 million grant from the NIH to reach minority
and underserved children and young adults with chronic and
recurring illnesses to detect if they have a possible
underlying condition of immune deficiency.
And when we came back to you last year and told you that
for all we were doing, we could do only so much, but that we
could do even more if you could appropriate funds and direct
the CDC to work with us to create a companion program with a
truly national impact, you responded once again. You told the
CDC in your report to increase its involvement in the National
Education and Awareness Campaign sponsored by the Jeffrey
Modell Foundation. And then in the conference report you
appropriated funds to the CDC to expand the physician education
and public awareness program for primary immunodeficiency.
We are humbled and grateful for this committee's confidence
in our work.
We know that the patients support what we are doing. We
know that the thought leaders and the researchers and the
scientists support what we are doing. And like you, they all
recognize that taking on this campaign is right for us, for the
Jeffrey Modell Foundation, because this is what we do; and we
believe we have a unique expertise in this area.
We hope that the CDC sees it the same way as this
committee, Mr. Chairman. We are now told that there might be a
program announcement in June, but then again perhaps there
might not be. We are told that the funds would likely be
available by September 30th. We know it is because they have to
be. With only 4\1/2\ months left to the fiscal year, we are
concerned that this public awareness and physician education is
not moving quickly enough, because the longer we wait, children
and young adults are going undiagnosed, becoming more ill and
even dying.
In the past years, I have told you about Dina LaVigna, a
young woman who lived her entire life with a primary
immunodeficiency that was undiagnosed. It scarred her lungs so
badly, she required a lung transplant and, unfortunately, did
not survive. She left a husband and a 2-year-old child.
I have told you about Christopher Longo, a 3-year-old boy
who was sick from the time he was 3 months old. His parents
finally received the correct diagnosis after he had his final
life-ending infection; and the specialist who treated him last
said, had he been diagnosed earlier, he could have been
treated, and he probably would have survived.
Can you imagine the heartbreak?
We have just one request of the Committee this year. Please
continue the funding to CDC to implement those programs to work
with us, to end the unnecessary suffering and despair.
And, Mr. Chairman, I believe deeply that, in the end, it is
not how many ideas you have, it is how many you make happen.
And this committee makes those ideas happen. You certainly have
for us and our patients. We remain grateful for your support
and your confidence. And let's continue to make things
together, and make things happen together in the future.
Thank you very much.
[The prepared statement of Ms. Modell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Higgins, the head of the staff, is going to
check on the CDC failure to use the funding.
Ms. Modell. I hope so; I would encourage it. Thank you very
much.
Mr. Regula. This creates an immune deficiency and then
other medical difficulties can invade the individual because
you do not have a strong immune system?
Ms. Modell. Exactly. You are open to all types of opportune
infections, viruses, bacteria, and a person whose immune system
is not functioning properly is unable to fight off these
invaders.
Mr. Regula. Do you think we are making progress?
Ms. Modell. I think we are making great progress. There are
better treatments and there are wonderful results in bone
marrow transplants today, and gene therapy is truly very, very
helpful. They actually have had the first successful gene
therapy transplants in France on about eight patients who are
primarily immunodeficient patients like ours, so it has been
highly successful.
Mr. Regula. Bless you and your work.
Ms. Modell. Thank you very much.
Mr. Regula. Mr. McMillan, we will hold you, even though you
are next on the list, because Mr. Wicker is coming and he would
like to introduce you. And he will preside over the balance of
the day.
----------
Tuesday, April 7, 2002.
AMERICAN FOUNDATION FOR THE BLIND
WITNESSES
PAUL SCHROEDER, VICE PRESIDENT, GOVERNMENT RELATIONS, THE AMERICAN
FOUNDATION FOR THE BLIND, ACCOMPANIED BY TERESA BYRNE, PARENT,
DIRECTOR OF GIRL SCOUTS, GREAT TRAIL, 16TH CONGRESSIONAL DISTRICT
Mr. Regula. Our next witness will be Paul Schroeder, Vice
President, Governmental Relations, the American Foundation for
the Blind; accompanied by Teresa Byrne, a parent, director of
Girl Scouts, Great Trail, and also from the 16th District. So
you get a plus.
Mr. Schroeder. Who is left in Canton, Mr. Chairman?
Mr. Regula. Well, the two most important ones today are
here.
Mr. Schroeder. My name is Paul Schroeder, with the American
Foundation for the Blind, and I want to thank you for the
opportunity to testify today. We first want to thank the
Subcommittee and you, Mr. Chairman, for your ongoing support of
the many disability programs that you do oversee. In
particular, we want to thank you for the continued support for
the Independent Living Services for Older Blind program. It is
unique. It is the only program of its kind. It is a State-
Federal partnership and it provides a most important gap-
filling service. It provides the services that allow people who
lose their vision as they get old to remain independent. There
is no other service that helps individuals make that adjustment
to sight loss.
Mr. Regula. Do many of the blind take advantage, and does
it work well for them to allow them to live independently?
Mr. Schroeder. It works extremely well for those who are
able to take advantage. Unfortunately, it serves about 1
percent of the estimated eligible adult population. We hope it
is the 1 percent that is most in need. But you may remember,
last year we were accompanied by a lady who was able to speak
to the independence that she was able to achieve in running her
household and remaining independent and outside of an
institution, because of some of the basic services that she
received, allowing her to read, continue balancing her
checkbook, and doing some of these mundane tasks that are so
important but so hard to do with sight loss without proper
skills and technology.
Mr. Regula. I have heard there are not enough textbooks in
schools, that they do not get them soon enough. Is that an
accurate criticism?
Mr. Schroeder. I know that is something that Mrs. Byrne
will address, and we will turn over to the teacher preparation
area because it is so important. The two biggest barriers
facing blind children, unfortunately, are indeed access to
textbooks in a timely fashion. It is so hard to get a book into
the hands of a blind student in Braille or in a large print
form they can read.
The other barrier, of course, is having a teacher who can
teach that student how to use Braille, or the special
technology that someone who is blind like me would use to use a
computer. It is not the same technology that you would have in
your office, although I think you would like it. It requires a
special training and it requires a specialist who has that
training; and, unfortunately, what we have found as we have
studied the problem across the country, far too often districts
who would like to provide an adequate level of service to their
blind students simply cannot because they do not have teachers
who have those skills in Braille or have those skills in
technology, or, for that matter, know how to teach a child how
to get around independently with a white cane so that blind
child can indeed thrive in the school setting.
Why don't I let Theresa Byrne talk a little bit about her
experience, because she has seen both sides of the story with
her two children.
Mrs. Byrne. Thank you, Mr. Chairman, for hearing me today
on behalf my two students who are either having exams are just
getting out of school today. My two children who are blind use
Braille on a daily basis. They have received services both in
Canton city schools when they were younger and in Plain
Township schools, which is their home district.
We have experienced teachers who have had some training to
teach the blind when the children were young, and it did indeed
provide a good foundation for their education. This service was
not provided in their home school district. The solution for
Plain local schools was to attempt to contract for teacher
services who traveled to the district from as far as way as 90
miles on an occasional basis, sometimes once every other week,
sometimes as little as once a month. That was when they could
find people who were not contracted to other districts and were
able to travel and provide that support and service.
Both of my children have needed teachers who knew and were
trained to teach Braille and work with adapted computerized
equipment, special equipment for the blind, and they also
required travel training. Nick, who is at college at Stark
State, completed the computer accounting vocational program at
his high school and needed a special program software to turn
text on the screen to a voice output. Our school had to locate
teacher support from as far away as Columbus to get this
accomplished. That meant every day if a problem arose, Nick did
not have somebody readily available to solve a software program
problem or reinforce a key element of how to work through
traditional accounting software packages until he could maybe
get home and reach someone else by phone.
His classroom teacher was a wonderful, fabulous computer
accounting vocational teacher, but not trained with what she
needed to help him adapt for his needs.
Another one of my children, Erin, is another Braille-using
student. Her need for trained teachers was just as great, but
her school focus has been slightly different. She is a high
school student taking college prep classes and more. She needed
training in both the Braille English literacy code and foreign
language support, as she studies French, Spanish, and German.
She also uses the technical code called the nimith code for
math and science. And she also needs Braille books in a timely
manner. Her sophomore year, she did not have any Braille
textbooks until the third quarter of the year, and was
surviving by bringing print materials home and having family
members read it to her as they could fit it in.
Trained personnel would have been helpful in both the
Braille code teaching, but also in knowing where to find the
who, what, when, where and how to access the resources that
these students need. No parent should ever be in the position
of having the sole responsibility to search and connect for
resources for students. My kids are lucky because I have a lot
of skills and a background advocating for populations of kids
with special needs.
No school should ever be in a position of providing a
substandard education to any student because they cannot find
trained personnel to teach blind and visually-impaired
students. And no student should be left without a solid
foundation, especially reading, in the Braille or large print
format that will become the bridge to their successful future.
Thank you.
Mr. Regula. Do the Girl Scouts have a program for the
blind?
Mrs. Byrne. Absolutely. You can get your books in Braille
if you need them.
Mr. Regula. And you get the equivalent of an Eagle Scout?
Mrs. Byrne. My daughter is soon finishing up the highest
award in Girl Scouting, the Gold Award, and has been a Girl
Scout for 13 years.
Mr. Schroeder. Her daughter is putting the rest us to
shame, I am afraid.
Mr. Chairman, we thank you for the time and we do hope that
the Committee can look favorably on the modest increase in the
Independent Living Services for the Blind, and keep that going
and keep the States allowed to provide those services, and also
look favorably on personnel prep. As we fund IDEA and try to
seek full funding for those services, we want to make sure that
there are teachers who have the specialized knowledge in place,
who can make sure that the students are able to take advantage
of the education that IDEA affords them.
Mr. Regula. Thank you for coming. It has been very helpful.
[The prepared statement of Mr. Schroeder follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
MARCH OF DIMES
WITNESS
NANCY A. MYERS, MEMBER, EXECUTIVE COMMITTEE FOR THE STATE OF OHIO MARCH
OF DIMES CHAPTER
Mr. Regula. I am going to skip over a little bit. Mr.
Wicker is going to finish the day shortly, but I have one more
witness from Ohio, Nancy Myers, the March of Dimes. You are out
of Columbus?
Ms. Myers. Cleveland. I live in Stow, not too far.
Mr. Regula. That is great.
Ms. Myers. Good afternoon Mr. Chairman. I am Nancy Myers. I
am a volunteer member of the Executive Committee of the March
of Dimes, Ohio Chapter. And as you know, the March of Dimes was
founded in 1938 as a voluntary health agency by President
Roosevelt to fight polio. Today, our 3 million foundation
volunteers and 1,600 staff members work in every State, the
District of Columbia, and Puerto Rico to improve the health of
infants and children by preventing birth defects and infant
mortality.
The statistics on birth defects and developmental
stabilities are disturbing and illustrate a serious health
problem for our Nation today. I am here seeking additional
funds for programs to improve the health and well-being of
mothers, infants, and children through research and prevention
of birth defects and developmental disabilities as well as
improved access to care. I will highlight just a few areas
where, by providing adequate funding, Congress can take some
significant and affordable steps towards those ends. Additional
details are provided in my written statement.
The National Center on Birth Defects and Developmental
Disabilities at the CDC began operation a year ago in its
mission to prevent birth defects and developmental disabilities
and to promote health and wellness among children and adults
with disabilities. We urge this subcommittee to increase
funding for this center to $115 million in 2003. A modest
increase of $25 million will provide the resources to expand
Center-supported research and prevention activities.
The Center funds eight regional centers on birth defects
research and prevention, where groundbreaking work on life-
threatening work is underway. After 5 years of collecting
information, these centers are conducting studies to identify
the causes of birth defects. Current work includes a focus on
environmental causes of birth defects and genetic factors that
make people susceptible to them. This is exciting and leading-
edge research that merits additional support, and we recommend
an increase of $6 million for a total of $12 million to these
centers.
Currently, only three-quarters of our States monitor the
incidence of birth defects. The National Center is working with
States to increase this number and to improve data collection
through 28 cooperative agreements. However, funds are not
adequate to support all the States seeking assistance,
including our own State of Ohio.
We recommend adding $3,400,000 to CDC's State-based Birth
Defects Surveillance program which currently receives
$4,100,000. The Center also administers the Folic Acid
Education Campaign for reducing number of babies born with
neural tube defects. And while the Committee has noted the
importance of this program in its past reports, it has not been
explicit about the amount of funds it believes should be
directed to this program. We recommend that at least $5 million
be committed to expand this program in 2003.
Finally, as I mentioned earlier, the March of Dimes was
founded to find ways of fighting polio. The Foundation
continues to advocate polio eradication worldwide and supports
a funding level of $106,400,000 for CDC's 2003 global polio
eradication activities. If approved, the additional $4 million
would help cover the costs associated with a 33 percent
increase in the cost of the polio vaccine.
The Foundation wholeheartedly supports the 5-year effort to
double-fund the National Institutes of Health, and we are
especially interested in two areas within NIH. First, the
mission of the NICHD is closely aligned with that of the March
of Dimes, and we recommend an increase of 16 percent for NICHD
to expand research in several areas crucial to the health of
mothers and children.
Next, we recommend increased funding for the National Human
Genome Research Institute. The Human Genome Project has
identified the sequence of DNA comprising human genes, but this
is just the beginning. Additional funding would help expedite
this important work.
Finally, I want to focus your attention on two programs
administered by the Health Resources and Services
Administration that improve access to health care for mothers
and children. We recommend funding the MCH block grant at the
authorized level of $850 million to enable States to expand
prenatal and infancy home visitation programs, a proven
strategy that improves birth outcomes.
Secondly, newborn screening for metabolic diseases and
functional disorders is a great advance in preventive medicine.
Such disorders if left untreated can cause death or serious
lifelong problems. We propose an appropriation of $25 million
to support HRSA's work with States to implement newborn
screening programs.
Thank you for allowing me to testify on the programs of
highest priority to the March of Dimes.
[The prepared statement of Ms. Myers follows:]
Mr. Regula. Thank you. You might be interested, Nancy, that
the gentleman who did the genome project will be in Canton
Saturday morning.
Ms. Myers. I saw that. Dr. Collins. And I have heard him
speak before. He is wonderful. I am encouraging all of my
colleagues to get there.
Mr. Regula. I went to Mr. Obey's district last Saturday and
we did a program with NIH, and now this Saturday he is coming
to my district, and Dr. Collins will be a member of the panel.
Ms. Myers. I hope to be able to attend as well.
Mr. Regula. Saturday morning, Kent State.
----------
Tuesday, May 7, 2002.
DEVELOPMENTAL DISABILITIES RESEARCH CENTERS ASSOCIATION
WITNESS
DR. MICHAEL FRIEDLANDER, DIRECTOR, DEVELOPMENTAL DISABILITIES RESEARCH
CENTERS ASSOCIATION
Mr. Regula. Dr. Michael Friedlander, Developmental
Disabilities Research Center Association.
Dr. Friedlander. Thank you, Mr. Chairman. It is a pleasure
to be here today--and members of the Committee. First of all, I
would like to thank this committee very much for the ongoing
support for funding biomedical research at the National
Institutes of Health that many of us involved with
developmental disabilities research depend on to make some of
the breakthroughs that I am sure you have heard about in the
last few years.
By way of background, Mr. Chairman, I am serving as the
Chair of the Association of Developmental Disabilities Research
Centers, and I am also the Chairman of the Department of
Neurobiology at the University of Alabama, Birmingham, School
of Medicine. These centers were established by an act of
Congress in 1963 and have grown to 21 such centers of which 14
are currently funded through the NICHD as National Mental
Retardation Research Centers.
As you are probably aware, mental retardation and other
developmental disorders have a tremendous impact on a number of
children throughout the United States. Approximately a half
million children are born each year with mental retardation or
developmental disabilities or go on to develop them. Estimates
of the fraction of the United States population that suffers
from this range of disabilities range from 1 to 3 percent,
representing several million citizens of the United States.
By way of good news, we have had some tremendously exciting
breakthroughs in the last couple of years, and I just want to
highlight a couple that the Developmental Disabilities Research
Centers have supported.
You may have heard about fragile X syndrome. This
particular inherited form of mental retardation accounts for
the largest number of inheritable forms, about 4 percent. There
have been tremendous breakthroughs in understanding the
underlying genetic basis, the function of cells, what goes
wrong in them, and development of animal models. So now we have
begun much through Developmental Research Centers and the
initiative on fragile X to look at the underlying mechanicians
to target with therapeutic intervention.
Another dramatic form of mental retardation and
developmental disability is Rett's syndrome, the single largest
genetic cause of mental retardation in girls in the United
States. Recently at the Baylor College of Medicine
Developmental Disabilities Research Center, an animal model has
been developed where the gene has been discovered, and now
clinical trials are about to begin to look at how this gene
product can be interfered with to try to prevent the results of
this devastating condition on girls within our country.
Interestingly, like so much of what we are learning from
the biomedical science revolution in molecular genetics,
investigators have found that the gene involved with Rett's
syndrome is also implicated in autism and a number of other
behavioral disorders, including bipolar disorders. What we are
learning is that many of these genes have an impact on the
development of the brain that affect a number of disorders, not
only in children but in adults. So the investment in this
research pays off again and again at being able to get at a
number of these disorders.
You may have heard about some of the recently highlighted
statistics with respect to autism in the United States. Indeed,
Time Magazine last week had a cover story about the apparent
increasing prevalence of autism within the United States. There
is some argument exactly on what the statistics are and what
the incidence is, depending on how it is diagnosed and
categorized, but clearly this is a major problem that schools,
educators, and physicians are having to deal with that is
costing more and having a tremendous impact on children within
our society.
I am happy to say that through a lot of the work at
Developmental Disabilities Research Centers that you support,
we are beginning to get a handle on the underlying genetic
basis and the underlying molecular biology that can cause this.
Like so much of what you have heard before me today, many of
these organizations have to deal with trying to help the
children and families that suffer from the consequences of
these devastating disorders. At the Developmental Disabilities
Research Centers, what we try to do is find the cause, get to
the heart of it, and try to eliminate them in the long run. In
addition, what we have found at many of these centers is there
are interventional therapies that have a tremendous effect. For
example, at the University of Washington DDRC in Seattle, they
have developed a new set of methods to allow diagnosis of
autism at 1 year of age. This now allows rapid interventions
and intensive behavioral therapies that can have a dramatic
effect on these children's outcomes and for their whole
family's life from that point on.
The last example I will give you is something that I am
very familiar with because it was developed at the center that
I am affiliated with, the Civitan International Research Center
in Birmingham, Alabama. It is a new type of therapy call the
``constraint induced therapy'' in pediatric trials. This
emanated from work on stroke, and that emanated from very basic
molecular biology neuroscience research. What we learned is
that the brain is capable throughout life of changing under
intensive training regimes.
This was applied to stroke patients, adults, many of whom
have had symptoms for years and years with no improvement. What
is done here is forcing the people to use the affected limb,
the side of the brain that has been affected, in a very
detailed and highly vigorous training regime, and tremendous
recovery can occur over a period of weeks. Recently, this was
used to see if an outcome can be effected in children with
cerebral palsy, and the preliminary effects are quite
remarkable.
Indeed, the National Institutes of Health, through the
NICHD, is about to launch funding on a trial to extend that
work. And it is another example of where the multidisciplinary
action of using molecular genetics, the human genome project,
imaging, behavioral research, et cetera, are coming together to
attack these problems that no single investigator would be able
to do.
In closing, I would like to thank you very much for the
support over the last few years. I would like to encourage you
to support the NIH budget doubling that we are on track for
this fiscal year, and, in particular, to increase the funding
along those lines for the National Institute of Child Health as
well, and for these Disability Research Centers. They are a
unique national resource and they represent a kind of research
and interaction of investigators you simply cannot have within
individual laboratories without bringing together all of this
expertise with the necessary funding.
Thank you very much for your time.
[The prepared statement of Dr. Friedlander follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker [presiding]. Thank you, Dr. Friedlander. Let me
apologize for a little business up here while you were
testifying. You began with Chairman Regula in the Chair, and
now you have me, and I hope that wasn't too distracting.
Also, the Chairman probably explained that many Members are
traveling today and have other obligations, but our staffs are
here, and this testimony is, of course, being transcribed, and
your full testimony is also accepted. So do not feel from the
absence of the Members or from the lack of attendance that your
testimony or the testimony of any of our witnesses is less than
very significant.
Let me just ask you--I am going to get the cover story from
Time Magazine about autism, because I know how devastating that
can be--and you mentioned to schools, the education system, to
families.
Certainly if anybody has talked to a family that is faced
with this, just the fact that you have to have somebody all the
time, and there are folks that come in and give you a night or
two off just to keep the family from having to be burdened 24
hours a day, 7 days a week.
Let me just ask you your opinion based on what you know
about whether autism is indeed more prevalent nowadays, or if
we simply notice it more, know about it more.
Dr. Friedlander. This is certainly one of the key questions
with a lot of diseases. As diagnostic techniques improve and as
information is brought to the public consciousness, often we
are able to flush out a lot of this information that we did not
have access to.
However, as you look through the best data that we can get
our hands on over the last 30 years or so, there is a hint that
this has been increasing. The estimates now are anywhere from 1
in 500 or 1 in 300 to 1 in 2,000; whereas in the 1970s, the
estimates would have put it almost on an order of magnitude
below that.
Again, one has to be very cautious, and to try to parse out
exactly how much of that is due to better diagnosis and the
classification, versus a real increase, is going to take much
more intensive work. And indeed this is part of the type of
research the center network can do. And there are a number of
centers that are working on that right now.
So I am afraid I am having to qualify that answer a bit in
that we haven't been able to separate all of those components.
But clearly the amount of costs to society, once this diagnosis
is made, besides the individual impact on families that you
mentioned, is tremendously increasing and society has to deal
with that not only in emotional terms but financial terms as
well.
There is a tremendous effort out there amongst the DDRC
community, both in the individual universities, the medical
centers, and within the institutions of the center network to
try to get at exactly those numbers and see how much it has
increased, if indeed it is significantly increasing.
It is our hope that with some of the research that I
described that we can pinpoint some of the genetic causes and
the predisposition factors. Right now it looks like there is a
family of genes ranging anywhere from a few genes up to tens of
genes that seems to predispose one for this particular type of
syndrome. It is not going to be as simple, like some diseases
where a single gene can be found to attribute the entire cause.
Mr. Wicker. Is there any research on perhaps vaccinations,
childhood vaccinations causing autism?
Dr. Friedlander. Yes. You have hit on the other area that
has certainly generated a lot of interest. There has been a
suggestion that vaccinations lead to this. The data on that are
not conclusive. There has been a lot of anecdotal evidence
reporting that their children started to develop these symptoms
soon after the time of these vaccinations. On the other hand,
one has to be very careful with that, because that is about the
same age that you are likely to see the symptoms develop
anyway.
So once again, what is really required is a systematic
investigation to parse that out and try to separate that. I
would say at the present time, we cannot definitely attribute
the vaccination as the cause of autism.
Mr. Wicker. What is the typical age of onset?
Dr. Friedlander. Right now, within the current diagnostic
techniques, around 2 to 3 years of age is when this is picked
up. As I mentioned, one of the Developmental Disability Centers
has come up with a new battery of tests, the University of
Washington at Seattle, where they can start to pick this up as
early as a year of age. So it is moving earlier, but again that
probably reflects the better diagnostic techniques.
Mr. Wicker. Well, thank you for your testimony and your
work. Needless to say, I think the Subcommittee will be
responsive to your request for overall funding for a wide array
of research. Thank you very much.
----------
Tuesday, May 7, 2002.
NATIONAL ORGANIZATION OF REHABILITATION PARTNERS
WITNESSES
H.S. ``BUTCH'' McMILLAN, EXECUTIVE DIRECTOR, MISSISSIPPI DEPARTMENT OF
REHABILITATION SERVICES, PRESIDENT, NATIONAL ORGANIZATION OF
REHABILITATION PARTNERS, ACCOMPANIED BY ELIZABETH SAMMONS, CLAIMS
REPRESENTATIVE, SOCIAL SECURITY ADMINISTRATION, FORMER CONSUMER/
CLIENT, VOCATIONAL REHABILITATION SERVICES
Mr. Wicker. Our next witnesses are H.R. ``Butch'' McMillan
and Elizabeth Sammons. So if they will come forward.
Butch McMillan is Executive Director of the Mississippi
Department of Rehabilitation Services and is a former colleague
of mine in the Mississippi State legislature. And it is
wonderful to have him with us to introduce Ms. Sammons who,
Chairman Regula wanted me to point out in the strongest of
terms, is a constituent of his from Canton, Ohio. And he is
mighty proud of all of her accomplishments, particularly the
fact that she speaks about, I don't know, how many languages is
it?
Ms. Sammons. Enough to talk with several people in the
world.
Mr. Wicker. Way more than he and I could ever hope to
speak, put together. We are delighted to have both of you, and
I believe, Mr. McMillan, we recognize you first.
Mr. McMillan. Thank you, Mr. Chairman.
Mr. Wicker. Thank you for waiting for me.
Mr. McMillan. Certainly. I do have to catch a plane
shortly, so I may leave here after a while. We are going to
double-team you here today, and I was hoping that Chairman
Regula would have been able to stay, but I could tell that he
had read with interest the testimony, as you pointed out.
Thank you for inviting us here today. In addition to being
Executive Director of the Mississippi Department of Rehab
Services, I have the honor of serving as the first President of
the National Organization of Rehabilitation Partners, or now
called NORP. That acronym caught on quickly, and most people
now that know that we exist are quickly picking up that
acronym.
We do have some other people that are with us today. We
have John Connolly with the Ohio Rehab Services, my counterpart
there; and Eric Parks, one of his commissioners. Walter
Blalock, sitting over here, is on our State Independent Living
Council, from Mississippi; and Sheila Browning from my staff is
sitting back somewhere back there. Brian McLean from the New
York agency, Brian is assistant commissioner there. They are
some of our member States.
Mr. Wicker. Welcome you all.
Mr. McMillan. NORP is a newly created and rapidly expanding
agency, representing State rehabilitation agencies, disability
service providers, individuals with disabilities, and their
families, and our mission is to promote employment and
independence for people with disabilities. And I know you are
well aware of that from our work in Mississippi and some of the
conversations that we have had.
But this task is much more complicated than it may sound.
It takes a lot of resources, all sorts of resources on a daily
basis, to reach our goals; and obviously one of our key
resources is resources, and that is why I am before this
Committee, and that is the Federal funding that is provided,
which under the Rehab act, 78.7 percent--I think that is
right--78.3 percent is provided from Federal funds.
Our written statement outlines the details of our request
and why we think those should be granted. And basically our
request starts with the President's budget and builds from
there, because obviously we felt like there were some
additional funds that are always needed. But it is a major
start in this Administration's budget, in that it puts in
additional dollars above our CPI or what we call our COLA that
that is under the Rehab Act. So that is significant, and we
wanted to start from there. But we gave those details.
What we wanted to do today was put a face on what we do,
and that face is Ms. Elizabeth Schuster-Sammons, one of
Chairman Regula's constituents. We would like Elizabeth to
share her experience with us. Go ahead.
Ms. Sammons. Hello, Chairman Wicker, and hello to all of
you. Thank you for being here. I have a story to tell you, and
I feel honored that you have invited me to share it. When I was
a little girl, I think the only thing bigger than my
imagination was my curiosity about the world that I couldn't
see, so I decided to study languages and journalism. After
that, I took a job in 1990 with the U.S. Information Agency in
Russia, and I decided to stay there. In fact, I decided to stay
in Siberia because I felt very free there. People's belief in
me and wonderful public transportation let me do just about
anything I wanted to do.
I enjoyed 10 years of teaching, interpreting, doing
journalistic research, and heading two nonprofit organizations,
both in Siberia and in central Asia. Then, when I returned to
America 2 years ago and started looking for work, I ran into a
lot of barriers that I hadn't thought about. First, I couldn't
get many places independently, since I couldn't drive. Second,
interviewers greeted me with, oh, you are on time. That made me
think that they did not expect that of anyone with a
disability. And third, I kept sensing these unexpressed
concerns from employers. Looking back, I now realize that
probably issues of liability or health insurance that I might
need simply outweighed the interest of hiring me. The cons
outweighed the pros.
After 6 disheartening months of this, I asked a counselor
at the Ohio Rehabilitation Services Commission to help me, if I
was willing to expand my career horizons, and I was. That same
week, RSC lined up an interview for me with Social Security. I
was interviewed one day, and I was hired the next.
Now, since October 2000, I have been a claims
representative with Social Security. I still dream of doing
other things at times, such as writing or international
relations, but thanks to RSC, I have a good job in my own
country.
As a claims representative with Social Security, I
interview disabled people every day, and every day I realize
that it could easily be me on the other side of the desk.
Claimants tell me that as soon as their employer realizes that
they have a physical problem, that they never get their chance
to show their mettle, even though many times they think they
could do the job.
Most employers in America have to focus so much on the
bottom line that they simply look much more at what people with
disabilities cannot do than what we can do.
If I could bring one thing back from the Russian work
world, it would be the trust in you that you are as good as
your word until and unless you prove otherwise. I thank you for
your attention, and if you have any questions I invite you to
ask them now.
[The prepared statements of Mr. McMillan and Ms. Sammons
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. Thank you both very much. We appreciate your
testimony. We are joined by Mr. Hoyer who may have a question.
Mr. Hoyer. I do not have a question, I just got in very
late. I came to welcome another witness, but as a principal
sponsor of the Americans with Disabilities Act, I was struck by
your comment that employers and others look at what people
cannot do. And I tell people, I am about 6 foot tall, and Abe
Polin, who is the owner of the Wizards, Washington Wizards, has
never asked me to play center for the Washington Wizards,
because I have a disability for that position. I am about 12
inches too short to play center for the Washington Wizards. But
there are a whole lot of things that I can do, and what the
Americans with Disabilities Act was all about was, of course,
dropping the ``dis.'' We dis people when we look at what they
cannot do. We need to look at the ability. And the fact is that
most of us can do a lot of things, notwithstanding the fact
that there are some things that we cannot do for whatever
reasons. So I welcome you here and thank you for your
testimony.
Ms. Sammons. It was an honor.
Mr. Wicker. I would just observe that my friend from
Maryland, there are probably other reasons also why he has not
been asked to play for the Washington Wizards, height being
only one of them.
Mr. Hoyer. The Chairman is such a cynic.
Mr. Wicker. I want to thank our guests for being here
today. I had mentioned the number of languages that Ms. Sammons
speaks. Let me just be specific for the people in the room
today. She is fluent in French and Russian and has
conversational fluency in Hungarian, German, Italian, with some
knowledge of Spanish and Cossack. Of course the only one of
those that I know well is Cossack.
Ms. Sammons. (Speaking Cossack).
Mr. Wicker. You betcha.
We thank you very much. And, Mr. McMillan, I hope you make
your plane.
Mr. McMillan. Thank you, Congressman.
----------
Tuesday, May 7, 2002.
NATIONAL ASSOCIATION OF DEVELOPMENTAL DISABILITIES COUNCILS
WITNESS
HONORABLE DENNIS BYARS, SENATOR, NEBRASKA STATE LEGISLATURE,
CHAIRPERSON, PUBLIC POLICY COMMITTEE, NATIONAL ASSOCIATION OF
DEVELOPMENTAL DISABILITIES COUNCILS
Mr. Wicker. Our next witness is the Honorable Dennis Byars,
Senator of the Nebraska State Legislature, and he is speaking
today on behalf of the National Association of Developmental
Disabilities Councils. Senator Byars, if you would come forward
and proceed at your own pleasure.
Mr. Hoyer. While he is coming forward, Roger, I always
thought when I was in the State senate for 12 years, I did not
think it was so unfortunate; but having been in the House for
21 years, I always lament the fact that Nebraska chose to name
their unicameral legislature the Senate rather than the House.
Mr. Byars. Thank you, Mr. Wicker and Mr. Hoyer, for having
me here today. I speak unicameralese. I am not good at those
other languages. But before Mr. Regula left, I was feeling that
I needed to be adopted by somebody from Ohio in order to have
any impact here. We thank you for hearing our testimony today.
Certainly staff members also have been very attentive, and
we who are legislators recognize how important staff is to all
of us in doing our jobs.
I am here today on behalf of the National Association of
Developmental Disabilities Councils. I am a member of the
Nebraska Council on Developmental Disabilities, a member of the
National Association of Developmental Disabilities Councils
Board of Directors, and Chair the NADDC Public Policy
Committee. And I am very, very proud to serve my State as a
Senator in the Nebraska legislature.
On behalf of NADDC, I want to thank you for the opportunity
to be here this afternoon and discuss the activities of our
State councils and their funding needs.
The Developmental Disabilities Assistance and Bill of
Rights Act authorizes funding for the activities of State
councils, one in each State and the four territories. The act
was first passed in 1963 and has been expanded to meet the
growing demand for community support in subsequent
reauthorizations.
We have two requests today. First, for fiscal year 2003, we
are asking for funding of $76 million, the authorized funding
level for the State councils. The current appropriated level is
$69,800,000.
Secondly, we are in an immediate fiscal crisis that will
result in the redistribution of $2,400,000 of already
appropriated funds, due to a legislative drafting oversight. We
need help in reversing this loss.
Individuals with developmental disabilities continue to be
among the most disenfranchised in our country. President Bush
has made a clear commitment through the Olmsted activities to
address their isolation and the lack of sufficient services and
supports. State DD councils pave the way for successful Olmsted
implementation. We work with and for individuals with
developmental disabilities to promote comprehensive systems of
services and supports that increase independence, productivity,
integration, inclusion, and self-determination.
Council priorities are set based on a thorough State
planning process identifying the unique needs of individuals
within their own State. Council activities have resulted in so
many accomplishments. Let me give you just a sampling: Strong
early childhood programs, improvements in school services,
access to real inclusive jobs through supported employment,
small business ownership, self-advocacy training and
empowerment, homeownership, appropriate community activities
for individuals as they becomes older, and tremendously
important supports for families so they can remain healthy and
intact.
Councils are addressing issues of crisis in our systems:
severe shortage of direct support staff, shortage of quality
inclusive child care for working parents, lack of
transportation and burgeoning community waiting lists. With a
very small amount of money, councils are fulfilling their
responsibilities to make this country a better place to live
for individuals with developmental disabilities. But they have
to work overtime with creative resource management in order to
make a dent.
Our written testimony outlines in far more detail how our
councils are doing this, most especially among your own
constituencies. This year the 14 smallest State councils
receive $446,373 in funding. And the average allocation across
the country is approximately $1.3 million far less than needed
to keep pace with the cost of living, let alone to fulfill the
promises of the DD Act. To remedy this shortfall we request the
authorized level of $76 million.
On the more immediate issue, 23 councils, including yours,
Mr. Wicker, face a loss totaling $2.4 million for this year. A
provision preserving a predictable funding base for State
councils was inadvertently dropped from the DD Act in the last
reauthorization. On April 23rd, Agency officials notified the
State councils the hold harmless language was no longer in the
Act, and there would be a retroactive adjustment in the
allotments.
The Agency tells us they currently have no other legal
option. We are asking Congress to pass a technical amendment to
restore the language. We also will need a one-time additional
$2.4 million in fiscal year 2003, or in the fiscal year 2002
supplemental appropriation, to restore these funds.
We thank you for the opportunity to talk to you today about
the accomplishments and the needs of the State Councils on
Developmental Disabilities and we appreciate the members of
this Committee who have been so supportive of us before in the
past. Thank you.
[The prepared statement of Senator Byars follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. Thank you, Senator, for your kind words, your
testimony, and also for bringing to our attention the matter of
the inadvertent omission. Mr. Hoyer?
Mr. Hoyer. Thank you. Senator, thank you for your
testimony. Each one of us is asked to submit a letter to the
Committee in terms of our priorities and what we think we need
to focus on. I know you will be pleased to hear that every one
of the issues that you raised was in my 7-page letter, but
particularly the hold harmless which was inadvertently dropped
out. That should hopefully be no problem. We have asked for the
$2.4 million which you referenced, as well as all of the sums
mentioned in your last page of your testimony, which of course
is the--I suppose the consortium's considered opinion, we have
also asked for. I think all of these investments are well paid
for in terms of the empowerment that we give to individuals.
Thank you.
Mr. Byars. Thank you, Congressman. We appreciate that
support. Seven pages, 10 pages, 6 pages, we will accept
whatever you would like to say.
Mr. Wicker. Thank you very much.
Tuesday, May 7, 2002.
ASSOCIATION FOR PERSONS IN SUPPORTED EMPLOYMENT
WITNESSES
RON RUCKER, CHIEF EXECUTIVE OFFICER, VIA COMPANY, ACCOMPANIED BY DAVID
BOYD, COURTESY CLERK, SAFEWAY, LaPLATA, MD; AND CHERYL JONES,
EMPLOYMENT SPECIALIST, MELWOOD, WALDORF, MD
Mr. Wicker. Our next witness is Ron Rucker, Chief Executive
Officer of Via Company, on behalf of the Association for
Persons in Supported Employment. And he is joined by David Boyd
and Cheryl Jones. We are delighted to have each of you.
Mr. Rucker. Thank you, Mr. Wicker, we are pleased to be
here, honored to be here, and humbled by how much you guys have
to sort through to figure out what to do with our dollars.
Good afternoon. Thank you for the opportunity to testify
today. My name is Ron Rucker. I am president and CEO of Via, a
not-for-profit agency providing supported employment in
Bethlehem, Pennsylvania. I am also a board member of the
Association for Persons in Supported Employment, known as APSE.
APSE is a national membership organization promoting quality
inclusive employment and workplace supports for individuals
with significant disabilities. I am speaking today on behalf of
the 4,600 members and 39 State chapters of APSE to urge
continued supported employment funding under the Rehabilitation
Act.
Since 1986, you have appropriated funds for Title VI-C of
this act. During this time, that funding has supported real
work for a large number of individuals with significant
disabilities. The Administration now proposes to eliminate
6(c), along with three other programs in the Act, based on the
misconception that these programs could easily be folded into
Title I.
Please reject this consolidation. The consequences will be
terrible for hundreds of thousands of individuals with
significant disabilities.
With me today is David Boyd, one of over 150,000 people who
through supported employment has entered the labor market for
the first time. Mr. Boyd lives in Waldorf, Maryland, and worked
for Safeway in LaPlata, where he is employed as a courtesy
clerk, and his other duties include frontline work, light
janitorial and stocking. He has been in this job for 13 years.
He is good at what he does and he loves going to work.
Supported employment is defined as competitive employment
in an integrated setting with ongoing supports. It is designed
for individuals like David, who otherwise would not have access
to work due to the nature and severity of their disability. It
is collaborative funding with short-term training dollars from
VR and long-term supports primarily from Medicaid. These funds
allow people to work who otherwise would be written off as
unemployable.
In supported employment we assume competence. We plan with
the individual rather than for the individual, and work closely
to create a match between the interest, skills, and abilities
of the job seeker and the needs of each business.
Also with me is Cheryl Jones. She is an employment
specialist who supports Mr. Boyd. Ms. Jones works for Melwood,
a nonprofit organization much like Via, providing supported
employment services in southern Maryland. Professionals like
Ms. Jones are key to successful supported employment. Cheryl
provides individual training, workplace supports, and job
development, all in partnership with David and Safeway
Corporation.
Unfortunately, the story changed dramatically. The La Plata
Safeway was destroyed by the tornado that recently wreaked
havoc on southern Maryland. Thanks to Melwood, Ms. Jones, and a
very supportive employer, David did not lose his job. He has
been transferred to another Safeway. Change can be challenging,
and Cheryl and David will work together at the new work site.
She will assist him in acclimating to the changes. And,
fortunately, public transportation is available and they will
travel the new route together until he is confident at going
alone.
Title VI-C makes this story possible. While we celebrate
these achievements, we continue to feed the dinosaur. There are
at least 500,000, and probably closer to 1 million, adults in
segregated settings who have not had this option that David has
to choose a real job in the community. The issue is not the
ability to work. David has been at his job 13 years, and
hundreds of thousands of people like him are proof of that
issue.
The issue is not outcomes. The average supported employment
wage is $5.42 per hour compared to an average sheltered wage of
$2.42 per hour. The real issue is funding disincentives. What
gets paid for gets done, and currently 75 percent of Federal
and State employment funding for individuals with significant
disabilities supports sheltered settings.
As a provider who has chosen to convert my sheltered
workshop to supported employment, I can tell you it is a lonely
journey, moving against the flow when funding is not available
to support those efforts. The State grant program is the one
bright spot. It is the incentive that supports systems change.
President Bush is correct; States can and should use Title
I funds for supported employment. However it will be difficult
for States to maintain a commitment to supported employment
when the funds can and will be used for individuals with less
severe disabilities, especially when OVR counselors will be
rewarded for the same number of closures, regardless of the
severity of disability.
As outlined in the new Freedom Initiative and Olmsted
activities, this administration has a strong commitment to
community integration for people with significant disabilities.
It follows that employment must be a key element of that
community participation. In fact, if the President had
understood the crucial role supported employment plays in
advancing community integration, he would have significantly
increased the funding level and expanded possible uses rather
than targeting it for elimination.
We ask you to not only reject the Administration's request,
but to actually increase the funding for supported employment
State grant programs. This is the only funding stream
designated specifically for supported employment. It is a
valuable tool for opening doors. Please do not slam that door
in David's face.
Mr. Wicker. Mr. Hoyer, I believe these are constituents of
yours.
Mr. Hoyer. Not all of them. As a matter of fact Melwood is
no longer in my district. It is actually in Al Wynn's district.
But this is a crucial issue that has been raised. When we
passed the Americans with Disabilities Act, it had a number of
titles, Mr. Wicker, as you know, public accommodations,
transportation, communications. One of its central provisions,
however, dealt with employment. We heard earlier about the
discrimination thinking about what people can't do. We have had
a lot of successes. You can go to a theater now. You can go to
a sports event if you are mobility impaired. We are moving on
election reform, as you know, to make sure that people can vote
in private, whether they are blind or have mobility
impairments, access to polling places. But where we have not
been as successful as we had hoped is in employment.
The overwhelming majority of the disabled are still
essentially on some type of public support.
Mr. Rucker. The figure is as high as 75 percent.
Mr. Hoyer. These are folks who want to work. You heard
David's background. David works for the Safeway that the
tornado tore down in La Plata, and I have been there three
times in the last week. I am going to be back there on Friday
trying to make sure we can buildup and rebuild that Safeway so
you can move back to La Plata at some time. But David has been
employed for 13 years.
Ms. Jones, who works for Melwood, Melwood is an
extraordinary organization. Melwood has contracts for millions
of dollars.
At Goddard Space Flight Center, it is Melwood employees
that maintain the grounds at the Goddard Space Flight Center,
and they do an extraordinary job. And they do that consistent
with a statute that says it is important that we make
opportunities for those with disabilities because they want to
do, and they can do, and they do well.
And I thank you for your testimony. I am certainly going to
be working towards making sure that we restore that--we haven't
cut it yet, but it is still in being, but not adopt that
portion of the President's program. It was the President's
father who signed in July of 1990, the Americans with
Disabilities Act. And indicated in his speech when he signed
that bill, that this was, in effect, a bill of rights for those
with disabilities.
And it would be a shame for us to undermine to some degree
the incentive that is available to make sure that those with
disabilities are, in fact, able to be independent. We talk
about empowerment. This is an empowerment program. Newt
Gingrich talked about it and he was absolutely right. I voted
for the welfare reform bill, which was an attempt to say that
we expect work. If you can work, you need to work. You need to
support yourself and support our society and not be supported
by others.
But here it is, an opportunity for us to accomplish that
objective if we will not withdraw the incentives and assistance
to that end.
Ms. Jones. The key thing you said was independence because,
that is all Mr. Boyd wants and other individuals and programs
like we have for supported employment. They do want their
independence to be able to get out there and work and do and
support themselves in society. I think it is wonderful. I
commend them.
Mr. Hoyer. Roger, if you go to Melwood, you see a lot of
young people, and frankly middle-aged people--David you are
young, as far as I am concerned, but my daughters wouldn't
think you were young. It is all relative, I suppose. But people
who have come to Melwood learn a skill and are now very proud
of their independence and their ability to perform a service
and earn a living, and not be dependent on somebody else. They
need some help. We call that, in the Americans with
Disabilities Act, a reasonable accommodation. We all need
reasonable accommodation from time to time.
David, I congratulate you. Because in the final analysis,
David, the fact that you do so well and you do your job so well
is the reason that the taxpayers will support programs that
make sure that you can participate and, frankly, be a taxpayer.
We love you, David. You know, we are for those people who pay
taxes and keep our government going. So thank you very much for
all you do.
Mr. Wicker. Thank you, Mr. Hoyer. I believe President Bush
the elder said the Americans with Disabilities Act was the
greatest civil rights legislation in a generation. So I
appreciate your comments, Mr. Hoyer, and I appreciate the
testimony.
Let me just ask you, Ms. Jones, Melwood is the nonprofit
that will take your used car off of your hand; is that right?
Ms. Jones. Would you like the phone number?
Mr. Wicker. I have a couple that have been candidates for
that. Just out of curiosity, how many cars, how many
automobiles are donated per year to you?
Ms. Jones. I honestly can't tell you. I am not in that
department, I am in the vocational department. But I could get
that information.
Mr. Hoyer. Please do that.
Mr. Wicker. Thank you very much.
Mr. Hoyer. The fact of the matter is, and I don't know the
number, but the response to that program has been so great that
they have had to stop taking total clunkers because----
Mr. Wicker. Perhaps my car would not be qualified then.
Mr. Hoyer. I just wanted to advise you of that it has been
so successful, they can be selective.
Mr. Wicker. I drove to the White House today and they
almost did not let me pass security. Thank you very much.
[The prepared statement of Mr. Rucker follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
RESIDENTIAL CARE CONSORTIUM
WITNESS
STEVE C. BORCHARDT, SHERIFF, OLMSTED COUNTY, ROCHESTER, MINNESOTA
Mr. Wicker. Next we have Steve C. Borchardt, sheriff of
Olmsted County, Rochester, Minnesota. Sheriff, we are mighty
glad have you.
Mr. Borchardt. It is an honor to be here.
Mr. Wicker. I believe you are speaking about the
Residential Care Consortium.
Mr. Borchardt. I am indeed, but allow me to add my voice to
that of the previous speaker. I got on a plane in Minneapolis,
Minnesota, at 7 o'clock this morning to come here and educate
you about my program, and instead, it has been I who has been
educated for the last hour and a half as I sat and listened to
the daunting decisions you must make. I appreciate the
challenge.
Mr. Hoyer. Sheriff, I apologize. I have a 4 o'clock
appointment. You have been sitting here for a long time. I wish
I could sit here. But the person who knows much more about what
goes on is going to be here and listen and then she will tell
me exactly what to do. Thank you. I apologize.
Mr. Borchardt. Mr. Wicker, Members, staff, thank you for
allowing me to share with you the mission and the work of the
Residential Care Consortium, a collection of independent
agencies serving some of the country's most challenged children
and youth.
I serve on the Board of Trustees of the Minnesota Sheriffs
Youth Programs, a member organization of the Residential Care
Consortium. The Residential Care Consortium consists of several
independent community-based homes offering residential care for
children who need guidance and support.
In addition to Minnesota, Residential Care Consortium
members are located in Texas, Indiana, Kentucky, Pennsylvania,
Maine and Georgia. Membership in the consortium includes
America's oldest children's homes founded as early as 1740 and
as recently as 1970. The reputation of each of these facilities
places them in a leadership position on a national level.
Members of the Residential Care Consortium provide
structured homes and intense support at campus-style facilities
for youth that have become wards of the State, due to severe
emotional problems or lack of parental support. These are the
kids for whom foster care has not been successful and
institutionalization is likely the next step.
To be frank about it, we do a decent job getting these kids
on their feet and helping them put the pieces of their life
together, and then it is time for them to leave the residential
setting because they turn 18 and the money runs out and we hold
our breath. We hold our breath because no matter how well your
life has gone, how extensive your support system, the
transition from youth to adult can be a difficult time for our
kids. It is a treacherous time.
Each of our facilities reaches financial support from State
and local governments, charitable foundations, the private
sector. One area that is least funded, and arguably the most
critical aspect of our work, is supporting the transition
period when teenagers age out of residential services.
The Federal Government provides formula funding through the
Chafee Foster Care Independence Program for just this purpose.
However these resources are inadequate for a comprehensive
program of services to these kids who are transitioning. We
were formed specifically for that purpose.
Sir, as I am sure you are well aware, coming of age is
tough enough, even for kids from strong functional families and
intact support systems. And one of our kids at 19 years of age
who has all the normal challenges to begin with and you add the
additional challenges of diminished or dysfunctional families,
or nonexistent family support systems that most of us take for
granted is going to have a tough time because they do not have
the kind of common sense support that most us take for granted.
They better figure it out fast, because running drugs or
working in the sex trade can make quick money, but also ruin
any chances that they might have had for getting a better
education or securing a decent job with any probability of
sustaining self-sufficiency. Data supports the notion that
young people who have a mentor during this transitional face
have a greater chance of becoming productive members of our
society. Without it, they are far too likely to make the easy
choices rather than the good choices, and then we are serving
them once again; this time in my jail and in jails across the
Nation.
So how do we address this? The Residential Care Consortium
has identified two areas of need that we are asking your
assistance for. Number one, job training and number two,
substance abuse and mental health counseling on an ongoing
basis.
Why job training? Well, many large and small employers are
unwilling to risk hiring our kids. There was a day only a
generation ago when judges frequently gave kids the choice of a
sentence to a confinement facility or enlisting in the military
in order to grow up with military discipline. Now even our
military has determined that they cannot take the risks
associated with hiring this population of kids. If even our
military cannot tolerate this risk, certainly it is prohibitive
for local businesses to fill this need at local level.
As a result, these kids have no mentors and few prospects
and most assuredly are filling our jails. Therefore, we seek
$1,800,000 through the Department of Labor to provide mentors
and job coaches. We want to create financial incentives for
employers to take these young people on. We want to get them
started in the right direction with the satisfaction of a
secure, well-paying employment.
The other area that is so critical for us to address is
mental health and substance abuse. We are asking the Committee
to set aside $1,200,000 at the Substance Abuse and Mental
Health Services Administration for this component of our
transitional services initiative. Most of our clients have
experienced severe emotional disturbances or have been
diagnosed with mental health conditions. The needs are real,
the risks are real, and the numbers of mentally ill and
chemically dependent that are filling our jails are very real.
This transition support is worth doing. We know it can make
a difference in kids' lives, people who are on the balance beam
between making it or not making it. We need your help. We
intend to deliver transition services, set measurable outcomes,
evaluate our efforts, and share the results with the industry
and you, our policymakers.
In closing, sir, I would say it does not make sense to put
so much effort and energy into these kids only to stand back
and hold our breath as they walk out the door. I am here as a
local sheriff, not as a child care provider, not as a counselor
or a therapist.
I run a jail that is rapidly overcrowding with the kids
that I have described. And the same is happening to sheriffs
all across our Nation. We must find better answers than
warehousing misguided kids. If nothing else, besides being the
right thing to do, it is simply enlightened self-interest to
invest in supporting kids at this time of transition from
structured residential care to independent adulthood.
Thank you again for the honor of addressing you this
afternoon. I ask you to grant the funding requests that we have
before you. Together we will make a difference. Thank you.
Mr. Wicker. Thank you very much, Sheriff.
[The prepared statement of Sheriff Borchardt follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. You are asking for $1,800,000 throughout
Department of Labor and $1,200,000 from SAMHSA; is that
correct?
Mr. Borchardt. Yes, sir.
Mr. Wicker. Have you had discussions with the professionals
at SAMHSA about how they might inspect you or do you know if
people in your organization have had conversations with SAMHSA?
Mr. Borchardt. I believe they have. I have not personally,
sir. I can get that answer for you.
Mr. Wicker. It might be a good additional step for your
group to meet with both of these agencies and draw on their
expertise also as to how this subcommittee might best provide
assistance to you. But I appreciate what you are doing and you
have certainly outlined an area of grave concern.
Mr. Borchardt. Thank you, sir.
Mr. Wicker. Thank you, Sheriff.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
NATIONAL ASSOCIATION OF FOSTER GRANDPARENTS PROGRAM DIRECTORS
WITNESS
JANE H. WATKINS, ASSISTANT DIRECTOR, FOSTER GRANDPARENT PROGRAM,
ORLANDO, FLORIDA
Mr. Wicker. Next we have Jane H. Watkins appearing on
behalf of the National Association of Foster Grandparents
Program. We are delighted to have you with us this afternoon.
Ms. Watkins. I am honored to testify in support of fiscal
year 2003 funding for the Foster Grandparent Program. The
Foster Grandparent Program is the old oldest and largest of the
three programs collectively known as the National Senior
Volunteer Corps.
My name is Jane Watkins I am here in my capacity as the
immediate past President of the National Association of Foster
Grandparent Program Directors. NAFGPD is a membership-driven
professional organization representing the majority of the 350
members across the Nation as well as the local sponsoring
agencies and others who value and support the work of foster
grandparents.
Mr. Chairman, before I begin my testimony, I would like to
thank you and the members of the Subcommittee for your
steadfast support of Foster Grandparents Programs. In fiscal
year 2002, the Labor HHS appropriations bill included an
increase of $7,800,000 for foster grandparents. That is nearly
twice what the President requested in his budget.
These vital funds are now being used to provide our 34,000
foster grandparents volunteers with their first stipend
increase in 5 years. On behalf of the 34,000 foster
grandparents volunteers and the nearly 300,000 special needs
children that they serve across the country, I want to thank
you, the Subcommittee members, and your staff for believing in
the Foster Grandparent Program. We simply could not carry on
our mission without your support.
It is difficult for me to talk about the Foster Grandparent
Program without thinking about individual volunteers like
Margaret Finnigan, who has been a foster grandparent for over a
decade. Over the years, she has impacted the lives of so many
children. Parents and former students routinely inquire whether
Grandma is still with the program and how is she doing? All
staff and children take comfort in her warmth, her loyalty, and
her ability to listen.
The staff, parents and children continue to ask about
Margaret. But Margaret has developed a special relationship
with a young man named Brent. Brent is a very small child for
his age and has numerous illnesses which has prevented him from
assimilating into the classroom. Brent sought Margaret's
comfort when other children were progressing with their reading
and he lagged behind. This is a very difficult position for a
child of Brent's age. But working together, Brent drew strength
from Margaret's patience, persistence, guidance and
understanding and progress was made. And Brent now excels in
elementary school.
Mr. Chairman, this is the thrust of our program, giving
seniors the opportunity to contribute their time and experience
in helping the next generation to succeed. Without the Foster
Grandparent Program, people like Margaret and the thousands of
foster grandparent volunteers each with stories of their own
would not be able to afford to volunteer 20 hours every week.
This is truly what makes the Foster Grandparent Program unique
among all programs. We enable older people who are living at or
below 125 percent of poverty level to volunteer 4 hours a day,
5 days a week by providing them with a small nontaxable stipend
to help offset the out-of-pocket expenses that they have as a
result of volunteering.
Additionally, it provides low-income seniors with the
opportunity to use their talents, skills and wisdom that they
have accumulated over a lifetime to give back to the
communities which have nurtured them within their lives.
Seniors in general are not valued or respected in today's
society, and low-income seniors are particularly devalued
because of their economic status.
They are rarely asked to volunteer by their communities
because they have traditionally not participated in those
community activities. Through their service, our older
volunteers report that they feel healthier and we also know
that they can remain a productive part of our society. But most
importantly, they leave to the next generation a legacy of
skills, values and knowledge that has been learned the hard
way--through experience.
We believe that every community in America needs foster
grandparents and we believe that every low-income person like
Margaret deserves the opportunity to be a foster grandparent.
Given the growing number of low-income seniors, there are
currently 6 million seniors eligible to be foster grandparents
right now and we know that that figure will double by the year
2030. And everyone knows, as we have heard today, that we have
an ever increasing number of children with serious problems,
and this could be associated with drug abuse, with domestic
violence or poverty.
But Mr. Chairman, we are troubled and disappointed that the
President's budget contained level funding for our program for
the first time in 9 years. For more than 35 years, the Foster
Grandparent Program has been the foundation for community
service. While we applaud the President's leadership in calling
for a renewed sense of community service in America through the
U.S.A. Freedom Corps, our needs have not gone away. Our
programs are still faced with increasing costs of insurance,
with the lack of technology, and in fiscal year 2003, it is
going to be critical in maintaining the quality of our
programs.
Our request is that the Committee provide $115 million for
the Foster Grandparent Program in fiscal year 2003. This is an
increase of $8.3 million. And this increase will provide a 4
percent increase to existing programs to provide for the
critical program operational funding needs and that will
specifically allow us to enhance our recruitment efforts and to
improve our technology infrastructure.
Also, it will allow for expansion of existing programs
through programs of national significance and allow us to begin
five new foster grandparent projects in geographically
uncertain areas. Thank you for the opportunity to approach the
panel.
Mr. Wicker. Thank you very much for your testimony.
[The prepared statement of Ms. Watkins follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. I might note for the record that Mr. Peterson
is a member of this subcommittee who was not able to be here
today, but he sent along his good wishes and his assurance of
very strong support for foster grandparents.
Let me just ask you,what types of geographic areas are
currently underserved with this program?
Ms. Watkins. We have a lot of areas that are underserved,
but we have a lot that are unserved as well. I know former
Congressman Porter's area did not have a Foster Grandparent
Program in that area. There are 350 Foster Grandparent Programs
nationwide, so there are still some areas that are unserved.
Mr. Wicker. Are they principally in small towns, big
cities?
Ms. Watkins. Principally they would be in small towns and
rural areas.
Mr. Wicker. Thank you very much for your good work. And we
hope that we can accommodate your request.
Ms. Watkins. Thank you so much.
----------
Tuesday, May 7, 2002.
NATIONAL ASSOCIATION OF STATE WORKFORCE AGENCIES
WITNESS
JON BROCK, NATIONAL ASSOCIATION OF STATE WORKFORCE AGENCIES, EXECUTIVE
DIRECTOR, OKLAHOMA EMPLOYMENT SECURITY COMMISSION
Mr. Wicker. Next we will call forward Mr. Jon Brock,
appearing on behalf of the National Association of State
Workforce Agencies. Thank you very much Mr. Brock. We are glad
to have you.
Mr. Brock. Thank you.
Mr. Wicker. You are very patient.
Mr. Brock. It is a pleasure to be able to address the
Subcommittee this afternoon. Actually, I am the President of
the National Association of State Workforce Agencies, but my
real job is as executive Director for the Oklahoma Employment
Security Commission in Oklahoma City. On behalf of the National
Association of State Workforce Agencies, I wish to thank the
Subcommittee for the opportunity to share the vital
contributions our members provide in strengthening or Nation's
economy by linking workers and jobs.
The members of our associations constitute the workforce
system responsible for helping millions of Americans find
employment that brings with it the hope of the future. It is
the funding that you appropriate that makes much of our
workforce system possible. To highlight the experience of our
services, one must only look back on two events in our Nation's
recent history, the terrorists attacks of September 11th and
the recession.
The response of the workforce system to these events
demonstrates how the system works to improve career
opportunities for workers, helping businesses find qualified
workers and helps to stabilize the national economy. As much of
the Nation stood virtually transfixed by the horrors of the
terrorist attacks of September 11th, the Virginia Employment
Commission, or VEC, sprang into action to assist workers
displaced by the temporary closing of Reagan National Airport.
Recognizing that 12,000 jobs were at risk, 8 percent of all
employed workers in Arlington Virginia, the VEC expanded its
hours of operation to include Saturdays and opened a temporary
office in Reagan National Airport to expedite unemployment
claims and provide other employment assistance. After one
month, the VEC had served an additional 5,000 unexpected
unemployed workers.
While the actions of Virginia and other States during the
terrorist crisis are worthy of recognition, their work is not
unlike that which occurs throughout each State during mass
layoffs.
As an example, over 3,000 workers in Northwest Wisconsin
lost their jobs during the last half of 2001. Nearly half of
these displaced workers were part of 15 plant closings. The
Wisconsin Department of Workforce Development was able to
mobilize staff rapidly and bring its service directly to the
dislocated workers providing guidance on applying for
unemployment benefits and making available the career services
that help workers reintegrate into the workplace.
Unfortunately, the administration fails to recognize how
Virginia, Wisconsin, and all the other States must carry over
Federal moneys when it asserts within its budget that the
proposed $891 million cut in workforce-related program funding
will not reduce the employment and training services provided
to your constituents. Their position is based on the assumption
that much of the carryover dollars earmarked for WIA programs
are unexpended or will not be utilized. However the Workforce
Investment Act authorized States and governments 3 and 2 years
respectively, to expend WIA funds, allowing managers of our
Nation's workforce system to assist workers during parts of
years that overlap Federal fiscal and program years.
To preserve the commitment to WIA programs for fiscal year
2003, we recommend: $1.6 billion for dislocated workers; $950
million for adult training; $1.1 billion for youth training.
These amounts represent the same funding levels allocated for
the system in fiscal year 2001.
We applaud Congress and the Administration for the recent
enactment of the economic stimulus package, which, as you know,
includes an $8 billion redact distribution. This distribution
to State accounts is a long overdue temporary infusion of funds
into the State unemployment insurance and employment insurance
programs, but it is not a permanent reform of the system. In
fact, it is far from it.
The Federal Government has been overtaxing employers and
employers under the Federal Unemployment Tax Act and
underfunding these programs for many years. Although we accept
the administration's UI and ES budget, we were concerned that
FUTA taxes do not fully fund UI administration and employment
services.
NASWA fully supports the Administration's fiscal year 2002
supplemental budget request, which restores last year's
rescission of $110 million from State formula grants for
dislocated workers, and replenishes $550 million in National
Emergency Grants. We urge you to take immediate action on this
supplemental request.
The Nation's publicly funded workforce system must continue
to receive strong levels of congressional support in order to
maintain and increase the quality of services your constituents
have come to expect.
We look forward to working with members of this committee
and the Congress to continue providing the necessary commitment
to our workforce system. Thank you for the opportunity to make
this presentation this afternoon.
Mr. Wicker. Thank you very much for your testimony, for the
words of support for aspects of the President's budget and also
for some suggestions. And I can assure you that the
Subcommittee member and their staff will carefully consider the
information.
Mr. Brock. We know you will.
[The prepared statement of Mr. Brock follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
NATIONAL COUNCIL OF SOCIAL SECURITY MANAGEMENT ASSOCIATIONS, INC.
WITNESS
ANTHONY PEZZA, PRESIDENT, NATIONAL COUNCIL OF SOCIAL SECURITY
MANAGEMENT ASSOCIATIONS, INC.
Mr. Wicker. We are now joined by Mr. Anthony T. Pezza,
President of the National Council of Social Security Management
Associations, Incorporated. Please come forward and first of
all, tell me, how I did trying to pronounce your name.
Mr. Pezza. Perfect, absolutely perfect and very few people
do that. So thank you.
Mr. Chairman and members of the Subcommittee, my name is
Anthony T. Pezza, and I am here as President of the National
Council of Social Security Management Associations, which is an
organization of 3,000 managers and supervisors who work at
SSA's field offices and teleservice centers throughout the
country. I thank you for giving me the opportunity to come
before you today to talk about the budgetary needs of the
Social Security Administration from the perspective of the
frontline managers and supervisors who are responsible for
delivering services directly to the American public.
Over the past two decades, SSA has witnessed a dramatic
reduction in staff. Today the staff is 30 percent smaller than
it was 20 years ago. The most recent report of the Social
Security Advisory Board issued this past March found that there
was ``a universal view'' among SSA employees across the country
and among witnesses before the board's hearings that SSA does
not have the resources to do the work that should be done.
This is compounded by the fact that over the past several
years, SSA's field offices and teleservice centers have lost
over a thousand frontline supervisors. This loss has had a
direct and negative impact on the ability of SSA to provide
service to the American public because it affects training,
quality, and control of work.
At the same time SSA was suffering reductions in staff and
supervisors, SSA's workloads were growing. SSA is, in a matter
of speaking, a growth industry. The aging of the 76 million
strong baby boomer generation means increases in SSA's
workloads in the years between now and 2010. Consequently,
there is a pressing need to significantly increase SSA's
resources now.
We agree completely with the Social Security Advisory Board
when it said in its March 2002 report, ``SSA currently has
inadequate resources to carry out its many complex
responsibilities.'' Over the past several years, it has become
obvious that SSA has not been allocated resources commensurate
with its burgeoning workloads. Compounding the reductions in
staff and supervisors at the same time workloads were growing
was the impending loss of experienced personnel. SSA estimates
that between now and 2010, 28,000 experienced people will be
eligible to retire and another 10,000 will leave for other
reasons. Consider the fact that it literally takes several
years to develop a claims representative--that is SSA's chief
technical direct service operative--to the point where they
become a fully competent journeyman and you will appreciate the
problem the Agency faces in replacing experienced personnel
while trying to handle ever increasing demands for public
service.
Further, I have to mention that SSA is currently faced with
a huge and essentially unanticipated workload in the form of
literally hundreds of thousands of cases that are referred to
as special Title II disability cases. These involve situations
whereby there was a failure to properly identify SSI recipients
who, after becoming eligible for Title XVI payments,
subsequently became eligible for Title II benefits. At that
point, an application for Title II benefits should have been
solicited and processed. Having identified these cases, SSA is
now obligated to secure and process applications. This will
involve a very significant and unanticipated expenditure of
SSA's frontline field office resources and will have a direct
impact on the ability of SSA to continue to provide an
appropriate level of service.
To deal with these challenges, we respectfully ask that the
Subcommittee, number one, exclude the LAE from any cap that
sets an arbitrary limit on discretionary spending; number two,
set the base level of SSA's field office staffing at 33,500
FTEs; number three, direct SSA to allow field office and
teleservice center managers the flexibility to fill frontline
management positions within overall staffing levels based on
the need to maintain adequate levels of quality, training and
public service; number four, grant SSA the authority and the
funding to do advanced hiring of significant numbers of
replacement personnel so that workforce transition can take
place in a measured and effective manner; number five, grant
SSA automatic funding mechanisms for stewardship activities
based upon projected savings; number 6, provide special funding
for the processing of the special Title II disability workload
to minimize the impact on current public service.
Mr. Chairman, thank you for inviting my testimony, and I
would be happy to try to answer any questions that you may
have.
[The prepared statement of Mr. Pezza follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. Thank you very much, Mr. Pezza. You have
certainly made a very clear case on behalf of your position.
You represent some 3,000 persons in your category of
administration; is that correct?
Mr. Pezza. Yes, I do.
Mr. Wicker. What would be the salary range of your
membership?
Mr. Pezza. It ranges from a GS-12, which is approximately
$60,000 to a GS-14, which, depending on what section of the
country you are in, could be about $100,000.
Mr. Wicker. And you mentioned the less experienced
personnel and bringing them from a claims adjustors----
Mr. Pezza. Claims representative.
Mr. Wicker [continuing]. Claims representative to an
experienced journeyman. What would be the level of salary
there?
Mr. Pezza. That is a GS-11. And that would be approximately
$40,000 to approximately $55,000. We hire them, though, at a
GS-5 or a GS-7, depending on their qualifications. I have been
working for the Social Security Administration for many years
and I have been very proud to work for Social Security. I was
doubly proud this afternoon when I heard Ms. Sammons testify.
We hired her as a claims representative, so she is one of the
people that we are talking about.
Mr. Wicker. We certainly appreciate your testimony.
Mr. Pezza. Thank you.
----------
Tuesday, May 7, 2002.
AMERICAN SOCIETY OF TRANSPLANT SURGEONS
WITNESS
JAMES A. SCHULAK, PRESIDENT, AMERICAN SOCIETY OF TRANSPLANT SURGEONS
Mr. Wicker. Dr. James A. Schulak, American Society of
Transplant Surgeons. Dr. Schulak, we are glad have you with us.
Dr. Schulak. It is a pleasure to be here. By background, I
am Jim Schulak, I am the Chairman of the Department of Surgery
at University Hospitals of Cleveland, and Case Western Reserve
University, where I also serve as the Director of abdominal
organ transplantation. And I come to you today as President of
the American Society of Transplant Surgeons. We are a
professional society comprised primarily of surgeons and
scientists whose mission it is to advance the field of
transplantation.
Today, I would like to discuss funding for the two agencies
that most directly impact our mission, the division of
transplantation within HRSA and the National Institutes of
Health. Let me first address the DOT, which among other things
works to increase organ donation through public education
campaigns and demonstration projects.
In the past two fiscal years, the administration and this
Subcommittee have been very supportive of the DOT allocating
$20 million to it in fiscal year 2002. The President's current
2003 budget proposal calls for an increase in the DOT
appropriation to $25 million. While we are most grateful for
this continued commitment, the ASTS encourages the subcommittee
to consider further increasing fiscal year 2003 funding of the
DOT to $30 million, an increase, we believe, commensurate with
the enormity of the challenge the DOT faces if it is to
significantly increase organ donation in this country. Mr.
Chairman, we believe that every additional dollar spent at the
DOT saves lives.
As this Subcommittee well knows, the most pressing problem
facing transplantation today is the lack of sufficient donors
to meet the ever-increasing need. In the past 10 years, the
number of registrants on the national organ transplant waiting
list had quadrupled to nearly 80,000 people, while in contrast,
the number of cadaver organ donors has increased very modestly,
now numbering only 6,000 per year. The sad truth is that many
of these people will die before an organ becomes available.
In the past year alone, over 6,000 patients in the United
States died while waiting for an organ transplant. On a
personal note, just this past week, I lost one of my liver
transplant patients who died of recurrent liver failure 10
years after his first transplant. He was waiting for his second
transplant. In appreciation of his first donor, this man
volunteered countless hours to our local organ procurement
organization, including serving both as its treasurer and
president.
Unfortunately, in his hour of greatest need, he was failed
by the system for which he worked so hard to improve.
Mr. Chairman, the ASTS applauds the Secretary of Health and
Human Services Tommy Thompson for making organ donation a
priority of his administration. And there are signs that this
initiative is succeeding. In the past years, the total number
of both live and dead organ donors increased 7 percent to over
12,500. Most of this increase has been due to a dramatic
increase of donation of organs by live persons who now actually
outnumber dead donors in this country.
If we are going to significantly reduce the size of the
national transplant waiting list, we must find ways to increase
the number of people who give consent for organ donation at the
time of their death. And we must also find ways to improve the
outcomes of people undergoing transplantation underscoring the
importance of the NIH.
In this regard the ASTS enthusiastically supports Congress
and the Administration in their attempt to double the NIH
budget over the next 5 years and we support the President's
request for $27.3 million for the NIH in fiscal year 2003.
In view of the severe organ donor shortage to which I have
already alluded, the ASTA believes it is more important than
ever that additional efforts be made to support research in
transplantation at the NIH. We must learn to more successfully
utilize organs from the growing number of marginally suitable
donors, many of which are now being discarded for fear that
they will not function after their transplantation. We must
also find ways to significantly reduce the risk of irreversible
rejection after technically successful transplantation in order
to decrease the risks of immunosuppression medication and to
lessen the necessity for retransplantation.
Finally, we must initiate programs to better identify the
actual risks to the growing number of live organ donors in
America, the true altruistic heroes of our time. The ASTS
strongly believes that an increased effort by the NIH in the
area of transplantation research will help to achieve these
goals. And to this end, I am proud to report that our society
has recently offered to partner with the NIH by donating up to
$2 million over the next 7 years to systematically study long-
term outcomes in live liver donors. We encourage this Committee
once again to continue its generous investment in the mission
of the NIH.
Mr. Chairman, in closing I would like to thank you and the
Subcommittee for the privilege of testifying today and I will
be happy to answer any questions that you may have.
Mr. Wicker. Thank you, Doctor.
[The prepared statement of Dr. Schulak follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. With regard to live organ donors, I believe you
said they are the truly altruistic people of our time. What is
the failure rate among donors nationwide? Can you give us some
sort of idea about that?
Dr. Schulak. With regard to the actual donors, the people
who would donate their kidney or part of their liver to a loved
one, there is very little failure. The vast, vast majority of
these patients will do well and live a normal life. The success
rates for the recipients of their organs has increased
dramatically, and this is something that is very important for
most of the public to understand. Because often there is a
reluctance to donate an organ whether one is alive or has a
loved one who dies, because the thought is that transplantation
is just not successful.
Well, today a person who gets a kidney transplant has a 95
percent of chance that kidney will work 1 year and has anywhere
between 70 to 80 percent chance that it will work for 5 years,
and it is as high as 70 percent or greater they will work 10
years or longer. With liver and heart transplantation, the
success rates are slightly below that. So it is truly a very
successful endeavor today.
Mr. Wicker. And the donor of that one kidney who has one
left, what is the difference in his or her life expectancy?
Dr. Schulak. There is none whatsoever. There are two
studies that compared that to the general population and found
that the probability or the survival probably is greater than
the general population. Why might that be? These patients are
selected out as extremely healthy people.
Mr. Wicker. I know if Mr. Miller of Florida were here, he
would want to commend you for your research and your efforts,
because two of his children, at least that we know of, have
been involved in live organ donation, and it has been very
heartening to hear from Dan Miller about how his children are
doing.
Let me ask you about this. I have a driver's license here.
On the back it says I hereby make anatomical gift upon my
death, signature of donor date and two witnesses. Is that any
good?
Dr. Schulak. It is good in several ways. First of all, it
indicates to your family if they did not know, and it also
indicates to an organ procurement organization if you were to
die that you wanted to be a donor. Now they will use that
information through a State Registry to go to the family, and
if the family wasn't aware that you wished to be a donor, they
will make them aware so that perhaps it would increase their
likelihood of consenting for the donation of your organs.
In some states legislation has been passed that that alone
is the consent.
Mr. Wicker. Do you know how many States?
Dr. Schulak. I do not know how many. In Ohio, we are going
to begin enacting that legislation this summer.
Mr. Wicker. Now, it is interesting that on the front of
this driver's license, which had to be done digitally, and it
is very much state of the art, I signed the driver's license
before it was actually produced in final form. But on the back
it is up to me to sign that if I want to and get a couple of
witnesses. Wouldn't it be a good idea if we asked people when
they renewed their driver's license if they wanted to go ahead
and sign that with witnesses there, and that way it wouldn't be
like this one which is totally blank because I have simply
neglected to sign it? I am going to sign it right now.
Dr. Schulak. I think in most States they are supposed to
ask you each time you renew. I know in Ohio, at least in
Cleveland where I get my license renewed, they ask me every 4
years, am I still an organ donor.
Mr. Wicker. But that is simply a matter of State law. They
forgot to ask me or perhaps we were in a hurry that day. What
else do I need to do to make darned sure that I donate organs
on my death?
Dr. Schulak. The most important thing anybody can do is to
be sure that all of your family know that is what you want to
do. Because in most cases, when you die, if you are a potential
organ donor, the organ procurement organization which will be
trying to set up the organ donation will go to your family and
ask for consent. If they know you want to do it, hopefully they
will give the consent.
Mr. Wicker. The organ donor procurement people go to the
people in the majority of deaths?
Dr. Schulak. There are only a few people who die in such a
way that their organs can be transplanted. Those that occur in
hospital under certain circumstances where donation is
possible, and that may only be as many as 10,000, 15,000 deaths
a year in the United States.
Mr. Wicker. We could go on and on. At Case Western, do you
do a lot of NIH research?
Dr. Schulak. Yes, it is ranked somewhere around 12th or
13th in the United States in NIH research. $170 million a year.
Mr. Wicker. I am green with envy, Doctor. Do you do most of
that competitively, are there ongoing contracts?
Dr. Schulak. Most of it is competitive but there is both.
Mr. Wicker. Thank you for your testimony and for your
personal advice to me and the Committee will receive it with
great interest.
Our next witness is Dr. Michael M.E. Johns of Emory
University. Another very fine institution of higher learning.
What do you have for us?
----------
Tuesday, May 7, 2002.
EMORY UNIVERSITY
WITNESS
MICHAEL M.E. JOHNS, DIRECTOR, WOODRUFF HEALTH SCIENCES CENTER,
EXECUTIVE VICE PRESIDENT FOR HEALTH AFFAIRS, EMORY UNIVERSITY AND
CEO, EMORY HEALTHCARE
Dr. Johns. Thank you and good afternoon, thank you for
inviting me to speak to you today. I am Michael Johns. I am a
doctor. I have to say I went into medicine because I thought it
was a noble profession and I wanted to be able to help other
people. And I have to say thanks for allowing me to sit through
this afternoon. I realize I am near the end. But it was of
great benefit to me personally to listen to other people who
are trying to do good for others. And it is a good feeling from
that standpoint. And as others have expressed, I can see the
complexity for you to try to determine how to support all of
these worthy programs.
I am a cancer surgeon by training. Somehow I fell off the
straight and narrow and became an administrator and was the
Dean of the Johns Hopkins University School of Medicine prior
to moving to Emory to serve as the Vice President for Health
Affairs and Director of Woodruff Health Sciences Center.
Emory Health Sciences Center is a national leader in health
care, health research and health policy, and we have an annual
budget of $1.5 billion and our research funding topped $233
million last year.
Our system includes the School of Medicine, the School of
Nursing, the School of Public Health, the Yerkes National
Primate Research Center, and the Health Sciences Center
includes Emory Healthcare, which is the most comprehensive
health care system in Atlanta and one of the largest in the
southeast. And I have the privilege and opportunity to oversee
all of the good work of that organization.
Today I am here on behalf of the Saturday Morning Working
Group, which is a coalition of 20 academic health centers, and
we conduct a large portion of the extramural biomedical and
behavioral research that you fund and that is administered by
the National Institutes of Health.
I would like to thank you, Chairman Wicker, and all of the
members of the Subcommittee for the outstanding support that
you have provided to the NIH. This support has led to many
discoveries at our member institutions, including Emory
University. For example, researchers at our internationally
renowned vaccine center are testing vaccines today for anthrax
and infectious diseases that are likely to be used in a
bioterrorist attack, and researchers at this facility have
developed a promising AIDS vaccine that will soon begin testing
in human clinical trials.
Our NIH-funded Parkinson Disease Center of Excellence is at
the forefront of efforts to develop new treatments for the
disease, and Emory transplant physicians are working to
establish immune tolerance for patients. And this research--
follows up on what you just heard--that research would
eliminate the need for immunosuppressant medicines and could
save the American health care system millions of dollars in
drug costs.
We have a new Center for Islet Transplantation that will
enable us to participate in one of the most exciting scientific
ventures of our times, the transplantation of human islet cells
from donor pancreases to the recipients who we would hope then
would produce insulin and thus have a cure for diabetes. This
research has real, measurable impacts on the day-to-day lives
of millions of Americans, and it has been made possible by you
and by others who have been committed to doubling the NIH
budget by fiscal year 2002.
The Saturday Morning Working Group strongly supports the
President's $27.3 billion for NIH, an increase of $3.7 billion.
In addition to our support for this increase, I would like to
mention two suggestions for strengthening our existing
partnership.
First we recommend that you maintain the salary cap for
NIH-funded extramural researchers at the current level of
Executive Level I. The higher salary level allows academic
medical centers to attract and retain the most talented
individuals.
Second, we recommend that you increase extramural
construction funding so that NIH investigators can continue to
have state-of-the-art research facilities. This can be done in
two ways: through increased appropriations for extramural
facilities construction grants, and through the creation of a
new extramural facilities loan guarantee program.
In fiscal year 2002, Congress appropriated $110 million in
extramural construction funding through NIH's NCRR. Yet a June
2001 report prepared by the NIH Working Group on Construction
of Research Facilities estimated that the expansion of
biomedical research has created demand for new research space
costing as much as $7 billion. This report echoes the concerns
raised by a 1998 National Science Foundation report that
identified an estimated $5.6 billion in deferred construction
or repair projects. There is a clear and documented need for
several billion dollars to rectify the situation, and we urge
the Subcommittee to increase this appropriation for NIH's
extramural facilities improvement grants by $190 million.
Consistent with this recommendation of the NIH Working
Group on Construction of Research Facilities, we also urge that
the Subcommittee establish a new Federal loan guarantee program
to support the construction and renovation of biomedical
research facilities. And using a conservative assumption of a 5
percent default rate for eligible research institutions, we
estimate this would cost about $30 million in the budget
authority in the fiscal 2003 bill.
I want to say thank you for allowing me to come and speak
to you. I am more than happy to answer your questions.
[Clerk's note.--The Disclosure of Federal grants submitted
by Dr. Johns was too lengthy to be printed, and is available in
committee files.]
[The prepared statement of Dr. Johns follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. Super. Could you leave with the Subcommittee a
list of the 20 academic health centers and university-based
research institutions that form the Saturday Morning Working
Group? And has this number been constant since it was formed,
or are you adding members?
Dr. Johns. We are more than happy to add members, if the
University of Mississippi would like to join, of course. But it
started back in----
Mr. Wicker. Was my question that transparent?
Dr. Johns. Not at all, sir. But they are good friends
there. And we came together as a group back in the era of
health care reform when we were asked for some opinions about
the future of health care in this country, and we continued to
stick together. And people have come together, and that group
has grown to this size over the last several years.
Mr. Wicker. Do you think it might be a bit of an incentive
for the medical profession if Congress enacted a degree of
medical malpractice reform? Do you think that might be
beneficial to the country as a whole?
Dr. Johns. Well, that is a different topic, but my opinion
is, absolutely, yes. I mean, the cost to our health care system
for starters from this one item alone is quite immense. The
growth in our own institution for this year of our malpractice
cost will be over 50 percent. In addition, there are the
immeasurable costs to the practice of defensive medicine.
So I think that there could be some significant changes
created that could make a difference for health care in this
country if we could come to some kind of an agreement on how to
make changes that still provide enough protection for the
public and yet control the costs of malpractice and liability
insurance. That really is an essential item. It is driving our
costs up.
Mr. Wicker. I appreciate you letting me go off on that
particular tangent.
Let me, lastly, ask you about islet transplantation. And
just tell us--you say this is an exciting venture and what we
hope to do. Are we making any progress, and do we have any
success stories either in human or animal research with regard
to curing diabetes in this fashion?
Dr. Johns. Clearly the animal evidence is really excellent
in terms of being able to transplant islet cells into animals,
but now we are seeing--the protocol started up in Alberta, in
Canada. It is called the--I guess it is called the Alberta
Protocol, and we are working in cooperation with that group.
Because of the research that we are doing in immunobiology
that relates to the immune reaction that occurs when you
transplant human cells into another human, we have developed
some very interesting approaches to suppressing that response
that hold great promise. That work has been very successful in
animals. We are now looking at how do we take that into humans.
Mr. Wicker. Where are the islet cells obtained?
Dr. Johns. From the pancreas.
Mr. Wicker. Of deceased animals or living animals?
Dr. Johns. In animals? Well, we can do it in mice from
living animals, yes. Yes. You can take it from living animals
or, in theory, from transplantation.
Mr. Wicker. So the hope would be that we would simply go
into a live human donor and extract----
Dr. Johns. Harvest islet cells. That would be an option. Or
in donors, as we just discussed, who may have been in an
automobile accident, harvesting a pancreas.
Mr. Wicker. Would you care to speculate for the
Subcommittee how far we are away from being able to do this on
a large-scale basis?
Dr. Johns. I don't believe I can give you that answer
directly. I will go back and find out what the people who are
doing this in our institution think.
Mr. Wicker. Great deal of interest in that.
We appreciate your work, and thank you for visiting with
me.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, May 7, 2002.
COMMITTEE FOR EDUCATION FUNDING
WITNESS
CYNDY LITTLEFIELD, PRESIDENT, COMMITTEE FOR EDUCATION FUNDING
Mr. Wicker. Our last witness this afternoon is Cyndy
Littlefield, president of the Committee for Education Funding.
Ms. Littlefield, I don't know if you simply lost the
lottery or were unlucky----
Ms. Littlefield. I feel very honored.
Mr. Wicker [continuing].Or you somehow offended a member of
the staff, but you are our last witness of the day, and we
appreciate very much your patience.
Ms. Littlefield. Well, thank you, Mr. Chairman. And I
appreciate the opportunity to testify today. I want to thank
you, Mr. Chairman, as well as the distinguished staff for the
opportunity that CEF has had through the years to work with
you.
I also want to commend the Committee on two counts. One, I
want to thank you for the historic increase of $6.7 billion for
education funding in last year's 2002 budget and
appropriations. We are extremely grateful for that. And,
second, I want to commend the Committee for encouraging the
inclusion of $1 billion on the Pell shortfall in the
supplemental for fiscal year 2002. That will indeed make great
strides and assist our efforts in some education funding this
year.
Mr. Chairman, I am testifying today on behalf of CEF, the
Nation's largest and oldest education coalition in the United
States. I am here representing 107 national organizations from
prekindergarten through elementary and secondary and higher
education and beyond.
Two years ago CEF established a natural goal to increase
education funding from 2.1 cents to 5 cents on the Federal
dollar. This last year we achieved a portion of that by
increasing our goal from 2.1 cents to 2.4 cents.
Incidentally, 54 percent of the American public agree with
our goal; 30 percent believe that that goal is not even high
enough. Mr. Chairman, today we are testifying post-9/11. Pre-
September 11th, 85 percent of the American public agreed that
education was the number one priority. Now our budget presented
by President Bush exemplifies a new national priority for a war
on terrorism and national security concerns.
Yet we acknowledge that our national priorities have
changed, but we also know that to train the next fighter pilot,
or to have a linguist proficient in Farsi, I thought that I
would throw that in, we need to have an education system that
exemplifies the best that our Nation can offer. To that end,
the American public still concurs with our objectives.
Now, in March, in the recent polling data, 67 percent of
Americans believe that there has to be increased spending on
education from kindergarten through college even if it means a
larger deficit. Even so, 38 percent have ranked education as
their number one Federal spending priority this year over very
popular programs such as prescription drug benefits for the
elderly, tax cuts, extending unemployment benefits and
environmental protection concerns.
Now, I am here to testify today, Mr. Chairman, to draw
attention to two complications for the education community
across the Nation this year. One is demographics. The second is
State budget cuts.
On demographics in our K-to-12 enrollments, we are at
record levels, rising to 54 million students by the year 2007.
For higher education our enrollment is going to increase from
15.4 million in 2000 to about 17.5 million in the year 2010. We
also know that more than 4 million students enrolled in
postsecondary education will come from low-income families,
with that number expected to increase by 25 percent to 5
million more students over the next decade.
Now, because of those demographic changes, our Nation's
public schools still need to expand. One-half of the teaching
force needs to be replaced by--a retiring teaching force of
about 2 million teachers. And we also know that we need more
Federal student aid to allocate for burgeoning student
populations.
Now, the second factor, as I mentioned before, is the State
budget cuts. Right now we know that 29 States have cut higher
education in this past year, 13 States have cut elementary and
secondary education about $5.5 billion, and higher education
has been cut from the State budgets, thus forcing some public
institutions to increase their tuition because of those cuts.
Education is a third of the State budgets across the country.
With the squeeze in the cuts in the State budgets, and limited
increases on the Federal side, education is literally squeezed
this year.
Now, Mr. Chairman, if we were to increase that long-term
goal of a 5 cent strategy, which is daunting and commendable,
in and of itself we would need about $12 billion a year over
the next 5 or 6 years in order to do that. That is a formidable
and difficult goal, we realize; however, let's just for a
moment imagine what we could achieve with that goal.
With $12 billion we could begin to fully fund the IDEA,
Individuals with Disabilities Education Act, needing about $2.5
billion a year to do so. We also could do more toward fully
funding the authorized levels of $16 billion for Title 1, in
the ESEA and Leave No Child Behind, and we could also increase
by $4.6 billion for higher education, including a $500 Pell
grant increase for fiscal year 2003 and other campus-based
student aid.
These are just some of the things that we would accomplish
with more funding. We encourage the Committee to restore the
proposed 40 education programs that were cut and targeted
totalling $1 billion, including the drop-out prevention
program, National Board for Professional Teaching Standards,
LEAP State grants for colleges, for example.
We also naturally encourage not freezing the 66 programs
that were also targeted, including Pell grants, ESEA which have
an impact on math/science partnerships, after-school programs
and vocational education to mention just a few.
Mr. Chairman, I can go on and on about the value of all of
the tremendous programs that we represent and the excellent
organizations that we represent. I think this Committee has
exhibited tremendous support not only through Mr. Wicker, you
serving as Chairman right at the moment, but also through
Chairman Regula and Ranking Member Obey and all of their staff.
We look forward to continuing to work with you in the
future, and we know you will continue to do the right thing not
only for our students, but our country. We are all counting on
you. So thank you for this testimony.
Mr. Wicker. Thank you for your testimony and your patience.
[The prepared statement of Ms. Littlefield follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. You mentioned 100 member organizations
nationally. How many States are represented by your committee?
Ms. Littlefield. All 50.
Mr. Wicker. What sort of organizations? What would be some
examples?
Ms. Littlefield. Well, we have the National Education
Association, American Federation for Teachers. We have the New
York State Board Association behind me. We also have the
American Council on Education. It runs the gamut from
prekindergarten through kindergarten through elementary and
secondary. We represent the principals, the school boards,
every imaginable one from the State school superintendents on
up the line in our education coalition.
Mr. Wicker. Well, I thank you very much for enlightening me
about that and also for your testimony, which will be received
in full by the Subcommittee with our thanks and appreciation.
Ms. Littlefield. Thank you.
Mr. Wicker. If there is no further business, we will stand
adjourned.
Thursday, May 9, 2002.
NATIONAL COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
WITNESS
KATRINA BACHE, ADVOCATE, NATIONAL COALITION FOR OSTEOPOROSIS AND
RELATED BONE DISEASES, OLNEY, MARYLAND
Mr. Regula. Okay. We are going to get this hearing started.
We have a number of witnesses today that want to be heard on a
wide variety of subjects. The rules are generally 5 minutes for
witnesses and then whatever time the Committee members take in
questions and so on.
We have to move in order to get through the agenda that is
before us. We have a little time because the Full Committee has
recessed, but the other problem is we have votes on the floor
that are going to interrupt our procedure, but that is the way
that it is.
So our first witness today, Katrina Bache, 8 years old.
Katrina. Where is Katrina? She is advocating for the
National Coalition for Osteoporosis and Related Bone Disease.
Katrina, we are happy to have you here.
Ms. Bache. Thank you.
Mr. Regula. Eight years old. I have a grandson that is 8.
It is a wonderful age.
Would you like to testify, Katrina? Okay. You just go
ahead.
Ms. Bache. Hello. My name is Katrina Bache, and I am 8
years old. I am in second grade, and I live in Olney, Maryland.
I am here to speak on behalf of children with Osteogenesis
Imperfecta. OI is a disease you are born with. Some kids can
die from it. When I was born, my parents were sad and confused.
My bones are very thin and break easily. I have had so many
broken bones that we have lost count. One time I rolled off the
coach, it broke my bone and bent my rod. When I was a baby, my
daddy sneezed, and it startled me, and I broke my femur. My
daddy felt very bad. When my daddy carried me up to bed one
night, he tripped, and it broke a bone. He felt very guilty for
a long time.
I have had so many surgeries that we have lost count. Some
of those surgeries were to repair fractures, and some were to
put rods in my bones to straighten them and help prevent
fractures. When I have surgery, I have to wear a cast for at
least 2 months. Sometimes I have to wear a big cast called a
spica. In the summer it is very, very hot, and I can't move. I
just have to lay on my back, and I can't go swimming.
At school I use a wheelchair, and I cannot play with the my
friends on the block, the playground, because I have to stay on
the blacktop. I am not allowed on the playground in my
wheelchair. I miss out on a lot of things when I break a bone.
I can't go to parties or to school or see my friends until I'm
feeling better.
At the hospital, I scream and cry when it is time for the
anesthesia. People often stare at me and say mean things
wherever I go. It makes me mad and sad. I am taking
experimental treatment that is increasing my bone density, and
my parents see more of the benefits. I can walk without my
walker for the first time in my life. I have scoliosis, which
is a back problem that makes my spine curve in. That treatment
makes my spine stronger, and it hurts much less.
NIH needs more money to study these and other treatments to
find a cure. I would like to see more kids benefit from medical
research. Thank you very much.
Mr. Regula. Thank you, Katrina. You read very well.
Ms. Bache. Thank you.
[The prepared statement of Ms. Bache follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. We worry about reading in the United States, so
you are a great example. You are a third-grader?
Ms. Bache. Second.
Mr. Regula. You do very, very well.
Ms. Bache. Thank you.
Mr. Regula. Would you like us to put more funding to
research?
Ms. Bache. I would really like that.
Mr. Regula. Well, you know, Katrina, you are doing a great
service, because maybe other little girls and boys as a result
of the research that you are encouraging will not have as much
difficulty as you may have had. So you are making a wonderful
contribution. We appreciate you being here.
And I don't know what the order is.
Mr. Obey.
Mr. Obey. I just want to say I think you did a very fine
job, and I wonder if you would willing to give some reading
lessons to some Members of Congress.
Mr. Regula. Only the Democrats is what he meant.
Mr. Jackson, you were next.
Mr. Jackson. No, Mr. Chairman. I have no further questions.
I just wanted to thank you for your testimony. It was very
compelling, and we will do the very best we can to get you some
more research moneys.
Ms. Bache. Thank you.
Mr. Regula. I didn't see the order you got in, but we will
start with Mr. Sherwood.
Mr. Sherwood. Katrina, thank you very much for your
testimony. You were a wonderful advocate this morning, and we
appreciate your testimony.
Ms. Bache. Thank you.
Mr. Peterson. I would just add to that, Katrina. I am sure
your family and friends are very proud of you to be brave like
you are to go in front of this group and testify so bravely.
God bless you. And I think you will make a difference.
Ms. Bache. Thank you very much.
Mr. Miller. Katrina, you are a very nice young lady. Thank
you very much for coming.
Mr. Regula. Katrina, do you have brothers and sisters?
Ms. Bache. No. No brothers or sisters.
Mr. Regula. Is that your mother that is holding you? Your
best pal. Well, thank you very much for coming.
----------
Thursday, May 9, 2002.
CROHN'S AND COLITIS FOUNDATION OF AMERICA
WITNESSES
RODGER DeROSE, PRESIDENT AND CEO, CROHN'S AND COLITIS FOUNDATION OF
AMERICA, ACCOMPANIED BY NATHAN KOURIS, BEREA, OHIO
Mr. Regula. Our next witness is Roger DeRose, President and
CEO of the Crohn's and Colitis Foundation of America,
accompanied by Nathan Kouris, 10 years old, from Berea, Ohio.
Okay. We will be pleased to hear from you.
Mr. DeRose. Mr. Chairman, thanks for letting both Nathan
and I present our views on behalf of the Crohn's and Colitis
Foundation of America, or CCFA as it is to known to so many.
Nathan and I are representing about a million Americans who
suffer from this disease. Crohn's and colitis fall into the
family of inflammatory bowel disease, or IBD. Crohn's and
colitis are chronic disorders of the gastrointestinal tract,
with the most common symptoms being abdominal pain, diarrhea,
intestinal bleeding, and these illnesses can cause many other
complications, including arthritis, osteoporosis, liver
disease, and colon cancer.
Crohn's and colitis are seldom fatal, but they are
physically and emotionally devastating, stripping patients of
all of the things that are important in our life, including our
work, social relationships and our social life. The disease
affects not only the patient, but, of course, family members.
You may remember that Nathan gave testimony last year with
his mother Jean, and Nathan is one of 100,000 sufferers,
children that suffer from Crohn's. Nathan has not lived a
normal life. He has had to endure invasive medical tests, tube
feeds, as well as endless hospital stays. And his 10 short
years really been a study in courage and determination and the
healing power of medicine. And yet these obstacles have not
stopped Nathan. He is doing well, as you can see, and he is
also conducting himself in sports as most children his age do.
His success is due in part to some of the breakthroughs
that have occurred in biomedical research which you and the NIH
have strongly supported. The medical community is reporting
that they are seeing more children of Nathan's age coming into
this world with the disease, and, therefore, it is very
important that we dedicate more research dollars to the cause
of the disease, which we believe will lead us to a disease
prevention strategy.
There are 30,000 new cases a year, and we think it is very
important that we put together a strategy that would allow
disease prevention. Scientists have not yet determined which
genetic and environmental factors are responsible for the
disease, and so understanding the factors that accelerate it
will help us with a prevention model.
Last year a team of investigators announced the identity of
the very first gene linked to Crohn's, and that breakthrough
was allowed to us through the support of Congress which they
provided to NIDDK in recent years. We think the next step is
that we build on that knowledge to speed up our understanding
of how the first gene discovery interacts with the other cells.
We would like to present three recommendations, Mr.
Chairman, on behalf of the 1 million patients. First we suggest
that the Committee support the goal of doubling NIH's budget.
We also recommend a 16 percent increase for NIDDK, NIAID
nonbioterrorism-related research, and NIH over all in fiscal
year 2003. We encourage the Subcommittee to increase IBD
research funding within the NIDDK and NIAID at the same rate as
NIH overall. And second, we strongly advocate for the
appropriation of $1 million to the CDC for the development of
an IBD prevention program, which would necessarily include
epidemiology studies on the frequency of these diseases as well
the environmental factors that promote them. And finally, we
propose allocating $20 million to CDC's National Colorectal
Roundtable Awareness Program, which should also include studies
on colon cancer in this very high-risk group of Crohn's and
colitis sufferers.
So these three objectives will help us understand the
factors that contribute to IBD and the steps that we can take
in terms of a prevention strategy.
On behalf of CCFA, thank you. Perhaps you have a question
for Nathan or me.
[The prepared statement of Mr. DeRose follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Is progress being made with the research of
NIH?
Mr. DeRose. I think it is dramatic. And we have a very
strong relationship. The CCFA organization has a very strong
relationship with NIH, and we share results. And oftentimes
many of the research grants that we provide are seed fund
grants that once the research is proven, NIH takes it from
there. So I would say we are making very good success in the
area.
Mr. Regula. Mr. Young.
Mr. Young. I have no questions. Thank you.
Mr. Regula. Mr. Obey.
Mr. Obey. No questions.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Mr. Chairman, let me just say that this is a
disease that I am very familiar with, and there is a member of
my staff, who will remain anonymous, who has been stricken with
this disease as well. So I am very familiar with it.
And let me just thank you for your testimony. We will do
everything that we can to try to broaden the research in this
area.
Mr. DeRose. Thank you, Mr. Jackson.
Mr. Regula. Mr. Sherwood.
Mr. Peterson.
Mr. Miller.
Mr. Wicker.
Mr. Hoyer.
Thank you very much for coming, and we hope that they will
have continued success.
----------
Thursday, May 9, 2002.
INTERNATIONAL RETT SYNDROME ASSOCIATION
WITNESSES
ALAN PERCY, M.D., DIRECTOR, RETT CENTER FOR EXCELLENCE, UNIVERSITY OF
ALABAMA AT BIRMINGHAM, ACCOMPANIED BY KATHY HUNTER, FOUNDER,
INTERNATIONAL RETT SYNDROME ASSOCIATION, AND JULIA ROBERTS, ACTRESS
Mr. Regula. All right. Next is Dr. Alan Percy, Director of
the Rett Center for Excellence at the University of Alabama at
Birmingham. He is accompanied by Kathy Hunter, the founder of
International Rett Syndrome Association, and Julia Roberts, the
actress.
Mr. Hoyer. Mr. Chairman, while Julia Roberts is coming in
and Kathy Hunter is coming in, I would like to thank both Kathy
Hunter and Ms. Roberts and Dr. Percy for their work. Last year
we had a hearing when, during the course of Kathy's testimony
on Rett Syndrome, she mentioned that Julia Roberts was very
interested in this issue.
After the hearing, I talked to Kathy and I said, if Julia
Roberts is interested in this, we ought to have her come by,
and we ought to have her come by because Julia Roberts can
bring a lot of attention to Rett Syndrome. Is there any doubt
in anybody's mind that I was correct that Julia Roberts could
bring a lot of attention to Rett Syndrome and to the Committee?
These photographers, of course, are critically interested in
Rett Syndrome, and they are going to find out a lot about Rett
Syndrome. I hope they stay for that purpose. And Julia has
performed the function that we wanted her to do that, bring the
attention to a very serious illness.
Mr. Chairman, while Julia is getting to her seat, this
committee, ladies and gentlemen of the Committee, particularly
for those of you who are new, started in the 1980s focusing on
Rett Syndrome, which was not identified until 1983 as a
particular illness. Prior to that time it was misdiagnosed,
still misdiagnosed on numerous occasions. Kathy Hunter's
daughter Stacey, who is now 28 years of age, she will explain
to you--I am not going to go through her testimony--but has
shown incredible leadership in getting together families who
are--who have beautiful, beautiful little girls for the most
part who have a syndrome called and identified by Dr. Rett.
Kathy, we are pleased that you are here.
Julia, we are extraordinarily pleased that you are here to
bring attention to this and your personal experience with it.
And, Doctor, we thank you for your work on this as well.
Thank you, Mr. Chairman.
Mr. Regula. Julia, I want to say you have brought a lot of
pleasure to a lot of people with your abilities as an actress.
I certainly have enjoyed your movies. But you have an
opportunity here to do something far more important, and that
is to bring healing to children and, in effect, to their
parents. So we are pleased that you take the time to come and
share your insights as to this serious disease and the parents
of children, born and unborn, that might have a better chance
because you are going to testify. So we are grateful for that.
And, Mr. Chairman, would you like to say anything?
Mr. Young. Mr. Chairman, I want to congratulate you for
holding this hearing today and bringing these important issues
before the Congress. We appreciate all of the witnesses who
have been here, and the three at the table. And Mr. Regula and
Mr. Hoyer have both made it very clear that a lot of attention
is being paid to this disease today, thank you very much to
Julia Roberts.
We are proud of what this Committee has done in this last 4
or 5 years. We have, in fact, doubled the amount of money being
invested each year for study and research for Rett syndromee.
So we are doing the best we can. Medical science needs money.
We provide the money. The scientists do the good work.
Together, as a team, with support from people like you, one of
these days we are going to get ahold of all of these bad
diseases and find a way to improve the quality of life for
everybody.
Thank you for being here.
Mr. Regula. Mr. Obey.
Mr. Obey. Mr. Chairman, I think I will wait until the
testimony is concluded for my remarks.
Mr. Regula. Okay. To the visitors and our friends here
today, during Ms. Robert's testimony we would kindly request
that you not snap pictures so we don't have an interruption for
that.
Ms. Roberts, do you want to be the lead person testifying,
or do you----
Ms. Roberts. Okay. Well, I will go first. This is very
impressive and nerve-wracking.
Now, are you guys going to take pictures or not take
pictures?
Mr. Regula. We told them not to. You know the press doesn't
always obey.
Ms. Roberts. You guys will listen to me better than they
listen to you guys.
Mr. Chairman and members of the committee, thank you so
much for giving us your precious time today. We are incredibly
grateful, and I, as well you know, want to talk about Rett
Syndrome. I am joined by Kathy Hunter, Founder and President of
the International Rett Syndrome Association, and lots and lots
of family members, I am happy to say, who, like me, know
personally the disastrous toll of this neurological disorder.
I usually just kind of ramble, but this is important, so
today I read. We have come here to share our stories so that
our girls and potentially hundreds of thousands of other
children like them get the support and the encouragement they
need and the medical research that will give them a better
life.
You may know that Rett Syndrome doesn't usually appear at
birth. That moment is filled with the joy of new life. It is
not until somewhere between 6 and 18 months that early signs of
this terrible disease emerge, and the girls show signs of
devastating regression in their ability to speak, walk, use
their hands and perform even the simplest acts of daily life.
By the age of 3, their parents, brothers and sisters must
be their arms, their legs and their voices. These are the
voices we hear today in these halls of Congress. Each of those
innocent little girls begins life as a child of promise with
unlimited potential, but once this disorder takes hold, their
lives take on incredible hurt and challenge. They listen, but
cannot speak. They struggle to accomplish the many things we
take for granted every single day.
But those who know and love them see beyond these obstacles
to the intelligence and spirit that shines from within. While
their hopes and dreams are altered forever, families of these
girls somehow find an infinite reservoir of love and commitment
to care for them. But in this particular instance, love and
commitment are not enough.
I come to you today at a time that has never been more
encouraging. I am so happy to say that. We are all witnessing
today the convergence of science and technology as bringing
great promise for treatment, prevention and ultimately, we
believe, a cure at speeds never before imagined.
It has only been 18 years since Rett Syndrome took its
name. Before that time most girls were misdiagnosed with autism
or cerebral palsy. Not long ago getting the diagnosis of Rett
Syndrome could take agonizing years as parents had to wait for
the cascade of symptoms to develop. Today, due to the
extraordinary gene discovery, the diagnosis is made through a
simple blood test. While the test takes only moments, its
result change lives forever.
I have been pleased and have been touched by someone with
Rett Syndrome, a little girl named Abigail.
Anybody have some water for me?
Rett Syndrome could not supress her sparkling smile and her
inner light. Abigail, her parents, David and Ronnie, and my
family have been friends for a long time, and Abigail was my
pal. We spent time together without words. We connected with
our eyes, with her squeals of delight and her incredibly wicked
sense of humor. She was a joy to be around, and everyone who
was ever near her loved her. Abigail joined the film Silent
Angels as a wonderful ambassador for Rett Syndrome. Then last
June the silent disorder suddenly and unexpectedly took Abigail
from us, and she was just 10 years old.
It is easy to underestimate these girls because of their
silence; not so silent this morning. And I like to think that
that is why Abigail and her family picked me, because I am so
chatty. In their quiet I create the balance.
In the past this Committee has taken a chance on this
little known disorder by providing important funding for
scientific research. Over the last 2 years, that funding has
paid tremendous dividends. For instance, we now know this gene
is more prevalent than anyone ever thought in other well-known
disorders from autism to learning disabilities. Therefore, many
hundreds of thousands of other Americans will share the
benefits of Rett Syndrome research.
In recognition of its importance, the genetics of Rett
Syndrome are now being taught in our Nation's leading medical
schools. Congress has within its power the ability to provide
the funding needed to accelerate our understanding of Rett
Syndrome. There is an urgent need now with this gene discovery
to increase support for researchers and capitalize on their
important work.
Thanks to the continued leadership of Congressman Hoyer and
the Committee, funds already appropriated have helped to bring
us to where we are today: facing a future that for the first
time holds the promise of treating, preventing and even curing
Rett Syndrome. Researchers are not cautiously optimistic, they
are confident that they can master the disease if they have the
continued resources to do it.
As you consider our request, our deeply heartfelt request,
please keep my friend Abigail and my friends here and others
that aren't here today in your hearts and in your minds. Her
death was painful for her family and her friends, but Abigail's
spirit motivates me and those with us today to raise our voices
and the public's awareness about the urgent need for research
funding of Rett Syndrome. So I beg you to hear our plea. Thank
you.
Mr. Regula. You can clap. Thank you for an effective and
moving statement. That certainly will be something we will
consider.
[The prepared statement of the International Rett Syndrome
Association follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Would you like to add to the statement?
Dr. Percy. Mr. Chairman, Mr. Hoyer, other members of the
Committee, good afternoon. I am not very good with prepared
remarks either, but I will perhaps digress a few times as I go
through this. Thank you very much for giving me the opportunity
to tell you about a scientific endeavor that has the potential
to help millions of children worldwide.
You know that the burden of serious illness is especially
heartbreaking when it afflicts young children. But what you may
not know is that the discovery in 1999 of mutations in a gene
called MECP2, you will hear that a lot, set off a revolution in
research into the causes of certain serious neurologic diseases
of children such as Rett Syndrome and autism.
Rett Syndrome is seen predominately in females. Between age
6 to 18 months these happy, playful children begin to lose
communication skills and the ability to control their body
movements and functions. Parents are forced to watch their
children slip into a state of silent, immobilized withdrawal.
The medical, psychological and social burdens on Rett
Syndrome families are great. Let me say that unfortunately,
Professor Rett died just before this gene was identified, but
he pointed out very clearly that despite the fact that these
girls could not communicate using their hands or their words,
their eyes were an effective means of communication. So if you
look at these young girls or women, you will see that they have
some message in their eyes that is very penetrating.
The heart of this devastating disorder lies within the
genetic structure called chromatin. Chromatin is the very
tightly packed form of chromosomes that permit tens of
thousands of genes to fit neatly into each tiny human cell.
Chromatin is like a ball of yarn made up of chromosomes. The
cell has ways of reaching into that ball to turn on just those
specific genes it needs to make specific proteins exactly when
the cell needs them.
The MECP2 gene is critical to both the development and the
maintenance of a healthy brain. Normally MECP2 stifles or
regulates the action of certain other genes in the chromatin
until they are needed or when they are no longer needed. When
MECP2 is mutated and cannot work properly, some areas of the
brain simply run wild, while others lapse into gridlock.
Therefore, the discovery of mutations in the MECP2 gene in
girls with Rett Syndrome by Dr. Huda Zoghbi and her colleagues
at the Baylor College of Medicine, Houston, gave researchers an
important clue as to how the healthy brain develops in growing
children.
That was exciting in and of itself, but just as exciting
the discovery also contributed significantly to recognition of
a new class of inherited neurodevelopmental disorders based on
these MECP2 mutations. Among those disorders are autism,
psychosis, severe mental retardation and spastic syndromes in
boys.
We are now at a critical time in chromatin disease
research. There is growing excitement among scientists and
increasing awareness that investment in Rett Syndrome research
will pay handsome dividends in understanding this and other
chromatin disorders. By increasing appropriations to the
relevant NIH institutes such as NINDS or NICHD, you will help
us continue to reap these dividends. We must learn more about
how MECP2 and its proteins affect other genes and tissues
during nervous system development and how the nervous system is
remodeled during development and throughout life by activation
and inactivation of genes like those regulated by MECP2.
We also need to develop animal models of chromatin diseases
that give us new insights into the rapid development of the
human brain during infancy. We need to study the genetic makeup
of families of Rett Syndrome and related disorders for clues to
disease onset and progression. To accomplish this would require
an investment of $15.5 million in the next fiscal year; $9
million would allow the necessary studies to learn about the
role of MECP2 and its related genes. In addition, I also
encourage you to add $2.5 million to support animal model
research into understanding and treatment of chromatin
diseases. And finally, I encourage you to appropriate at least
$4 million toward research into the daily problems that afflict
these girls or women, such as disorders of breathing,
digestion, cardiovascular function and epilepsy.
I believe that with your support we can bring hope and
relief to the children and the families of the children
afflicted with the devastating burdens of chromatin disorders.
Thank you for your time.
Mr. Hoyer. Mr. Chairman. If Kathy could also, Ms. Hunter,
could also introduce the four young people she has brought with
them. I know Abigail's parents. And Abigail obviously sadly
can't be here. But we have four beautiful young women who are
here.
Kathy, could you introduce them?
Ms. Hunter. I will introduce them. These are some of our
foot soldiers for Rett Syndrome, some little girls that we
picked today because we wanted to show you the face of Rett
Syndrome and what it is like to grow up with Rett Syndrome. So,
Daisy is here with us, Daisy Herlitz, who is 2 years old. She
is the tiniest little one there. As you see, she is just a
happy baby enjoying herself and smiling at everybody and having
a good time.
Abby is next to her. Abby is 5 years old. Abby
Yentslenger.
Then we have Megan Fay, who is 9 years old, right here. She
has been singing a little song for us all throughout.
And our oldest person here today is Joclyn Curtin at the
end. She is the old woman of the group. She is not the oldest
with our group downstairs, but she is the oldest with us here
today. She is 23 years old.
So you can see that Rett Syndrome starts out as a disorder,
almost unrecognizable. That is why Rett Syndrome went for so
long without anyone even noticing it. You don't know in the
beginning until your child stops developing. They develop
speech, they begin to walk, they interact, and all of a sudden
something happens. They go through a regression, they have
autistic-like symptoms, and they become withdrawn in many of
them, and then go on to develop severe handicaps by the time
they are 3.
So they are here to help us. We have a whole room full of
families downstairs, and I hope that the reporters will get to
see them and interview them to talk about what it is like to
have a child with Rett Syndrome.
Mr. Regula. Well, thank you very much.
Mr. Chairman would like to yield his time to his wife
Beverly. She is very active pushing for diseases and in getting
help for people. Furthermore, she is from my district.
Beverly.
Mrs. Young. Give them the money.
Mr. Regula. Mr. Obey.
Mr. Young. I listen closely to what my wife says. Every
word.
Mr. Obey. Mr. Chairman, I would simply--I would like to
thank you for coming, and to say that I think we have all been
moved by your statement today. You have raised serious concerns
about a terrible disease, and this committee will try to
respond as it has for the past years.
But I think it is important, and I--I am saying this for
your benefit and the benefit of all of the witnesses who will
testify today. I think it is important that everyone understand
how this committee goes about doing its business, because,
while we appropriate funds to the various institutes of the
National Institutes of Health, we do not substitute political
judgments for scientific judgments by dictating exactly how
much can be spent on each disease, because if we did, medical
research would be a shambles. We try to pressure, we try to
press the institutes. But in the end, we don't appropriate a
specific amount of dollars for any disease.
I think it is also important to understand something else.
When I first came on this committee in 1973, we provided $1.8
billion to NIH. Today we provide $23.6 billion. That is a 13-
fold increase over that time period, and I wish it could have
been double that. Over the last 5 years, with the appropriation
this year, we will have doubled NIH funding.
But we are facing some problems, and each and every person
who is testifying needs to understand what those problems are.
First of all, in the budget that has been sent down to us by
OMB, we have a big increase for NIH, but that is paid for by a
$1.4 billion cutback in other health programs. I don't think
that cutback can be allowed to stand.
Secondly, even though NIH's budget would rise by 16 percent
this year, the OMB long-range plan calls for that 16 percent
increase to shrink to 2 percent in future years. That 2 percent
will make it virtually impossible for NIH to even renew
existing grants let alone make new ones.
And even without that problem, we face the fact that NIH
with available funding is only able to fund one-third of what
is judged to be scientifically sound research. So if we could,
we would like to get that up even higher. But the problem is
that for that to happen, we need to enlist each and every one
of you in the effort to make the public understand something
else, and that is that as long as we continue to stick to the
idea that over the next 20 years we should pass out $7 trillion
in tax cuts, we will never have the money on the table that is
needed to provide needed medical research, to provide needed
upgrades for schools or any other worthy social cause.
And so I very much welcome your testimony and the testimony
of every person who will testify on every deserving disease
today, but I would ask you, in addition to what you are doing,
to fight for added funding for those diseases. Please help us
in making the broader argument about the need to increase our
investments across the board or else we will miss all kinds of
scientific opportunities, and we will leave many children
behind both in the health care area and in the education area.
Thank you for coming.
Mr. Regula. For the Committee members, we have three votes:
the previous question, the rule, and the motion to adjourn. And
I know Ms. Roberts has another schedule to make. So what I
would like to do--I will need your cooperation--is go--we will
go on our side, then back over. If you have a burning question,
or if you have a comment, something you would like to say, we
can get done here in about 8 minutes or so. Then that will fit
with your schedule and ours, too.
Mr. Hoyer, since Ms. Roberts is your guest--that is the 10-
minute warning bell.
Mr. Hoyer. Well, if Ms. Roberts is my guest, it has been a
highlight of my day, that is for sure.
My Abigail was a young woman named Christy. I went to
church with her for approximately 15 years. She lived longer
than Abigail. She was--I met her as a very young 4-year-old.
And at some 20 years of age, Judy and I moved, and so we didn't
go to Broad View Baptist any longer, but we go back all of the
time because my mother-in-law still goes to church there, and
we see her parents, Allen and Gail. Christy is now in a full-
care facility because it is difficult for her to be cared for.
Julia, the Christy and the Abigails and all of the young
people not just of this neurological disorder, but of every
neurological disorder, and, frankly, all of the people here, we
have taken an inordinate amount of time because we have one of
America's greatest actresses here with us, and she gets a lot
of attention. She could use that to bring attention to all
sorts of inconsequential things. She has chosen to spend at
least a couple of days, maybe 3, to call attention not just to
Rett Syndrome, but to the maladies that affect mankind in each
of your sons and your daughters, or your husbands or your
wives.
And, Julia, we thank you for dedicating your time to that
objective. It is critically important, because to the extent
that people know, my view is they will do, they will act. As
Beverly said, give them the money. Thank you for being here.
Mr. Regula. Who on this side? Any of you would like to--Mr.
Sherwood, you are the next in line.
Mr. Sherwood. Well, thank you all for coming today. It is
always so informative for us to see the families and the
children that the NIH helps with their research.
And, you know, this has been a morning that we will all
remember for various reasons, Julia and the children and your
eloquent testimony, and we will do our best with it. Thank you
very much.
Mr. Regula. Mr. Jackson.
Mr. Jackson. Thank you, Mr. Chairman. My remarks are
unusually brief. I want to associate myself with Ranking Member
Obey's comments because we do need your participation in the
broader struggle to make humane priorities a part of our
Federal budget process for which this disease and the funding
for this disease becomes an important aspect.
I also want to associate myself in a very unusual way with
Mrs. Young's comments. On September the 10th, there was no
money for Social Security, no money for education, and no money
for health care in our country. And on September the 12th, this
Congress mustered up the energy and the resources to find $40
billion, another 15- to bail out the airline industry, another
40,000,000,000 in a supplemental. And as we adjourn this
hearing shortly at 3:00, we will be contemplating even more
money in pursuit of Osama bin Laden in Afghanistan, more than
$100 billion in about a year's time for that purpose. And the
Committee seems to be having a problem finding $15.5 million
for Rett Syndrome, and so at some point in time the Committee
is going to have to move beyond the rhetoric and put its money
where its mouth is.
So I want to associate myself with what Mrs. Young knows to
be the case, that when this Congress decides it wants to spend
money on a particular disease or on a particular entity or on
something of concern, they have the money. But when it comes to
finding and being motivated by these children, the Congress
seems to move a lot slower. And so I still pray for the day
when this Congress will treat the young witnesses that you have
brought here today the same way it is treating Mr. bin Laden in
Afghanistan.
Mr. Regula. Mr. Peterson.
Mr. Peterson. Thank you very much.
I would like to thank Kathy and Julia and Dr. Percy for
your excellent testimony and for the family and the children.
You are the brightest of the witnesses. Your faces will not be
forgotten. But I would like to say to Julia, when someone like
you lends your name to an issue like this, you do raise the
awareness level immensely in this country. And today, from this
day forward, Rett Syndrome will be much more understood by more
Americans than it ever was before.
And Mr. Obey said we don't earmark funding for NIH. That is
true. But each and every one of us as members of this committee
or Members of Congress do share our views in many ways with
NIH, where we think their priorities ought to be. And so I
think your time here today will be very meaningful in helping
the appropriate amount of funding to be allocated to this
terrible disease. And I want to commend all of you giving of
yourselves. It will make a difference.
Mr. Regula. Mr. Miller.
Mr. Miller. Thank you for being here today and bringing us
attention to this dreaded disease. But thank you for bringing
attention to biomedical research. This is really one of the
crown jewels of the Federal Government, and most people don't
realize that we are going to spend up to $27 billion this year
that will spread throughout the country for all diseases and
such. There is an interrelationship when you look at the cancer
or AIDS and such. There is knowledge that comes from all of the
research that helps individual ones. So your presence here
helps raise the profile for all biomedical research. Thank you.
Mr. Regula. Ms. DeLauro.
Ms. DeLauro. Thank you very much, Mr. Chairman.
And what can we say but thank you very, very much for
taking the power that you have. It is really extraordinary. And
we can talk all day and all night, but we cannot get all of
these folks to pay much attention. So we thank you for what you
do. And the faces of the youngsters will not be forgotten.
I associate myself with Mr. Obey's comments. Budgets,
whether they be Federal, State or local budgets, are living
documents. They are about the priorities that we as a
government have and what we hold dear and what we want to try
to do in our society.
We welcome your speaking out on this disease, and we will
pay attention to it. We welcome your speaking out on what the
priorities of this great Nation are in terms of what it must do
on behalf of families in this country. So we thank you for
being here. And just keep on going.
Mr. Regula. Mr. Wicker.
Mr. Wicker. Well, thank you, Mr. Chairman. And I, too, will
be brief.
I want to thank all three members of the panel for their
testimony. I want to thank the Chairman of the Subcommittee for
scheduling this hearing.
The chairman has stated in the past that there are two
great commandments. One, of course, is to love God. The other
is to love your neighbor. And we like to think that this
Subcommittee is the Subcommittee about loving your neighbor. So
thank you very much for highlighting this very important issue,
and I can assure the witnesses that we will be very interested
in following up on the testimony.
Mr. Regula. I want to thank the parents that have been
here, because you are eloquent testimony to the importance of
what Ms. Roberts is talking about. And this is very impressive.
Along with your testimony, you each will have a videotape,
Silent Angels, and it is narrated by Ms. Roberts. And if this
Committee has anything to do with it, you are going to get an
Oscar for this.
Ms. Hunter. It is also going to be shown on Discovery
Health on June 1.
Mr. Regula. Thank you very much.
Ms. Roberts. That is my friend Abigail on the cover with me
there.
Mr. Regula. I see.
Mr. Hoyer. I see Abigail, but who is this?
Ms. Roberts. Some chick looking for some dough.
Mr. Regula. Thank you very much.
Ms. Hunter. I would like to thank the Committee one more
time for taking a chance on Rett Syndrome back in 1986 when
this disorder barely had even a name. It was a fishing
expedition. You put the money towards it. The gene that causes
Rett Syndrome, it is the first time it has ever been implicated
in human disease. It goes way beyond--it may affect millions of
Americans, disorders from autism to mental retardation to
schizophrenia and bipolar disorder. It is huge.
Mr. Regula. The Committee is in recess to vote. We have the
three votes. They are holding the vote for us and full
Committee at 3 o'clock. We have many other witnesses today. So
let's get back as quickly as we can, Committee members.
----------
Thursday, May 9, 2002.
COOLEY'S ANEMIA FOUNDATION
WITNESSES
PETER CHIECO, FIRST VICE PRESIDENT OF THE MEDICAL ADVISORY BOARD,
COOLEY'S ANEMIA FOUNDATION, ACCOMPANIED BY MICHELLE CHIECO,
GREENWICH, CONNECTICUT
Mr. Regula. We will reconvene the hearing. The pressure is
off a little bit. Peter Chieco, First Vice President of the
Medical Advisory Board of the Cooley's Anemia Foundation,
accompanied by Michelle, and they want to testify. So,
Michelle, I will call on you first.
Mr. Chieco. Thank you, Mr. Chairman. Good afternoon. As you
said, my name is Peter Chieco. I serve as the Vice President of
medical information with the Cooley's Anemia Foundation, and
today I am here with my daughter Michelle, who you will hear
from in just a minute. Michelle is a 13-year-old high school
student and is a Cooley's anemia patient. I would like Michelle
to explain what Cooley's anemia, or thalassemia, is all about
and what it is like to live with that, and when she concludes
her presentation, I would like to talk about the Foundation's
legislative priorities for fiscal year 2003.
Michelle.
Ms. Chieco. Mr. Chairman, thank you for letting me talk to
the Subcommittee today. I know that as I sit before you, I seem
to be as healthy as any other teenager you know, but I actually
have a fatal genetic blood disease, and I need your help.
In front of me I have put four apples to help me explain to
you what I have. For the first apple, which is large and
perfectly shaped, is what your red blood cells look like, Mr.
Chairman. Probably most everyone else in this room has red
blood cells that look like this. These two second apples,
however, are smaller. They are not shaped exactly right and are
not as bright red of a color. This is not my red blood cell.
These represent my dad and mom's red blood cells. They are both
trait carriers. If both parents are trait carriers, there is a
1 in 4 chance that the child will have Cooley's anemia.
I am the 1 in 4. This green apple represents my blood
cells. They are not the same as yours. They are not even the
same as my parents'. My red blood cells do not work right, and
we all know that red blood cells are needed to carry oxygen
throughout the body to keep us alive. So I need to try to get
from this apple to the red one.
How do I go from the green apple to the red one? Every 2
weeks I receive a blood transfusion. I am 13 years old, and I
have already received about 500 units of blood, probably more
than every person in this entire building all together. It
hurts, and it is no fun, but it keeps me alive.
But that is not the end of my story. Transfused blood
brings with it infections. Many thalassemia patients, for
example, have hepatitis C or HIV. It also brings iron overload.
Iron from the transfused blood builds up and especially in the
liver and heart, and our bodies cannot remove it. To get rid of
it, I place a needle under the skin of my leg or stomach 6
nights a week. The needle is attached to a pump that infuses a
drug called Desferal that binds with the iron and lets the body
get rid of it. I have to do that for 12 hours a night.
Mr. Chairman, I am not complaining. I am happy and grateful
for what I have, but I would not be telling you the truth if it
wasn't a problem. It is a problem. I know kids that suffer
terribly. I have known people who have died of AIDS that they
got from their transfusion. I have friends with the disease I
have that are my age with osteoporosis, and again, I am only 13
years old.
Now my dad would like to tell you what you can do to help
me and other Cooley's anemia patients.
Mr. Chieco. Mr. Chairman, our written statements include
the complete legislative program of the Cooley's Anemia
Foundation as it relates to this subcommittee in some detail. I
would like to summarize for you now.
We have four legislative priorities. The first, we are
seeking continuation of the $2.2 million that Congress has
appropriated to the CDC last year to operate a blood safety
program directed at thalassemia patients. We are grateful that
you did that and urge you to continue this critical program.
Second, we urge you to continue report language that
supports the NHLBI's Thalassemia Clinical Research Network,
which is doing critical research on osteoporosis and other
important effects of Cooley's anemia. As always, we have to
recognize the key role of our good friend Congresswoman Rosa
DeLauro in supporting the establishment of that network.
Third, we ask for continued support for NIDDK's research
agenda that includes finding better, less barbaric ways of
removing iron and better means of measuring it. Ideally we are
looking for an oral chelator to get rid of this nightly pump.
Finally, with the help of some of the members of this
subcommittee, the Maternal and Child Health Bureau backed off
of plans to eliminate funding for three comprehensive
thalassemia treatment centers. We ask that you would continue
strong support language on that topic as well.
Mr. Chairman, as I sit here before you today, I am very
proud of my daughter and the way she deals proactively with
this disease and the strength that she shows not only to my
family, but to other patients. Michelle and I are honored to be
here to testify today. We would be pleased to respond to any
questions that you or any member of the Subcommittee may have.
Thank you.
[The prepared statement of Mr. Chieco follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Michelle, you maintain a regular school
routine?
Ms. Chieco. Yes, I do.
Mr. Regula. You handle yourself very well.
Ms. Chieco. Thank you.
Mr. Regula. What you seek is more money and research on
this condition?
Mr. Chieco. We seek that the NHLBI continues to get
funding, and that the NIDDK continues to get funding for better
ways of dealing with it. Obviously we are waiting for gene
therapy to cure the disease, but right now she has to go
through--and she handles it great--a very demanding program
every day, and we are losing our patients as they get older,
because they can't do this nightly pump routine, and they are
dying from the iron overload. We lose half of our patients over
the age of 30 because of the inability to do this every single
night.
She handles it great, and we do it great, but it is
barbaric, and we are hopeful that with her great attitude as
she gets older, she will be able to do this on her own as she
goes into, you know, college, and she has to take care of
herself without our influence as parents. And we know she will.
She is doing a great job of it.
Mr. Regula. You exhibit a lot of discipline, and that is
remarkable. Thank you for coming. Your testimony will not only
help you, we hope, but many others.
Unfortunately, we have to move on.
Mr. Chieco. Thank you, Mr. Chairman.
----------
Thursday, May 9, 2002.
POLYCYSTIC KIDNEY DISEASE FOUNDATION
WITNESSES
DAN LARSON, PRESIDENT AND CEO, PKD FOUNDATION, ACCOMPANIED BY JOSHUA
DENTON WASZAK, BONNER SPRINGS, KANSAS
Mr. Regula. Our next witness, Dan Larson, President and CEO
of PKD Foundation. He is accompanied by Joshua Waszak, who is
11 years old.
Okay. Joshua, are you going to testify for us?
Mr. Larson. I will start out, and I will introduce Josh.
Good afternoon, Mr. Chairman and members of the
Subcommittee. My name is Dan Larson, President and CEO of the
PKD Foundation, the only organization worldwide solely devoted
to programs of biomedical research, patient education, public
awareness and advocacy for 600,000 Americans, the 12.5 million
people worldwide who suffer from polycystic kidney disease, or
PKD.
Today I have the high honor of introducing to you Joshua
Waszak, a courageous 11-year-old boy from America's heartland.
Josh is an all-American boy, the kid next door, a model
student, yet because PKD equally affects people irrespective of
age, race, gender or ethnic background, Josh and approximately
1,400 men, women and children in each of America's 435
congressional districts have an inheritance they don't want and
can't give back, something he is here to tell you about.
Mr. Waszak. Hi. I am Josh. I am 11 years old and in the
fifth grade. Like most kids my age, I like riding my bike and
playing with my dog. My favorite subject in school is math, but
I am really not like other kids my age. That is because I have
PKD. My mom says I was born premature, because PKD caused my
kidneys to fail when I was still in her stomach. She says they
did something called a C-section to save my life. Then I had to
spend a long time in the hospital before I could go home.
PKD sounds like it just hurts the kidneys, but that is not
true. Among other things, it causes high blood pressure. So I
have had to take tons of pills ever since I was a baby. My mom
says I take more blood pressure pills than most adults. I have
a regular doctor, a kidney doctor and a heart doctor. Oh, yeah,
and a surgeon, too.
Today I feel pretty good, but I am still scared. That is
because my grandpa recently died from PKD. Grandpa and I were
best buds. We used to like to go fishing together, but when he
was in the hospital, I used to crawl in bed with him and keep
him company, and he would tell me stories. I loved my grandpa a
lot. My mom says even though he was a grandpa, PKD killed him
early because he was only 56.
I am afraid because my mom has PKD, too, and it causes her
lots of pain. It makes me sad when she is hurting. So when she
is in the hospital, I crawl in bed with her and tell her
stories. My mom is a nurse, and she takes care of people all
day long, but then she comes home really tired. I wish she had
more time to rest, but she says she needs more money to keep
working to pay for all of the pills we take, and even though
something they call a genetic discrimination often keeps people
like my mom from getting health insurance or a good job, we
feel it is more important to speak up for people who suffer
from PKD, because if we don't, who will? I don't want my mom to
die young like my grandpa did, and I don't want to die young
either. I want to do something, but I am just a kid.
My mom tells me I am helping because I let the researchers
do tests on me and stick me with needles to take blood for
research. I hate needles, but I hold still so they don't miss.
My mom gets studied, too. Every year we spend a week of our
vacation in the hospital together so doctors can learn more
about PKD. Scientists have already found the bad PKD genes, and
now they are discovering new things about PKD all the time in
time to help them find a cure. Mom says now all they need is
more money for research, but that PKD doesn't get near as much
funding from the government as other diseases, even though lots
more people have PKD. Plus, PKD costs the government about $2
billion a year.
I sure hope they can find something in time to help me and
my mom, too. And you know what? Because she inherited PKD from
my grandpa and I got it from her, they say my kids will get PKD
from me, too, and that scares me.
Will you help the scientists get more money for research so
my mom and I don't die young like my grandpa did? More research
is our only hope. So please help the scientists get more money
to find a treatment for PKD. Thank you for letting me come and
tell my story.
Mr. Larson. Thank you, Josh, and my sincere thanks to the
Subcommittee for your long-standing support for increased PKD
research at the NIDDK. Purely on the basis of prevalence,
morbidity, mortality, costs to the Federal Government, the
scientific momentum and therapeutic opportunity, PKD would, by
any objective standard, qualify for a full-court press by the
NIH to find a treatment and cure. Therefore we are grateful
NIDDK has scheduled a PKD strategic planning meeting this
year--this July to guide Federal research efforts for the next
3 to 5 years. Likewise, we hope the positive new leadership at
NIDDK will more aggressively allocate research funding towards
finding a treatment and cure for PKD before it is too late for
boys like Josh and adults like his mom. Therefore, I
respectively urge the Subcommittee to take whatever steps
necessary to assure ample resources are committed to PKD
research in fiscal year 2003 by the National Institutes of
Health.
Thank you. If you would have any questions, I would be
happy to respond to them, or Josh as well.
[The prepared statement of Mr. Larson and Mr. Wazak
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Are their efforts to date helping, you think?
Mr. Larson. Yes, sir. There is a blood pressure study that
has been done at the University of Colorado in which Josh
participates that shows that if you catch it early, and you are
able to monitor the blood pressure and keep it at a low level
using an ACE inhibitor, you can prolong kidney function by
perhaps 10 to 15 years. The difficult thing is because it is a
genetic disease and dominantly inherited, people don't get
tested because they don't want to have a preexisting condition
which then jeopardizes their health insurance, their
employability, their promotability, things of that nature.
Mr. Regula. Do you use dialysis with this at all?
Mr. Larson. Yes, sir. PKD is the fourth leading cause of
kidney failure, and it affects about 10 percent of those who
have end-stage renal disease, and so while dialysis and a
transplant treat end-stage renal disease, it doesn't do
anything for polycystic kidney disease, because most people
have already started their families by the time they reach
kidney failure, roughly by the age of 50.
Mr. Regula. Mr. Miller.
Mr. Miller. No questions. Thank you. Josh, you did a very
fine job. Thank you.
Mr. Regula. Ms. Granger.
Thank you very much.
----------
Thursday, May 9, 2002.
AMERICAN LIVER FOUNDATION
WITNESSES
PAUL D. BERK, M.D., CHAIRMAN, BOARD OF DIRECTORS, AMERICAN LIVER
FOUNDATION, ACCOMPANIED BY HOWELL SMITH, LIVER TRANSPLANT RECIPIENT
Mr. Regula. All right. Our next witness will be introduced
by our colleague and member of the Committee, Dr. Paul Berk,
chairman, board of directors, American Liver Foundation.
Mr. Miller. Mr. Chairman, thank you for giving me an
opportunity to introduce a friend of mine. Just as Julia
Roberts was here today advocating something that she felt
personally impacted by a close friend, I have been personally
impacted by liver disease, and as you may know, our daughter
donated half her liver to our son last October in New York City
at Mount Sinai, which is where Dr. Berk is now. He is the
Emeritus Chief of the liver diseases. And it is an outstanding
facility, an outstanding program, a real leader in the Nation,
and we felt very fortunate that they agreed to do the living
donor transplant, which is a very rare type of procedure.
There are just not enough organs. I know we provide some
resources. I hope we can increase the resources for organ
donation. I know Secretary Thompson--it is a big issue from his
days in Wisconsin, and liver research is something that is
important at NIH, and it spreads throughout a number of
different institutes, which I have learned.
So anyway, I have learned a great deal about the liver
disease. I am delighted that Dr. Berk is here, and I introduce
you to my friend Dr. Berk.
Dr. Berk. Thank you. Mr. Chairman, Mr. Miller, members of
the Committee, you have just heard, my name is Paul Berk. I am
the Stratton Professor of Molecular Medicine at the Mount Sinai
School of Medicine and currently Chairman of the Board of the
American Liver Foundation.
I want to thank the Committee for the opportunity to submit
this testimony as you consider your funding priorities for
fiscal 2003, and I am proud to share my allotted time with
Coach Howell Smith of Malone College in Canton, Ohio, who is a
liver transplant recipient.
Now, the specifics of ALF's funding recommendations for
fiscal 2003 are included in the formal statement that you have
already received and I summarized in the final page. What I
would like to do here is to look at some broader issues.
Twenty-eight million Americans have either hepatitis or other
liver and biliary tract diseases. This year NIH spending on all
liver disease research will be about $319 million, representing
about $11 per year per patient. Funding for hepatitis C
research at about $95 million is something like $24 per year
per patient for each of the 4 million Americans infected with
that virus.
Throughout the mid-1990s, liver disease research funded by
NIDDK, which is one of the lead institutes interested in that
problem, averaged $48 million a year. That was and remains less
than the amount being spent each year at my hospital alone for
the treatment of patients with end-stage liver disease. By
contrast, although the number of patients infected with HIV is
far smaller, NIH is spending about $2,700 a year per patient
with AIDS on AIDS research. The discrepancy in research
investment is paralleled by discrepancy in the progress made in
developing medical therapies for hepatitis C, and, in fact,
rather ironically with improved control of HIV, hepatitis C has
now become the principal cause of death among patients with
AIDS.
For a long time we were protected from some of this by the
ability of liver transplantation to be the treatment of last
resort for patients with end-stage liver disease, but as the
development of treatment for hepatitis C lagged, the ability of
the transplant system to provide livers for all those who need
them has been stretched to and now beyond its limits. While
about 18,000 people are on transplant waiting lists waiting for
livers, fewer than 5,000 will receive liver transplants this
year. That is because that is the limited supply of organs
available. Tragically, significant numbers of patients who are
curable by transplantation are now dying on transplant waiting
lists.
We certainly support strategies to increase organ donation,
but we feel strongly that a long-term strategy must be
developed to improve medical treatment for liver disease and to
thereby decrease the need for liver transplants. Since we seem
unlikely ever to be able to increase the supply of livers to
meet the growing demand, we must invest more research to
decrease the demand down to the available supply and have
alternate treatments for other people.
From ALF's view, funding for liver disease research is
going to need continued long-term support and a more focused
leadership among the various government agencies involved in
supporting this research.
I would like to give the rest of my time to Mr. Smith.
[The prepared statement of Dr. Berk follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Smith. Thank you. Mr. Chairman, and members of the
Committee, in many ways my story is similar to thousands,
having been inflicted with a chronic liver disease. I happen to
have had the disease called primary sclerosing cholangitis. The
disease that took Walter Payton's life was a part of that. But
mine is not like many because I am one of the more fortunate
who happens to be a survivor, a survivor through the miracle of
modern medicine and a gracious magnanimous gift of a friend. I
received a living donor transplant 2 years ago.
It was extremely frustrating 11 years ago to be told by
eminent physicians that you have this disease. We don't know
what causes it. There is no known cure. We can only hope to
slow it down, but you are going to need a liver transplant. And
take these pills, and let us see what happens. Six years of
medication and gradual increase in severity of the disease put
me on a waiting list for a liver at the Cleveland Clinic in
1997. From 1997 to 2000, my frustration was impacted by two
major law changes due to the severe shortness of available
organs for transplant. But as I mentioned, this living donor
procedure, which was relatively new, in fact maybe unknown in
1997 when I went on the list, provided my way out.
My story is a little bit unique in the sense that three
other coaches in our area--four if we go with the Wayne County
and go to Wooster--have primary sclerosing cholangitis. One had
been transplanted traditionally, I received the living donor,
and two are waiting. We have partnered together to create a
foundation called Hoops for Healing. We have put on numerous
golf tournaments and basketball tournaments to raise funds for
the Liver Foundation, as well as Life Bank in Ohio.
It is my hope and my prayer that my two friends, Steve and
Bruce, will not ever have to get a transplant due to research.
Mr. Regula. Thank you very much.
Mr. Miller.
Mr. Miller. The only comment is one of our colleagues, a
new Member from Massachusetts, is a living donor liver
transplant from--Congressman Lynch took Congressman Moakley's
place. So we have our own little liver caucus in Congress. But,
you know, you are very fortunate to have found a living donor,
as I think we were with our son.
But one of the things that--when you start looking into
this, one of the concerns you have is coordination of research
is so much--in so many different institutes, and liver--it is
not in the name of any of the institutes, and the question is
how do we make sure we are not duplicating and such? And so I
know we have discussed that. We are going to discuss it some
more and hopefully do that.
The total amount of money going in NIH has just been going
up at a very rapid rate, and hepatitis C has now caught the
attention of the American people, but we ought to be concerned
about the other liver diseases and not just hepatitis C, even
though that is the predominant one that is causing, I think,
more deaths than HIV these days.
So thank you for being here to advocate, and I hope I can
do what I can to help.
And I hope, Mr. Chairman, we can provide for them as we do
for all of these diseases. Thank you.
Mr. Regula. Thank you. I am sorry we have to move on, but
we have a long list today.
Ms. Granger, do you have any questions?
----------
Thursday, May 9, 2002.
ALZHEIMER'S ASSOCIATION
WITNESS
ROBERT J. ENTWISLE, ADVOCATE, ALZHEIMER'S ASSOCIATION, NORTH CANTON,
OHIO
Mr. Regula. Mr. Robert Entwisle, advocate, Alzheimer's
Association, North Canton.
Mr. Entwisle. Good morning. Thank you for inviting me here
today. My name is Robert Entwisle. I am 70 years old, and I
have Alzheimer's disease. I have a degree in electrical
engineering and an MBA. I have worked in electric motor design
for 37 years. My last position was as research engineer for the
Hoover.
My supervisor was first--was the first one to notice I was
having a problem with my work, so in 1996, after going to one
doctor, to two doctors, and taking tests and more tests, I
learned that I had Alzheimer's disease. That was a very sad
day. I fight to this day this disease every day.
I struggle with--to button my shirt. I can no longer tie my
shoes or my tie. My wife must drive me to the doctor's office,
to the barbershop, to the drugstore. I have a wonderful library
of math and motor electric design books. I cannot any longer--I
cannot read them nor do calculations with them. Still I can
still leaf through the pages of the old ones. I have--I also
have--I have trouble talking, and sometimes I can't get the
words out of my mouth--the words in my head to come out of my
mouth.
I am mad as hell, but I am not going to give up. My wife
and I are active in the early stages of support groups, led by
the Akron and Canton chapters of the Alzheimer's Association.
These monthly meetings allow me to express my feelings and
frustrations to my fellow sufferers. It is a good opportunity
to get off steam.
I am currently enrolled in a clinical drug trial at the
University Hospital in Cleveland, Ohio. This drug might greatly
reduce the worsening of the Alzheimer's symptoms. I am also
taking Exelon at the monthly cost of over $200. I worry about
my future as I need more and more care and I watch my finances
dwindle.
I am hoping that additional funding could--for Alzheimer's
research will be put--will put an end to this terrible disease.
Please help all of us--please help all us to see the light at
the end of the tunnel. Thank you for listening.
[The prepared statement of Entwisle follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Entwisle. Do you have any questions?
Mr. Regula. Would you like to make any comments?
Ms. Entwisle. I think he has said it all, and the way he
has said it makes it even more poignant.
Mr. Regula. He makes a powerful case.
Ms. Entwisle. We do need more funding. He is in this
experimental drug trial at the University Hospitals. He is
doing everything he can to help maybe not himself, but other
people that are going to be coming down the stream.
Mr. Regula. Well, that is wonderful that you are making an
effort. It is wonderful you came here today to share this with
us. It reminds me of the letter that President Reagan wrote at
one point to--which I think brought to the attention of the
American people when this was done, as you recall, before he
really became even in more difficult circumstances. And----
Ms. Entwisle. It could change one's life in just a matter
of a few years.
Mr. Regula. You were at the Hoover Company, I gather?
Mr. Entwisle. Yes.
Mr. Regula. You were the electrical engineer there?
Mr. Entwisle. Yes.
Mr. Regula. Well, they make good sweepers.
Mr. Entwisle. Yes, they do, and they didn't tell me to say
that either.
Mr. Regula. I see them around here in the Capitol, so I
know they are good. I have even seen some down at the White
House.
Ms. Entwisle. That will keep our pension going.
Mr. Regula. That is right.
Well, that is great, and thank you for coming.
Ms. Entwisle. Thank you.
----------
Thursday, May 9, 2002.
CARNEGIE HALL
WITNESS
MICHAEL STERN, CONDUCTOR AND ADVOCATE, CARNEGIE HALL, NEW YORK, NEW
YORK
Mr. Regula. Mr. Michael Stern, conductor and advocate,
Carnegie Hall, New York.
Let me say to all of you, under the rules of the House, we
cannot meet when the Full Committee meets, and they are meeting
at 3 o'clock, so that gives us essentially about an hour, and I
have a number of witnesses. If you can keep it short, I will
try to keep my questions at a minimum. I don't want to cut
anyone short, but I don't want anyone at 3 o'clock to be
stranded. So go ahead.
Mr. Stern. I will do my best to be brief.
Like I said, Chairman Regula, thank you very much for
allowing me to come to the Subcommittee today, and I must say I
was a little daunted when I saw my name on today's list of
witnesses, because of the subject matter for a lot of people.
But I think that what I have to come and say to you about the
Carnegie Hall program is perhaps no less important to the long-
term health and welfare of a lot of especially younger
Americans, and that has to do with the Isaac Stern Education
Legacy.
My father, Isaac Stern, as you know, passed away less than
a year ago.
Mr. Regula. I met him.
Mr. Stern. I know you did, and he appreciated that meeting.
And he has left a void in the music world not only for my
family personally, but for music lovers and music students and
music teachers all over the country and around the world. And
aside from his obvious legacy as a performer and indisputably
one of the greatest violinists of the last century, perhaps his
great achievement was what he did for young people and his
commitment to giving back to the culture which nurtured him as
a young immigrant, and to the city and the country which
allowed him to use his position to try to do something
substantive in this country for young people and for music.
And as you know, his life was inextricably bound up with
Carnegie Hall. When Carnegie Hall was threatened with
demolition, it was he who stepped in. He saved it. He got it
landmark status, and it reestablished its place as the
preeminent stage in this country, which is why I feel very
strongly about the program which is before you today.
It is this opportunity from the bully pulpit of Carnegie
Hall to do something truly unique and ground-breaking, and
while the Isaac Stern Education Legacy is a fitting tribute to
him, actually the idea goes much further than that. Essentially
it will allow the kind of outreach very similar perhaps to the
Challenge America program, which I know that you are very
familiar with, to be able to bring excellence across the board
outside of Carnegie Hall, outside of New York to every corner
of this country, to schoolchildren, to audiences and to music
lovers who would not be able in any other circumstance to
receive that kind of gift.
It is not the intention of this program to try to
standardize that kind of educational or artistic experience and
sanitize it for the rest of the country, but rather to give the
country a unique opportunity----
Mr. Regula. You are seeking some help for this program?
Mr. Stern. The program is called the Isaac Stern Education
Legacy, and it is a program already being set up by Carnegie
Hall to disseminate with long-distance teaching and the help of
technologies now in place to bring not only programs designed
specifically for education, but all kinds of ancillary
activities across the board, not only classical music, jazz,
world music, perhaps appearances by Julia Roberts, I don't
know, to every--conceivably every classroom and every community
in the United States.
It was my father's dream. He set up this program before he
died so that--and in a very visionary way so that, especially
in the new space which is being built in Carnegie Hall with the
technology built in, that they would be able to bring this
educational and artistic initiative to places which, in an age
where the educational impetus for the arts may be threatened,
would do a great deal to make up for that. And I think that my
father, with his desire to give back that kind of gift, the
responsibility that he had to the great capitals of the world
to bring his music, but also to the smaller communities--this
is his reflection, and it is in his honor. If he were here
today, he would be able to say this to you directly, and I will
be proud to be able to come in his stead: On behalf of the
Carnegie Hall family, I thank the subcommittee for the
$6,000,000 that has already been afforded the program. More is
needed to make this a reality, and it is a great model and a
great chance to do something substantive for arts, for
education and for young people in this country.
Mr. Regula. Well, thank you.
Mr. Kennedy.
Mr. Kennedy. No.
Mr. Regula. Thank you for coming.
[The prepared statement of Mr. Stern follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 9, 2002.
SCLERODERMA FOUNDATION
WITNESSES
KAREN GREENSPAN, ADVOCATE, SCLERODERMA FOUNDATION, HOUSTON, TEXAS,
ACCOMPANIED BY LAUREN BEESON, PEMBROKE PINES, FLORIDA
Mr. Regula. Next is Karen Greenspan for the Scleroderma
Foundation, President, accompanied by Lauren Beeson.
Are you going to testify, Lauren?
Ms. Beeson. No.
Mr. Regula. It is nice of you to come tell us your story.
Ms. Greenspan. Mr. Chairman and members of the
Subcommittee, my name is Karen Greenspan. I am a scleroderma
patient and----
Mr. Regula. It is a familiar name around this town.
Ms. Greenspan. No relationship.
Thank you for giving me an opportunity to speak with you
today.
Scleroderma is really a spectrum of multiple diseases
involving the irregular growth of connective tissue which
supports the skin and internal organs. The effects of
scleroderma range from minor inconveniences to life-threatening
involvement of the heart, lungs and kidneys.
Currently there are 300,000 people in this country who
suffer from scleroderma. Four out of five of those are women.
Many of its symptoms resemble those of other diseases, making
diagnosis an extremely difficult and lengthy process.
Thank you, Mr. Chairman, for your work in doubling the
budget for the NIH. As you know, NIAMS primarily supports
current research efforts into the understanding and treatment
of scleroderma, as do other components of the NIH. With your
continued support, the budget for scleroderma research has
slightly increased in recent years.
We are encouraged by NIAMS' growing interest in
scleroderma; however, much more funding is needed to
understand, to treat, to prevent, and to ultimately find a cure
for scleroderma. As part of those efforts we support the NIAMS
Coalition's request for a 15 percent increase, bridging the
agency's total budget to $521 million. This increase will
benefit scleroderma and other diseases that fall under the
NIAMS umbrella.
Your leadership in the area of research funding, has
dramatically improved the quality of life for many patients. I
would like to share with you a story of three generations of
scleroderma patients.
In 1952, a 39-year-old woman, wife and mother of two,
suffered for months with several unusual symptoms, including
hard, shiny, tight skin; inability to bend certain joints
without bleeding; tremendous fatigue; and increasing shortness
of breath. The woman, whose name was Fay, was eventually
diagnosed with a mysterious disease called scleroderma,
literally meaning hard skin. In 1952, scleroderma was an
automatic death sentence, and sure enough, within 4 years, Fay
had died from scleroderma lung involvement.
Fast forward now about 30 areas. Fay's husband had
remarried and added another son to the family. Fay's daughter
grew up to become an Army wife and later a career woman and
single parent. In 1982, she got a flu-like infection, and
although the infection cleared, she became progressively weaker
and easily fatigued. She started to have heartburn, difficulty
swallowing, frequent vomiting and severe bouts of diarrhea. Her
hips and shoulders became incredibly painful. Her fingers
turned blue and numb in the cold. Her family doctor thought it
might be stress at first, then anemia.
The doctor referred her to a rheumatologist who, aware of
her family history, told her there was nothing wrong with her
that a new boyfriend and a yoga class wouldn't cure. Several
months and doctors later, she was diagnosed with and treated
for an inflammatory muscle disease, but this was not the entire
problem.
Her GI problems worsened, eventually preventing her from
swallowing and keeping down solid food. Thirteen years later
she was finally diagnosed with systemic scleroderma with
polymyositis overlap. Her disease is chronic and debilitating,
but no longer an automatic death sentence.
If you haven't guessed by now, Fay was my mother, and I am
the patient who was told to take a yoga class and get a new
boyfriend, and I have tried both on occasion, and the yoga
works better.
Several years ago my family became acquainted with a third-
generation patient I referred to earlier, a young girl named
Lauren, who was diagnosed as age 6 with a form of linear
scleroderma called ``the slash of the saber.'' Lauren is here
with me today. And as you can see, half of her face looks
normal, and the other half is disfigured. The disease goes the
length of Lauren's body and not only affects her
musculoskeletal system, but because she is growing normally on
one side of her body and not on the other, her internal organs
are also affected. Lauren has already had several operations
and will need more as she gets older.
Just as my life changed 6 years ago by going public about
my disease, Lauren's life has also changed tremendously since
she was chosen as the Scleroderma Foundation's first national
poster child.
As you can see, my three generations story has shown that
the medical community has come a long way from barely being
able to identify the disease to approaching a cure. Three main
problems persist in the area of scleroderma research: the need
to conduct more federally-funded research to better understand
the disease, the need for new researchers to come into this
area, and the lack of comprehensive drug treatment and therapy.
Currently there is no treatment that controls or stops the
underlying problem, which is the overproduction of collagen.
Therefore, the focus of treatment and disease management has
been on relieving symptoms. In closing, Mr. Chairman, I am here
as a patient to ask you to help us find that cure.
We have come a long way since my mother died in 1957. The
Scleroderma Foundation has worked tirelessly to disseminate
information about this disease and raise funds for research. My
brother, Seinfeld star Jason Alexander, has committed his time
and resources by serving as a celebrity spokesperson for the
eradication of scleroderma, giving children such as Lauren
great hope.
However, our most crucial tool in fighting this disease is
increased funding of NIH grant programs, and we cannot do this
without your help. The Scleroderma Foundation has in the past
and on its own funded approximately 20 percent of the annual
research done on this disease. We are not here simply with our
hand out. We have done and will continue to do our part. We are
requesting, though, that Congress take a strong look at this
disease and increase the dollars available to help us find a
cure. Thank you.
Mr. Regula. Thank you for your testimony.
Also we appreciate your coming here today, Lauren.
[The prepared statement of Ms. Greenspan follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 9, 2002.
AMERICAN LUNG ASSOCIATION OF RHODE ISLAND
WITNESSES
WALTER STONE AND LYNNE EVANS-STONE, VOLUNTEERS, AMERICAN LUNG
ASSOCIATION OF RHODE ISLAND
Mr. Regula. Okay. Our next witnesses will be introduced by
Mr. Kennedy. Walter Stone and Lynn Evans-Stone.
Mr. Kennedy. Thank you, Mr. Chairman. It is my honor today
to welcome Mr. and Mrs. Stone and thank them for their
participation today.
It takes great courage to share your personal tragedy with
strangers, and I certainly appreciate, the Committee
appreciates, your willingness to be an advocate on behalf of
funding for asthma and other lung diseases. The story of your
daughter, Morgan, will be an inspiration to all of us, showing
us the need to do more to end this terrible disease. It is of
epidemic proportions in this country.
Just last week we had a field hearing here in the Congress
talking about things that we should be doing across the country
to reach out and address the needs in our schools, among which
an Epi-pen and bronchodilator in every single school, nurses in
schools, making sure that we have clean air in our schools
because of the indoor air quality. And, of course, we have to
go to the root cause and what it is, and let's find it, and
let's discover it, and let's end the horrible tragedies like
your family has suffered.
So I want to thank you for your being here today, and
adding your voice to many, many families across this country
who, like yourselves, have lost a loved one as a result of this
terrible disease.
Mr. Stone. Thank you.
Mr. Chairman, I think this committee probably has the
responsibility of solving it. When you have kids, you think of
them in terms of car accidents or drunk driving or drugs, but
you never think of them dying from asthma. No kid should.
Morgan was 18 years old when this happened. The thing I
think that I would like to suggest to you is that the public is
not aware that asthma can be fatal. As a parent I don't think I
took it seriously enough. Certainly I don't think Morgan took
it seriously enough.
I suggest that the answer isn't always in the money that
you spend, but in the information that you gather. You know,
when I saw the full Committee here earlier today, the thought
that crossed my mind, the 26 million people that suffer from
asthma are approximately 10 percent of the population. There
are over 8 million kids under the age of 18 that suffer from
asthma. How many people in this room either have suffered from
asthma, do suffer from asthma, have someone in their family
that suffers from asthma, or know someone that either has
suffered or has died from it? I would suggest it might be a
project for your staff, just to find out among your own staff
the problems, or to use--as one of the PR people said of one of
the political parties, use your franking privileges to write
your constituents, ask them these three or four questions, and
see what kind of responses you get. That is a good place to
start with education.
Secondly, we certainly need money for research. And, third,
I think that we would be making a terrible mistake to not deal
with those triggering factors that have strangely increased the
amount of asthma in this country. To say that the increased
pollution that is in our urban areas has not had an effect
would be nonsense. It has. And until we make that connection
and put the two together, people will continue to die.
Mr. Regula. Thank you.
Mrs. Evans-Stone. I think Walter has said a lot of what I
would have liked to have been able to say if I could get it
out. Morgan was diagnosed at the age of 9 with asthma, and I at
the age of 25. And when we took her--this is her high school
graduation picture in June of 2000. We took her to the College
of Santa Fe in New Mexico in August of the same year. That is
the last time I saw her alive.
[The prepared statement of Mr. and Mrs. Stone follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I don't think we take asthma seriously enough.
It is not like cancer or something. We just don't see it as a
life-threatening matter.
Mr. Stone. You think you can recover from every episode.
Mrs. Evans-Stone. I think that is the issue, because even
though I am an asthmatic as well, we were both considered to be
mild asthmatics. We never had an emergency room visit, I never
have, and I think that for me, as much as it is important for
education, for research and to find a cure, I think for people
to be educated on a level where they understand the fact that
it is life-threatening and that at any minute your breathing
capability could change is really all that I can ask you to do
at this point.
Mr. Stone. Congressman, one of the things that I find
fascinating, the human body is such an incredible machine. It
is almost as if the increase in asthma is a signalling device
telling us there is something wrong with the environment.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you.
Having suffered from the most chronic and severe asthma my
whole life, being hospitalized more times than I can count,
giving myself adrenaline injections, and having four different
inhalers and Prednisone and theophyline every single day up
until just a couple of years ago where I was able to get rid of
the steroids, I was shocked to learn that the deaths from
asthma occur amongst those who are mild asthmatics as much as
more severe asthmatics like myself.
And it was just because of that thought that people do not
understand and even, I think, with chronic asthmatics the
feeling is that you can always control it.
And the problem that we had, we showed through the hearing,
was that schools do not take asthma seriously enough, because
you can't see it. Someone is struggling quietly to breathe.
They can't--it is not clear to people that they are really
struggling, and, therefore, it is discounted, and that is a
terrible, terrible phenomenon.
I hope that we are able to do more to educate more schools,
make sure there is someone on staff who understands this
disease, a school nurse. But, of course, many of our schools
don't have school nurses.
And then you were also talking about the fact that just
having an Epi-pen in the school, having bronchodilators in our
schools. We have those defibrillators in the airports and
everywhere else. Why don't we have a very simple device like
that in our schools? But as you know from back home, the school
air is not very good for asthmatics either. Many of these
schools have mold going throughout the school. It is impossible
for kids. So we have a lot of areas the tackle when it comes to
asthma.
I want to let you know that we fought to get increases at
the Centers for Disease Control so we can have more education.
As you said, the quickest way for us to reduce the number of
fatalities is simply through a public education campaign,
directed where it should be, and you have got my commitment
along with, I am sure, the rest of the Committee to do
something to make sure.
It is an epidemic right now, the largest single reason for
missed school days in this country. We really have a big crisis
on our hands. My condolences and sympathies to both of you. I
just want to commend you again on your courage to share your
tragedy with us, because I really believe that we will keep
that in mind when we think about our policies in helping to
address this so other families don't have to go through what
you have.
Mr. Stone. Thank you.
Mr. Regula. No problem.
----------
Thursday, May 9, 2002.
JOSLIN DIABETES CENTER
WITNESS
ALAN C. MOSES, M.D., CHIEF MEDICAL OFFICER AND MEDICAL DIRECTOR, JOSLIN
DIABETES CENTER, BOSTON, MASSACHUSETTS
Mr. Regula. Dr. Alan Moses, Joslin Diabetes Center in
Boston.
Dr. Moses. Thank you, Mr. Chairman. You have heard some
compelling and often poignant testimony this morning from
individuals with diseases both rare and common that have
devastated them or family members.
I would like to turn your attention to another common
disease that not only adversely affects the individuals
affected, but I think it is having a devastating affect on the
health of our Nation. The Joslin Diabetes Center in Boston is
developing a pilot program with the CDC that addresses the link
between obesity and diabetes and that developed a mechanism to
get effective treatment and prevention in the hands of those
individuals at risk.
Obesity is a major risk factor for the development of type
2 diabetes and a major cause of morbidity and mortality in the
United States. Let me begin with a few sobering facts. One in
every two Americans is overweight, and the prevalence of
obesity has increased 57 percent in the last decade.
Obesity disproportionately affects minorities. Sixty
percent of African-Americans, Mexican Americans, and Native
American women meet the criteria for being overweight. Between
33 and 37 percent are obese. Obesity in children and
adolescents is increasing at an alarming rate, leading to the
occurrence of type 2 diabetes in these groups that
traditionally have been spared this form of diabetes.
This increase in obesity is driving an emerging epidemic in
diabetes in this country. Over 90 percent of diabetes is type 2
or adult-onset diabetes, and over 90 percent of people with
type 2 diabetes are obese. The CDC reported that diabetes
increased to 6.5 percent prevalence, an increase of 33 percent,
between the years of 1990 and 1998. That rate continues.
Diabetes increased in all age groups, but most profound,
approximately a 70 percent increase in people age 30 to 39.
Young people with diabetes are at particular risk for
developing severe complications because of their anticipated
longer life than older individuals. For the rapidly expanding
population of Americans over age 50, diabetes approaches 20
percent of the population, and diabetes and its complications
comprise 25 percent of Medicare costs. Twenty-five percent.
The following facts provide some understanding of the
magnitude of the diabetes problem. Over 17 million Americans
have diagnosed diabetes, and an equal number are estimated to
have prediabetes. It is the sixth leading cause of death by
disease in the United States. And every day, every day, 2,700
have a new diagnosis of diabetes; 1,200 people die from
diabetes; 180 have an amputation from diabetes; 120 go on
dialysis because of diabetes; and 75 go blind because of
diabetes.
Mr. Regula. In the interest of time, let me say we have
heard this message, we are very persuaded. I have heard it back
home. I have heard it from many, many people.
Dr. Moses. What we are proposing then is to work with the
CDC to develop a translational program to not only get the
information out, but begin to end the epidemic by going into a
prevention mode.
Mr. Regula. I think they are. They have a film coming out
that is for TV that will be aimed at young people.
Dr. Moses. I agree that is terribly important, but I
believe that we have to do much more, because we have to make
these culturally competent, linguistically competent and
appreciate the different needs of the different populations.
Mr. Regula. We are very sensitive to the problem.
Dr. Moses. You been helpful in this effort.
Mr. Regula. Thank you for coming.
[The prepared statement of Dr. Moses follows:]
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Thursday, May 9, 2280.
FACIOSCAPULOHUMERAL MUSCULAR DYSTROPHY (FSH) SOCIETY, INC.
WITNESS
DANIEL P. PEREZ, PRESIDENT AND CEO, FSH SOCIETY, INC.
Mr. Regula. Next is Mr. Daniel Perez, President and CEO,
FSH Society. And I will let you pronounce the title of it.
Mr. Perez. Mr. Chairman, it is a great pleasure to submit
this testimony to you today. My name is Daniel Paul Perez of
Lexington, Massachusetts, and I am testifying as the Founder,
President and CEO of the Facioscapulohumeral Muscular Dystrophy
Society, the FSH Society, and, as you can see, as one who has
this devastating disorder, facioscapulohumeral muscular
dystrophy.
Facioscapulohumeral muscular dystrophy, FSHD, is the third
most prevalent form of muscle disease. FSHD is a neuromuscular
disorder that is transmitted genetically and affects 12249,500
to 37,500 persons in the United States. For men and women the
major consequence of inheriting FSHD is progressive and severe
loss of skeletal muscle.
The FSHD mutation was identified in 1990. Although this
molecular genetic defect is now known, there are no genes that
have been associated with or have been linked with FSHD to
date. The biochemical mechanism and cause of this common muscle
disease remains absolutely unknown and elusive. The same is
true for any treatment therapy or cure. None exists.
For 40 years I have dealt with the continuing unrelenting
and unending loss caused by FSHD. Less than 10 years ago, I
walked, with some difficulty, into this very room to testify.
Today I sit before you in a wheelchair because of this disease
called FSHD.
Nearly a decade ago I appeared before this committee to
testify for the first time. Since then the congressional
appropriations committees have repeatedly instructed the
National Institutes of Health, the NIH, to enhance and broaden
the portfolio in FSHD. Due to the Appropriation Committee's
interest, FSHD research has begun to take a number of steps
forward this past year. I am pleased to report that three major
programs to accelerate funding and research on FSHD have been
initiated by the NIH.
The FSH Society, incorporated in 1991, solely addresses
specific issues and needs regarding FSH muscular dystrophy, and
has invested more than $750,000 into new research initiatives
for this common muscle disease. The Society actively represents
and educates more than 10,000 patients with FSHD.
Last year, thanks to your efforts, the United States
Congress passed the Muscular Dystrophy Community Assistance
Research and Education Act of 2001. The purpose of this law is
to rapidly accelerate, develop and broaden the base of research
on muscular dystrophy and FSHD and to bring that research into
the clinic.
In spite of all of this, the state of research on FSHD is
not good. Since 1998, the overall budget for the NIH has
increased 70 percent. The budget for the Arthritis Institute
has increased 75 percent. The Neurology Institute budget has
increased 70 percent. Yet, the budget for muscular dystrophy
has increased only 49 percent. In spite of all of this, the NIH
funding research on FSHD is minimal at best, and, frankly, we
are not sure that that 49 percent increase for muscular
dystrophy is reliable. During this period the total number of
grants at the NIH has increased nearly 30 percent, while grants
in muscular dystrophy have barely increased just over 10
percent. Budget estimates for increases in future years for
muscular dystrophy as indicated by the NIH can only be
described as anemic.
Mr. Regula. Your case would be to get them more?
Mr. Perez. I will make my case.
Mr. Regula. Okay.
Mr. Perez. Congress has been very generous with the NIH and
has repeatedly expressed its desire to see greater efforts in
muscular dystrophy research, and FSHD research in particular.
This is not happening. The rising tide is not raising all
boats.
Thanks to this committee the NIH and the FSH Society held a
research planning conference in May of 2000. Recommendations
for future direction included specific projects in basic
molecular research, therapeutic candidate population studies
and the creation of new animal models. Today, 2 years later,
that agenda is still in its initial working stages and perhaps
25 percent complete. We are very concerned that the enormous
scientific progress that is possible for FSHD is not reflected
in the budget presented by the NIH.
Mr. Chairman, we trust your judgment on the matter before
us. We believe that the Committee should explore why muscular
dystrophy has been left behind at the NIH. Frankly, we are
extremely frustrated that amid a huge increase in funding and
strong, unambiguous expressions of congressional support, the
NIH commitment in muscular dystrophy continues to be so weak.
Only you can answer that question.
Mr. Chairman, again, thank you for providing this
opportunity to testify before your Subcommittee.
Mr. Regula. Thank you.
[The prepared statement of Mr. Perez follows:]
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Thursday, May 9, 2002.
PENNSYLVANIA ASSOCIATION FOR INDIVIDUALS WITH DISABILITIES
WITNESS
DAVID H. FYOCK, VICE PRESIDENT, PENNSYLVANIA ASSOCIATION FOR
INDIVIDUALS WITH DISABILITIES
Mr. Regula. Mr. Kennedy, you are introducing the next guest
Mr. Fyock, David Fyock.
Mr. Kennedy. Thank you very much for your testimony.
Thank you, Mr. Chairman. I am proud to introduce the Vice
President of the Pennsylvania Association for the Individuals
with Diabilities, Mr. David Fyock.
PAID is an initiative with the goal of decreasing
unemployment for those Americans with disabilities, and I
commend him for his work. Many of you may not know, but while
the unemployment rate nationally is 4 percent, the unemployment
rate for persons with disabilities between 18 and 64 is over 71
percent. In Rhode Island alone, in my State, there are over
160,000 adults with disabilities, and nearly 50 percent of them
earn less than $15,000 a year.
This organization is an organization that came to my
attention thanks to Congressman Murtha and his staff person,
Carmen Scialabba, who is also here with us today, and I am very
proud that both of them have been working hard.
I might add that even though this organization is called
PAID, neither one of them is paid for what they are doing. They
are working in a very selfless manner to advance the cause of
people with disabilities and help them get integrated into the
workforce and into American life. I thank you for that.
Mr. Fyock. Thank you, Mr. Kennedy, and thank you, Mr.
Chairman. In reality we are paid in the most important way
possible; that is, by helping other people. Thank you.
I am David Fyock. I am Vice President. PAID is a nonprofit
corporation whose goal is to help reduce the existing high
levels of unemployment of people with disabilities.
Right now, as Representative Kennedy said, the unemployment
levels for people with severe disabilities is over 70 percent.
That fact makes it obvious that we have a lot more work to do
in this country to help reduce that and to help these people
find good, well-paid, fulfilling jobs.
People who want to help bridge the gap between people who
want to work and need to work and a lot of high-tech jobs out
there that are going begging need to know a number of facts.
That is that 54 million people, 54 million Americans, have
disabilities; 17 million of them are of working age. Only 29
percent are employed now full or part time. Of those 12 million
unemployed, 79 percent would prefer to work.
In 1990, it was estimated that local, State and Federal
Governments spent more than $300 billion to assist unemployed
people with disabilities. Today that may well be closer to $400
billion. Aggressive steps to help unemployed people with
disabilities obtain well-paid employment can reverse this drain
on the Treasury by making more people with disabilities into
anxious and willing taxpayers.
People with disabilities clearly need a national placement
effort to maximize employment opportunities. PAID is working
with individual States' rehabilitation agencies to address the
task of matching available labor force with employment
opportunities. PAID is establishing a national labor exchange
for persons with disabilities to bring those individuals who
want to work and are willing to work together with the
potential employers who need to hire people.
As a step in that direction, PAID is working with the Hiram
G. Andrews Center in Johnstown and with representatives of the
other existing State schools that are comprehensive
rehabilitation centers. PAID is working with Rhode Island, with
Virginia, Maryland, West Virginia, Georgia, Arkansas, Kentucky,
Tennessee, and Michigan to extend its program into those
States. PAID is meeting next week in Providence with a group
brought together by Representative Kennedy and his staff to
discuss starting a branch there.
It is our goal to help establish similar branches in all 50
States. PAID needs your help to do this. Congress in the past
has taken steps to deal with this problem. The Rehabilitation
Act and the Americans with Disabilities Act both embrace the
vision of economic independence and the participation of people
with disabilities in all aspects of American life. However, the
actual provisions of these acts are not well known by the
disability community, by business leaders or service providers.
The need exists to expand awareness and opportunity, and PAID
will help to bridge the gap between these groups.
Individuals with disabilities constitute one of the most
disadvantaged groups in our society, yet disability is a
natural part of the human experience and in no way diminishes
the right of individuals to participate in the mainstream of
our society.
Increased employment of individuals with disabilities can
be achieved through training and education brought together
with meaningful opportunities for employment. People with
disabilities have repeatedly demonstrated their ability to
achieve gainful employment if appropriate systems for
preparation and support are provided.
It is our goal at PAID to help many other companies come to
the realization that not only is it good social policy to hire
people with disabilities, but it is good business policy. It
helps them make money because those people work extremely well.
They are dedicated workers.
I will stop there and thank you for this opportunity.
Mr. Regula. Thank you.
[The prepared statement of Mr. Fyock follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I say to all of our witnesses, we have 10
people to testify. We got about 20 minutes because the full--
when the full committee meets next door, we have to shut down
under the rules of the House. So, very much appreciate if you
can summarize your full testimony. It will be put in the
record, and the staff will read it. It is just unfortunate we
have gotten in a time problem today.
----------
Thursday, May 9, 2002.
NATIONAL NEUROFIBROMATOSIS FOUNDATION, INC.
WITNESSES
DAN STROEH, PLAYWRIGHT AND ADVOCATE, NATIONAL NEUROFIBROMATOSIS
FOUNDATION, INC., ACCOMPANIED BY PETER BELLERMANN, PRESIDENT,
NATIONAL NEUROFIBROMATOSIS FOUNDATION, INC.
Mr. Regula. So with that, Mr. Hobson, you are going to
introduce our next witness.
Mr. Hobson. I want to thank my friend Mr. Regula and Mr.
Kennedy for allowing me to be here today. It is a pleasure to
introduce Dan Stroeh, who is here to testify on behalf of the
Neurofibromatosis Foundation. Dan is a graduate of Wittenberg
University, which is located in my district and my hometown of
Springfield, although I was born in Cincinnati, which you will
hear about in a minute.
Chairman Regula should be familiar with Wittenberg since
his Mount Union Purple Raiders usually defeat Wittenberg on
their way to winning the division III football championships.
Mr. Regula. It is a new age.
Mr. Hobson. I believe in the past 9 years, Mount Union has
won six Division III football championships. Now, both Dan and
I congratulate Mr. Chairman for that, but maybe you can let
Wittenberg just win once in a while.
However, we are not here to talk about football. We are
here to talk about a genetic disorder called NF for short. A
native of Loveland, Ohio, near Cincinnati, Dan was diagnosed
with NF when he was 19, during his freshman year at Wittenberg.
Thanks to successful treatment at Children's Medical Center in
Cincinnati, and ultimately at NIH, Dan completed school and
graduated cum laude with a dual degree in English and theatre.
Like most theatre majors, Dan was involved in a number of
productions. The most pivotal production was an
autobiographical one-man play about his encounter with NF,
titled ``It is No Desert,'' in which he wrote, directed, and
starred. Dan received the 2001 National Student Playwright
Award for ``It is No Desert'' and performed at the Kennedy
Center last April.
Since graduation Dan has been a visiting artist at the
Sundance Theatre Lab, Chautauqua 2001, and currently lives in
New York where he is working on a play commissioned by the
Kennedy Center. In addition, his play ``It is No Desert'' will
be published later this year.
Unfortunately, in the interest of time, Dan is not going to
perform his play for you today, but he is going to give us an
overview of NF as a genetic disorder and, more importantly, the
advances the medical research community has made thanks to the
funding this committee directs to NIH as well as support from
the Department of Defense.
I tried to be very brief, sir.
Dan.
Mr. Stroeh. Thank you, sir.
Good afternoon. Mr. Chairman, and members of the
Subcommittee, I am pleased to be here today with my Congressman
Representative David Hobson and Peter Bellermann, who is the
President of the National Neurofibromatosis Foundation,
Incorporated. And I will try to keep my remarks as brief as
possible. But I am pleased to be here to talk about the
importance of NF research.
Neurofibromatosis is a surprisingly common genetic disorder
which causes a variety of serious and debilitating health
problems. I was unaware that I had it until I was 19. My family
had no history of the disorder. I was athletic all of the way
through high school until I discovered that I began to have
trouble walking. It was at this point that I went in for a CAT
scan and discovered that there were numerous growths around my
spine, and I was diagnosed with NF just as I was starting my
freshman year of college.
Neurofibromatosis is a genetic disorder that causes tumors
to grow along the nerves anywhere in the body. It also causes a
variety of other problems, including learning disabilities,
skeletal abnormalities, disfigurement, deafness, blindness,
loss of limbs and brain, spinal and dermal tumors. NF can also
be fatal.
There is still no way to prevent NF, and there is still no
cure, but prior Federal funding has helped lead to important
advances. Researchers are hopeful that a cure can be found
within the next 10 to 15 years and believe that this time frame
could possibly be cut in half if more research dollars were
made available. As a result, continued and aggressive research
in this area holds great promise for the more than 100,000
Americans with NF and related illnesses. In fact, NF research
has been so productive that scientists have moved from cloning
the NF gene to the start of clinical trials within a single
decade.
For me, the patient, 10 years may seem like a long time,
but I realize that in science and medicine it is a very short
time in which to reach these milestones. This progress is all
the more impressive when considering it has occurred with a
fraction of the private and public resources that are available
to other often less common medical conditions. But there is
still a long way to go.
The next step in the neurofibromatosis research agenda
includes continuing work in basic research, preparing
comprehensive natural history studies for NF, and maintaining
the all-important process of clinical trials with innovative
approaches. With these goals in mind, our goal continues to be
directing limited resources to support research activities that
will lead to better understanding, diagnosis and treatment of
NF and enhanced quality of life for persons with the disorder.
Congress and the Administration have demonstrated their
commitment to scientific advances in this field with funding
and directives for improved coordination at the National
Institutes of Health. As a disorder with multiple
manifestations that implicates several disciplines, the fight
against NF and the care of patients with NF require
multidisciplinary approaches. I can happily report that the NIH
Institutes are actively working together across their
institutional boundaries to address the needs of the NF
population.
In recent years this subcommittee has added language to its
Appropriations Committee report directing NIH to coordinate
their efforts across various institutes to find a cure for NF.
NF research has wide-ranging impacts beyond neurofibromatosis.
It has linked the disease to cancer, brain tumors and all
neurological developmental disorders. This subcommittee has
recognized that the wide variety of symptoms of NF and the
significant potential that NF research has for the very large
patient population demands the continued integration of
neurofibromatosis research with the basic and clinical research
goals of NIH.
In summary, NF research demonstrates several things. First,
it attests to the foresightedness and the wisdom of Congress to
continue to invest in basic medical research through NIH and
elsewhere. And NF is a compelling example of what happens to
such investments. These payoffs do come.
Second, public-private partnerships can and do work. The
collaboration between the Federal NIH and the Department of
Army's CDMRP and the private Howard Hughes and National NF
Foundation is almost seamless. One leverages the other in NF
research to move the science forward.
Finally, NIH institutes are capable of effective
collaborations across multiple disciplines. They are clearly
demonstrating the rewards in terms of cost savings, efficiency
and improved medical care for large patient populations.
Today I am asking that you continue to provide clear
directives to the National Institutes of Health to express the
Subcommittee's commitment to NF research conducted at NIH and
to ensure that the level of funding to find the cure for
neurofibromatosis continues to grow every year.
NF has had a tremendous research success story for all of
those who are invested in it. Chairman Regula and members of
the Subcommittee, on behalf of National NF Foundation,
Incorporated, as well as the thousands of children and the
adults affected by NF, I thank you for your continuing support.
Mr. Regula. Well, thank you for bringing this to our
attention. Certainly we will be looking at it.
[The prepared statement of Mr. Stroeh follows:]
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Thursday, May 9, 2002.
SOCIETY OF GYNECOLOGIC ONCOLOGISTS
WITNESS
JAMES MAXWELL AUSTIN, JR., M.D., PRESIDENT, SOCIETY OF GYNECOLOGIC
ONCOLOGISTS
Mr. Regula. Dr. James Austin. Dr. Austin.
Dr. Austin. Mr. Chairman and Mr. Kennedy, in the essence of
time, I am going to be brief with my presentation. Our
statement has been given to you.
But I come here representing GYN/oncologists, who are
physicians that take care of women with cancer. We are patient
advocates for our patients, and we are a small group of
physicians, only 1,000 in this country, but we feel so strongly
that we want to present before you.
We feel like we need to continue to support NIH, NCI and
the CDC in all of the efforts against women's cancer. We need
to fund at the present level and even increase if we can.
Some very outstanding developments have taken place in the
last year. For instance, we may have a blood test for ovarian
cancer now. We also are very, very well along the path for a
vaccine for cervical cancer. Cervical cancer kills more women
in the world than any other disease process. It is the number
one killer of women. In our country it is not, but there would
be a very, very significant effort if we proceed with the same.
We also thank you for the support you have given us in the
past, but we need more.
Mr. Regula. NIH is working on this, I assume.
Dr. Austin. Yes, sir.
Mr. Regula. And there is a lot of breakthrough taking
place.
Dr. Austin. Yes, sir. We are just beginning to scratch the
surface. So we need to have the impetus to go ahead.
Mr. Regula. Thank you for coming and making your statement
abbreviated.
[The prepared statement of Dr. Austin follows:]
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Thursday, May 9, 2002.
AMERICAN HEART ASSOCIATION
WITNESS
TRACY WEBBER, VOLUNTEER, STARK COUNTY, OHIO, DIVISION OF THE AMERICAN
HEART ASSOCIATION
Mr. Regula. Next is Tracy Webber, Stark County, American
Heart Association.
Ms. Webber. Good afternoon. I am a 45-year-old American
Heart Association volunteer from Ohio. I am a stroke and heart
attack survivor. I wouldn't be here if it weren't for the new
technique used to save my life. I am proof that research saves
lives.
Thank you for your outstanding leadership in providing
historic funding increases for NIH and CDC, but I am concerned
that heart disease and stroke research prevention programs
receive inadequate funding. The budget for heart disease
receives 8 percent of the NIH budget, and stroke receives 1
percent. Also, only 6 States receive comprehensive funding from
the CDC to prevent and control heart disease and stroke. We
must do more.
Heart disease is still our number one killer, and stroke is
our number three killer. Heart disease and stroke and other
cardiovascular diseases kill nearly 1 million Americans and
cost us more than any other disease, an estimated $330 billion
this year. Nearly 62 million Americans live with the often
disabling effects of those diseases.
Please remember, strokes and heart attacks do not only
happen to other people. No one knows when family tragedies will
strike. It will change your life forever.
Thank you so very much for your time today.
[The prepared statement of Ms. Webber follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Was quick response the key to your being well
in view of the fact that you had these?
Ms. Webber. Yes. And having a stroke specialist on staff.
Mr. Regula. Getting a quick response and treatment, that is
really very important. Thank you very much for coming.
----------
Thursday, May 9, 2002.
NATIONAL KIDNEY FOUNDATION
WITNESS
JANET MELSON BURNS, VOLUNTEER, NATIONAL KIDNEY FOUNDATION OF THE
NATIONAL CAPITAL AREA, INC.
Mr. Regula. Janet Burns, National Kidney Foundation.
Ms. Burns. Good afternoon. Thank you so much for giving me
the opportunity to testify on behalf of the National Kidney
Foundation. I will make mine as brief as possible.
Since July 2001, I have needed dialysis treatment three
times a week because my kidneys failed. Fortunately I was
better prepared for kidney failure than many dialysis patients.
I monitor my diet and control my blood pressure, and I am
convinced that I would have needed to initiate dialysis sooner
if I had not received the benefit of predialysis care.
Predialysis care has had a positive impact on my health, making
it possible for me to continue to pursue a fulfilling career.
My written statement that was submitted 2 weeks ago
mentions my hope for a kidney donor. Just last week I learned
that a neighbor and good friend had received medical clearance
to donate one of her kidneys to me. Not all dialysis patients
are so fortunate, as many spend years on the transplant list.
Twenty million Americans have signs of kidney disease, and
an additional 20 million individuals in this country are at
risk for kidney disease. Most of these individuals are unaware
of this danger to their health. This finding of the National
Kidney Foundation prompts a call to action for new and
additional research and education programs in both the public
and private sectors.
I am encouraging this subcommittee to allocate more money
to help with this effort of research and public development of
education programs for both the public and private sector. I
also encourage this subcommittee to provide more research in
the area of diabetes. Diabetes is the most common cause of end-
stage renal disease, accounting for 43 percent of new cases.
Dialysis patients who have diabetes tend to be sicker and
more debilitated. The National Institute of Diabetes and
Digestive and Kidney Disease, NIDDK, supports an impressive
portfolio of basic research concerning diabetes, but it should
augment that commitment by devoting additional resources to
investigate the relationship between diabetes and kidney
disease, develop new approaches to prevent or delay kidney
failure caused by diabetes, and improve the health of patients
who suffer from both diabetes and kidney disease. This problem
will become even more critical in the near future due to the
increase of the prevalence of the type 2 diabetes.
Living organ donation. The number of individuals serving as
living organ donors in this country increased by 122 percent
between 1990 and 1999. With this dramatic rise it is important
that the transplant community assure the well-being of these
donors. In June 2000, NKF and the American Association of
Transplantation, the American Society for Transplant Surgeons
and the American Society of Nephrology endorsed the development
of a living donor registry to collect and evaluate demographic,
clinical and outcome information on living donors. Such a
registry would improve the transplant community's understanding
of the long-term consequences of living donation and would
enable physicians to evaluate the impact of changes in criteria
for donor eligibility.
We request congressional support for this initiative, which
could be administered by the Health Resources and Services
Administrations Division of Transplantation. We also urge
Congress to fund the Administration's fiscal year 2003 request
for organ transplant programs to help support organ donation
awareness activities.
Thank you for your consideration of our request.
Mr. Regula. Thank you for coming.
[The prepared statement of Ms. Burns follows:]
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Thursday, May 9, 2002.
LYMPHOMA RESEARCH FOUNDATION
WITNESS
BARBARA FREUNDLICH, MEMBER, BOARD OF DIRECTORS, LYMPHOMA RESEARCH
FOUNDATION
Mr. Regula. Barbara Freundlich from the Lymphoma Research
Foundation.
Ms. Freundlich. I will make this real quick. Barbara
Freundlich from the Lymphoma Research Foundation.
I do not now and I have never had lymphoma, yet I consider
myself a lymphoma survivor. Eleven years ago my husband Jerry
was diagnosed with this disease, and we were told that he had a
50/50 chance of cure. Fortunately, he was one of the lucky
ones.
I call myself a survivor because a diagnosis of lymphoma
touches not only the patient, but the entire family. In 1994,
Jerry and I founded an organization to fund research and to
provide support and education for lymphoma patients. What I
have learned since we were plunged into this world of lymphoma
is that for many lymphoma patients the word "cure," even a 50/
50 chance, is not a part of their vocabulary. Those with slow-
growing lymphomas typically follow a pattern of remission,
relapse, remission, but there is no known cure. And for those
whose lymphoma proves resistant to treatment, their once hope
for a cure becomes a very difficult and painful reality.
To be truthful, when Jerry was first diagnosed we weren't
even certain that lymphoma was a kind of cancer. We heard of
Hodgkin's disease, but the name non-Hodgkins lymphoma was
foreign to us. Since then it seems every week we learn of
another friend, a friend of a friend, a relative, someone
diagnosed with this disease. And if there are those of you here
on this committee and in this room who have not been touched by
lymphoma, I can say with certainty that you will know or hear
of someone in the near future.
Lymphoma has been on the rise, and no one really knows why.
There is no known preventive diet or lifestyle that one can
adopt to prevent this disease. There is no diagnostic test such
as the mammogram or PSA test to predict lymphoma.
I will make this really quick. The one quick action that we
request is that Congress fund the programs that are included in
the recently passed Hematological Cancer Research Investment in
Education Act. The bill passed the House this past April 30th
during our Blood Cancer Coalition's advocacy days. It was
especially gratifying to the hundreds of patient advocates who
came to Washington last month to speak on behalf of the blood
cancers.
We are thankful for the efforts of Representatives Crane
and Roukema and to Vic Snyder, who introduced the House
companion bill H.R. 2629, and we urge the Subcommittee to act
on the key provisions of the bill.
I thank you for this opportunity to speak. On behalf of the
thousands of people living with lymphoma, we may speak softly
now, but as our numbers increase, so will our voice. Thank you.
Mr. Regula. Thank you.
[The prepared statement of Ms. Freundlich follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 9, 2002.
DYSTONIA MEDICAL RESEARCH FOUNDATION
WITNESS
ROSALIE LEWIS, PRESIDENT, DYSTONIA MEDICAL RESEARCH FOUNDATION
Mr. Regula. Rosalie Lewis, President Dystonia Medical
Research.
Ms. Lewis. Thank you, Chairman. The same. I will keep it
very brief.
Not only am I the President of the Dystonia Medical
Research Foundation, but I am the proud parent of three of four
sons who have the disorder. Dystonia is a neurologic disorder
that can affect any part of the body, and indeed affects close
to 1 million people in the United States today.
This is contrary to what we had expected before. We were
told only 350,000 people. But a recent pilot study that the
Dystonia Foundation funded indeed showed that there are as many
people with dystonia in the U.S. that have Parkinson's disease.
So we are looking at a disease that is exploding in the Nation.
It can affect your eyes, making you essentially blind. It
can affect your neck, making you twisted; your speech.
Spasmatic dysphonia that Diane Rehms has is dystonia, and in my
children's position, it unfortunately affects their entire body
so that walking is difficult; writing is impossible.
The NIH has been extremely helpful and in partnership with
the Dystonia Foundation. I want to thank you and the Committee
for the efforts you have put forward. I would like to ask you
to continue the funding because you are getting results.
The research that is coming out of dystonia is spilling
over into Parkinson's and into to Alzheimer's. It is a model
disease to fund. So I appreciate it. I will let somebody else
have some time.
Mr. Regula. Thank you. We will be giving a substantial
increase to the NIH. Thank you.
[The prepared statement of Ms. Lewis follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 9, 2002.
AMERICAN UROLOGICAL ASSOCIATION
WITNESS
DARRACOTT VAUGHAN, JR., PRESIDENT, AMERICAN UROLOGICAL ASSOCIATION
Mr. Regula. Dr. Darracott Vaughan.
Dr. Vaughan. Thank you for allowing me to make it here at
the end. I will be brief.
I am President of the American Urological Association and
the 10,000 urologists who take care of patients and young
people, men and women.
There are three areas that I would like to discuss. First,
thank you for your continued support to the National Cancer
Institute. We still need more money for exciting new research
in prostate cancer; 32,000 men still die of that disease per
year. And we need to increase that funding. At the CDC we have
an educational program for prostate cancer and prostate
diseases. That needs to be increased in its activity, and that
group of people also needs to take more cognizance of the
different men's groups and listen to them to give them advice
as they put this together. They have not been terribly
responsive to some of the patient groups.
Thirdly, at NIDDK, which is our home for women's disease,
for children's disease, for diabetes and for other urologic
problems of the bladder, we need to have better coordination of
that institute and more voice for urology.
You have heard some elegant statements concerning diabetes
today. Don't forget the bladder and the sexual dysfunction that
occurs with diabetes. That should be included. And we need more
O'Brien Centers. I testified years ago when we started those
centers. We need more for urology, for pediatric urology.
Thank you.
Mr. Regula. Thank you.
[The prepared statement of Dr. Vaughan follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, May 9, 2002.
NATIONAL ASSOCIATION OF SCHOOL NURSES
WITNESS
LINDA WOLFE, PRESIDENT, NATIONAL ASSOCIATION OF SCHOOL NURSES
Mr. Regula. Linda Wolfe, president of the National
Association of School Nurses.
Ms. Wolfe. Thank you. I am Linda Wolfe. I am President of
the National Association of School Nurses, and so I represent
school nurses throughout the United States who serve children
in our schools, and also those families in the armed services
abroad. We are dedicated to improving the health and
educational success of children, and so today I am here to talk
about the rising epidemic of obesity in our children.
I would ask people in the audience if they would consider
what they had for breakfast, or perhaps if we had time for
lunch today, and how many hours of exercise we are going to
spend, how many hours towards exercise this week.
See, our children are watching what we and those around us
do, and poor nutrition and inadequate exercise is going to
shorten their lives. It is our responsibility to teach them how
to live.
The percentage of young people who are overweight has more
than doubled in the past 10 years. It is estimated that 4.5
million children are obese. I am not going read you all of
those figures, but in a typical classroom of 30--if we had 30
13-years-olds, in that classroom alone there would be three
students who were clinically obese, and out of those three,
they would be at special risk for heart attack. This growing
trend of obesity is happening to children in every classroom.
You have heard about diabetes today. We are starting to see
more and more cases of diabetes in our young people being
diagnosed with type 2 diabetes, which we have always called
adult-onset diabetes. School nurses are concerned about this.
Out of that typical classroom of 30 students, only 6 of them
eat what they should every day.
So we have four recommendations, and this is all fleshed
out in the written part. But our four recommendations are, one,
that daily quality physical education must be ensured for all
school grades. Currently there is only one State in the
country, Illinois, that requires physical education for grades
K to 12.
Our second recommendation is that more nutritious food
options are available to our children. And at school events,
you know about the soda contracts and the junk food that is
available. USDA has outlined a lot of good promises. They need
to be supported.
Our third recommendation is supporting the coordinated
school health programs established by CDC, which takes a
multidisciplinary approach to holistically addressing the
inactivity and the unhealthy diets of children.
And our fourth recommendation is that healthy eating
programs must be encouraged and supported. We heard about
asthma earlier and the importance of education.
Thank you from the school nurses for the opportunity to
speak.
[The prepared statement of Ms. Wolfe follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Would it help if the vending machines had
apples instead of candy bars?
Ms. Wolfe. Sounds good to me.
Mr. Regula. How is your school? Are you at a school?
Ms. Wolfe. My school, I was in elementary school, so the
vending machines aren't available to our young people.
Mr. Regula. That is something that ought to be looked at.
Thank you very much for your testimony.
----------
Thursday, May 9, 2002.
THE PROSTATITIS FOUNDATION
WITNESS
CLARK HICKMAN, ASSOCIATE DEAN FOR CONTINUING EDUCATION, ASSISTANT
PROFESSOR OF EDUCATIONAL PSYCHOLOGY, RESEARCH AND EVALUATION,
COLLEGE OF EDUCATION, UNIVERSITY OF MISSOURI-ST. LOUIS
Mr. Regula. Dr. Clark Hickman.
Dr. Hickman. Thank you, Mr. Chairman. I am representing the
Prostatitis Foundation. I am a former sufferer of prostatitis
myself, which is sometimes ignored in prostate diseases. It is
an inflammation of the prostrate gland as opposed to the benign
prostate hypertrophy that comes with older age as well as
prostate cancer.
The CDC estimates that 50 percent of men sometime in their
life will experience symptoms of prostatitis. In 1996, Richard
Alexander at the University of Maryland School of Medicine
testified before this committee as to the dearth of knowledge
in the medical community regarding prostatitis and outlined
systematic steps to empirically research the problem, and I am
one of the teachers that has researched the problem.
In the ensuing 6 years, some progress has been made in this
area, especially through the Chronic Prostatitis Collaborative
Research Network. Scientific work is continuing in this area to
learn as much as possible about the multiple facets of this
disease. Therefore, in order to make this brief, cutting to the
chase, I am asking for an increase in funding for the Chronic
Prostatitis Collaborative Research Network, currently being
funded in the National Institutes of Diabetes and Kidney
Diseases, NIDDK, at NIH, which is due to expire this fiscal
year 2003, a modest amount moving the budget up to $3.5
million. This would allow for additional research centers and
continue the progress they are making.
And we also want a scientific and clinical workshop with
international expertise to be held in 2003 to disseminate the
findings of the research network and the development of a
strategic plan.
[The prepared statement of Dr. Hickman follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. It doesn't have an age factor? Young men could
be afflicted as well as older?
Dr. Hickman. It is typically a younger man's disease. It
strikes between 18 and 23.
Mr. Regula. Really?
Dr. Hickman. In a study I did of 70 men last year, I got
age ranges of 18 to 80.
Mr. Regula. What is the treatment?
Dr. Hickman. Right now there is no efficacious treatment.
Typically you go into a doctor's office, you get the requisite
10-day supply of antibiotics, they hope you don't come back. If
you do, they shrug their shoulders and say that you have to
live with it.
We just don't understand this disease. We don't understand
what causes it, let alone treat it. It is a very painful
disease. I am in touch with everybody from police officers,
Navy men. A Secret Service agent down the street is on leave
now because he can't perform his job. It just brings you to
your knees.
Mr. Regula. It affects the urinary tract, I assume.
Dr. Hickman. Yes. You get pain in the pelvic area, burning,
there can be rectal dysfunctions, and it just lessens the
quality of life considerably.
Mr. Regula. At the moment no cure on the horizon.
Dr. Hickman. No cure on the horizon, but with continued
money through the NIH, Dr. Alexander and his team and the
research collaborative are taking great strides.
Mr. Regula. Are they aggressive in their research?
Dr. Hickman. Very. And they are getting some good results.
Mr. Regula. Thank you very much.
----------
Thursday, May 9, 2002.
NATIONAL ASSOCIATION OF ANOREXIA NERVOSA AND ASSOCIATED DISORDERS
WITNESS
SHEILA DEARYBURY WALCOFF, WASHINGTON, D.C., REPRESENTATIVE, NATIONAL
ASSOCIATION OF ANOREXIA NERVOSA AND ASSOCIATED DISORDERS
Mr. Regula. Okay. We are going to make it. Sheila Dearybury
Walcoff.
Ms. Walcoff. Dearybury.
Mr. Regula. Washington, D.C. representative, National
Association of Anorexia Nervosa and Associated Disorders. You
are the last witness.
Ms. Walcoff. Thank you for hanging in there and waiting for
me to be number 23 out of 23.
Mr. Regula. Okay.
Ms. Walcoff. As you said, I am Sheila Dearybury Walcoff. I
am the Washington, D.C. representative of ANAD, the National
Association of Anorexia Nervosa and Associated Disorders.
Founded in 1976, ANAD is our Nation's oldest nonprofit
organization dedicated to alleviating the problems of anorexia
nervosa, bulimia nervosa and binge eating disorder.
ANAD's education, early detection and prevention programs
provide models for low-cost outreach services that benefit
hundreds of thousands----
Mr. Regula. Tell me, what does this--what happens if you
have anorexia nervosa? What are the symptoms?
Ms. Walcoff. Not eating. Well, it is typically a disease
that you see most often, particularly in movies. It has been
more greatly advertised in the last 10 years. Young women will
have a distorted body image, and no matter how thin they get,
they still believe that they are fat.
You know, I think you might recall the commercials that
were on NPR and some others in the last few years. I wake up in
the morning, I think I am fat. You know, I go to breakfast, I
think I am fat. It is a distorted body image that results in
basically anorexia, not wanting to eat, not wanting to feed
one's body.
Mr. Regula. It is mentally driven to some extent.
Ms. Walcoff. It is a mental illness, a very severe mental
illness.
In my testimony I pointed out some recent genetic studies.
It has become very important in terms of treating mental
illnesses to, you know, identify biological bases.
Mr. Regula. Any age components?
Ms. Walcoff. Primarily young women. Also affects young
boys, but really crosses all boundaries, all ethnic boundaries,
all age boundaries. Men also suffer from eating disorders.
Mr. Regula. What is the treatment?
Ms. Walcoff. Primarily it is--I have to admit that I am an
attorney and not a doctor, so I can't speak completely
confidently in terms of all treatment practices, but in-patient
treatment is most often recommended, intense treatment to get
in and reeducate the victim to try to help them have a better
understanding of good nutritional eating habits, positive body
image in order to really change the way that they think about
themselves, accepting themselves in order to properly feed, you
know, their body in order to live and to be a productive member
of society.
Mr. Regula. Is there research going on now at NIH?
Ms. Walcoff. I am not sure about NIH. The mental--in the
mental health section of that there is research ongoing. And
there have been a number of studies--I actually pointed to an
Ohio study in my testimony that talks about how to develop,
better prevention and better education programs.
One of the key things is identifying this disorder early so
that you can get the victim into a program, which they can be
treated, and that makes the treatment more successful over
time.
Mr. Regula. You are seeking research money with NIH?
Ms. Walcoff. Research money and also educational programs.
The woman that actually--she is still here--that testified sort
of on the other side of this in terms of adolescent and
childhood obesity, it is really, you know, part of the same
problem. It is part of not understanding nutritional eating
habits, getting proper exercise, having a good self-image. It
is education in terms of how to feed yourself and also, you
know, taking away the very unhealthy, destructive images that
are really forced upon our society through the Internet,
television. The multibillion-dollar diet industry really
promotes destructive eating habits. Being able to teach
children, starting from a very young age how to properly eat,
feed their bodies.
Mr. Regula. Education of the parents as well.
Ms. Walcoff. Parents and the medical community.
One of the most important things is enabling people to
recognize when there is a problem. You know, so often people
are rewarded. I actually had the opposite thing. My parents
rewarded me when I cleaned my plate. If I had seconds, that was
even better. But, you know, not rewarding our youth for
unhealthy eating habits and eating practices.
Mr. Regula. I assume that Hollywood, the magazines are a
factor, because they worship the altar of thinness.
Ms. Walcoff. Very significant factor. It really comes down
to, the images you get; what is a positive body image, what is
a realistic weight to be, what is a healthy weight to be. You
know, not always thinking, I can lose another 5 pounds, I can
be thinner, I am not a successful person unless I am thin.
Mr. Regula. You are seeking money for NIH research then?
Ms. Walcoff. Yes.
Mr. Regula. NIMH?
Ms. Walcoff. So many acronyms.
[The prepared statement of Ms. Walcoff follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I want to thank all of you for sticking with
us. If you are not familiar with the system, those two lights
and two bells mean you have a vote on the floor. So the timing
is exquisite.
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
AGENCIES APPROPRIATIONS FOR 2003
----------
Thursday, April 18, 2002.
EDUCATION BUDGET; TITLE I; IDEA; 21ST CENTURY COMMUNITY LEARNING
CENTERS
WITNESS
HON. ALBERT R. WYNN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MARYLAND
Mr. Regula. We will get started this morning. We have a
long morning, a lot of requests, I think. And, Mr. Wynn, you
get to lead off today.
Mr. Wynn. Well, thank you very much, Mr. Chairman. And good
morning. I will try to move quickly. I would like to divide my
testimony into two parts. First, I'll talk about three
programs, and while they are very important to my district,
they are important to every district in our country,
nationwide. That would be Title I, the IDEA special education
plan, and then the 21st Century Learning Centers.
The second part of my testimony will focus on a few
projects specific to my district that I want to apprise the
committee of. We will, of course, be submitting specific
detailed written requests, but I wanted to, as they say, get it
on the radar screen.
With that in mind, I would like to begin by talking about
Title I, which is a very important program for disadvantaged
students. About a third of the students in my school districts
have schoolwide Title I programs. In fiscal year 2003, the
House budget is $11.5 billion for 2002.
I am pleased that the increase--obviously it is a
significant increase, but nonetheless it is significantly below
the $16 billion authorized for this program in the No Child
Left Behind Act. So really what I am here to say with respect
to Title I is I hope the committee will be able to move closer
to the authorized level in the bill rather than the budget's
figure that we----
Mr. Regula. Depends on our allocation.
Mr. Wynn. Exactly.
Second, IDEA programs. Special ed, of course, is very
important. Again, there is a significant gap between our goals
and what we are currently looking at. I understand we are
looking at approximately $8.5 billion in 2003, which would
cover about 18 percent of the cost of these services. Some time
ago, Congress made a commitment to provide 40 percent of these
services. The thrust of my comments on special ed is simply
this. The less the Federal Government pays, the more local
governments have to pay, and that takes away from other
education programs. And the consequences, I think, are pretty
obvious there.
Probably one of the programs dearest to my heart is the
21st Century Learning Centers. We designated a need to provide
programs for young people after school: academic programs,
athletic programs, arts and crafts, cultural programs, personal
development programs. And the fact is, we are basically flat
funding this program. Substantially less than was authorized
again in the No Child Left Behind Act which would be about 1.25
billion as opposed to the $1 billion we are looking at.
So those are the areas of concern that I have overall. And
I realize you have great limitations. We are cutting about $90
million out of the No Child Left Behind Act, including 28
programs that deal with the problems such as drop-out
prevention, particularly of concern to Hispanic and the
African-American communities, rural education programs, as well
as civic education, which is important in terms of rebuilding
character among our young people.
Having talked about these 3 areas that are important from a
national perspective, I would like to talk specifically about
my district. The first project dealing with an allocation that
I will be requesting in writing deals with an allocation to the
Prince Georges Community College. This request is based on the
events of September 11th. Prior to that, the community college
used facilities at Andrews Air Force Base. You are probably
familiar with that.
Well, that base also housed our local community college, a
significant portion of it, not its entirety. Roughly a thousand
students attended. A third of them were military personnel. The
other two-thirds were not. And, as a result of some
restrictions, there was a disruption. Classes resumed, but it
is anticipated that given our current climate that this will
not be a hospitable location for civilian community college
classes. We will be submitting a detailed request to assist
with off-site housing for the community college programs.
Mr. Wynn. The second request is a program at Bowie State
University, which is in our colleague Mr. Hoyer's district,
adjacent to mine, which serves a large number of students from
my district. It is a historical black college in Prince Georges
County. We are looking to develop and design a bioscience
training laboratory that will teach analytical technologies
used to identify biological agents--obviously since September
11th this is a major issue, particularly important to the
Washington metropolitan area, given our location in relation to
the terrorist threat.
The university is close to Washington, D.C. And would be an
ideal location. We have been providing the committee with
details on that.
The third project I wanted to--the specific project I
wanted to bring to your attention from the Children's Rights
Council. You may be familiar. They are promoting parenthood or
parenting between divorced parents. One of the issues is the
transfer of the children when there are cases of domestic
conflict. We are going to ask for an additional 25 child
transfer centers which provide supervised settings so that one
parent can drop off a child at a neutral site and the other can
pick up at a neutral supervised site.
Actually in my law practice, I saw an unfortunate incident
where a McDonald's was used and the McDonald's ended up being
shot up because the two parents could not get along. Cars were
crashed. It was quite a situation.
But I think this is a worthwhile project. I hope you will
give it full consideration.
And, finally, we would like to secure funds for our high
school debate program. A lot of emphasis is placed on athletics
to help disadvantaged students. Academic reinforcement is
obviously very important. But we would like to promote a high
school debate program that would take a somewhat different
focus and provide young people with the opportunity to engage
in policy debate at the high school level. I think this would
be a very worthwhile activity.
Mr. Regula. Have you presented these in the order in which
they are important to you? Have you prioritized? Because you
know obviously we cannot do everything.
Mr. Wynn. I am well aware of that. I have presented them in
order of priority.
Mr. Regula. So the way you have listed them in your
presentation would be your priorities?
Mr. Wynn. That is correct, sir.
Mr. Regula. Thank you very much for coming.
Mr. Wynn. Thank you very much for your indulgence, Mr.
Chairman. Have a nice day.
[The prepared statement of Congressman Wynn follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
I don't think that we have another Member here. Here is--
okay. Welcome. You are on.
----------
Thursday, April 18, 2002.
TRAUMATIC BRAIN INJURY ACT--HRSA, NIH, CDC; PROJECTS
WITNESS
HON. BILL PASCRELL, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW JERSEY
Mr. Pascrell. Mr. Chairman, I want to begin by thanking you
and the Ranking Member, who is not here, for dedicating so much
time to hear public and Member testimony. I will provide the
longer version to you, and I will go quickly through this.
Mr. Regula. I appreciate that.
Mr. Pascrell. An issue of utmost importance to me and many
Members is the condition known as traumatic brain injury, Mr.
Chairman. And we have done a lot of work in the last few years
on a bipartisan basis along this line.
Every year millions of Americans experience TBI, and about
half of these cases result in at least short-term disability.
It is about 80,000 people who sustain severe brain injuries
leading to long-term disability. TBI is defined as an insult to
the brain caused by an external force that may produce
something as small as a concussion to impairing a person of
cognitive abilities, physical functioning. It even can change a
person's behavior, emotional function.
I am very committed to this issue. And we formed, myself
and Congressman Greenwood, a task force on the brain injured 2
years ago. I wanted to bring to your attention three programs
that were expanded in scope and responsibility by the TBI Act
to urge you to fully fund at $36.8 million.
The first program I would like to bring to your attention
is the State grant program administered under the Health
Resources and Services Administration. The TBI Act specifically
directs States receiving grants to develop, to change, or
enhance community-based service delivery systems for victims of
TBI. I request for the State programs and the P&I programs to
be funded at a total of 14.8 million.
The second program you should be aware of, Mr. Chairman, is
the CDC's effort to build on its work with State registries to
collect information that would help improve service delivery.
If we do not know who is out there we cannot--we do not know
the depth of the problem.
Since its inception for traumatic brain injury in 1996, the
CDC program has continuously been underfunded at $3 million.
Mr. Chairman, I am requesting a total of $3 million for CDC's
expanded activities.
NIH directs the National Center for Medical Rehab Research
to launch a cooperative multi-center traumatic brain injury
clinic trials network and fund five bench science research
centers via the National Institute for Neurological Disorders
and Strokes.
I request support for $15 million for these existing
programs at NIH. Those funds are sorely needed and will help a
great percentage of the estimated 5.3 million Americans living
with this disability as a result of traumatic brain injury.
In addition to TBI, there are also two project requests. I
will go through them quickly, Mr. Chairman. The first project I
am here to ask you to support is the 21st Century Institute for
Medical Rehabilitation Research. During the last cycle I asked
for $3 million. Congress provided $350,000 of that amount, for
which I am deeply grateful. I am here today to ask for the
remaining funds if that is at all possible. One of the areas
that could benefit from greater support is the field of
rehabilitation medicine and research.
Up until now this area has not seen the kinds of increases
that many others have enjoyed, and the need remains
substantial. One of the premier institutions in the country in
the rehab research field is in my Congressional district. It is
the Kessler Medical Rehab Research and Education Corporation.
Kessler Rehab Hospital decided to create a new and unique
effort in the United States. It is called the 21st Century for
Medical Rehab Research. State of the art, Mr. Chairman. You
would be very, very proud.
My second request is for St. Joseph's Medical Center at
Patterson for a total of $2,000,000, the first designated
children's hospital and the administrator of the largest WIC
program in the State of New Jersey. The $2,000,000 will allow
the institution to continue to serve and assist the region's
vulnerable pediatric population in 2 specific areas, pediatric
emergency department and the pediatric intensive care unit. It
is a vital urban safety net providing care for the region's
uninsured and underserved.
PICUs are crucial for the care of the region's pediatric
patients, as evidenced by its receipt of 254 transports last
year under agreements with New Jersey and New York hospitals.
The children's hospital emergency department recorded
30,000 pediatric visits last year. It is pretty outstanding.
Mr. Chairman, I really appreciate your indulgence.
Mr. Regula. I assume you have given the special requests in
the order in which they have priority with the----
Mr. Pascrell. I would be happy to answer any of your
questions.
Mr. Regula. Well, we probably will not have the ability to
fund everything.
Mr. Pascrell. Well, these are priorities, you know, and
everything is a priority, nothing is a priority. You know that
better than I do. These are three. I had about 8 or 9 of them.
I hope you can respond in some manner, shape or form. I always
trust your judgment and I will leave it at that.
Mr. Regula. Thank you. Do you have the project
questionnaire with you? If not, just get it to us.
Mr. Pascrell. I think we did.
Mr. Regula. Yes. Okay.
Mr. Pascrell. Thank you, Mr. Chairman.
Mr. Regula. Next Ms. Woolsey.
[The prepared statement of Congressman Pascrell follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. LYNN WOOLSEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Ms. Woolsey. Wow, this chair is hot.
Thank you, Mr. Chairman. This is a good opportunity. I
understand that we do not have all of the money in the world.
But again I am here to ask for education and health projects
for the 6th Congressional District of California just north of
the Golden Gate Bridge.
Mr. Regula. I have been there.
Ms. Woolsey. I know you have. You are usually there on the
park stuff. Yes, and Fort Baker.
Mr. Regula. What do you think of the rehab of Fort Baker?
They are trying to get a contractor to do it.
Ms. Woolsey. Right. They are going to make a good decision.
We have gotten some good infrastructure money now from DOD for
the rehab.
Mr. Regula. I think it is a terrific asset.
Ms. Woolsey. I know. I thank you for your interest. You are
already familiar with Center Point, a nonprofit comprehensive
drug and alcohol treatment center in my district. And Center
Point is one of the very few drug and alcohol treatment centers
nationwide that provides comprehensive social, education,
vocational, medical, psychological, housing and rehabilitation
services.
Mr. Regula. We gave them a half a million last year.
Ms. Woolsey. Right. They are here asking for $350,000 this
year in order to----
Mr. Regula. That is still your number 1 priority?
Ms. Woolsey. It is my number 1 priority.
Next, Sonoma State University is in my district. It is the
only public 4-year university in the 6-county region north of
the San Francisco Bay. It is a really good school that is doing
great work.
On behalf of Sonoma State, I am asking for $1 million from
the fund for the improvement of post secondary education,
FIPSE. And they need this for laboratory equipment for their
master's program in computer engineering sciences. And it would
be very useful to them and helpful if we could give them that
funding.
And I need to brag a minute about the Yosemite National
Institute. The Yosemite National Institute conducts
educational, rigorous hands-on environmental science programs.
And they are in my district and elsewhere in California.
When I first came to this subcommittee on Yosemite's behalf
2 years ago, less than 10 percent of their students were from
low income and/or minority families. But, with the help of
Federal funds, Yosemite has been able to make these programs
available to low income minority communities that have
traditionally not had access to quality science-based
educational education.
Today almost 40 percent of Yosemite's students receive
scholarships. That is why I support their request for $1
million so that they can increase their outreach.
Now those are good statistics for Yosemite and Center Point
has got good statistics. But we have some really bad statistics
in my district. And that is about the success rate in our fight
against breast cancer in Marin County. Marin County is the
district--well, you know all of that. Patrick, you know that,
too, don't you?
But Marin County has the highest rate in the Nation of
breast cancer cases and deaths for Caucasian women. And that
figure is increasing at an alarming rate, and we have no idea
why. Half of the breast cancer cases in Marin County cannot be
explained by known risk factors, by mothers and grandmothers,
and having had breast cancer.
And that is why I am asking for $1\1/2\ million from the
Center for Disease Control to expand breast cancer research and
health outreach programs in Marin County. We have twice already
helped them, not--to almost a million dollars, but now they are
ready to go with their project to find out what is going on.
And then, finally, Mr. Chairman, we have another university
in my district. This one is a private university. It is
Dominican University. It used to be Dominican College. They are
seeking Federal assistance, and we do not know the amount yet,
for a center--to build a center for science and technology.
Their center will teach teachers and nurses who will then be
able to go into the hospitals and to the schools and expand our
access to high-tech people so we do not have to go overseas and
hire them.
So that is the 6th Congressional District, a leader in
meeting the health and education needs of the 21st Century, but
needing help along the way. Absolutely a donor district in this
country for taxes. I made a commitment to them that it is my
job to make sure that they get some of something back.
Mr. Regula. Is Center Point your number 1?
Ms. Woolsey. Center Point is my number 1, continues to be
my number 1.
Mr. Regula. Mr. Kennedy, any questions?
Mr. Kennedy. No. But thank you.
Ms. Woolsey. Thank you. Thank you both. A part of something
for all of it would be good. I mean, rather than have
everything going to one program.
Mr. Regula. You would rather divide it up?
Ms. Woolsey. I would. Thank you very much.
Mr. Regula. Well, we do not have any more members here at
the moment. Good morning.
[The prepared statement of Congresswoman Woolsey follows:]
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Thursday, April 18, 2002.
CHILD ABUSE PREVENTION AND TREATMENT ACT
WITNESS
HON. JOHN B. LARSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CONNECTICUT
Mr. Larson. Thank you, Mr. Chairman. I want to thank both
you and Ranking Member Obey and the distinguished Members of
the Subcommittee and my dear colleague, Patrick Kennedy.
I am grateful for the opportunity this morning to bring to
your attention the needs of the underfunded programs in the
Child Abuse and Prevention and Treatment Act.
I join with a host of sponsors from my district who have
aligned themselves with the National Child Abuse Coalition to
ask specifically that CAPTA receive an appropriation equal to
its fully authorized amount, $70,000,000 for basic State
grants, 66,000,000 for community-based prevention grants, and
30,000,000 for research and demonstration grants.
It is my hope that with this funding, we will be one step
closer to ensuring the safety of our Nation's abused children.
As I am sure you know already, Mr. Chairman, and Members of
this committee, in 1999 the Department of Health and Human
Services reported that child prevention services agencies
received over 2.9 million reports of suspected child abuse and
neglect.
National incident studies found since 1988 all forms of
abuse and neglect, sexual, physical and emotional, have risen
at least 42 percent, while some individual types of neglect
have risen over 300 percent.
Unfortunately, funding for neither CAPTA nor the CPS
agencies has kept pace with the scope of this problem, Mr.
Chairman, which by way of anecdote, and I know that you are
inundated all of the time with the numerous amounts of data and
information, but I think for Members of Congress the most
compelling thing is when we have people visit our office and
have an opportunity to express their concerns. I was visited
most recently by a dear friend, Eva Bannell, who is a child
abuse victim herself, who like so many has only recently come
forward and acknowledged this and is dealing in her own way
with this concern. And yet she comes forward not so much for
herself, but to be an advocate on behalf of children and to
make sure that children in the future are spared the ravages
and God-awful problematic things that she encountered having
gone through what has got to be a horrific situation.
I commend her. I thank her and the coalition for bringing
this very important issue before you. I know, Mr. Chairman, you
have many weighty things that you have to balance in the course
of putting an appropriations bill together. But clearly the
concern for the abused children in this Nation I know will take
precedence in the Committee's deliberations.
I have further written testimony that I would like to
submit.
Mr. Regula. It will be made part of the record.
Mr. Larson. But I wanted for the record, especially when we
have courageous people like Eva Bannell who come forward, are
willing to both talk about their own experience, but do so not
in seeking something for themselves, but clearly in wanting to
be advocates to spare all children from what they have
experienced. Thank you very much for the opportunity to appear
before the Committee.
Mr. Kennedy. Thank you, Mr. Larson. I have had the chance
to also meet with Eva Bannell, who is an extraordinary woman,
great advocate for her cause. Thank you for your work to be an
advocate for this very important cause.
Mr. Cunningham. Just a question. In San Diego the child
protective services, we had a real bad problem. As a matter of
fact, we had a court case that almost went a year against the
Advocates Child Protective Services that they got overhanded a
little bit and they were ripping children out when they really
should not.
Now I know there is a fine line. But have you had that
problem?
Mr. Larson. No. In fact, I think the importance of the
moneys that we have been able to receive, for example, in the
State of Connecticut with child protective services, the grants
that we received have provided the moneys for the additional
kind of training. And I think that is to your point, very
important that the people that we have going in understand
there is a very fine line here. And what that means is that
they have to be trained appropriately, have the appropriate
kind of education and counseling background and work to achieve
that goal. But that has not been the experience in the State of
Connecticut. In fact, we have been benefited tremendously and
have been able to leverage the Federal dollars that we need
these in instances, Duke.
Mr. Cunningham. My daughter is up at New Haven, in Ms.
DeLauro's district. She will tell you that she is an abused
child because I do not give her enough money.
Mr. Larson. Well, we will not report that.
Mr. Cunningham. Thank you.
Mr. Larson. Thank you, Mr. Chairman.
Mr. Regula. Thank you. Mr. McNulty, we welcome your
testimony.
[The prepared statement of Congressman Larson follows:]
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Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. MICHAEL McNULTY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
NEW YORK
Mr. McNulty. Thank you, Mr. Chairman, Mr. Cunningham,
Members of the Committee.
Thank you not only for being on time, but being ahead of
schedule. I know your time is precious. Mr. Chairman, I would
like to submit my entire statement for the record and then
summarize it, if that is okay.
I am requesting some assistance for a variety of projects
in my district and I will just go over them briefly. The
Schenectady Family Health Services is an upstate federally-
qualified health care urban community health center. It is
located in the City of Schenectady, New York. They are seeking
to obtain a 2.1 acre property located on State Street in
Schenectady, New York, to construct a new building that would
not only house the core participants but also space for other
agencies and programs that complement their core services.
The Whitney Young Health Center, also a community health
center located in the heart of my district in Albany, New York,
is doing a massive renovation project.
Mr. Regula. This is the same one that you had last year?
Mr. McNulty. Both of those did receive some funding last
year.
On Whitney Young, Mr. Chairman, they have completed their
phase one renovation project. I have seen it. It is serving a
much larger clientele because of the fact that we have been
able to expand their services. They do need to do a phase two
expansion, and that is why I am asking for continued
consideration for their project.
Just one example, Mr. Chairman. On the HIV/AIDS program,
there has been a 62 percent growth in that program at this
particular facility from 1999 through 2001, and so I would ask
some additional help for them as well.
The Albany Medical Center in my district is not only a
tremendous health care facility providing for the health care
needs of hundreds of thousands of people, really throughout the
capital region, they employ almost 6,000 people. So they are
vital to our economy, too, and they are renovating and
modernizing their trauma emergency department, and they are
asking for some assistance in that regard. Their current
facility, that part of their facility, the trauma unit, was
originally built to accommodate 45,000 annual visits, and last
year had over 63,000 visits. So they are really taxed to the
maximum in that regard.
Also, the Albany Medical Center is the only state-
designated trauma center in the 23-county Northeast region of
New York State. So that whole portion of the State of New York
is served by that facility.
Excelsior College, which you helped us with in the past,
also is a non-profit fully accredited institution of higher
learning. It specializes in distance learning, and they are
seeking funding for the establishment of a nursing management
certificate program.
Another project, Mr. Chairman, since 1990, the Institute
for Student Achievement, commonly referred to as the ISA, has
worked to keep at-risk kids in school and get them into
college. We have a program run through ISA over in the Troy
school district that has shown tremendous success in keeping
at-risk youth in school and helping them graduate and getting
them on to college. Over 96 percent of the students who have
participated in the Troy program have graduated, and over 85
percent of them have been accepted to college. So that has been
a tremendously successful program.
Union College is an independent liberal arts college that
traces its origins back to 1779. In 1795 it became the first
college chartered by the regents of the State of New York. They
have designated a program to foster multi-disciplinary
undergraduate science and engineering learning in research by
integrating several traditional disciplines including
engineering, physics, chemistry and computer science. I would
like to help them to continue that program.
Rensselaer Polytechnic Institute in Troy was founded in
1824, was the first degree-granting technology university in
the English-speaking world. They are establishing an IT
corridor in the capital region of the State of New York
anchored by their incubator program and their technology park,
which incidentally, Mr. Chairman, has been helped before by you
on other committees.
They took a vacant tract of land in the town of North
Greenbush, just adjacent to Troy, and established the
technology park, which--so there was just nothing there 20
years ago, and today is the home of 2,500 new high-tech jobs.
So it has been the largest source of private job development in
the capital region in the State of New York in the last 20
years, so I want to help them as well.
And finally, the Sage College is also a comprehensive
institution of higher learning, has three components in my
particular area, in Troy and at University Heights in Albany.
The college has made a $12.5 million commitment to its
facilities improvement, and I would like to help them continue
in that regard.
Mr. Chairman, I would like to say to you that I know this
is a pretty comprehensive list. I know that the resources
available to you are very tight. And I would point out that
each and every one of those projects is getting funding from
other sources and from private sources and so on, and I would
like to work with the Committee to try to get some measure of
funding to help each one of them just progress.
Mr. Regula. Have you prioritized these?
Mr. McNulty. I have in my testimony. I might want to work
with the staff a little bit more, prioritizing a little bit
more.
Mr. Regula. You may want to spread it around a little, too.
Mr. McNulty. We will work with you.
Mr. Regula. Thank you for coming. Mr. Cunningham, any
questions?
Mr. Cunningham. No real questions. Like Mr. Kennedy said,
it is always good to see him. It is good to see Members come up
and fight for these kinds of programs for kids in the inner
cities.
Mr. McNulty. Thank you.
Mr. Regula. Thank Patrick for his consideration as well as
all of the Members of the Committee.
Thank you.
Mr. Sherman, we welcome you. We are looking for Members.
Since you are here, we will put you on.
[The prepared statement of Congressman NcNulty follows:]
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Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BRAD SHERMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Sherman. I have been in Congress 6 years. This is the
first time anything has been early. I am amazed.
Mr. Regula. Well, we start on time.
Mr. Sherman. Chairman Regula, Members of the Committee, I
am here to support two projects that are important to my
district. Both of them involve innovative programs to provide
high technology that will equip students for jobs of the
future.
The first is at a high school, the second at a college.
HighTechHigh School, Los Angeles, is seeking $750,000 for in-
school improvement programs. This is an opportunity to leverage
local funds in order to provide technology training. It is, in
effect, a high school inside of Birmingham High School. It will
serve predominantly disadvantaged and minority students.
The $750,000 in Federal funding would be used to wire the
school to accommodate powerful multi-user networked computers,
and to fund acquisition of necessary computer technologies and
provide comprehensive training to teachers and other personnel.
This high tech high school will use an innovative project-based
curriculum that I think may become a model for high-tech
education at the high school level around the country.
The local funding has already allowed us to complete
architectural facility designs. We have raised $5.2 million
from State and local and private sources. We have completed
recruitment and the organization of teams to do the work and
developed an innovative curriculum. And with these
accomplishments completed, we will be able to implement and
test curriculum perhaps as early as the fall of 2002, 2003 with
the group of 9th and 10th grade students attending Birmingham
High School and acting as a magnet bringing in students in from
all over the Los Angeles area.
The high tech enrollment will be 350 students and, as I
mentioned, will be serving as predominantly minority and
underserved students who face the greatest difficulty in
preparing themselves for the high tech jobs of the future.
We are asking, as I said, for $750,000. I am trying to hit
just the high points of my testimony and expect that the entire
testimony will be made part of the record.
The second program is an engineering technology program at
California State University, Northridge. We are seeking
$1,000,000 from the Fund for the Improvement of Post-Secondary
Education. I do not have to tell Mr. Cunningham how effective
the California State University system is. And it is indeed
well represented by its campus in my area in Northridge.
We are seeking $1 million to provide a 50 percent match in
the start-up costs of a new entertainment engineering
curriculum. People know that the entertainment industry is the
lifeblood of Los Angeles. But there is an image that it is all
glitzy Hollywood actors. No. It is the people behind the
scenes. And it is increasingly a part of the high tech industry
of this country, and we need to provide the educated people for
that industry to do the high tech, keeping in mind that this is
one of the largest export industries of the United States and
is important for creating not always beneficial, but, I think
on balance, beneficial images of this country around the world.
Clearly, if this is the American century, it will be viewed
as such because of what the entertainment industry has done and
will do.
The Federal funds are requested to assist with the
acquisition of high technology equipment, software, network
expansion, and the integration to link the expertise of the
College of Arts, Art Media and Communications, of Business
Administration and Economics and Engineering and Computer
Science, bringing together three schools at the California
State University at Northridge.
In the last decade, as I have said, the entertainment
industry has been revolutionized through technology. These are
the jobs not for the rich movie stars, but for the work-a-day
people that make this industry. We have seen this technology in
Shrek and Toy Story and in other films that do not seem to be
high tech, but have high tech special effects.
This is a one-time earmark of $1 million which would enable
the University to develop and utilize the convergence of
technologies for mechanical engineering, computer science, art
and theatre, to prepare an educated and highly trained work
force for this important industry.
The Entertainment Industry Institute that this program
would support already has more than 50 industry partners who
enthusiastically embrace the initiative and have supported this
undertaking with funding and with in-kind contributions.
I urge the subcommittee to accommodate this effort by
providing $1 million of funding. The University believes that
the total cost will approach $4,000,000, and is confident that
in addition to the funds it has already put together that it
can fund the balance of that cost.
I thank you for your consideration.
Mr. Regula. Questions?
Mr. Cunningham. Just I would say, Brad, the gentleman from
California, excuse me, my daughter is up at UCLA in graduate
school, and I would tell the Chairman that California is a
donor state both in transportation and education where you have
shortages of funds in Title I with hold harmless, these other
programs that Brad is talking about, that in the inner cities,
like many of the inner cities, we are trying to attract jobs.
This is not what he is talking about, the technology is not in
the center of Hollywood where the glitz is. This is out in the
areas where we are trying to attract jobs for different people.
And I think what he is trying to do is noteworthy, bringing
those kind of jobs, and long-lasting jobs. Also the economy in
California which is in about a $17 billion deficit right now. I
thank the gentleman.
Mr. Sherman. Thank you for your support.
Mr. Regula. Further questions? If not, thank you for
coming.
Mr. Langevin.
[The prepared statement of Congressman Sherman follows:]
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Thursday, April 18, 2002.
STEM CELL RESEARCH; DISABILITY PROGRAMS
WITNESS
HON. JIM LANGEVIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF RHODE
ISLAND
Mr. Langevin. Well, good morning. I would like to thank
Chairman Regula and Ranking Member Obey and all of the Members
of the panel, particularly if I could recognize my senior
colleague from Rhode Island, and all of the work that he is
doing for his district and our State.
Mr. Regula. You are the only two from Rhode Island, right?
Mr. Langevin. The entire delegation.
Mr. Kennedy. That makes me the dean.
Mr. Langevin. We are always proud when the entire Rhode
Island delegation can show up. It impresses a lot of people.
I also thank all of the Members of the panel for taking the
time to listen to us and discuss a range of policies and
programs deserving your consideration. I do not envy the task
before you. You are forced to choose appropriate funding levels
for countless and valuable and competing programs.
Today, I would like to address two issues, stem cell
research and disabilities programs. Since last summer, I have
championed stem cell research. I urge Congress to take the lead
in eliminating the August 9th cutoff date on embryonic stem
cell research.
Since then, numerous stem cells derived from excess frozen
embryos have been discarded when they could have been added to
the NIH stem cell registry and used to save, extend, and
improve countless lives. The decision to ignore this valuable
resource after August 9th is tying the hands of America's most
talented scientists, while unnecessarily risking the potential
loss of life.
Another untapped resource is umbilical cord blood stem
cells. 99 percent of cord blood is treated as medical waste
presently. While I applaud the work of the National Marrow
Donor Program, which is facilitating stem cell transplants to
patients, I would like to see the same vigor drive the adult
stem cell and embryonic stem cells research applied to
umbilical cord blood stem cell research as well.
Moreover, more research demonstrates the value of these
cells. The creation of a federally-supported umbilical cord
blood bank to store, register, and manage the distribution of
these stem cells may eventually be the most appropriate step to
insure their proper utilization.
In the meantime, I would like to see Congress eliminate the
August 9th cutoff date and encourage more umbilical cord blood
stem cell research. To turn what was once ignored into a
resource for lengthening and improving and enhancing life is an
option that we must embrace.
I believe this also applies to various programs for people
with disabilities. As you know, last year I advocated funding
for President Bush's New Freedom Initiative. I am back again to
advocate for more. In the written testimony that I have
submitted to the Subcommittee, I listed several programs I
would like to see funded by the Appropriations Committee.
I know my time is limited so I will just mention three that
could help better integrate the 54 million people with
disabilities into society in helping them to lead more active
and productive lives.
First, the President's budget includes $20 million for the
rehabilitation engineering research centers which conduct some
of the most innovative assistive technology research in the
Nation, helping bring those technologies to market and provide
valuable training and opportunities to individuals to become
researchers and practitioners of rehabilitation technology.
Second, while research is important, it serves little use
if people cannot afford the resulting technologies. The budget
requests $40 million for States to establish low interest loan
programs to help individuals with disabilities purchase
assistive technology, which can be prohibitively expensive.
Finally, the President's budget also attempts to break down
physical barriers. As some of you know, I have led an ADA
working group over the last year to develop ways to strengthen
Title 3 requirements that all public accommodations be
accessible when readily achievable, while also assisting small
businesses in making such adjustments easy and as inexpensively
as possible.
The budget includes $20 million in competitive grants for
improving access initiatives within the Community Development
Block Grant program to help ADA-exempt organizations, including
private clubs and religious institutions, make their facilities
accessible.
Turning challenges into opportunities is my motto for life.
Eliminating the August 9th embryonic stem cell research cutoff
date and accelerating umbilical blood bank research would save
and enhance many lives, and funding these disability programs
will enrich all of our lives.
Mr. Chairman, I want to thank you and the Members of the
Committee for your time this morning.
Mr. Regula. Thank you. These are different than you had
last year. You had cancer prevention last year, I guess you had
requested.
Mr. Langevin. That is right. Yes, sir.
Mr. Regula. Any questions?
Mr. Kennedy. None. Thank you. Thank you, Mr. Chairman. Let
me just say I am so proud to have Jim in Rhode Island's
delegation. He is a fantastic advocate on behalf of stem cell
research, as you know. He made a number of the Sunday morning
talk shows, national shows last year talking about stem cell
research, has really made this a real priority. And I am really
proud that he is in our delegation advocating for something
that is going to prove to be a real success for millions of
Americans.
Mr. Hoyer. Mr. Chairman, you were not here when Christopher
Reeve testified. But, in my opinion, if we have the courage to
allow scientists and researchers to pursue the kind of research
of which Jim Langevin is talking, in the not too distant future
Jim Langevin is going to walk into our committee room and be
able to testify.
The possibilities that exist to regenerate nerves is an
incredible breakthrough. But it will require courage for us to
stay the course. There will be some who, as they have through
history, have said, well, we ought not to go down that road. I
understand the complexity and the controversy. But Jim
Langevin, Christopher Reeve and others who have had nerve
damage and therefore cannot communicate with their legs the way
you and I can, or their other limbs the way you and I can, have
the possibility to have that restored, which is an incredible
opportunity. Not just for Jim Langevin or Christopher Reeve,
but for literally hundreds of thousands and millions of people
who will be even more productive.
Now it is hard to think, Patrick, how Jim Langevin can be
more productive than he is now, because his motto is that he
overcomes challenges, and he has done an extraordinary job.
What a compelling example he is for so many people who are
challenged in America.
Jim, we are just so proud of you, and we want to keep the
faith with you. Assistive technology. We are going to try to
reauthorize that. Jim Langevin and I will be circulating--
Patrick, I think you are on that Dear Colleague, trying to get
everybody focused on that. Buck McKeon has been helping us. But
in the final analysis, what we want to do is not need assistive
technology, and that is what we are talking about with some of
this research.
So, Jim, thank you for all you do and thank you for the
example you set for all of us in terms of your courage and
commitment and incredible good spirit. Thank you.
Mr. Regula. Thank you. Thank you for being here.
Mr. Sanders, I think that we have time to get yours in. We
have two votes. We have a 15 and a 5, the second one.
First is the journal and the second is the Ag bill
instructions.
[The prepared statement of Congressman Langevin follows:]
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Thursday, April 18, 2002.
DENTAL CARE; NATIONAL COMMUNITY HEALTH CENTER SYSTEM
WITNESS
HON. BERNARD SANDERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
VERMONT
Mr. Sanders. I will be brief. Mr. Chairman, there are two
issues that I wanted to touch on dealing with health care. A
year ago, in Montpelier, Vermont, I held a hearing on the
crisis in dental care in our State. It turns out I had not
realized it, but we are looking at a severe dental crisis all
over this country.
In the largest city in the state of Vermont, which, by the
way, does better than most States, there are kids today whose
teeth are rotting in their mouth, who are low-income kids whose
family is on Medicaid. They cannot find a dentist who will
treat them because reimbursement rates are too low.
But what I am proposing, we are going to introduce a bill,
a kind of a comprehensive bill on dental care. We are not
educating enough dentists now. For every three dentists who
retire, two dentists are graduating dental school.
The long and short of the crisis that exists rurally and in
urban areas affects minorities, affects low income people. I
think this shortcut to make care available for lower income
people is to adequately fund federally-funded health clinics
all over this country.
Okay. The FQHCs, the look-alikes, the rural health clinics,
et cetera. As a matter of fact, our new FQHCs are required to
have dental clinics. They do not have the adequate funding that
they need. So without going into all of the details, I hope--
right now if you were to call up the Government, the
administration, say who is your dental guy who will tell me the
problem in Ohio, there ain't nobody there.
So I would appreciate if you would raise the issue of the
crisis in dental care which especially affects the children,
and let's see if we can move and put some money into that. I
would put the money into dental clinics right now. There is
some thought that we can put some money into the Head Start
Program for some demonstration programs. Early hygiene for the
little kids is extremely important.
So my first message is please do something about dental
care in this country. We can talk about some of the details
later.
The second issue I want to touch on, and I know the
President actually is moving forward on this, I would move
forward more aggressively, is again the issue of community
health centers all over this country.
September 11th told us, and I think no one disagrees, that,
God forbid, think of what one letter to Senator Daschle did to
this country. What happens if 500 letters go out around this
country. Nobody believes that we have the public health
infrastructure to address that. Panic. Millions of people
needing doctors on the same day. Where do I get my antibiotics
and so forth and so on.
No one thinks that we have the capability of addressing
that. Community health centers--you tell me and I agree, more
money is going into the community health centers. Let's put
more money in there. Let's get a community health center in
every community in America. It will do two things. It will
protect us in the event of a national emergency, and also it
will go a long way to solving the crisis in primary care
access.
I would urge you to go higher than the President. Fund
these things for national security, as well as health care in
general.
[The prepared statement of Congressman Sanders follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. I like those myself. Because it
relieves your emergency rooms, and it gives access to others
who may not get that.
Mr. Sanders. It is cost-effective.
Mr. Hoyer. Bernie, I agree with you on all of the points
that you raised. Number one, I have always found it--and my
wife, Judy, found it very ironic that the only dental program
we have for young people is for baby teeth. That is in Head
Start. There is a dental requirement, as you know, in Head
Start, but at no other level do we require. So if you lose your
baby teeth, you are out the door.
Secondly, I have a bill that I want you to help me co-
sponsor, and I would like to get involved with yours as well.
That deals with--and we have had it in before, medically
necessary dental expenses being covered under Medicare, because
the medical community says there is a direct nexus between lack
of dental health and myriad other physical things covered by
Medicare. So we do not involve ourselves with the cheaper, we
wait until it gets more critical.
I will talk to you about that bill. We have been fighting
that and the cost--ironically, one of the problems we have had
is the CBO's cost note on that which seems to be expensive
until you compare it with what you have prevented.
Mr. Sanders. Right. Thank you. Those are the two issues.
Mr. Kennedy. I have 25,000 kids in my State whose teeth are
rotting out, and actually one of my priorities and earmarks
this year among the Committee is to get one of those clinics
funded in one of my poor cities. So it is the same thing that
all of my people are telling me, too.
Mr. Regula. I think they are very important. One thing we
need to do is to get local officials to be more interested in
participating. I have had that problem. Of course, their
budgets are constrained, too. But I agree with you.
Thank you for coming.
----------
Thursday, April 18, 2002.
NURSE SHORTAGE; COMMUNITY ACCESS PROGRAM; CDC
WITNESS
HON. LOIS CAPPS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. We will put your full statement in the record
and in the meantime you can give us the highlights.
Mrs. Capps. Mr. Chairman, I am honored to be coming before
you.
Mr. Regula. Let me ask you. I see you are going to be
talking about nurse shortage.
Mrs. Capps. Yes, I am.
Mr. Regula. A friend of mine who is a psychologist at a
school where they educate nurses said one of the big problems
we are losing nurses is because of stress.
Mrs. Capps. That is a piece of it. It surely is.
Mr. Regula. In fact she is going to testify next week about
the impact of stress on retention of nurses.
Mrs. Capps. There are many factors in the workplace that do
affect the job, and health care is stressful at best and with
changing delivery system.
Mr. Regula. I have a suspicion that the doctors turn the
stress part over to the nurses.
Mrs. Capps. Do you think that is what happens? The nurses
would like to hear that.
Mr. Regula. Okay.
Mrs. Capps. My written statement is entered into the
record; so I will just briefly touch on some of the pieces of
it. You acknowledge that there are many factors having to do
with the shortage and anecdotes give you a good snapshot of it.
The piece that I am attending to is the aging nursing work
force and the dwindling supply of new nurses, the supply/demand
part of it and focusing on the education piece of that.
The shortage ironically, and I think adding to the stress,
if you will, is going to peak just as the baby boom generation
begins to retire. They are talking about a couple of us looking
at each other, and we need to increase the resources that the
Federal Government devotes to recruiting, educating and
retaining nurses.
Professions have cycles of supply and demand. This one has
earmarks of having a crisis attached to it if we don't address
it. The events of the September 11 and recent spate of anthrax
letters remind us that nurses are the backbone of the public
health system and we need to make sure there are enough nurses
to deal with any eventuality, and this Subcommittee can help by
increasing funds for the Nurse Education Loan Repayment Program
by $10 million and the Nurse Education Act Program by $40
million. That is our suggestion.
I hope you can set aside some funds for programs included
in the Nurse Reinvestment Act that we hope is going to be
enacted into law this year. The House bill authorizes such sums
as are necessary, the Senate bill authorizes $130 million, and
those two bills are now at the conference stage. So it would be
wonderful to have some moneys available when that is signed
into law.
Other programs, I hope you will include funding for the
Community Access Program, the CAP. This program helps
communities coordinate public and private efforts to provide
medical care to the underinsured and the uninsured. These are
big topics as well, and I hope the Subcommittee will maintain
or increase funding for the chronic disease programs at the
Centers for Disease Control and Prevention, the CDC. According
to CDC, chronic diseases account for 60 percent of our Nation's
health care cost and 70 percent of all deaths in the United
States.
So that is my testimony and I thank you very much for
allowing me the time to present it to you.
Mr. Regula. Well, I think you have touched on two
challenging problems, community access and the nurse shortage,
and now is the time when we should be thinking about addressing
these.
Mrs. Capps. Thank you very much.
Mr. Regula. Thanks for coming. Susan Davis.
[The prepared statement of Congresswoman Capps follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. SUSAN A. DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mrs. Davis. Good morning. Thank you, Chairman Regula. I
wanted to thank you as well for the help for San Diego in the
appropriations last year. As you know, we were able to fortify
many of those nursing programs and expand some of the services
in our emergency rooms, and I can assure you that the
communities feel well supported and are moving forward in that
area. We also had some proposals to eradicate tuberculosis in
the San Diego area as well, and that has been very helpful to
us.
The areas that I would like to focus on today revolve
around the expansion of the family health centers of San
Diego's Logan Heights Clinic. This is an area that has been
underserved for many years. It provides comprehensive care
services to low income, medically underserved population. In
1970, they began with just one clinic and that health center
serves several locations throughout San Diego and provides
medical assistance to over 600,000 uninsured individuals now.
What I am requesting is $1 million to expand the Logan
Heights Center, which has a main clinical side and
administrative offices for Family Health Centers of San Diego.
There has been major growth in utilization in that area, and
really it is bursting at the seams. This funding will help
increase its ability to serve approximately 300,000 patient
visits and it is fulfilling the commitment of the President to
expand the National Community Health Centers System.
There are other requests that we have as well. The
Children's Hospital and Health Center Regional Emergency Care
Center; I am requesting $4.5 million from the Health Research
and Service Administration Health Care Construction Program to
help expand the Regional Emergency Care Center operating rooms
and specialty clinics at Children's Hospital in San Diego. And
I know as a long timer in San Diego that our Children's
Hospital certainly has provided the most unique services for
children of the region.
Mr. Regula. Excuse me. Do they train pediatricians?
Mrs. Davis. They certainly use and have residents from UCSD
and other universities in the region.
Mr. Regula. It is a Children's Hospital?
Mrs. Davis. Yes.
Mr. Regula. You put extra money in for the Children's
Hospital that do pediatric----
Mrs. Davis. Yes, it certainly does that, and it really
serves the entire region now, which we think it is very
special, but what they need is better help and support in the
Emergency Care Center there, and that is what we would be
looking for. It really has been impossible for them to keep
pace with the demand, and that is why if we can provide this
more specialized pediatric care there and expand that, it will
be of great benefit to all of the children in the area.
The other request is in the area of education, and I know
you focused on nursing shortages and trying to increase and
certainly reach out to the community and let them know how
critical this is. Our University of San Diego's Health Service
Program in continuation with the Hahn School of Nursing there
is doing just that, and what we are requesting is additional
funding for the outreach in the nursing program but also to
provide for the kind of critical nursing skills that are needed
to help and support many of our special needs patients in the
area.
I think with these three modest proposals that we will be
able to answer some critical needs in the region and help it
serve as it has been, a beacon for communities throughout the
area.
Mr. Regula. Is the city helping the community health
centers? Are they mostly county, city----.
Mrs. Davis. The county is certainly doing that. I think we
have developed a good----.
Mr. Regula. And it serves the whole county then?
Mrs. Davis. Yes, absolutely. But these particular services
really serve as a magnet for people throughout the region,
which is from the border with Orange County and down.
Mr. Regula. Thank you very much.
Mrs. Davis. Thank you very much.
[The prepared statement of Congresswoman Davis follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
IMPACT AID; NIH
WITNESS
HON. MARK STEVEN KIRK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Regula. Mr. Kirk.
Mr. Kirk. Mr. Chairman, good morning. It is good to see you
here following in the footsteps of my predecessor.
Mr. Regula. Big shoes to fill, but we have had an
interesting challenge.
Mr. Kirk. No, you have done it and I commend you on last
year's bill which was like a battle royale, and as I remember,
it turned out to be very, very good.
Mr. Regula. It went pretty well.
Mr. Kirk. Yes. I will be doing whatever you want me to do
to get to 218 no matter what the weather is like.
Mr. Regula. If I can just persuade Mr. Tauzin, I will be
in----
Mr. Tauzin. That is enough kissing up.
Mr. Kirk. I have come here basically on two points, and I
ask unanimous consent to include my statement in the record.
The key point that I want to raise is on two programs.
One is Impact Aid. Since our country is now at war, I can
tell you from the position of the cockpit, as you go into
combat, and there are men and women now both flying over
Afghanistan and Iraq this morning, about the quickest way to
take your head out of the shed, as they say, is to have
problems at home with your kids' schools. Everybody on these
deployments, both the four carriers we have in the Arabian Gulf
and the Incirlik deployment, those are unaccompanied tours. So
your spouse and kids are back home, and no doubt they are on
base, in housing, most likely they are in a local school.
You did a hell of a job last year for Impact Aid. I have
got to thank the Committee for what you did, and I am here
simply in support of the President's request on Impact Aid in
the future, and I want to tell you what the impact is on two
school districts that I represent. In Highland Park, Illinois,
my hometown, we have got 267 military kids in school. The
Impact Aid Program kicks in 616 bucks and the State kicks in
220 bucks, but our average cost per pupil is $10,600. So the
local taxpayers of Highland Park basically have to fund 90
percent of the cost of educating these military kids.
In our elementary school District----
Mr. Regula. Great Lakes, I assume.
Mr. Kirk. This is Great Lakes.
In our elementary school district, you have to have more
than 3 percent Impact Aid kids to get any Impact Aid funds. So
we are at 2.9 percent. So we have got 60 kids in school, each
at a cost of about ten grand, zip from the Federal Government,
and we can't tax the housing there. So that is basically a
million out the door with no resources.
So it is simply to underscore the point that not only is
this important to six school districts around the country, but
if you are sending your kid to a financially strapped school
district like District 187, North Chicago, which has about
3,000 military kids in it, about the fastest way to get my head
out of Afghanistan or Iraq is to get an e-mail from back home.
You know all the ships are loaded up with e-mail, everybody is
on hotmail accounts, saying we just had canceled PE and art and
other extracurriculars at school and I don't know what I am
doing with my kids back here. What are you doing over there?
And you know in an aircraft carrier it is four acres, probably
the most dangerous. The average age on an aircraft carrier is
20 and a half and you are dealing with high explosive ordinance
and having planes take off and land on the same little place,
and if I just got an e-mail back home saying there is chaos in
the school district--and your program funded with this bill is
a huge way we can keep people's heads focused on the mission.
That is point one.
Point two is we just founded and I am head of the Kidney
Caucus, and we have a growing crisis and I think Chairman
Tauzin can back this up. You know the End-stage Renal Disease
Program is the most expensive in Medicare. The primary focus of
this caucus is keeping people out of the ESRD Program to save
Federal money. We know that most people go into a dialysis
center and they end up in that total roller coaster, and you
know Ms. Helen in the Republican cloakroom there?
Mr. Regula. Yes.
Mr. Kirk. She is now on dialysis.
Mr. Regula. Helen.
Mr. Kirk. Yes, and this is a disease that more affects
African Americans than anyone else; so it is a particular
concern in that community. Most people on hemodialysis. Three
times a week they go on that emotional roller coaster. Ms.
Helen is in the middle of that right now.
There is another treatment, peritoneal dialysis, which is
only about 10 percent of patients, but we know that if we
properly counsel these patients as they go into this that half
of kidney patients would be in peritoneal dialysis, doing it at
home and doing it on a daily basis rather than hemodialysis. I
think it is an important point to raise.
Secondly is that the data is fairly clear that if you are
an African American hypertensive diabetic you are on the road
to kidney disease. We have got 40 million at risk, 160 million
Americans showing tendencies in that direction. Directing NIDDK
and other resources of this subcommittee for an effort to
prevent as many Americans as possible from entering the ESRD
program I think saves Federal dollars and improves the quality
of life.
Mr. Regula. What is the solution? What should we be doing.
Mr. Kirk. Probably the best, biggest solution is making
sure that we educate patients that they have a peritoneal
dialysis option which allows them to stay out of the dialysis
center, doing it at home daily. They will be in better moods,
have higher health status and at lower cost.
Mr. Regula. Is this a mechanical device or----
Mr. Kirk. Yes. Basically it uses the peritoneum to flush
the waste----
Mr. Regula. The patient can administer?
Mr. Kirk. They do. And the way Medicare is structured and
the way it pays, it dramatically encourages hemodialysis. In
Europe, where there is not a financial incentive for
hemodialysis, we have about half of patients on peritoneal
dialysis.
Mr. Regula. Would this be a statutory----
Mr. Kirk. I am more modest in just having Federal education
and encouragement. A lot of this is in the phrenology community
of not really understanding all of the benefits therein, and
everybody is basically directed towards the massive
hemodialysis.
Mr. Regula. Does a reimbursement program of Medicare,
Medicaid----
Mr. Kirk. Yes.
Mr. Regula [continuing]. Prejudice in that direction?
Mr. Kirk. Yes. So we get what we pay for.
Mr. Regula. Did you talk to Ways and Means, Bill Thomas? A
change in the statute is in order.
Mr. Kirk. It is. And I think just at NIH, the concern of
this committee is education, making sure we are getting the
word out, and then also to make sure that we are really looking
at hypertension and diabetes as precursors to kidney disease,
with the goal--and I know this doesn't save money in your bill,
but even so you are just as interested as everyone else in
saving the taxpayer money, of keeping them out of ESRD, and
that is the message here.
So with that, I thank you and thank you for your support on
Impact Aid.
[The prepared statement of Congressman Kirk follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. The President of--was it Northwest in your
district?
Mr. Kirk. That is right.
Mr. Regula. Are you strongly supportive of his request?
Mr. Kirk. I am and I think that is a good, solid proposal
that he has got.
Mr. Regula. Okay. And on the Impact Aid, is this
requirement that there be over 3 percent?
Mr. Kirk. That is an authorizing committee issue. The
program itself doesn't cover all the costs and that is not
before this committee. I am just urging you to support the
President's request. You did a great job last year and this is
a program that has not received a lot of attention but because
of the war should receive more attention because it keeps
everybody focused on the mission.
Mr. Regula. Okay. Thank you.
Mr. Kirk. Thank you, Mr. Chairman.
Mr. Regula. Mr. Evans was here.
Mr. Tauzin. No problem.
Mr. Regula. Okay.
----------
Thursday, April 18, 2002.
PARKINSON'S DISEASE RESEARCH
WITNESS
HON. LANE EVANS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
ILLINOIS
Mr. Evans. Thank you, Mr. Chairman. I appreciate the
opportunity to testify before you today. I would like to start
out by saluting this committee for strong support of
Parkinson's disease research. Through funding for the Morris
Udall centers and funding for NIH's 5-year Parkinson's research
agenda, this committee has ensured advances in the treatment
and taken us closer to a cure.
The value of federally funded Parkinson's research is many
fold. Breakthroughs will not only benefit the 1 million
Americans suffering from Parkinson's disease, but it will give
researchers much greater insight into other neurological
illnesses.
The time is ripe for investments in this research.
Scientists believe that Parkinson's disease could be cured in 5
to 10 years. They have good reason to be optimistic. The pace
of discovery has been astonishing. Just last week reports of a
Parkinson's patient who nearly had all of his motor ability
restored following an adult stem cell transplant gave hope to
Parkinson's patients every year and spurred further research
into harnessing the brain natural ability to restore cells.
NIH recognizes the need to be close at hand and has
responded to developing the 5-year research agenda. This report
outlines the plan for development of more effective disease
management techniques and even a cure. With this comprehensive
plan and the expertise and science at NIH, a cure is sure to
follow. The only question is how quickly. The answer lies in
the willingness of this Congress to provide the funding
necessary for a cure.
I am requesting that this committee fully fund the third
year of the Parkinson's research agenda in fiscal year 2003,
which calls for $353 million dedicated to Parkinson's research.
The funding for the third year plan represents $197.4 million
increase over the baseline spending of $155.9 million in fiscal
year 2000. This level of funding will allow NIH to continue to
conduct research that is going to lead us to a cure, we
believe.
I thank you for this opportunity to testify. As a
Parkinson's patient, I can attest to the hope that every
discovery brings and the Parkinson's community's appreciation
for this committee's work that has been done. We know that with
a strong federal commitment, that pace of discovery will
continue at the rapid clip we have seen over the past few
years. I urge to you build on the strides made in the first 2
years of this plan, and I ask you to fully fund the third year
of the research agenda.
Thank you, Mr. Chairman.
[The prepared statement of Congressman Evans follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. And it is a difficult problem, but I
think they are making progress on it and the testimony we have
had from the NIH people would indicate that there is on the
horizon a chance for success. I know that we have had
individuals in my district who have come to testify and they
are very strongly in support of continued research.
NIH is well-funded. We will be giving them a very
substantial increase into which they in turn decide where to
put it, or they spread it over the categories. But I know a lot
of it will get into Parkinson's and I appreciate your
testimony.
Mr. Evans. Thank you, Mr. Chairman.
----------
Thursday, April 18, 2002.
FRIEDREICH'S ATAXIA
WITNESS
HON. BILLY TAUZIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
LOUISIANA
Mr. Regula. Mr. Tauzin. Are you going to bring your two
helpers along?
Mr. Tauzin. I have got two helpers. I always need a lot of
help.
Mr. Regula. I know. Are these two young men with you?
Mr. Tauzin. They are with me.
Mr. Regula. Okay. Let them come up to the table if they
would like. It is good chance to see how the system works. They
might even vote for you if you do well.
Mr. Tauzin. Thank you, Mr. Chairman. Let me, before we
begin the official reason I came here, also mention NIH with
you. I know that you are doing a marvelous job in terms of
increasing the funding. I want to congratulate you for that.
Mr. Regula. And the administration has given us and the
Chairman a good budget to work with.
Mr. Tauzin. They have. I want to thank you for that. As you
know, the Energy and Commerce Committee has jurisdiction over
NIH and we are incredibly impressed every year with the
advances being made, and you are so right. We are this close on
Parkinson's and so many other diseases.
Mr. Regula. Juvenile diabetes and others, we are getting
close.
Mr. Tauzin. We really are.
By the way, in terms of the kidney disease problems that
were referred to earlier, let me concur with the testimony you
have heard, with the caveat, however, that home health is one
of the fastest rising cost items in the Medicare budget. It is
now about 30 percent per year increase, and it is the only one
without a co-pay requirement.
So I know that Bill Thomas--we had discussions yesterday.
We are trying to make sure that home health continues to be
able to satisfy what we consider to be real attempts to lower
health care costs in the long run.
Mr. Regula. When you say home health, you are talking
generically across the board?
Mr. Tauzin. Across the board. It is about a 30 percent per
year increase. So we are seeing more and more type activities
as were described to you in the peritoneal treatments for
kidney disease at home and those numbers are going up. So we
have got to deal with that and we will be discussing that with
you and others as we go forward.
But Bill Thomas and I are going to be offering a Medicare
reform bill with prescription drug benefits in it to the House
floor----
Mr. Regula. If you want to get a picture of these young
men, come on up here.
Mr. Tauzin. That is Mom, by the way. Let me introduce them
to you. Rachel Andrus and her husband are here today with their
two sons, and Mr. and Mrs. Andrus are not only dear friends of
mine, but Rachel has been my office director. She has
controlled all of our office management systems for a long,
long time and she goes all the way back to 1976, I think, when
she served our committee that I chaired in the Louisiana
Legislature. She is of Cajun extraction. She married a young
man in this area who happened to have Cajun roots as well and,
as a result of the concurrence of their genetic compositions,
they produced some beautiful kids, two of whom are here today.
One is unfortunately afflicted with a disease that appears to
somehow be very much associated with the Acadian or Cajun
population, Friedreich's Ataxia, which Keith Andrus suffers,
who is right next to me. His brother Stuart is right next to
him, one of his best friends and helpers today.
Keith has literally been diagnosed from childhood with this
disease. It is a neurodegenerative disease. It has no known
cure. It gradually debilitates its victims, and life expectancy
is limited because of it, and Keith is aware of that. We are on
a timetable to try to find a cure in time for him and so many
other young people who are afflicted with it.
It is a disease incredibly that attacks my culture, Cajun
population, at two and a half times the rate of any other
culture in this country, much like other diseases that attack
specific races, sickle cell anemia for the black minority
population of our country, and others. It is a disease that
particularly associates with our culture for some reason. It is
in our genes, and the great genetic work that is being done at
NIH and other centers around the country is hopefully our best
chance for Keith and so many others like him.
He is an amazingly courageous young man and he and his
family have been for years coming to Washington to seek the
help of our committees and our appropriators in trying to find
some chance for his survival and others like him.
Mr. Regula. Is NIH focusing their work on this?
Mr. Tauzin. Yes. More importantly, we came before you
several years ago and asked you to create the Center for
Acadiana Genetics and Hereditary Health Care through the Rural
Health Outreach Grant Program of HRSA, and in 1999 your
Committee approved it and we have created it. The center is in
operation today because of funds you provide and funds provided
by state and private sources now.
It links school medicines with the biomedical research
centers, the hospitals, the rural clinics, with a strong
telecommunications network so we can get information out about
health care and about potential treatments and work being done
on a cure. It provides education on these genetic diseases,
research into these and, by the way, Usher Syndrome, which is
closely related we understand.
I want to thank you again and ask you for your continued
support for the center. We are asking for $1.4 million of
federal assistance to the center again.
Mr. Regula. This is the center at NIH?
Mr. Tauzin. No. It is the center in Louisiana that you
helped establish. It works through the LSU System and the
Medical School. The Governor, the President of the LSU System,
and the Dean have all sent you letters outlining the incredible
work we are doing with it. We now provide over 50 percent of
the funding from state and private donors. So we are heavily
invested at the local level into the work of the center as
well, and the work of the center has now caught national
attention.
People suffer with the disease in 50 States. We just happen
to have the greatest majority of the incidents of it in our
culture. The Discovery Health channel recently focused on the
center and Friedreich's Ataxia and the incredible damage it
does to young bodies and to young people like Keith and the
fact that it claims their lives if we don't find a cure soon.
And so I want to first of all thank you because----
Mr. Regula. I see we put a million in last year at your
request.
Mr. Tauzin. And we are asking for 1.4 million this year.
Mr. Regula. Another million this time or----
Mr. Tauzin. If you can keep this up, we are getting close.
Mr. Regula. So that is your number one priority then?
Mr. Tauzin. Absolutely. It is number one and number 1-A.
And I just learned that my chief of staff in Louisiana, the
next-door neighbor, a young 15-year-old girl, was just
diagnosed with it. We have discovered it in ages as late as 15.
With Keith we learned it early. I have watched and I know some
of you have watched as I brought him year after year to you.
You have watched the disease ravage him and you have seen him
being more limited every time he comes here. His family is so
supportive and so loving and he is such a courageous young man.
Mr. Regula. Your center works with NIH, I presume?
Mr. Tauzin. We all do. NIH works with them, the center
communicates with them and the center operates with the
communication system that reaches out nationally to assist all
those who are doing work in this area. We learned at one of
your hearings that some genetic work being done at NIH may hold
some of the answers. It looks like it is related and as they do
a study on one disease, they are finding out the relationship
to a potential cure on another. So we stay in touch with all
those studies that are going on.
I just want again to say thank you. If you can continue the
federal support for the center, I have every expectation that
we are going to come up here one day and pop some champagne and
we are all going to----
Mr. Regula. We hope so.
Mr. Tauzin. We are all going to toast and thank you for
saving not only Keith's life but so many young people like him
around the country, particularly the large number that happen
to be Acadians like myself who for some reason in their gene
code have this disease special threat. So thank you. I know
that Keith thanks you personally, his family thanks you, and
more importantly the cause of a cure thanks you.
Mr. Regula. Keith, we will do the best we can for you.
Mr. Tauzin. Thank you, Mr. Chairman.
Mr. Regula. Thank you.
[The prepared statement of Mr. Tauzin follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. CIRO D. RODRIGUEZ, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
TEXAS
Mr. Regula. Mr. Rodriguez.
Mr. Rodriguez. Thank you, Mr. Chairman, for taking the time
to listen to us and for allowing us this opportunity to testify
before you.
Mr. Regula. Your full statement will be in the record and
the staff will peruse it.
Mr. Rodriguez. Thank you very much. Let me take this
opportunity, first of all, to talk to you about three projects,
and especially two of them, that I want to mention to you. One
of the first ones is project VIDA, which is Valley Initiative
for Development and Advancement. It is in the lower part of the
Rio Grande Valley, and it basically has been helping to train
over 2,000 residents on the U.S.-Mexican border.
It is in both my district and Congressman Ortiz's and
Congressman Hinojosa's. That area has over a million people. It
is the poorest in the entire United States. In fact Starr
County that I represent there on the border is the most poor
based on the 2000 census, and Hidalgo is right next to it and
then Cameron County.
Project VIDA, which is Valley Interfaith Development and
Assistance, provides job training. 94 percent of their
participant placements are placed in high skilled job areas.
VIDA is modeled after Project Quest, which is out of San
Antonio, which has gotten nationwide recognition for their high
caliber of work, and I wouldn't be here talking about any kind
of job training program unless I know that they would do a good
job.
These people are from the community. They have been
reaching out and have been making things happen with a lot of
people and these are people that have been unemployed for a
long time and have been provided that service. So I am here to
ask for half a million dollars for Project VIDA in the valley
that encompasses part of my district and part of two other
congressional districts.
In addition to that, I am also here to ask you to consider
half a million dollars also for a unique project in San Antonio
that not only services the four Congressmen there, which is
Lamar Smith, Bonilla, Gonzalez and myself, but is going to
service four States, New Mexico, Louisiana, Oklahoma and Texas,
with a unique project that is called the American Originals.
This gives an opportunity for people in Texas in that region,
especially south Texas.
The Witte Museum right now has over 200,000 people that go
through it on an annual basis. Of that, over 75,000 come from
the lower Rio Grande Valley, and the American Originals allows
an opportunity for them to look at the Louisiana Purchase
Treaty, to look at the Emancipation Proclamation, to review a
lot of the actual documents, and along with that this
particular $500,000 will allow them to prepare these rare and
significant documents as well as educational programs that they
are hoping to develop with that and, after the project is gone,
to continue to be utilized.
It is a unique project that a lot of the young people in
south Texas will never have an opportunity to come to
Washington, D.C., to see and it is the only one of the museums
that are going to be--in fact the only one in the Southwest
that will have this particular exhibit and is for the year
2003.
Those two projects, each for half a million, I ask your
serious consideration.
In addition, there is a Boysville Home for Boys and Girls
out in Converse, but they service the entire State. This is a
school that has been there since the 1930s and 1940s. They pick
up youngsters that have been abused either physically,
sexually, and they live there, and one of the things that they
are asking for it is a total of 3 million, but there are two
programs. One of them asks after they release the youngster--
and, I apologize, Mr. Chairman, I didn't check if you have a
family but when they----
Mr. Regula. I do.
Mr. Rodriguez. When they reach 18, you don't want to let
them go either. Well, you almost have to let them go and a lot
of times at that age, you know if you have any children, they
are not ready to be let go out there without any resources,
without anything. So they want to be able to work with them and
prepare them for the jobs that are out there and be able to
make sure that they can land those jobs and follow up with
them.
So part of those resources is to follow up for those
youngsters, and there truly are youngsters throughout the
entire State of Texas and the region. And the other aspect of
it is also to provide intensive counseling and training in the
area of drug abuse, and specifically for that area we are
seeking some money to help them and assist them in those areas.
So those are the three projects I wanted to present to you
and ask for your serious consideration.
[The prepared statement of Congressman Rodriguez follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I am impressed with your placement rate from
the school you described; 94 percent is remarkable.
Mr. Rodriguez. It is a beautiful program and it is modeled
after the one out of San Antonio, which is Project Quest. It
has a different name but that one is remarkable, and one of the
things they do is they use grassroots people. So these are
people that are----
Mr. Regula. You mean to teach?
Mr. Rodriguez. Exactly. So these are people out there in
the community, and that is why I feel very confident that it is
a darn good program. You are not providing resources for
these--I shouldn't say bureaucrats to remain in their jobs. You
are really looking at providing resources to those people out
there working with those people who are in need and providing
that assistance.
We just recently heard in the Valley, not in my district
but in the region that is going to be impacted, Levi Strauss is
closing some additional facilities and is going to let go a
large number of people. So the need for job training is
extremely critical.
Mr. Regula. Well, thank you for coming and bringing this to
our attention.
Mr. Rodriguez. Thank you, Mr. Chairman, for allowing me to
be here before you.
----------
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BOB FILNER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
CALIFORNIA
Mr. Regula. Mr. Filner.
Mr. Filner. Good morning, Mr. Chairman. Thank you for
taking the time to listen to the Members and I know it is a
long day.
Mr. Regula. It is interesting.
Mr. Filner. You learn----
Mr. Regula. You get a variety that gives you a sense of
some of the problems that confronts all of us in various ways.
Mr. Filner. Thank you for your interest and your commitment
in this case to our students and around the Nation.
I want to tell you, Mr. Chairman, about Imperial County,
California, and the needs of its schoolchildren. Imperial
County is in the extreme southeast corner of California. It
goes from San Diego to the Arizona border. It is a very
agricultural area, once in fact provided a lot or most of the
vegetables and fruits for the whole Nation, the Imperial
Valley, and it is----
Mr. Regula. It is irrigated?
Mr. Filner. From the Colorado River, which is a whole
different issue from your other Committee, I suspect.
Mr. Regula. You would be at the tail end of the River,
wouldn't you?
Mr. Filner. Well, under the law of the River Imperial
County gets an incredible amount, about 80 percent of
California's water. That is a whole different issue, if you
would like me to spend 3 hours with you. It is a very difficult
situation because the agricultural area and the urban areas,
both of which I represent and I am in middle of, have to fight
over that water. It is a large county, over 4,000 square miles,
deserts, mountains. It has several medium sized cities, several
small towns, lowest population density in California probably,
but I tell you this because there is a lot of isolation of
students and teachers in various parts of the county.
It is also a very poor county, the poorest by almost any
measure in California's counties. Unemployment rates have
reached in recent years as high as 30 percent. We go crazy with
6 or 7 percent. Imagine 30 percent. The seasonal unemployment
rate is the highest in the United States. The median income is
$14,000, lowest in the State. Seventy-one percent of all the
students in fact are on the free lunch program.
I tell you this because this kind of geographical isolation
and the relative poverty of the county makes it extremely
difficult for the basic fiber-optic networks that schools must
rely on these days. It is just not there and the students are
denied the Internet access and the communication that marks the
21st century.
The Department of Education has put together an Imperial
Valley Telecommunications Authority to provide that technology
infrastructure and to make sure all of the schools are
connected with fiber-optics. The Imperial Irrigation District,
which is one of the most powerful organizations in the county
because it controls not only the water but the power, is
working collaboratively with the school districts to try to
change the situation. In fact the IID, the Imperial Irrigation
District, is giving the schools and other public agencies
access to their fiber-optic communication network that goes
throughout the region, and the IID is providing a whole multi-
million dollar contribution to the schools to attempt to try to
end their isolation. In addition, $17 million has been
contributed by the local districts and cities and counties to
this effort.
So for every dollar that we are asking the Federal
Government for, $3 has been spent by the local agencies. In
fact, the planning for the project was completed with State of
California grants and a border link grant in the past of
$775,000. So grants have been given, cities, counties,
Irrigation District, everybody is contributing. What has to
happen is to connect all the elementary, middle and high
schools to a fiber-optic structure, backbone. That will cost an
additional $6 million and we are asking that for the Department
of Education's Fund for the Improvement of Education.
Given the geographic isolation, given the relative poverty
of this county, we need this backbone to make sure our students
can in fact compete in the 21st century. The local agencies,
school districts, cities have all taken a role and we are
asking for some help from the Federal Government to complete
the project.
Mr. Regula. Okay. I was interested, and apparently you have
sort of a public agency that not only controls water but
controls electricity?
Mr. Filner. It is very unique.
Mr. Regula. Do they buy from the producers of electricity
and resell to the people?
Mr. Filner. No. The Irrigation District has its own power
plants, hydropower mainly.
Mr. Regula. This is sort of a quasi-public board, I assume?
Mr. Filner. No. It is a public board.
Mr. Regula. Are they appointed?
Mr. Filner. Elected. It is very unique.
Mr. Regula. It is unique.
Mr. Filner. And the politics is very interesting and it is
changing over time. The election to the IID board is the most
significant election in that county.
I thank you for your interest. Mr. Cunningham is familiar
with the county, our next-door neighbor and----
Mr. Cunningham. Also, the next-door neighbor is where El
Centro is, where most of the Navy training goes, and where Top
Gun is, adversary with the Rangers, and then we go over to Yuma
and fly as well.
Mr. Regula. So there are air fields in this area?
Mr. Cunningham. Yes. Maybe, Bob, if you would vote for
defense, we would get----
Mr. Filner. Most of the training, as the pilot points out,
is done in El Centro. The one great advantage that this county
has is 363 days of sunshine each year and it is always
available for training. In fact, the Blue Angels, they train
there for 3 months before they go on their tour of the Nation.
They have just completed their training out in El Centro and
they can do it every day because of the weather. The weather is
extremely clear and sunny at all times.
Mr. Cunningham. It is their winter training area when they
move out of Pensacola and get ready. But Bob is right, the area
is dispersed. This is an area that in the BRAC belonged to
Duncan Hunter, and Duncan represented the Imperial Valley for
years and years, and Bob is telling the truth. It is kind of
out in the desert. Some of the facilities they have are
depreciated and stuff, and they do need help. I don't know if
we can put in $6 million with all of the requests we have, but
we ought to be able to help some, and, Bob, I will tell you
that New Millennium bill that President Clinton signed with
computers, where you get private companies to donate their
computers to a nonprofit, we want to expand that to the
libraries as well, but the prison system uses and upgrades
those computers and it goes into the school system. They are
eligible for that also. So if they do get the fibre wiring and
stuff, it is something that could help the Imperial Valley.
Mr. Filner. Thank you. You have led the fight for that
program. I appreciate it very much.
Mr. Regula. What is the name of the air base it serves?
Mr. Cunningham. El Centro.
Mr. Filner. Naval Air Facility, NAF El Centro.
Mr. Regula. That is a new one to me. I am not familiar with
it.
Mr. Cunningham. As you head right on Highway 8. We also
have deployments, and it is where the East Coast training
squadrons come in the winter.
Mr. Filner. It is a long well-established base, but it is
small and it plays an important training function for virtually
all of the West Coast.
Mr. Cunningham. It is an area where it is still remote to
the point where you do carrier qualification training in, say,
Miramar there are a lot of lights so you don't get the effect,
and what we do is train at Miramar these young kids and then we
go to El Centro because it is darker and simulates a carrier
deck more, and then we take them out to San Clemente Island
where there are absolutely no lights. It is a lot of military,
lot of housing, Hispanic area as well, and they do need help
out there. They are pretty remote and as in many cases rural
areas are the last to get support.
Mr. Regula. This is a big country. I keep finding out new
things about it all the time. Thank you.
Mr. Filner. Thank you, Mr. Chairman.
[The prepared statement of Congressman Filner follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Thursday, April 18, 2002.
PROJECTS
WITNESS
HON. BART STUPAK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
MICHIGAN
Mr. Regula. We will go to Michigan, Mr. Stupak.
Mr. Stupak. Thank you, Mr. Chairman, Mr. Cunningham. Thanks
for having me appear here.
You were talking about Mr. Filner's area there. That is
actually my first request is Operation Up-Link, $1.1 million.
Basically the same thing, trying to get the last mile, if you
will, of the fiber-optics in the Upper Peninsula of Michigan,
and we are remote and all the things you could have said for
Mr. Filner would basically apply to my district also.
We are working with our universities up there in Northern
Michigan and Michigan Technological, the colleges and the
hospitals. We want to link it. Last year this committee
appropriated $300,000 towards a project, and so we got the
initial infrastructure going and we want to finish it off, and
it would be $1.1 million is what we ask for to just finalize it
all up, and no disrespect to Mr. Filner, but I am six times
less than him so we should get the nod. I am just kidding, but
we would like the nod.
Mr. Cunningham. You could do that if you would waive Davis-
Bacon.
Mr. Stupak. We have got to keep Davis-Bacon. That is the
only good wages we have, especially with our telling the other
Committee. I think our unemployment up there right now is 8, 9,
10 percent. Literally 5.8 nationwide and Michigan is now above.
Next, the Center on Gerontological Studies, something new,
again through Northern Michigan University, we would like to
have the center especially for our senior population. That is
whom it would benefit, and up there it depends on what county.
The low counties have 17 percent seniors and the high counties
are 30 percent senior citizens out there, and the State average
is only 13 percent, and the center of course, as you know, will
promote knowledge of the aging process, aging network, provide
services that apply as a mechanism to enhance their lives.
Next I have is the BJ Stupak Olympic Scholarships. I want
to thank the committee again for naming it after my son. This
past weekend I had a unique opportunity. We did some stuff at
Michigan State University. But the Olympic Education Center at
Northern Michigan was a beneficiary. We raised some money for
them. So it is just not always relating to the million dollar
Olympic scholarships that we have appropriated in the past, and
with the change that we made last year in the structure, I will
tell you how critical that structure was. Some of the athletes
came down who were receiving some of this money, and they were
telling their story how they are allowed to finish their
schooling, and we have changed the requirements. Before you had
to carry 12 credit hours. That is what the Department of
Education had, so we changed that to you have got to carry at
least three.
So Allison Baver, who was one of our Olympic speed skaters,
she will finish up now at Northern this year. She will do her
last course back home at Penn State University, but she said
without this there is no way she ever could have done it,
competed around the world. But with the changes we have made
with the help of Mr. Cunningham and you, Mr. Chairman, by
making that change, in the next two semesters they will give
out $850,000 in scholarships, your place down there, Duke, Lake
Placid and Colorado Springs.
So it has been a big success. The athletes tell it best,
how dedicated they were. They got up at 3:30 in the morning at
Marquette, drove down to Lansing. That is about 450 miles for
them, and they drove down just so they could give presentations
all day on the Olympic Education Center, what we do, and the
great help this committee was. These students are exceptional
not just as athletes but as individuals, and the program has
been a great success. Unfortunately, the President didn't put
the money in. We ask that you put it back in.
I have a number of others. Let me quickly go through one or
two more, and then I will take any questions you may have.
Crooked Tree Art Center. This is in Petoskey, Michigan.
They are doing a whole renovation of their center. It is $4
million. They have already raised $3.5 million. They have
tapped every possible resource. Petoskey, a town of only 5,000
right now, this summer it will go to 30,000.
But this art center goes around to all of the schools. They
ask the schools to kick in to help pay for the program. They
have won many awards, especially for their violin program.
Of all things, in little parts of rural Michigan they are
teaching violin, and this center does it all on their own. They
have got to the point where the program keeps expanding. And
they have done $3.5 million. They are asking if you could do
$650,000 and let them finish off.
Ft. Brady Army Museum--that is up Sault St. Marie right by
the Soo Locks there--they are going to put in to preserve the
history of the fort's existence and will exhibit the history
for education future uses.
The Aging Nutrition Program. We have led the fight. I know
a lot of you have helped me on that one to increase meals, the
money we give for senior meals, whether it is Meals on Wheels
or at the senior center. I am requesting a $20 million increase
in that one, and we have always done an amendment on the floor.
Senate usually knocks us out. But hopefully, we can do
something this year.
Maybe if it came out of the Committee instead of doing the
amendment on the floor, because once we get it on the floor it
usually passes. If we could maybe put it in the bill it would
help us out. And $20 million is only keeping the rate of
inflation. That would give an extra penny per meal, or a penny
and a half per meal. That would be about all.
Marquette General, for their emergency outpatient. Last
year this committee was good enough, gave us $250,000. It
wasn't of course enough to complete the building. As we shift
from inpatient to outpatient we are asking for $4 million to
finish off the emergency outpatient. Marquette General is the
largest hospital in the north half of the state. That includes
northern lower Michigan too, because my district covers both
peninsulas. It is the tertiary care, great facility, if you
could see to help them out.
Charlevoix Hospital. I have a request in there. I want to
mention one more. Sault St. Marie Tribe Satellite Health
Center. Sault St. Marie Indians, Chippewa Indians, are the
largest tribe in Michigan. It is about 25,000 members. And they
spread out. The original treaty of 1836, their land in Sault
St. Marie was basically intact, and the 1856 treaty shoved them
basically out of the UP to the extreme western part of the
Upper Peninsula.
So their tribe has moved. Their main place is Sault St.
Marie. Their other main place is Manistique, Michigan, which is
probably about 120 miles from there. They have a huge health
center in Sault St. Marie. They want to put one in to service
their people in Manistique. It is a $3 million project. They
have put up the first $2 million. They are hoping this
committee could help them with the last million so they could
do it quicker and get it finalized.
Other than that all of the rest of it is there. I want to
thank this Committee. They were very good to my district last
year. There is a couple of projects that you have helped us
with we would like to finish off and a couple of new ones for
consideration.
With that, I would open up for any questions you may have.
And thank you for your time and courtesy.
Mr. Regula. Thank you.
Mr. Cunningham. Isn't Sault St. Marie--their reservation is
split on them now. Is it a reservation?
Mr. Stupak. Well, in Sault St. Marie it is a reservation,
and they have some land--actually pockets all over. Some of it
has been placed in trust. But there is some original parts in
different parts of the Upper Peninsula. The first treaty had
them in Sault St. Marie. The next treaty shoved them farther
west.
Mr. Cunningham. But the area in which you want to have
funding for the hospital, is that also a reservation?
Mr. Stupak. That is on trust land. Good question. I am sure
they are going to put it off Shrunk Road there. So that would
be reservation land.
Mr. Cunningham. Because in San Diego County we have many of
the tribes. They have gaming there and they are able to----
Mr. Stupak. This tribe has gaming. That is how they can put
up the $2 million. But the gaming, the casino in Manistique,
there is a small one there, is on the highway. Their
reservation is back off, and that is where most of their
offices for health care and things like that are right now. So
it is not near the casino.
Mr. Cunningham. Do you have an idea of what kind of
population, Native American population that that does serve,
because Impact Aid and a lot of those things are important.
Mr. Stupak. Because that would service the Delta County,
Schoolcraft, Luce and Elger--well, not Luce but Elger. That
would probably be pretty close to 3 to 4,000 members in that
area. There is a big one in Manistique and in the Escanaba area
there is another group there with all of their housing.
Mr. Cunningham. I am one of the Members that think what we
have done to Native Americans in this country is atrocious.
Mr. Stupak. Well, we kept moving them around.
Mr. Regula. Thank you.
Mr. Stupak. Thank you.
Mr. Regula. I think that completes our work for the day.
[The prepared statement of Congressman Stupak follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 23, 2002.
EMOTIONAL LABOR, BURNOUT, AND THE NATIONWIDE NURSING SHORTAGE
WITNESS
REBECCA J. ERICKSON, DEPARTMENT OF SOCIOLOGY, UNIVERSITY OF AKRON,
AKRON, OHIO
Mr. Regula. Well, we will get started here today. We have a
special inducement for you to stay. Elmo is the last witness
today. [Laughter.]
I have to confess, I did not know who Elmo was, but I guess
my grandchildren probably could have educated me.
We have three nice pretty little girls, not so little, who
are going to be testifying, or at least helping their mother. I
bet they know who Elmo is. Do you girls know who Elmo is? I
will be a hero to my two grandsons when I get home and tell
them I saw Elmo.
It is a great pleasure to welcome each of you today. I look
forward to hearing your testimony. We all, on the Committee,
value your views and your participation in our process. This
really is democracy at work.
In the next several weeks, we will be hearing from 200
public witnesses and Members of Congress. That is why, of
course, we cannot give too much time to anyone.
The President's budget requests $132.2 billion. That is
``billion'' with a ``b'' for the agencies. It is the second
largest program, second only to defense, for programs and
activities within the jurisdiction of this subcommittee.
Nearly all of the increased funding recommendations in the
President's budget are in three critical areas: homeland
security, medical research, and education.
I might tell you that this is almost $10 billion more than
last year's budget. Once again, tough decisions will need to be
made in the months ahead when we consider making funding
allocations.
For many of you, this will be your first time testifying
before the Subcommittee. As we begin the hearing, I want to
remind witnesses of a provision in the rules of the House,
which states that every non-Governmental witness must submit a
statement of Federal Grants or contract funds that they or the
entity they represent have received. I am sure all of you have
heard about that.
In order to accommodate as many witnesses of the public as
possible, we have scheduled about 25 witnesses for each
session. Even at this level, we will not be able to hear from
all who want to testify.
However, we do ask everyone that wants to testify, that we
cannot hear in person, to submit their testimony, and the staff
evaluates their suggestions.
Due to the volume of witnesses, I have to enforce the rule
limiting each testimony to five minutes, and I have to be
strict about that. Francine, she is the enforcer, recognizes
the importance of staying on time.
To help keep us on schedule, we will be using the lights
that are on the table. There are three lights: green, yellow,
and red. There are no fines on red, but we will appreciate if
you can close and move down on the yellow.
Once you begin speaking, the green light will indicate that
your time has started; the yellow light will indicate that you
have one minute remaining to sum up your testimony; and we
obviously know the red light means stop.
I hate to do that, because I find these programs extremely
interesting, and sometimes I am guilty of stretching it out,
myself, because I get interested in what you, as witnesses,
have to say.
But it is extremely valuable and particularly helpful to
our staff, because they do read all the testimony. With the
responsibilities we have, it is important that we try to do the
best job possible.
I said to the members of the Committee last year, since
this is my first year as Chairman, that the Bible says there
are two things that are vitally important, two rules: love the
Lord and love your neighbor.
This is the ``love your neighbor'' Committee, because
everything we do potentially touches the lives of Americans,
either through health research, the Centers for Disease
Control, and a whole host of children's programs.
Every dollar that we spend on education from Headstart to
Pell Grants goes through this committee, and it is all
discretionary. So we have to make some very difficult judgments
in allocating resources.
While $132 billion is a lot of money, it is surprising, but
we always come up what we consider to be short, simply because
there are so many needs. But we do the best we can in
allocating.
Our first witness today will be Dr. Rebecca Erickson, the
head of the Department of Sociology at the University of Akron.
She is going to talk about stress and its impact on retention
of nurses and new teachers. With the imminent retirement of the
babyboomers, we face some real shortages in these areas.
So Dr. Erickson, we are happy to have you here today, and
you can go forward.
Ms. Erickson. Thank you and good afternoon, Mr. Chairman,
my name is Rebecca Erickson, and I am an Associate Professor of
Sociology at the University of Akron and Chair-Elect of the
American Sociological Association's Section on the Sociology of
Emotions.
I want to thank you and members of the Committee for the
opportunity to speak today about how reducing the rate of
burnout among direct care nurses is essential to the
development of sound retention polices, and to our being able
to effectively address the national nursing shortage over the
long term.
Nurses typically burn out and leave bedside nursing after
just four years of employment. My goal here today is to propose
that a systematic program of research and intervention,
focusing on the emotional stresses of nursing, and the
conditions that exacerbate them, holds particular promise for
reducing the incidents of burnout and increasing nurse
retention.
Experienced RNs are choosing to leave bedside care in large
numbers. In the year 2000, there were 500,000 licensed nurses
not employed in nursing. If only a quarter of these had been
retained or could be induced to return, a significant
percentage of the 126,000 hospital nursing vacancies might be
filled.
Solving the Nation's nursing crisis in nurse staffing
requires that we understand why nurses leave direct care and
why they choose not to return.
There are many reasons for this, but the primary force
driving nurses away is the stress in the work environment.
Today's hospital nurses face increased patient loads, increased
floating between departments, decreased support services and
frequent demands for mandatory overtime.
Given these conditions, it is hardly surprising that the
National studies have reported that 59 percent of nurses say
their job is so stressful that they often feel burned out, and
43 percent of nurses experience significantly higher rates of
burnout than is expected for medical workers.
Burnout is a unique type of stress syndrome that is
fundamentally characterized by emotional exhaustion. We can
begin to appreciate what emotional exhaustion means for a nurse
by considering the results of a national survey that asks
nurses to identify how they usually felt at the end of their
work day.
The four most frequent responses were: exhausted and
discouraged; discouraged and saddened by what I could not
provide for my patients; powerless to effect the changes
necessary for safe, quality patient care; and frightened for
patients. Exhausted, discouraged, saddened, powerless,
frightened; these are the emotions experienced by nurses on a
daily basis.
Recognizing that burnout is rooted in such intense
emotional experiences is integral to preventing its occurrence.
This is especially true in the case of nursing, where the
ability to effectively manage one's own and other's emotions is
critical for the provision of excellent care.
To reduce the incidents of burnout, we must identify the
faucets of the care environment that lead to the frequent
experience and management of intense emotion. In doing so, we
would be specifying the conditions that influence the
performance of emotional labor; for the process through which
nurses induce and suppress emotion, in an effort to make others
feel cared for and safe, is indeed work. It is work that
requires a great deal of time, energy and skill.
While there is widespread agreement that issues concerning
the environment of care must be included in any comprehensive
strategy to address the nursing shortage, there has been no
systematic research done to isolate the sources of nurse's most
intense emotional experiences, and to develop a detailed
understanding of how the management of these emotions leads to
burnout and turnover.
Consistent with the recommendations in last year's General
Accounting Office report on the nursing workforce, I propose
the initiation of a demonstration project, that will generate
the data needed to effectively disrupt the burnout process.
Such a project would require the formation of an inter-
disciplinary and inter-organizational research advisory team,
that most importantly would include nurses currently employed
in bedside care. This research team would organize and oversee
a multi-method research project aimed at reducing burnout and
increasing retention.
Our first goal would be to specify the antecedents and
consequences of performing emotional labor among direct care
nurses. Our second goal would be to use this information to
develop and evaluate preventive intervention strategies among
these nurses.
The third facet of this project would consist of surveying
nursing students before, during, and after their first year of
clinical practice. This would be done to evaluate the extent to
which they are being prepared for the emotional demands of
nursing, and to identify any changes in educational and
hospital practice that might aid in the students' transition to
the care environment.
Understanding the emotional demands of caring work may be
one of the most important steps toward retaining many of the
nurses employed in bedside care. The proposed demonstration
project will provide the means of achieving these goals.
Thank you for your consideration, and I would be happy to
answer any questions you may have.
[The prepared statement and biography of Ms. Erickson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
As I understand it, at the University of Akron, you have
done some work with the nurse education program there, along
these lines. Am I correct?
Dr. Erickson. I have not specifically. I have been working
with hospital organizations in the area; but the nursing
program has been focused on these issues.
Mr. Regula. So the University is very much aware of the
problem of stress.
Dr. Erickson. Definitely.
Mr. Regula. I think if the statistic is correct, that we
lose 50 percent of the beginning teachers in the first five
years, that much of the same thing would be applicable in the
teaching profession.
Dr. Erickson. Yes, that is part of the importance of
looking at the burnout process, per se, to see what might be
generalized to other occupations, definitely.
Mr. Regula. Well, thank you very much for coming to speak
on this important topic.
Our next witness today is Lesa Coleman. She is accompanied
by her three children: Jaclyn, Corinne, and Emily.
----------
Tuesday, April 23, 2002.
NATIONAL CAMPAIGN FOR HEARING HEALTH
WITNESS
LESA COLEMAN, ACCOMPANIED BY CORINNE COLEMAN, EMILY COLEMAN, AND JACLYN
COLEMAN
Ms. Coleman. Thank you, and Jaclyn is over there. My
husband could not join us.
Mr. Regula. We are happy to have you. Tell us your story.
Ms. Coleman. Thank you; good afternoon Mr. Chairman and
members of the subcommittee. My name is Lesa Coleman, and I am
here today with Jaclyn, Corinne, and Emily on behalf of the
National Campaign for Hearing Health; not as an expert.
Mr. Regula. Lance is your husband, I take it?
Ms. Coleman. Right, Lance is my husband, and he could not
make it.
Mr. Regula. I got a little bad information here.
Ms. Coleman. I wish he was here.
Mr. Regula. Okay, I'm sorry.
Ms. Coleman. I am a mother of five children, two of whom,
Corinne and Emily, have severe hearing impairments.
As you know, the President's 2003 budget eliminates program
funding at the Health Resources and Service Administration for
the Universal Newborn Hearing Screening, or UNHS Program.
If funding for screening is cut, children and their
families will be hurt, just as my child, who was without
newborn hearing screening in 1994.
We are currently only screening 65 percent of newborns in
this country. Unbelievably, every day, 11 babies with hearing
loss leave the hospital, and their parents have no idea that
they have this loss.
That is why I am asking Congress to provide $11 million to
HRSA, so this vital program can continue to assist States with
developing and implementing newborn hearing screening and
intervention programs. To compliment HRSA's screening program,
the Centers for Disease Control needs $12 million for critical
tracking, surveillance and research efforts.
I have a very simple message. Without early detection and
intervention, children face delayed language, delayed speech,
and delayed learning development. Early identification is
critical, because we have wonderful interventions such as
cochlear implants, hearing aids, and therapies that can
dramatically improve the opportunities for a child with a
hearing loss.
I would like to share now the experience that we have had
with my daughters Corinne, age nine, who was not diagnosed
until she was age two; and then Emily, who is now age seven and
was diagnosed at birth.
If there were ever parents who should have self-diagnosed a
hearing loss, it should have been my husband and I. My husband,
Lance, is an ear, nose, and throat physician, and I, just
shortly before Corinne was born, received my Master's Degree in
child and family development.
When Corinne was born, she looked and responded very
normally, but as months progressed, we noticed that she did not
seem to be talking. Our pediatrician encouraged us to wait up
to 12 months before Corinne was sent for ear tubes.
Finally, after no improvement and without our
pediatrician's approval, Corinne's hearing was tested. So
finally, at two years old, Corinne was finally diagnosed with a
severe hearing loss.
Soon after the diagnosis, we tried to enroll Corinne in an
early intervention program. She was finally accepted at age two
and-a-half, only to be forced to exit at age three, because
early intervention ends in this country at age three.
Corinne started preschool at age three with essentially no
expressive and very little receptive speech. To improve other
communication skills, we started speech therapy, which resulted
in hundreds of hours and thousands of dollars of third party
system costs over the course of four years.
Our Emily, on the other hand, was born when Corinne was age
two and-a-half. She was tested at birth with the appropriate
equipment, and received her hearing aids at five months. Emily
was admitted to the early intervention program at six months,
where her speech was monitored regularly. She developed speech
normally, right along with her hearing peers.
Emily has never had to have regular speech therapy. Her
vocabulary has been very expressive, confident, and dramatic,
from a young age.
The contrast, in our experiences dealing with every aspect
of essentially the same hearing loss in both girls has been
dramatic. From testing to hearing aids to hearing intervention,
speech therapy, language development, socialization, and
ongoing voicing and speaking confidence issues, our younger
daughter, Emily, has had a tremendous advantage, because of her
earlier identification.
Federal funding for newborn hearing screening is critical
to ensuring that other families will not have to suffer
needlessly as Corinne and our family have.
Now Corinne and Emily would like to make a brief statement.
Ms. Emily Coleman. Hi, my name is Emily Coleman. I am glad
I was tested when I was born. I have not had to work as hard as
Corinne. Thank you.
Ms. Corinne Coleman. Hello, my name is Corinne. When I was
born, there was no newborn screening, and I had to do lots and
lots of speech therapy. My little sister, Emily, did not have
to do all this work.
I really wish that all kids with a hearing loss could be
identified early like she was. I really hope that you put the
money back into the budgets to help the other kids. Thank you.
[Applause.]
Mr. Regula. I have got to tell all of you, since our
funding is discretionary, you have got a disadvantage.
[Laughter.]
Ms. Coleman. We will use it.
In closing, I want to thank you, Mr. Chairman and members
of the committee for providing strong leadership and support
for these programs in the past. We also greatly appreciate the
support for these programs that you displayed at the agency
hearings this year.
On behalf of the National Campaign for Hearing Health, and
my family, and thousands of other families like ours, we
request your consideration to provide $1 million to HRSA for
screening, and $12 million to CDC for surveillance tracking and
research. Thank you for the opportunity to appear here today.
[The prepared statement and biography of Ms. Coleman
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Well, thank you, that is good.
We have a bill in Ohio to mandate that the hospitals do
just what you are describing.
Ms. Coleman. Right.
Mr. Regula. It seems to me that that would be something
that every hospital would do routinely.
Ms. Coleman. Right, but without the funding, they cannot do
it.
Mr. Regula. No, you are right.
Ms. Coleman. They need the funding. All the States need the
funding, because they have got bills. A lot of States have
bills, but without the funding, they cannot do it.
Mr. Regula. Well, thank you for coming; and Jackie, we are
happy to have you, too. You did not get a chance to speak, but
I am sure you could do well.
Ms. Coleman. She has been a lot of support.
Mr. Regula. Okay, thank you very much for coming.
Our next witness is Dr. Gregory Chadwick, President of the
American Dental Association. We are pleased to have you.
----------
Tuesday, April 23, 2002.
AMERICAN DENTAL ASSOCIATION
WITNESS
DR. D. GREGORY CHADWICK, PRESIDENT
Dr. Chadwick. Thank you, sir.
I will have to admit, that is a hard act to follow. I am
sure everybody in this room, though, has a compelling need that
we are very grateful for the opportunity to be able to express.
Mr. Regula. Well, if you stick around, we have got Elmo, I
think, as a wrap-up. [Laughter.]
Dr. Chadwick. We may do that.
Good afternoon, Mr. Chairman, my name is Dr. Greg Chadwick.
I am President of the American Dental Association and a
practicing endodontist in Charlotte, North Carolina.
Most Americans today enjoy good oral health and have the
access to the best dental care in the world. But dental decay
remains the most prevalent, chronic infectious childhood
disease. It is five times more common than asthma, and seven
times more common than hay fever. In addition, there are
disparities to access.
However, I am pleased to say that the oral health community
has made great strides in these last few years to improve
access to oral health care for the under-served population.
Some of what we have accomplished has developed from programs
that you funded here in this committee.
Mr. Chairman, we must have adequate funding for dental
education, the dental programs within CMS and HRSA, the
Division of Oral Health at CDC, and the dental research under
NIDCR, if we are to continue this forward movement.
Because dentistry receives only a small portion of the
Federal Budget, and because there must be a critical mass, if
these programs are to be effective, we simply cannot afford to
lose any of these programs.
Therefore, the Association strongly opposes the
Administration's proposal to eliminate funding for general
practice and pediatric dental residencies.
Currently, there are only 3,800 pediatric dentists in this
country. Some states have as few as ten. There is a high demand
for these residency positions, but almost half of all
applicants are turned away, because there are no residency
positions available for them.
Unlike medicine, most dental residencies are not paid
through dental Medicare. If Title VII funding for dental
residency is eliminated, 372 dental residencies will be
discontinued. Therefore, we urge the Committee to restore the
funding for these programs at a level of $15 million.
A strong education program is essential to maintaining the
dental workforce. Currently, there is a crisis in dental
education, with over 400 open faculty positions.
If we cannot recruit the very best and brightest into
academic and research, many of the oral health care concerns
that we are going to be discussing here today simply will not
be addressed.
I know the Committee will be hearing from my colleagues
representing the American Dental Education Association. We
support their requests, particularly the increased funding for
the Ryan White HIV AIDS dental program.
The ADA is concerned that CMS grants designed to enhance
access in two of our multi-year Medicaid programs will not be
continued, and in essence will be cut off in mid-stream by the
Administration's 2003 budget.
A grant to improve access to care for 7,000 low income
children under the age of six in California will be
discontinued, as well as a demonstration program in North
Carolina. That program would help children under the age of
three receive preventive health care services.
The ADA believes these pilot projects could be beneficial
to understanding the disparities to access in the current
dental care delivery system. We hope the committee will work
with us to reinstate funding to complete these projects.
We thank the Committee for its previous support of oral
health care programs at CMS and at HRSA, and we're grateful the
Committee understands the need to maintain the Chief Dental
Officers at both agencies.
This support is critical, because oral health is one of the
top three unmet needs of mothers and children. However, less
than two percent of HRSA's maternal and child health budget is
spent on oral health care.
The CDC's Division of Oral Health supports State and
community-based programs to prevent oral disease. Last year, 24
states and tribes applied for CDC grants to improve their Oral
Health Programs and increase Fluoridation and Dental Sealant
Programs.
Unfortunately, the division was only able to fund about
half of those grants. The ADA recommends a funding level of $17
million for CDC's Oral Health Program.
There is a compelling need to reduce the incidents of oral
cancer, gum disease, and tooth decay in our society. The
National Institute of Dental Craniofacial Research is engaged
in studies to determine the underlying causes of these
diseases.
In addition, they have taken the lead to develop salivary
diagnostics, which has the potential to develop non-invasive
tests for many diseases and situations like exposure to Anthrax
poisoning. The association recommends $420 million for NIDCR.
Thank you, Mr. Chairman. This concludes my testimony. I
will be pleased to try to answer any questions for you.
[The prepared statement and biography of Dr. Chadwick
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
As you know, I have got a proposal for an oral health
project in my district.
This is clearly a huge challenge to many communities across
this country, as I have seen in my communities in the Black
Stone Valley, in the number of children that are missing out on
any kind of oral health. It is staggering, and their mouths are
rotting out. It is leading to some terrible health
consequences; let alone, you know, the other ramifications of
this.
So I congratulate you for the work that you are doing,
trying to help that out.
Dr. Chadwick. Thank you, and we are pleased to have you
help raise the level of awareness on this need; because it is
only through the level of awareness, and everybody realizing
it, that we are going to finally be able to do something about
it.
Mr. Regula. Is it not correct that bad teeth can feed other
poisons, if you will, into your system, that can infect your
general health?
Dr. Chadwick. Well, it is probably even more than that. I
mean, you know, oral health is a part of general health. But I
would not want to say that infected teeth are infecting other
parts of the body. But certainly, there is a connection between
oral health and systemic health, yes.
Mr. Regula. Well, thank you very much for your testimony.
Dr. Chadwick. Thank you.
Mr. Regula. Our next witness is Marykate Connor, the
Executive Director of the Caduceus Outreach Services; welcome.
----------
Tuesday, April 23, 2002.
CADUCEUS OUTREACH SERVICES
WITNESS
MARYKATE CONNOR, EXECUTIVE DIRECTOR
Ms. Connor. Good afternoon, Mr. Chairman, Mr. Kennedy. I am
the Executive Director and the founder of Caduceus Outreach
Services.
We are a very small nonprofit organization in San Francisco
that serves homeless people who have co-occurring psychiatric
illness and addictive disorders. I have worked with homeless
people since 1986.
I am here today to speak to the issue of substance abuse
treatment on demand, which is something that Caduceus Outreach
provides to people who have co-occurring addictive and
psychiatric disorders; but I am here on behalf of all San
Franciscans and, in fact, all cities throughout the Nation that
need this kind of service, and not specifically for Caduceus.
I was one of the founding members of the Treatment on
Demand Planning Council in San Francisco. This is a
collaborative effort between the Department of Public Health
and community activists, providers of treatment, and consumers
of treatment.
We came together in 1996, in order to create a system of
treatment that is truly responsive to those who need it and
accountable to communities who fund it.
Treatment on demand is a very simple concept. What it does
is that it allows people who need substance abuse treatment to
receive it when they ask for it, as opposed to when we are
ready to help them.
It also recognizes that treatment must be relevant to the
lives of people that it serves, in order to be effective.
Treatment on demand not only asks to increase the capacity for
people that need treatment, but it broadens the scope of
treatment modalities. Our efforts in San Francisco present an
effective treatment model, but we simply need more of it.
Most communities only have a small portion of the funds
that they need to provide any kind of substance abuse treatment
at all, and as a result, people are turned away from treatment
every day.
Often, people are screened out because they do not fit the
criteria for treatment, and usually, the standard 12 step model
is what is brought about in terms of treatment.
People who have both psychiatric disorders and addictive
disorders are especially subject to discrimination, as both
conditions are stigmatized. Providers of substance abuse
treatment want people with psychiatric illness to get treatment
for their illness first, and providers of psychiatric treatment
will not treat people who are using substances.
In San Francisco, community activists have helped the
Department of Public Health pass a dual disorder policy, so
that both branches of the treatment providers must work with
each other in a simultaneous effort, and not a sequential one.
Providers have much to learn about this, but the Department
of Public Health has taken the lead in directing this modality
of treatment. This is one example of treatment on demand.
Addictive disorders and psychiatric disorders are both
biologically-based conditions. These diseases are some of the
most under-reported, stigmatized, and devastating conditions in
this country.
I believe that the stigma of these illnesses is one of the
reasons why treatment for this population is under-funded and
punishment in the form of jails and prisons and incarcerations
of all kinds are funded to the degree that they are.
There is a greater portion of funding going into
interdiction and incarceration of drugs and alcohol than there
is for treatment for people that are suffering from addictive
disorders. It actually costs more to incarcerate somebody than
it does to treat them.
Treatment really, really works. But in order for it to be
effective, it first must be available, and it must be
specifically relevant to people's lives.
I am asking you to use the power of your office to change
the fact that there is not enough treatment for everybody. Make
treatment on demand a reality for not just, you know, one city
or another city, but everywhere in the country.
It will save lives, and it will also save money, because as
I said earlier, it is cheaper to provide treatment than it is
to incarcerate them.
I believe that every life has value. When we do not provide
lifesaving treatment for someone who is begging for it, we are
clearly saying that their life is of no value.
You can change this and restore the worth of someone's
life. Please fund all efforts to provide treatment on demand,
both in San Francisco and nationwide.
Thank you, and I will answer any questions that you may
have.
[The prepared statement and biography of Ms. Connor
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Do you have a problem of people refusing
treatment? Now I heard you say they ask for it.
Ms. Connor. Yes, I do not often find there is a problem of
people refusing treatment. Sadly, I am one of those providers
that, because we are so very small, have to turn people away
every day, who are asking; and I know that this is the case for
many other treatment providers. There are long waiting lists.
There may be people who, in fact, are not ready for
treatment; but there are more people waiting in line for
treatment, and cannot get the treatment that is specifically
relevant to their conditions.
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. I have no questions at this time, Mr.
Chairman.
Mr. Regula. Thank you very much for coming.
Ms. Connor. Thank you.
Mr. Regula. Next is Dr. John Allegrante, President and
Chief Executive Officer of the National Center for Health
Education and Professor of Health Education, Teachers College;
welcome, Dr. Allegrante.
----------
Tuesday, April 23, 2002.
NATIONAL CENTER FOR HEALTH EDUCATION
WITNESS
JOHN P. ALLEGRANTE, PRESIDENT AND CHIEF EXECUTIVE OFFICER AND PROFESSOR
OF HEALTH EDUCATION, TEACHERS COLLEGE, COLUMBIA UNIVERSITY
Mr. Allegrante. Thank you very much, Mr. Chairman.
My name is John Allegrante, and I am indeed grateful for
the opportunity to appear before the Subcommittee. I am the
Senior Professor of Health Education, sometimes known as
``Health and Clean Hands'' at Teachers College at Columbia
University in Gotham, where I have been a member of the faculty
for over 20 years.
I am a past President of the Society for Public Health
Education; and last year, I was named the new President and
Chief Executive Officer of the National Center for Health
Education.
Mr. Chairman and Mr. Kennedy, I first want to thank you for
all the support and leadership that this subcommittee has
provided for programs and initiatives that do, indeed, invest
in our Nation's youth. But to be frank with you, I am here to
sound a wake-up call today.
Specifically, I am here to request that the Centers for
Disease Control and Prevention be funded at $35 million for
fiscal year 2003, so that CDC can provide additional States
with infrastructure grants for coordinated school health
programs.
Mr. Regula. Now you mean an increase?
Mr. Allegrante. No, they already get about $9.6 million or
$9.7 million, and we want an increase over that to bring it up
to $35 million. Let me tell you why I think we should do this.
More than 3,000 young people began smoking today; more than
3,000. Childhood obesity has doubled in the last decade, making
it now a national epidemic, and 10 to 15 percent of children
are overweight, and more than half have at least one
cardiovascular disease risk factor, such as elevated
cholesterol, hypertension, or risk for Type 2 diabetes. Mr.
Chairman, 21 percent of ninth graders in this country have been
drunk at least once.
Mr. Chairman, in your home State of Ohio, 73 percent of
young people report having smoked cigarettes; 72 percent do not
get even what I would call moderate physical activity; and 81
percent ate fewer than five servings of fruits and vegetables
daily during the past seven years.
I think the statistics are alarming. They tell me that we
are failing our young people, I think, in almost every
community around this country. The cost to the Nation of not
doing more than we are currently doing for them is, I think,
intolerable.
Moreover, the burden of the premature death, disease, and
disability that we see and that results is borne
disproportionately and dramatically so in communities where
racial minorities predominate.
To be honest, what I find so disturbing about these
statistics is that something can be done. We know already what
works. In many places, it is called coordinated school health
programming.
For example, Growing Healthy, our own organization's
programming, the comprehensive school health education
curriculum, that is part of a coordinated school health
program, can help young people acquire the knowledge and skills
they need to support healthy behavior.
Yet, despite the existence of programs like Growing
Healthy, most States do not have the resources to support
putting them or putting programs like them into their schools
as part of such a program.
Now Mr. Chairman, I know that many Federal and State
programs exist to provide schools with programs such as
immunizations, nutritious meals, and physical education
programs. However, most are uncoordinated. Funds for such
programs come from a variety of Federal agencies, including
education, agriculture, and health and human services.
Yet, fewer than half of America's schools really have the
capacity, if you will, to coordinate these many diverse
programs and services that are available. I think, personally,
that this results in costly duplication of services and a waste
of taxpayer dollars.
So funding this request would enable CDC to strengthen what
we know are cost effective coordinated school health programs
of 20 States right now currently funded through infrastructure
grants, and support an additional six to nine States nationwide
in fiscal year 2003, to develop similar programs.
These funds would be used to foster critical partnerships
between the Departments of Education and the Departments of
Health and other related agencies in States, that would allow
the high level State-directed coordination across programs.
These are programs, again, Mr. Chairman, that have been shown
to contribute to overall learning and academic success of
students.
Now I am not alone in this view. There have been
independent studies, including a Gallup poll that found that
seven out of ten adults in this country rated health
information as important for students to learn before
graduating from high school. We have got an opportunity to
reach some 53 million young people indeed in schools across
this country.
So I see this as an investment for the future. School
health programs can help limit the burden of chronic disease
for our Nation, and it will pay enormous dividends in Federal
dollars saved in the coming decades.
In closing, I want to say that I understand the constraints
with which the Committee works, with which our agencies of the
Federal Government must operate.
But I believe that when it comes to health of our children,
like these young ladies we saw a moment ago, the diagnosis is
clear and the treatment is really at hand. Expanding Federal
funding of school health programs is a prescription for the
health of our children.
I thank you, Mr. Chairman. I hope that you will write that
prescription.
[The prepared statement and biography of Mr. Allegrante
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Yes, in Rhode Island, we had a great program
that was put on by the Department of Agriculture, where
children learned how to eat healthy, and also play, and learn
how to exercise.
It was a huge event with families and children at the Rhode
Island Convention Center. It was the most mobbed exhibit or
convention you have ever seen. It was all a host of folks that
were talking about eating healthy and staying active.
Mr. Allegrante. Sir, what if we could replicate that in
communities beyond Rhode Island in America, and get that kind
of excitement going?
Mr. Kennedy. Yes.
Mr. Allegrante. I think this modest request could help us
do that.
Mr. Regula. Thank you very much.
Mr. Allegrante. Thank you.
Mr. Regula. Mr. Kennedy, I understand you will introduce
our next guest.
Mr. Kennedy. Thank you, Mr. Chairman.
I want to welcome one of our witnesses today, Sister Lapre.
You can come up, Sister, and sit right in the middle, please.
Thank you, Sister, for agreeing to testify today before the
House Appropriations Labor, Health and Human Services, and
Education Subcommittee.
I know it takes great courage for you to share your own
personal struggles and also the struggles of your neighbors and
friends, and we appreciate your willingness to speak and be an
advocate on their behalf and for all seniors.
The power of your testimony today will help impact the
progress that we make towards conquering mental illness in this
Nation, and I thank you for your great work.
Mr. Chairman, Sister Lapre has been known as the ``nun on
the run'' in Rhode Island, for her great and extensive work,
working with seniors all over the State, and particularly in
Newport, Rhode Island, at the Forest Farm Adult Day Center,
where she is involved in many activities with seniors there.
So Mr. Chairman, I thank you for the opportunity of
introducing Sister Lapre.
Mr. Regula. Welcome, Sister, and we will look forward to
your testimony.
----------
Tuesday, April 23, 2002.
NEWPORT COUNTY COMMUNITY MENTAL HEALTH CENTER, INC.
WITNESS
SISTER BERNADETTE LAPRE
Sister Lapre. Chairman Regula and members of this
subcommittee, thank you for giving me the opportunity to appear
before you and share my thoughts with you today, April 23rd,
2002, at approximately 1:00 p.m. in room 2358 on the third
floor of the Rayburn House Office Building.
I would like to address here my concern about funding for
senior citizens with mental health problems. I am here on
behalf of seniors who are homeless and depressed; seniors who
are schizophrenic and possibly a danger to themselves and
others, as well; and those who are suicidal.
We recently had someone jump from the Newport Mount Hope
Bridge in our area. Having the diagnosis of bi-polar disease
myself, I know the suffering and feeling anxious, upset, and
wanting to cry a lot. I also know how desperate people can
feel.
I ask that we get the health benefits that we need for our
mental health problems or sickness, and that the Government
gives us Federal aid to help us get therapy. It is very
important for us to get therapy, so that we can deal with our
problems. It would also help the society that we live in.
Many clients are poor, and cannot pay for the medication,
which is very important to help with our sickness? Why; because
it is so expensive.
If we have to go to the hospital, we may hesitate because
of the expense. We also avoid taking our medication for the
same reason. We would then become sick, again.
In my opinion, these seniors should also go to an adult day
care program a few times a week. This will help them to forget
about their problems, let them meet other people, make friends,
and also participate in different activities, which are so
important these days. Care centers offer nutritious meals, as
well.
Our center offers daily exercise, health promotion, a
variety of fun activities, and the support of a caring staff.
I, myself, like going to Forest Farm Adult Day Care three times
a week. It will be two years, May 1st, that I have been going.
I have been going to a psychiatrist and a therapist for
seven years now. I know that for myself, if funding resources
were not paying for it, I do not think I would keep taking my
medicine, because of the cost. What would happen is, I would
fall sick and probably be hospitalized.
Right now, I am doing very well, thanks to these programs.
But more people my age need more help. Seniors do not like to
talk about these things, because they are embarrassed. I hope
that my testimony will help other older people to talk about
their illness and get help.
Thank you for listening, and I urge you to support our plea
for funding. God Bless.
[The prepared statement and biography of Sister Lapre
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Kennedy. Thank you very much, Sister. It was great to
have you testify today. You really helped put a face with the
people out there who, like you, are talking about and, like
your own experience, have suffered tremendously from mental
illness. I congratulate you on your enormous success, working
to conquer your illness all the time.
Can you explain the difference in the quality of treatment
over the years since you have been suffering from mental
illness most of your life and how it's been?
Sister Lapre. I was in France for 26 years. I was getting
help from a psychiatrist. She followed me for 26 years. And
then I came back here to the States. I was going to say, I was
well taking my medication and I was taking care of the children
before school. And after that, I fell sick again. So I was
hospitalized at Boston, at Newport Hospital. I was there for 10
days.
Then Dr. Klein is the one that took me over. I had a
therapist for seven years. They have helped me a lot to deal
with my sickness. And now instead of going every week, I go
every three weeks, and I see Dr. Klein once every four months.
And I'm doing very well. I know I'm shaking today. But without
this help, I wouldn't be well today. And I'm getting a lot of
help.
And at the Day Fund Center, I say the rosary with them, I
go to different ones, because we have divided now our program
north and south. But it's adult day care just the same. I
should have read my biography, it would have been quicker.
[Laughter.]
Sister Lapre. So I came back to the States and I had to go
to the hospital for 10 days, as I was saying. Then after that,
Dr. Klein was there and he took over. I had taken a big amount
at the beginning. And he slowly diminished my pills. So now as
a clorozapad, I'm only taking three grams seven, instead of
ten.
Mr. Regula. Well, obviously whatever you're doing works.
Sister Lapre. Yes.
Mr. Kennedy. She is giving so much to her community, it
shows. She has so much to give. By helping her, we're really
helping the whole community. She's terrific.
Mr. Regula. Thank you. Thank you for coming and for your
testimony.
As I understand it, Mr. Kennedy, you're going to introduce
our next witness also.
----------
Tuesday, April 23, 2002.
THE PROVIDENCE CENTER
WITNESS
HAVEN MILES, SUPERVISOR OF EARLY CHILDHOOD SERVICES, THE PROVIDENCE
CENTER
Mr. Kennedy. Thank you, Mr. Chairman.
It's a great honor for me to introduce Haven Miles. Haven
is a supervisor of Early Childhood Services at the Providence
Center, which is the largest psychiatric hospital center in
Rhode Island. She works particularly with the young children
and was an instrumental help in my being able to put together
the Foundations for Learning Act, which became law last year as
part of the Elementary and Secondary Education Act.
So a lot of what I've learned about it, you know how
outspoken I've been on the Committee about it, I learned from
Haven. So I thank her for being here.
Ms. Miles. I'm really glad to be here, too. And I'd like to
thank the Subcommittee for allowing me to speak on behalf of
young children who struggle with behavioral and emotional
problems.
I'm testifying today in support of Federal funding for
programs that encourage a child's healthy social, emotional and
educational development. Traditionally, education and social-
emotional development have been considered programmatically
separate. I'm here to make the case that it is crucial for us
to shift this paradigm and begin to develop programs that
consider academics and emotional development equally and at the
same time.
I'd like to start off by telling you a couple of stories
about children who I've had the privilege to work with. I
encountered recently a little boy 18 months of age. After his
second expulsion from two separate child care settings for
biting other students, he was referred to our program. He left
in his little wake a host of frazzled child care workers and an
exasperated mother who was already stressed in her pursuit of
transitioning from welfare to work.
Was this a bad child? No. Was this a socially deviant
child? Of course not. The fact is, biting is quite normal for a
child this age. Some children bite more than others. Some
children quite naturally and with little guidance learn that
biting can't happen while others require special help in
learning non-biting behaviors.
This little boy came to our program and experienced a
structured classroom setting where we could give him more
individual attention. He also experienced success for perhaps
the first time. We stopped the biting before it happened, and
employed behavior management techniques that in essence
untaught his biting behavior. After four months we transitioned
him back to a community day care setting where he today enjoys
social success.
Not all children, however, are this easily remediated. I
also work with a three year old boy who, upon arriving on his
first day of preschool, used the length of his arm to clear off
the teacher's desk. As one might expect, this infuriated the
teacher and humiliated the parent. He threw a tantrum which
nobody, the teacher nor the parent, could control. He was
allowed back, and again, he cleared off the desk and threw
another all-out tantrum. This time he was isolated in an empty
classroom. After causing substantial damage to the room, he was
expelled from the school.
Again, this boy is not a bad child. He is a child who
missed, for a variety of reasons, crucial developmental
milestones. And he is in need of specialized remedial efforts
to prepare him to enter public school. He is also a child from
a family in which substance abuse is a major struggle.
He has been with us now for two years. We work with him in
a very structured classroom, using an approach that reflects
mental health principles combined with educational techniques.
This is not found in typical community preschool settings. And
of course, we also work quite closely with the child's family.
Our intention and goal is to help this child transition to
public kindergarten with a new set of emotional and behavioral
skills that he will use to form successful relationships with
his peers and teachers. These skills also will be crucial to
his academic success.
In addition, we will share with his new teaching staff the
techniques of this approach so they can continue his learning.
Without the specialized services this child is receiving, I
don't believe he would have a chance to experience social and
academic success in school and in society.
These examples are not isolated. In fact, they are more
typical than many of us realize. The demand for specialized
programs that address both the social-emotional and academic
needs of young children is growing. I can tell you that
enrollment at the Providence Center's early childhood program
has doubled over the past two years.
While programs like Head Start are a godsend to many
children who otherwise would not have quality preschool
experiences, they are unprepared to address the needs of young
children with behavioral and emotional problems. Head Start
staff members and the staffers of other child care and
preschool programs are in critical need of the advice and
counsel of professionals who are specially trained in early
childhood emotional development.
If we have the proper resources, we can help young children
who have emotional and social problems remain in community
settings and set them on a course toward academic success. The
Foundation for Learning Act can help provide these resources.
This Act is unlike any other Federal initiative, in that it
will help make possible the development of programs that merge
educational and emotional development principles through
service integration and professional collaboration, so that we
can have, in a typical community preschool classroom, teachers
and professionals trained in early childhood development,
working together to meet the comprehensive developmental needs
of children, putting emotional development in the daily
curriculum.
I strongly urge this Subcommittee to give the utmost
consideration to funding programs that support an integrated
approach to the educational and emotional development needs of
young children. I'm going to stop before the light goes on to
ask if there are any questions.
[The prepared statement of Ms. Miles follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Kennedy.
Mr. Kennedy. Thank you, Mr. Chairman.
Thank you, Haven. Maybe you could explain for the Committee
how you currently, the different funding streams you might be
able to get, if you don't have enough of the developmentally
delayed child to get to early intervention services through
Part C. How is it that Foundations for Learning would allow you
in a grant program like that to get these services so that you
can address these children's problems?
Ms. Miles. We are designing at the Providence Center
programs that can address the training needs for existing child
care staff who have not been trained in their own training
programs or their own college degree programs on how to manage
behavior problems. There is ample evidence, material and
information in the mental health field to provide answers to
the immediate questions that those staff have.
And one of the things we would wish very much to be able to
do is to begin sharing immediately with folks who are working
with these youngsters every day, at their places of work, child
care centers and day care homes also, the information that they
need, for example, about how to teach a youngster who is three
years old, who has never had the experience of waiting before,
how to wait, so that it becomes a successful experience for him
rather than another failure.
So the idea is to begin a process that can be, certainly
Rhode Island wide. I would like to see it nationwide, in which
the information and materials that we already have, that have
been around for people to use for at least the last decade, to
get those right into the hands of the people who need them this
very minute.
Mr. Kennedy. And so Mr. Chairman, this would address the
problem that we were talking about in the other hearing where
the Assistant Secretary of Education was testifying last week
about moving Head Start into the Department of Education, and
the real emphasis that needs to be put on literacy. They also
acknowledged after some prodding that emotional-social
competencies were equally as important. But maybe you could
underscore how it is the case where social-emotional
competencies are directly interrelated with literacy, and why
we should be very cognizant about providing those capacities
for teachers, just as we do literacy skills.
Ms. Miles. Literacy skills are taught in steps. And one of
the very first skills leading to literacy is learning how to
play with blocks. If what a two or three year old child knows
how to do with blocks is to throw them or hit people with them,
he's really not ready yet to learn that first you put the big
ones down and then you put the medium ones on top and then you
put the little ones on top of that.
You can't teach a child who is still in the process of
chucking blocks at people how to pay attention long enough to
learn that very first building block, pun intended, about how
to begin to read. If a child is not able to tolerate a waiting
period of longer than three or four seconds, he is not going to
be able to attend to a highly trained, very skillful, very
competent teacher when she is trying to demonstrate and teach
to him and include the rest of the class in the process of
learning that it's A for apple.
Mr. Kennedy. So maybe having these people, teachers, get
the education and how to deal with these children in these
fashions may help them be better literacy teachers as well.
Ms. Miles. Absolutely. Even the most basic of information
about how much stimulation to have available in a particular
classroom for a group of children can make an enormous
difference in whether a child can sit and pay attention to a
teacher or whether he's looking at all the drawings that are up
on the wall.
Mr. Regula. Mr. Wicker.
Mr. Wicker. No questions, thank you, Mr. Chairman.
Mr. Regula. Mr. Obey.
Mr. Obey. No questions, thank you, Mr. Chairman.
Mr. Regula. Thank you very much for being here.
Mr. Miles. Thank you, Mr. Chairman.
----------
Tuesday, April 23, 2002.
AMERICAN ASSOCIATION OF DENTAL RESEARCH
WITNESS
STEVEN OFFENBACHER, DIRECTOR, UNIVERSITY OF NORTH CAROLINA SCHOOL OF
DENTISTRY, CENTER FOR ORAL AND SYSTEMIC DISEASES, AND PRESIDENT,
AMERICAN ASSOCIATION FOR DENTAL RESEARCH
Mr. Regula. Dr. Steven Offenbacher, Director of the
University of North Carolina School of Dentistry Center for
Oral and Systemic Diseases. Thank you for coming.
Dr. Offenbacher. Mr. Chairman, members of the Committee, I
am Steve Offenbacher. I'm with the University of North Carolina
at Chapel Hill.
I'm here today testifying on behalf of the American
Association for Dental Research. I would like to discuss our
2003 budget recommendations for the National Institutes of
Dental and Craniofacial Research, as well as the Agency for
Health Care Research and Quality and the Centers for Disease
Control.
The American Association for Dental Research is a non-
profit organization with over 5,000 individual members and 100
institutional members within the U.S. Its mission rests on
three principal pillars. One is to advance the research and
increase knowledge for the improvement of oral health. Second
is to strengthen the oral health research community. And third
is to facilitate the communication and application of research
findings.
Mr. Chairman and members of the Committee, I want to thank
you for this opportunity to testify about the ongoing work of
the research community and that of the NIDCR. Dental research
is important because it is concerned with the prevention,
causes, diagnosis of diseases and disorders that affect the
teeth, the mouth, jaws and related systemic diseases. Dental
researchers are leaders in studies of disfiguring birth
defects, chronic pain conditions, oral cancer, infectious
diseases, including oral infections and immunity, bone and
joint diseases, the development of new diagnostics and
biomaterials and the interaction with systemic diseases that
can compromise oral, craniofacial and general well-being.
Throughout the life span, the oral cavity is continuously
challenged by both infections that may have systemic as well as
local implications for health. Through the research of dental
scientists, this field continues to demonstrate that the mouth
is truly a window to the body, and that in many ways, this is
an important portal for infection that can spread and
disseminate systemically.
Research into the causes of oral diseases and new ways to
treat and prevent these diseases is estimated to save Americans
$4 billion annually. Oral health is essential and an integral
part of health throughout the life span of an individual. Of
the 28 focus areas for Healthy People 2010, the oral health is
integrated into 20 of them. No one can truly be healthy unless
he or she is free from the burden of oral and craniofacial
diseases and conditions.
Just to mention some of the extent of the problems, dental
caries or tooth decay is one of the most common diseases among
5 to 17 year old individuals. Eighty percent of tooth decay in
permanent teeth is now found in about 25 percent of the school
age children, and minority children have more than their share
of the problem.
According to the Centers for Medicare and Medicaid
Services, approximately 500 million dental visits occur
annually in the U.S., with an estimated $60 billion currently
being spent on dental services. Yet many children and adults
needlessly suffer from oral diseases that could be prevented.
In fact, 30,000 Americans will be diagnosed with oral and
pharyngeal cancers this year with more than 8,000 deaths, many
of which could have been prevented.
I am a dentist, and I'm proud to be a dental scientist.
What's important in terms of research is that there have been
new evidences that have extended the role of oral disease and
oral infection into the mainstream of medicine. For example, we
now understand that periodontal infections are an important
risk factor for pre-term delivery, may increase the risk of a
mother having a pre-term delivery almost seven fold. In these
mothers that have pre-term delivery, we now understand that the
oral organisms can pass through the blood stream and target the
fetus in utero.
For example, a mother that has periodontal disease and has
a baby that's under 32 weeks of gestation, that premature baby
is likely to be about 400 grams smaller because of her
periodontal disease, the infection targeting the fetus and
impairing the growth of that fetus. We can understand that that
translates into a cost of approximately $30,000 in the first
two weeks of that baby's life in neonatal intensive care costs.
So research has taken us to the point where we've
identified the importance of periodontal infections, and we
need the infrastructure, we need the support to extend these
findings and translate them into clinical applications that can
affect the health of the public.
We feel that we are requesting support for the NIDCR, the
National Institute of Dental and Craniofacial Research, this
supports the research an increase of 22 percent for the fiscal
year of 2003 to a total appropriation of $420 million. The
Centers for Disease Control funded at $10,839,000, we are
recommending $17 million for fiscal year 2003. And for the
AHRQ, we are requesting an increase in funding to $390 million.
Thank you for your attention. This concludes my testimony
and thank you for this opportunity to meet with this Committee.
[The prepared statement of Dr. Offenbacher follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Wicker.
Mr. Wicker. Well, you said a lot, Doctor, in a very brief
time. Thank you for your testimony. I think your testimony is
right on target and I appreciate your being here.
Let me just ask you, in the brief time we have, about the
cavities. You say 80 percent of the cavities occur in about 25
percent of the children. I wonder if those children are in
areas where the water has fluoride, and do you know the
percentage of the drinking water in the United States that is
fluoridated, if you could comment on the effects of that?
Dr. Offenbacher. I'm sorry, I don't know the exact numbers.
But I know fluoridation has a tremendous impact. For example,
the rate of caries among non-fluoridated areas, such as in
Asian Pacific Islanders, is extremely high in areas where there
is no fluoride. So fluoride has a tremendous impact.
Access to care has another impact, in terms of the ability
of us to regulate or control the caries in these children. I
don't know the fluoride statistics.
Mr. Wicker. Well, maybe you could get that to the
Committee, submit it to the record.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Wicker. And also, just to say that I think this
Subcommittee is aware that a dentist is perhaps the only
opportunity that some people will have to see a professional
that could possibly diagnose other problems and send them to
other types of physicians that they need to see. So I, as one
member of this Subcommittee, I am very supportive of all the
dental programs, up to and including pediatric dentistry, and
also getting our dentists out to the communities where we know
that the area is under-served in other areas of medicine, so
that at least there is somebody there to take a look at them
from a professional standpoint and send them in the right
direction.
So thank you for your testimony.
Dr. Offenbacher. Thank you, sir.
Mr. Regula. Thank you very much.
----------
Tuesday, April 23, 2002.
AMERICAN DENTAL EDUCATIONAL ASSOCIATION
WITNESS
DAVID JOHNSEN, DEAN, UNIVERSITY OF IOWA COLLEGE OF DENTISTRY AND
PRESIDENT, AMERICAN DENTAL EDUCATION ASSOCIATION
Mr. Regula. Dr. David Johnsen, Dean, University of Iowa
College of Dentistry. We're getting a pretty good shot on the
dentists today. [Laughter.]
Dr. Johnsen. Good afternoon, Mr. Chairman and members of
the Subcommittee. My name is Dr. David Johnsen. I'm Dean of the
University of Iowa College of Dentistry and President of the
American Dental Education Association, representing all 55 U.S.
dental schools.
In 2000, the Surgeon General released a report entitled
Oral Health in America. The document makes clear that there are
profound disparities in the oral health of Americans amounting
to a silent epidemic of dental and oral diseases affecting our
most vulnerable populations.
And there are other significant challenges within the
infrastructure of dental education and the oral health delivery
system. For instance, the dentist to population ratio is
declining, decreasing the capability of the dental work force
to meet emerging demands of society. In one-third of the
counties in Iowa, 20 percent of the dentists are age 60 or
more.
Dental education debt has increased, limiting both career
choices and practice locations. In 2000, 45 percent of
individuals who graduated with debt over $100,000. Currently
there are 400 budgeted but vacant faculty positions in 55 U.S.
dental schools. Of dental students graduating in 2000, only one
half of 1 percent plan to seek careers in academia and
research. And lack of diversity and the number of under-
represented minorities in the oral health professions is
disproportionate to their distribution in the population at
large.
We urge the following. Number one, for general dentistry
and pediatric dentistry training programs, ADEA recommends that
the Subcommittee adequately fund the Primary Care Cluster to
ensure an appropriation of $15 million for these two primary
care dental programs. These two programs provide dentists with
the skills and clinical experiences needed to deliver a broad
array of oral health services to the full community of
patients. Post-doctoral general dentistry training programs
increase access to care while training dental residents to
treat geriatric, special needs and economically disadvantaged
patients.
The pediatric dentistry program began to expand after 20
years of little change. Preventive oral health care for
children is one of the great successes in public health. But 25
percent of the pediatric population still experiences 80
percent of the dental cavities. Two-thirds are Medicaid
recipients.
Number two, for the Health Professions Education and
Training Programs for Minority and Disadvantaged Students, ADEA
recommends $135 million, including $3 million for the faculty
loan repayment program. Two programs, the Centers of Excellence
and the Health Careers Opportunity Program, are key in
assisting health professions schools prepare disadvantaged and
minority students for entry into dental, medical pharmacy and
other health professions. The faculty loan repayment program is
the only Federal program that endeavors to increase the number
of economically disadvantaged faculty members.
Number three, for the Ryan White HIV-AIDS reimbursement
program, ADEA recommends an appropriation of $19 million. This
program increases access to oral health services for HIV-AIDS
patients and provides dental students and residents with
education and training. In 2001, 85 dental programs treated
more than 66,000 patients who could not pay for services
rendered.
Number four, for the National Health Service Corps
Scholarship and Loan Repayment Program, ADEA supports the
President's recommended funding level of $191 million. Programs
assist students with the rising costs of financing their health
professions education while promoting primary care, access to
under-served areas. NHSC should open the scholarship program to
all dental students and increase the number for dental hygiene
students.
Number five, for the National Institute for Dental and
Craniofacial Research, NIDCR, ADEA joins the American
Association for Dental Research in requesting an appropriation
of $420 million for NIDCR. Likewise, ADEA urges the
Subcommittee to encourage NIDCR to expand loan forgiveness
programs to researchers. Through collaborative efforts with
NIDCR, oral health researchers in U.S. dental schools have
built a base of scientific and clinical knowledge that has been
used to dramatically improve oral health in this country.
In conclusion, Mr. Chairman, I thank you again for the
opportunity to present fiscal year 2003 budget requests for
dental education and research programs, and urge the
Committee's support. Thank you.
[The prepared statement of Dr. Johnsen follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. No questions, thank you, Mr. Chairman.
Mr. Regula. Mr. Wicker.
Mr. Wicker. Nothing, thank you.
Mr. Regula. Thank you for being here.
----------
Tuesday, April 23, 2002.
COALITION FOR INTERNATIONAL EDUCATION
WITNESS
DAVID WARD, PRESIDENT, AMERICAN COUNCIL ON EDUCATION ON BEHALF OF THE
COALITION FOR INTERNATIONAL EDUCATION
Mr. Regula. Mr. David Ward, President of the American
Council on Education.
Mr. Ward. Mr. Chairman and members of the Subcommittee, my
name is David Ward, and I am President of the American Council
on Education, an association representing 1,800 public and
private two and four year colleges and universities. Prior to
that, I was Chancellor of the University of Wisconsin-Madison,
in the same State as the Ranking Member.
One of our top priorities is Federal student aid. Before I
address today's topic, I would like to thank the Chairman, the
Ranking Member and the rest of the Subcommittee for their
support of the Pell Grant program and campus-based student aid
programs. In addition, we thank the Committee for its support
of scientific research, specifically a longstanding commitment
to double the budget of the National Institutes of Health.
Today I am here to present testimony on behalf of the
Coalition for International Education on the fiscal year 2003
appropriations for the Title VI programs in the Higher
Education Act and the Mutual Educational and Cultural Exchange
Act, commonly known as Fulbright-Hays. The Coalition is an ad
hoc group of 28 national higher education organizations, with a
focus on international education, foreign language and exchange
programs. We express deep appreciation for the Subcommittee's
long-time support for these programs, especially for the
significant infusion of funding in fiscal year 2002.
The recent terrorist threats we're being forced to address
only underscore the importance of training specialists in
foreign languages, cultures and international business.
Developing the international expertise of the U.S. will need in
the 21st century sustained financing. At the top of the list is
adequate support for Title VI and Fulbright-Hays.
Just as the Federal Government maintains military reserves
to be called upon when needed, it must invest in an educational
infrastructure that steadily trains a sufficient number and
diversity of American students. International expertise cannot
be produced quickly. It must be cultivated and maintained.
Moreover, we cannot continue to prepare for yesterday's
problems, but we must build upon our existing knowledge base to
equip our Nation to meet tomorrow's challenges in international
matters.
Responding to demands to protect national security in a
broad range of arenas throughout the U.S. and the world,
virtually every Federal agency is engaged globally. One
estimate is that over 80 Federal agencies and offices rely on
human resources with foreign language proficiency and
international experience. Despite their own language training
programs, several agencies are now scrambling to address
deficiencies in the less commonly taught and difficult to learn
languages, such as those of central Eurasia, south Asia, and
the Middle East. Faced with shortages of language experts after
September 11th, the FBI sought U.S. citizens fluent in Arabic,
Persian and Pashto to help with the Nation's probe into the
terrorism attack. One Federal agency estimated its total needs
to be 30,000 employees dealing with more than 80 languages.
Title VI and Fulbright-Hays are among the few programs the
Federal Government supports that provide the necessary long
term investment in building language and foreign area capacity
that responds to national strategic priorities. At roughly $100
million, this is one of the smallest investments the Government
makes in national security, but it pays extraordinary
dividends.
National security is also linked to commerce, and U.S.
business is widely engaged around the world in joint ventures,
partnerships and other linkages that require employees to have
international expertise. A recent study on the
internationalization of American business education found that
knowledge of other cultures, cross cultural communications
skills, international business experience and foreign language
fluency rank among the top skills sought by corporations
involved in international business.
Title VI supports important programs that internationalize
business education and help small and medium size U.S.
businesses access emerging markets, a boost toward reducing the
trade deficit and creating more U.S. jobs. The U.S. Department
of Commerce reports that 97 percent of all U.S. export growth
in the 1990s was contributed by small and medium size
companies. Yet, only 10 percent of these companies are
exporting. The most common reasons cited by U.S. businesses for
not pursuing these export opportunities is a lack of knowledge
and understanding of how to function in the global business
environment.
Research is needed to identify specific policy measures and
avenues of public and private sector cooperation that will make
possible both homeland security and continued economic growth.
The Centers of International Business Education Research
supported by Title VI have made great strides in
internationalizing U.S. business education. Globalization is
also driving new demands for globally competent citizens, and
international knowledge in almost all fields of endeavor,
including health, the environment, journalism and the law.
Although funding has increased over the last three years in
constant dollars, these programs are below the fiscal year 1967
levels. The overall erosion of funding, combined with expanding
needs and rising costs, have contributed to the shortfall in
international expertise that our Nation requires.
Last year's funding increase was an important step towards
accomplishing our Nation's strategic objective in Title VI and
Fulbright-Hays funding. As a next step for fiscal year 2003,
the Coalition recommends $122.5 million, a total increase of
$24 million for Title VI and Fulbright-Hays programs, to be
allocated as outlined in my written testimony.
That is the end of my testimony. I would be happy to take
questions.
[The prepared statement of Mr. Ward follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you. Mr. Obey.
Mr. Obey. Mr. Chairman, let me simply say that in my
judgement, we can usually say that the need to fund programs in
education and science is usually inversely proportional to the
degree of political power demonstrated by their advocates, or
the political sexiness of the programs. Not many members of
Congress are going to get gold stars going home bragging about
what they've done to promote international education.
But I think events such as September 11th demonstrate the
wisdom of doing that. I was struck by the fact that,
Chancellor, in your statement you have this sentence: fiscal
year 1967, Title VI funded three programs that still exist, the
National Resource Centers, FLAS fellowships and Research and
Studies. Their combined estimated funding for fiscal year 2002
is about $58 million, or 32 percent below fiscal year 1967,
high point of $87 million in constant dollars.
It seems to me that our national interest in supporting
these kinds of programs has not declined since that time,
although the public interest and the political interest
certainly had, until September 11th. But I'm glad to see that
you're here supporting these programs. I must also say, I
confess I'm not objecting. Because I wouldn't be here if it
weren't for those programs. After Sputnik hit the newspapers in
1958, I received one of those three year fellowships in the
Russian area studies program. If I hadn't, I wouldn't be here
today. That might be regarded by some as a good reason not to
support the program. [Laughter.]
Mr. Obey. Nonetheless, I think it's an important program. I
thank you for being here today and support it.
Mr. Ward. I appreciate that.
Mr. Regula. Mr. Wicker, you're going to introduce the next
witness.
Thank you very much for coming.
Tuesday, April 23, 2002.
COUNCIL FOR OPPORTUNITY IN EDUCATION
WITNESS
REVEREND CLARENCE E. SMITH, REGISTRAR, RUST COLLEGE, HOLLY SPRINGS,
MISSISSIPPI
Mr. Wicker. Mr. Chairman, and my colleagues on the
Subcommittee, I am delighted to introduce Reverend Clarence
Smith. The record will show that he is Registrar at Rust
College in Holly Springs, Mississippi, that previously he was
Director of the Upward Bound program at Rust College. But he is
also my very good friend and neighbor. He works in Holly
Springs, but commutes back and forth to my home town of Tupelo,
Mississippi. Our children are in school together, and he is a
valuable member of our community.
I have but one concern, and that is that Mr. Smith recently
surrendered to the ministry and is going to seminary also. To
limit a Baptist minister to five minutes----
[Laughter.]
Mr. Wicker. I don't know if it's humanly possible, Mr.
Chairman. But Reverend Smith is here, and we're delighted to
have him here. I will yield and then I'll reclaim my time.
The first person to ever tell me about the TRIO program was
our next witness, and I appreciate that. We're delighted to
have you here, Clarence.
Rev. Smith. Mr. Chairman and members of the Subcommittee,
my name is Reverend Clarence E. Smith, and I am presently the
Registrar at Rust College in Holly Springs, Mississippi. Prior
to this position I was the Director of the TRIO program at Rust
College for about 11 years, and I'm still very involved in the
three TRIO programs that are currently on the campus.
I am testifying today on behalf of the Council for
Opportunity in Education, which represents administrators and
counselors working in TRIO programs nationally. Chairman
Regula, before I proceed with my testimony, I would like to
thank you and other members of the Subcommittee for your strong
commitment to the TRIO programs over the past few years, and
for expanding student access to these programs.
In particular, I would like to acknowledge my Congressman,
Congressman Roger Wicker, whom I have known for about eight
years and who has been a great supporter of TRIO programs and
Rust College. I have also had the privilege of presenting a
regional award to him for his outstanding support of TRIO
programs.
As you know, the TRIO programs are a complement to the
student financial aid programs and help students to overcome
the class and academic barriers that prevent many low income
first generation college students from enrolling in or
graduating from college. The five TRIO programs work with young
people and adults from sixth grade through college graduation.
Currently, there are almost 2,600 TRIO projects serving some
823,000 needy students.
Now, I would like to tell you a little about the programs
at Rust College. Rust College is a four year liberal arts
institution, and it is the oldest historically black
institution in the State of Mississippi. For over 30 years,
Rust College has been the host for three TRIO programs, Student
Support Services, Talent Search and Upward Bound.
The Rust College Upward Bound programs help eligible high
school students prepare for, pursue and complete post-secondary
education. As an incentive, Rust College also provides a $2,400
scholarship for each Upward Bound student who graduates from
high school and enrolls at Rust College. The Rust College
Education Talent Search Scholars Program also helps students
complete high school and enroll in post-secondary education.
But this program begins serving students at the middle school.
For both the Upward Bound and Talent Search programs, Rust
College serves four school districts located in rural counties
such as Benton, Marshall and Tate, which are economically
disadvantaged regions of the State. Rust College feels strongly
that providing services to the students in the target areas
through Talent Search and Upward Bound tremendously helps level
the playing field for those students, and also gives them equal
access to post-secondary education.
The Rust College Student Support Services program helps to
increase the retention and graduation rate of eligible college
students and tries to promote an institutional climate that
enhances the success of these students. I have been able to
witness first-hand the effectiveness of TRIO, and now I would
like to share with you the success story of one of my students
who benefitted from the TRIO programs at Rust College.
Charles LeSure came from a single parent family where his
mother had a meager income but had a desire for her children to
be successful. He entered the Upward Bound program at Rust
College after being referred by a counselor, because he had
academic need. While he thought about going to college, he did
not have extra support needed to help him prepare for college.
And he needed the Upward Bound program to help him stay
focused.
Of course, coming from a rural area, he also needed the
cultural experience and exposure that Upward Bound brings. He
graduated from high school and entered Rust College in the fall
of 1992. With the help of the Student Support Services program
at Rust, he graduated in 1996. Currently, he is a math teacher
in the Memphis City School System and an associate minister at
Anderson Chapel C.M.E. Church.
Current funding levels seriously limit the ability of TRIO
to serve more students and to strengthen the quality of program
services. There are almost 9.6 million low income students,
from middle school to college, currently eligible for TRIO. And
the demographics will show that.
For these reasons, the Council is recommending an
appropriation of $1 billion for TRIO in the fiscal year 2003,
an increase of $200 million. At this level of funding, the TRIO
programs will be able to serve almost 100,000 additional
students and strengthen existing services.
The Council also supports the Student Aid Alliance fiscal
year 2003 funding request, which includes a $500 increase for
the minimum Pell Grant award, to $4,500.
Mr. Chairman, Committee, we deeply appreciate and pray that
you will consider our views. I will be happy to entertain any
questions that you may have.
[The prepared statement and biography of Rev. Smith
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Mr. Wicker. Mr. Obey.
Mr. Obey. I do have just one comment. I have been a strong
supporter of TRIO ever since I have had a chance to deal with
that on the Subcommittee. But I would simply ask one thing of
the folks who are for TRIO and the folks who are for GEAR UP.
That is that they not fight each other.
I don't think the needs of the students who are served are
going to be very well met if we have a lot of time spent with
TRIO people begrudging what is appropriated for GEAR UP and
vice versa. So to the extent that you can deliver that message
to both organizations, I would appreciate it.
----------
Tuesday, April 23, 2002.
COALITION FOR COMMUNITY SCHOOLS
WITNESS
MARTIN J. BLANK, STAFF DIRECTOR, COALITION FOR COMMUNITY SCHOOLS,
INSTITUTE FOR EDUCATIONAL LEADERSHIP
Mr. Regula. Okay, Mr. Hoyer, thank you for coming and
introducing our next witness.
Mr. Hoyer. Thank you, Mr. Chairman.
I'm glad to welcome at this point in time Mr. Martin Blank,
who is the Staff Director of the Coalition for Community
Schools, Institute for Educational Leadership. Mr. Chairman,
the Coalition is an alliance that brings together leaders and
networks and education family support, youth development,
community development, government and philanthropy behind a
shared vision of full service community schools, where
community resources and capacity are mobilized around children
in public schools to support student learning. As you know, Mr.
Chairman, that's something I've been talking about for well
over a decade.
Marty Blank has extensive experience in research, practice
and policy related to full service community schools. Now,
that's his CV. He is also married to a very extraordinary
woman, Helen Blank, who is the Executive Director of the
Children's Defense Fund, and with whom I have worked for more
than a decade on issues related to children and families. She
does an extraordinary job herself.
So Marty and Helen are two extraordinary Americans serving
children in our country. And we welcome him here today.
Mr. Blank. Thank you, Mr. Hoyer. It's always a privilege to
follow in your footsteps and particularly in my wife's.
Mr. Hoyer. I had the same experience.
Mr. Blank. I know you have, and that's why we've been so
pleased with your support of full service community schools.
Mr. Chairman, I am Marty Blank, Staff Director of the
Coalition for Community Schools. My thanks to you, Mr. Chairman
and the Subcommittee, for the opportunity to testify today.
Research and common sense tell us that children from all
income groups experience barriers to learning. We've heard
about some of them today, the health, the mental health, the
dental issues that young people experience. In addition, there
are other barriers, unstructured time after school, lack of
engagement in learning, poverty in absence of family support,
student mobility, risky behavior, violence, absenteeism. These
all affect student learning. And full service community schools
address these needs in an intentional and strategic way.
Full service community schools are public schools open to
students, families and community members before, during and
after school, all year long. They have high standards and
expectations, qualified teachers, rigorous curriculum. At a
typical full service community school, the family support
center helps with early childhood development, parent
involvement in education. Employment and other services,
medical, dental, mental health and other services are readily
available. Before and after school programs build on classroom
experiences and help students expand their horizons. Parents
and community residents participate in adult education and job
training. The school curriculum uses the community as a
resource to engage students in learning and service, and
prepares them for adult civic responsibility.
Educators, families, students and community agencies and
organizations decide together what services and opportunities
are necessary to support student learning. No model is imposed
upon them. Research based strategies are applied.
You may be asking yourself, do we expect schools to do all
of this work? The answer is no. Rather, a full time
coordinator, in many instances hired by a partner community
organization, works with the principal to link the school to
the community and manage the additional supports and
opportunities available at a community school. Working with a
partner organization helps take the burden off principals and
teachers, so they can focus on teaching and learning.
Who pays for this? Financing is a shared responsibility.
the school funds the core instructional program and facilities
costs, obviously, but together the school and its community
partners fund the various services by coordinating and
integrating Federal, State, local and private funding streams
from Education, Health and Human Services, Justice, many of the
programs this Committee funds, as well as private sources.
Community partners include every sector of the community,
parks and recreation, child and family agencies, youth
organizations like the Ys, the Boys Clubs, United Way, small
and large business, museums, hospitals, the Forest Service,
police and fire departments are all involved in this effort in
communities across the country.
Do full service community schools work? Evaluation data
from 49 different initiatives compiled by leading authority Joy
Dreyfuss demonstrates their positive impact on student
learning, on healthy youth development, on family well being
and on community life. Moreover, community schools have strong
community support, strong public support. A recent poll by the
Knowledge Works Foundation in Ohio found that two-thirds or
more of Ohioans support community use of school facilities for
the kinds of programs envisioned in a full service community
school.
How can this Committee help to promote this promising
approach? At the present time, various agencies of the Federal
Government fund programs that should be integrated in a full
service community school. Too often, however, these programs
are fragmented and not focused on our key national priority:
improving student learning. The No Child Left Behind Act
requires States and local education agencies to coordinate and
integrate Federal, State and local services to help support
student learning.
We believe that to ensure the effective implementation of
this provision and to create full service community schools,
States and local education agencies need incentives and
technical assistance. Therefore, we ask this Committee to do
the following.
First, support a State full services community schools
incentive program that provides willing States with flexible
funds to create an infrastructure for full service community
schools. Support a similar program for local education agencies
that work in partnership with other organizations. Support a
national full service community schools support center where
research on this issue, coordination of training and technical
assistance and recognition programs can be implemented. And
finally, support the core underlying programs that must be
integrated at a full service community school, particularly
those where educators and community agencies must work
together, such as the 21st Century Community Learning Program,
the Safe Schools Healthy Students Program, and Learn and Serve
America.
In conclusion, Mr. Chairman, the Coalition believes that
bringing schools together with the assets of organizations and
individuals in our communities and with our families to improve
student learning is a common sense policy approach. Full
service schools help ensure that schools have support from
families and communities for the education enterprise that is
so vital to the future of our democratic society.
Thank you very much, and I'd be pleased to answer any
questions you may have.
[The prepared statement of Mr. Blank follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. If I understand you correctly, any school could
become a full service school, depending on its willingness?
Mr. Blank. That's correct, Mr. Chairman.
Mr. Regula. Your group's function is to encourage the
development of these kinds of units across the country?
Mr. Blank. That's quite correct, sir.
Mr. Regula. Thank you.
Mr. Hoyer.
Mr. Hoyer. Mr. Chairman, I don't have a question, but I
want to thank Marty for his testimony. The points that he has
made with respect to grant programs to fund the full service
community school grant program and the State full service
program as well as a support center funding, all of these I
think tie into what we need to do on this Committee, and what
I've urged in particular three Departments under our aegis to
do, and that is, obviously Health and Human Services that has
Head Start, in some respects now fully integrated at about a
quarter of the schools across the Nation, but not integrated in
about three quarters, and the President has spoken about that,
as you know. As well as educational health services that come
under both Department of Education and HHS. But also programs
for work incentive programs, worker training programs, adult
education programs which come under both Education and Labor.
In addition to that, of course, we have six or seven other
Departments including HUD, Agriculture and Nutritional
Services. The point is, Mr. Chairman, the full services school
concept is, as you know, that we have invested a lot of money
in a central, the only central facility that every community
has. Perhaps a fire hall or fire service is the other one. But
the only one that every community has, that is an elementary
school. If we fully utilize and coordinate these services, we
can get more bang for the buck that we appropriate, because
they will be coordinated and made much more efficient in terms
of delivery to those people who need them. That's the whole
concept of full service schools.
Mr. Chairman, I want to work with you over the next coming
months before we mark up the bill to see if we might start,
I've talked about this for a long time, and we're going to
introduce a piece of legislation, hopefully within the next
month. We've been working with Congressional Research Service.
Before we introduce it, I'm going to show it to you. I'd love
to have you look at it and if you think it's a good idea, to
co-sponsor it with me, along with others, but to see if we can
in effect energize this effort of utilizing our resources more
efficiently in this bill that we're going to mark up shortly.
Again, Marty, thank you very much for not only your
testimony but for the work that both you and Helen do.
Mr. Regula. How many units are there across the Nation that
do this?
Mr. Blank. It's a challenging question, Mr. Chairman. We
think there are several thousand schools that reflect this full
vision that I articulated. Many have pieces of this, and as you
correctly pointed out earlier, we are trying to get people to
see and understand this notion, this idea, and the kind of
support that we're seeking from this Committee will help us to
move that idea forward into implementation. And in addition to
all the goals that Mr. Hoyer articulated, we believe this
approach has a real connection to the student learning
objectives that are so important to this Committee, to the
President and the country.
Mr. Regula. That's an interesting thing. I have a couple in
my district that are headed that way, they're open 18 hours a
day and the community is involved. One of them has the YMCA
right in the building. That's the newest thing.
Mr. Blank. Right. Ohio is building many new schools, as you
are probably aware, because of the age of its facilities. We
would like to see them built in this way, because we believe
that it really engages all Americans in educating all our
children.
Mr. Regula. Makes a lot of sense. Thank you for coming.
Mr. Blank. Thank you so much.
Mr. Hoyer. Marty, if I can, before you leave, because the
Chairman asked the question how many there are, as you know,
Mr. Chairman, because we've had some conversations, we're going
to try to coordinate a schedule for you to go out to Eva Turner
in Charles County, which is a partially full service school.
We're not exactly where we want to be, but it's certainly a
multi-service school.
Marty, do you remember the school that I visited in New
York, whatever the number was?
Mr. Blank. Yes, IS 218, a school that's been a partnership
between the Children's Aid Society and the Community School
District Number 6.
Mr. Hoyer. It is an extraordinary school, Mr. Chairman.
When you're up in New York, this is north of the GW Bridge,
large Latino population in that area. They are doing some
extraordinary work with multi-service----
Mr. Blank. Right. They also have a site here in the
District of Columbia which might be another possibility for a
visit as well, Mr. Hoyer.
Mr. Hoyer. Obviously, yes. Thank you.
Mr. Regula. Thank you.
----------
Tuesday, April 23, 2002.
ASSOCIATION OF TECH ACT PROJECTS
WITNESS
PAUL RASINSKI, EXECUTIVE DIRECTOR AND CONSUMER, MARYLAND TECHNOLOGY
ASSISTANCE PROGRAM
Mr. Regula. Mr. Hoyer, I understand you want to introduce
our next witness.
Mr. Hoyer. Mr. Chairman, I've been very involved in
assistive technology, and you have been very helpful as last
year, as you recall, we cooperated with the authorizing
committee to preclude the assisted technology grant from
lapsing, as it would have happened under the legislation.
I'm pleased to welcome to the Committee Mr. Paul Rasinski,
who is the Executive Director of the Maryland Technology
Assistance Program, otherwise known as MTAP. Born and raised in
Baltimore, Mr. Rasinski takes pride in assisting individuals
with disabilities in our community, and we thank him for that.
He graduated from Coppin State College, began his career in
education as an industrial arts instructor in the Baltimore
City School System. He sustained a spinal cord injury in a
sports accident, and spent many years rehabilitating his
physical health and endeavoring to develop a new career. He
has, out of adversity, given great, positive effect to his own
injury and imparted great, positive wisdom to others. He joined
the staff of the Maryland Technology Assistance Program as the
Education Liaison. The position entailed, among other
responsibilities, assisting parents and educators in the proper
selection and use of assistive technology for the individual
education plans of children with disabilities.
He was promoted assistant director in 1996 and on July 1st,
1997, assumed the position of executive director. He testified
last month before the Education and Work Force Subcommittee on
21st Century Preparedness on this subject. Mr. Chairman, I am
hopeful that the authorizing committee will move legislation. I
have had discussions, I know you have talked to them as well.
Mr. Rasinski gave very compelling testimony there. And I
welcome him before our Committee today. Thank you for being
here, Paul.
Mr. Rasinski. Good afternoon, Mr. Regula, and the rest of
the members of the Subcommittee. Thank you for this opportunity
to share with you my thoughts about State programs funded by
the Assistive Technology Act. I want to especially thank our
Maryland representative, Mr. Hoyer, and the rest of the
Committee for your efforts last year, and throughout the years,
to assure that assistive technology projects have continued to
be funded.
The Assistive Technology Act of 1998 will be considered for
reauthorization next year, but without your support in this
legislative session, many of the projects will be terminated.
Before this year, and the activities of the House Subcommittee
on 21st Century Competitiveness, it had been almost a decade
since the House of Representatives had held a hearing on this
law. So much has happened over that decade, both in terms of
the accomplishments of the State grant programs, and in the
advances we have seen in technology. Remember that only a
decade ago, none of us used e-mail.
I am here today representing the Association of Tech Act
Projects, and to enlist your support in including an amendment
to the Assistive Technology as part of fiscal year 2003 Labor,
Health, Human Services, Education Appropriations bill again
this year as you did last year. As you said earlier today when
I met you, you said this was quite an important topic, and I
believe you. Last year, the amendment saved nine States from
being terminated from this important program that ensures that
people with disabilities will have access to assistive
technology that they need.
This year, we need your help again, as without an attached
amendment, 23 States will be eliminated from funding. The
States which will be eliminated are Arkansas, Alaska, Colorado,
Illinois, Indiana, Iowa, Kentucky, Maine, Maryland,
Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New
Mexico, New York, North Carolina, Oregon, Tennessee, Utah,
Vermont, Virginia and Wisconsin. As you can see, many of your
members here today represent those States. We would enlist your
help to continue our services in those States.
We request that the funding for Title I of the Assistive
Technology Act be provided at a $34 million level. This would
return us to the level of funding we received in fiscal year
2000. In addition, we request that you include the following
amendment, which would ensure that no State would be eliminated
from the program:
Provided that funding provided for Title I of the Assistive
Technology Act of 1998, the AT Act, shall be allocated
notwithstanding Section 105(b) of the AT Act; provided further
that Section 101(f) of the AT Act shall not limit the award of
an extension grant to three years; and provided further that no
State or underlying area awarded funds under Section 101 shall
receive less than the amount received for fiscal year 2002 and
funds available for increases over the fiscal year 2002
allocations shall be distributed to States on a formula basis.
I'm going to kind of go away from my written speech for a
few moments, and tell you what the $34 million provides. Each
State has a Tech Act project, and there are also six
territories. Each program takes the dollars that we get from
the Federal Government and coordinates efforts throughout each
State, along with other programs, to have the commission on
aging, education departments, anyone that has any dealings with
persons with disabilities. We enhance their programs by
educating them as to what assistive technology does for the
people, the students in school, workers on the sites, seniors
who are going home now and finding out that the houses that
they have lived in for many, many years are inadequate for
their needs. Ramps have to be built, stair lifts added, and we
do a lot of coordinating of the efforts that the person with a
disability just has to have within their lifestyle.
In conclusion, I'd like to say that in 2004, the Assistive
Technology Act is scheduled for reauthorization by Congress. I
and my colleagues around the country look forward to working
with you to develop new ways to support access to technology
for people with disabilities. We hope that you will ensure
continued support for programs in the 56 States and
territories, including the amendment to the Assistive
Technology Act as part of fiscal year 2003 Labor, Health, Human
Services, Education appropriations bill again this year as you
did last year.
We request that the funding for Title I of the Assistive
Technology Act be provided at the $34 million level. We believe
that this Federal leadership role provides the infrastructure
and seed money that leverages a great range of programs and
services that are critical to people with disabilities. For
example, all the Title III loan programs are administered by
Title I State programs. If there were no Title I program
infrastructure, there would be no Title III loan programs.
We are most grateful to you for your leadership on behalf
of Americans with disabilities who depend on assistive
technology for their independence and their full participation
in society. Thank you very much, and I welcome any questions
you might have.
[The prepared statement of Mr. Rasinski follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hoyer. I don't have any questions, but I thank Mr.
Rasinski for his testimony, and we'll certainly work toward the
objective that he seeks. I think it is so critically important,
for as he points out, a lot of States that are represented on
this panel. But much, much more importantly for thousands of
people who are enabled and empowered to participate in our
society through the use of assistive technology. Thank you.
Mr. Rasinski. Thank you.
----------
Tuesday, April 23, 2002.
UNITED NEGRO COLLEGE FUND
WITNESS
JOHN HENDERSON, PRESIDENT, WILBERFORCE UNIVERSITY
Mr. Regula. Next is Dr. John Henderson, President of the
Wilberforce University. Dr. Henderson.
Mr. Henderson. Good afternoon, Mr. Chairman and Mr. Hoyer.
My name is John Henderson, the President of Wilberforce
University in Wilberforce, Ohio. But today I appear on behalf
of the United Negro College Fund, UNCF, the Nation's oldest and
most successful African-American higher education assistance
organization. Since 1944, UNCF has been committed to increasing
and improving access to college for African-Americans, and
remains steadfast in its commitment to enroll, nurture and
graduate students who often do not have the social and
educational advantages of other college going populations.
This Subcommittee has attentively listened and responded to
our concerns in the past, and for this we gratefully thank you.
There is no more important partner in the HBCU's mission to
provide excellence and equal opportunity in higher education
than the Federal Government.
Mr. Chairman, the Labor, Health and Human Services
Education Appropriations Subcommittee can play a major role in
enhancing the capacity of HBCUs. Allow me to highlight the key
points of UNCF's recommendations in order to convey to the
Committee the importance and the value of American's HBCUs. The
primary support for low income first generation students at
HBCUs and all college campuses has been the Department of
Education's Title IV student financial assistance programs, in
particular, the Pell Grant and Federal Supplemental Educational
Opportunity grants.
With increasing numbers of low income first generation
students on our UNCF campuses, even with the longstanding
efforts to keep costs down, an increasing number of students
face a gap between the cost of education and the combination of
Federal aid, State and institutional assistance for which they
qualify and their families' capacity to meet college costs.
All institutions across the Nation, especially those like
UNCF members, and other HBCUs that enroll large numbers of poor
students, are extremely concerned about how Congress will
address the Pell Grant shortfall. Under your leadership, Mr.
Chairman, Congress provided the necessary funds to increase the
Pell Grant maximum award to a record level $4,000. And I can
personally attest to you the impact that this has had in
assisting some of our most low-risk disadvantaged students on
the Wilberforce University campus.
For this reason, UNCF supports a $4,500 Pell Grant maximum
award in fiscal year 2003. Moreover, as both a member of the
student aid alliance and a representative of 39 of the Nation's
HBCUs whose very mission and purpose is the education of
disadvantaged and poor students, UNCF urges Congress to include
funds to eliminate the shortfall in the fiscal year 2002
supplemental.
UNCF also appeals to Congress to not offset the necessary
funds needed to eliminate this shortfall by cutting fiscal year
2002 appropriations for other programs in the Labor, Health and
Human Services Education Bill. Since student enrollment at
Wilberforce and other historically black colleges and
universities is directly related to the increased demand for
Pell Grants, your support of the supplemental fiscal year 2003
appropriations is important.
In ensuring low income students access to college, we must
make sure that these students are receiving quality, early
information about college and that we are providing the
necessary student support services to truly ensure their
retention and graduation. In this regard, UNCF endorses the
student aid alliance request for TRIO as well as continued
funding of the supplemental to TRIO's student services support
program.
Members of the Committee, not only do we need your support
for increased funding for the Title IV programs, we also need
you to further your investment in HBCUs through the Title
III(B) Strengthening Historically Black Colleges and
Universities Program. These programs have been very
instrumental in enhancing the survival of HBCUs.
In the wake of September 11th, under this Subcommittee's
leadership, there was a dramatic increase in Title VI
international education programs. UNCF applauds this action and
urges you this year to further expand HBCU and minority student
participation in Title VI programs through affirmative outreach
and technical assistance efforts for both the overseas and
domestic programs and the international business programs, and
to provide increased funding for the Institute for
International Public Policy.
Mr. Chairman, UNCF also supports an increase to minority
science and engineering improvements programs, and the Thurgood
Marshall Legal Opportunities Program, that addresses access and
opportunity for under-represented minorities in law.
As I conclude my testimony, I ask that you consider
increased funding also for programs at the Department of Health
and Human Services that educate many African-Americans in the
health professions and that support research activities on HBCU
campuses.
Mr. Chairman and members of the Subcommittee, I appreciate
the time that you have given me to represent the views and
representations of the United Negro College Fund.
[The prepared statement and biography of Mr. Henderson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you, Mr. Henderson. Thank you for coming.
----------
Tuesday, April 23, 2002.
NATIONAL COUNCIL FOR COMMUNITY AND EDUCATION PARTNERSHIPS
WITNESS
HECTOR GARZA, PRESIDENT, NATIONAL COUNCIL FOR COMMUNITY AND EDUCATION
PARTNERSHIPS
Mr. Regula. Mr. Hector Garza, President of the National
Council for Community and Education Partnerships.
Mr. Garza. Good afternoon, Mr. Chairman, members of the
Subcommittee. My name is Dr. Hector Garza, I serve as President
of the National Council for Community and Education
Partnerships.
Today Ms. Corey Barber, representing the U.S. Student
Association, is present with me to signal the support on behalf
of GEAR UP, on behalf of America's college and university
students as well.
Additionally, I also have with me written letters of
support from several other education organizations, Mr.
Chairman, who also wish to be recognized as supporters for GEAR
UP. I do hope that you will allow me to enter these as part of
the official record.
NCCEP is an non-profit organization founded by the Ford
Foundation and the W.K. Kellogg Foundation to help schools,
colleges, universities and communities to improve public
education, to promote student achievement, and above all, to
increase access to college for all students, Mr. Chairman.
Today I will be talking to you about the Gaining Early
Awareness and Readiness for Undergraduate Programs, the GEAR UP
program, the program that Mr. Obey previously talked about. A
program designed to make sure that no child gets left behind in
areas of education.
I'm also here today to advocate for a significant increase
in the appropriations for GEAR UP for a total sum of $425
million. GEAR UP, as you know, is a unique Federal program that
offers a very effective approach to helping low income students
and their families prepare for success in college. It is
important for me to mention that GEAR UP is not a minority
program. It is a program for all low income students, Mr.
Chairman. Research studies have shown that the college going
rates for low income students remains substantially below those
of more affluent counterparts.
Millions of young people, especially those from poor,
minority and rural communities, still find the door to college
all but shut for them. Eighty-six percent of high income, high
achieving secondary school students go on to college, while
only 50 percent of low income high achievers enroll in post
secondary education. Young people whose family income is under
$25,000 have less than a 6 percent chance of earning a four
year college degree. High income students, on the other hand,
are seven times more likely than low income students to
graduate from college.
The students face barriers, such as under-funded public
schools and overburdened teachers. Students receive poor
academic preparation in our public K-12 schools. They have
little access to information about what it takes to be admitted
and be successful in college, little or no guidance on applying
to college, limited information about available grants and
scholarships, and in short, low income students face a
pervasive climate of despair rather than hope for a better
future in schools and at home.
Through GEAR UP, Mr. Chairman, our schools and GEAR UP
partners are working hard to change all of that. GEAR UP is a
Federal program that goes beyond serving individual students
with a primary emphasis to systemically reform whole schools
and school districts. Through GEAR UP we are changing outdated
educational practices and making lasting changes within schools
and systems so that they can have a lasting effect on the
communities.
In a recent poll, 77 percent of Americans agree that the
Federal Government should increase its education spending to
allow more people to enter and complete college. Eighty-eight
percent of Americans favored an increase in Federal funding to
improve educational opportunities for poor students in
particular. We have also discovered that through GEAR UP, all
students benefit, since GEAR UP is designed to revamp the
system, so that it works for all children.
GEAR UP helps low income students to stay in school, to
study hard, to take the right college prep courses, and to
learn about the requirements to pursue a college education.
GEAR UP is designed to transform entire schools to engage
parents and families, and to mobilize local communities to
support student achievement. The programs include mentoring
programs, tutoring, college visits, academic and career
advising programs, professional development for teachers, and
summer and after school academic enrichment programs. GEAR UP
allows students and schools to better coordinate their academic
support programs to align their curriculum to facilitate
student achievement and to provide more and better
opportunities for success in these students.
Research studies have suggested that parental and family
involvement is critical and GEAR UP achieves that. GEAR UP
prepares parents for active, productive roles in guiding their
children to educational excellence and bright futures. Because
we know that GEAR UP is a program that works, we are asking
this Congress to appropriate the required money to make this
program available to more students.
You may also be interested in knowing, Mr. Chairman, that
GEAR UP serves an extremely diverse group of students. Thirty-
four percent of students are Hispanic, 31 percent African-
American, 27 percent white, 4 percent Asian American and 4
percent American Indian. That is why low income students
deserve your support.
[The prepared statement of Mr. Garza follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. I'm familiar with the program, we have it in
our largest city.
Mr. Garza. Yes, you do.
Mr. Regula. I have visited the program.
So thank you for bringing the emphasis. It is a needed
program. Thank you.
Mr. Garza. Wonderful.
----------
Tuesday, April 23, 2002.
PUBLIC/PRIVATE VENTURES
WITNESS
GARY WALKER, PRESIDENT, PUBLIC/PRIVATE VENTURES
Mr. Regula. Mr. Gary Walker, President, Public/Private
Ventures.
Mr. Walker. Thank you, Chairman Regula, for having me here
today. My name is Gary Walker, I'm President of an organization
called Public/Private Ventures, that was set up in the late
1970s with a combination of Federal funding from what was then
HEW and several philanthropies. The mission of the organization
was to search the country for what looked like promising
approaches to assisting very high risk children, doing the
research on them to see if they worked, and then reporting back
to the various Congressional committees and philanthropic
funders as to whether or not they worked.
The issue that I wanted to report to the Committee on today
is one that does not make up a large part of your upcoming
budget considerations, but one which does generate more
discussion than perhaps the portion of the budget, and that is,
faith-based programming. We became interested in faith-based
programming in 1997, not because we are a faith-based
organization, but because it was becoming clear over the years
that the capacity of the not for profit and public sectors to
deal with high risk children was simply not adequate, even if
there was an enormous amount of additional funding by Congress.
And that the number of faith institutions out there might be
one way to go to deal with these problems at scale.
We decided at that point to focus on three issues, older
high risk youth who had been involved with juvenile justice,
younger children who had parents in prison and needed
mentoring, and youth who were already two to three years behind
in literacy and needed help but could not get it within the
cities that they lived.
At this point, we're five years along in collecting data
and looking at programs around the country. As you consider the
budget, I simply wanted to lay out the things that we have
learned to date. One, we're involved in 16 cities at this point
in these three programs. The very first issue was to see if
small and moderate size faith based organizations would really
be interested in undertaking these kinds of challenges.
We actually had to close down the major demonstration
because of the clamor to get into it by these small and medium
sized organizations. There are now 700 faith-based
organizations, Christian, mosques, synagogues, on the west
coast there are also Buddhist and Hindu temples involved in all
three of these efforts. So one of the first things we've
learned is that there is an interest out there in doing this.
The second is, they generate a level of volunteers beyond
anything we've seen in any of the other sectors. In
Philadelphia itself, within six months, the faith-based
community was able to generate 500 volunteers for mentoring for
children who had parents in prison, which was equal to the
largest mentoring program in all of Philadelphia that had been
around for 70 years.
Thirdly, what we're seeing so far at least in the research
is that we are able to get results, or the faith community is
getting results. The literacy program has gotten on average of
1.9 grade level improvement in six months of students who have
stayed within that program.
Fourthly, and perhaps equally important as the good news,
is the things that those who are most worried about in faith-
based programming, namely, do they actually have the capacity
to do anything, and is there too much proselytizing, we have at
this point seen that both those issues are very manageable. The
capacity issue is an important one. Assistance is needed in
order to carry out these programs. If Congress were merely to
appropriate money, it would probably not be adequately used all
around the country.
Proselytizing is the more interesting issue. In looking it
over, 600 faith-based organizations in 16 cities, we have not
in 5 years documented one instance of proselytizing to any
degree where either the youth, their parents or anyone was
bothered. Evidence of faith was all around these programs,
there's lots of praying and lots of symbols. But proselytizing
was not a part of any of them. Actually, faith was the reason
that these volunteers wanted to help these youth, not to get
them to become members in their church.
So I guess we've concluded, as ourselves a non-faith based
organization, that if the country is really interested in
dealing with larger numbers of the highest risk youth, this is
a sector that probably is the greatest untapped resource out
there right now. It needs careful working with, but it's
something, as you look at the compassionate capital bill and
the mentoring bill really deserves attention for its potential
for the future.
Thank you.
[The prepared statement and biography of Mr. Walker
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Thank you.
----------
Tuesday, April 23, 2002.
NATIONAL ASSOCIATION OF STATE STUDENT GRANT AND AID PROGRAMS
WITNESS
JIM GARCIA, PRESIDENT, NATIONAL ASSOCIATION OF STATE STUDENT GRANT AND
AID PROGRAMS
Mr. Cunningham [assuming chair]. Thank you, Mr. Chairman.
The Chairman has asked me to sit in for a while, he's got
another meeting. I always look forward to being Chairman.
Jim Garcia, President, National Association of State
Student Grant and Aid Programs. Is Jim here? Mr. Garcia. And
the clock, if you would be diligent in monitoring the clock,
because we've got a lot of witnesses. You don't want to take
their time, because they'd get mad at you.
Mr. Garcia. Thank you, Mr. Chairman.
My name is Jim Garcia, I'm the Chief of the Grant Services
Division for the California Student Aid Commission. But I am
here today in my role as President of the National Association
of State Student Grant and Aid Programs, otherwise referred to
as NASSGAP.
We greatly appreciate the opportunity you are providing for
us here today to address the future of a higher education grant
program vitally important to States, the Leveraging Educational
Assistance Partnership program, LEAP for short.
Let me first briefly discuss the group I represent. NASSGAP
is an organization comprised of individuals who operate State-
based student aid programs in the 50 States, including the
District of Columbia and Puerto Rico. Our organization does not
employ Washington based staff, relying instead on our members'
continuous grass roots efforts to advocate for strong student
aid programs. We are proud to represent over 3 million students
and their families to whom our members provide over $4.68
billion in State student aid.
I'm here to talk about why LEAP is such a worthy program to
fund at a time when our Nation's budget is already strained by
the demands of a war-time economy. To help explain, I have a
little story which I believe illustrates the value of LEAP. Not
too long ago, NASSGAP invited a senior staff person from the
Office of Management and Budget to speak at our spring
conference in Washington. At the end of his formal comments, a
member of the audience asked him how he would describe the
ideal college financial aid program of the future.
The OMB representative replied that the ideal program would
be a need-based program, would provide a grant to students,
would have a shared funding responsibility between States and
the Federal Government, and would be integrated within the
Title IV delivery system. The program would also be designed to
serve the poorest students and would have no administrative
funds.
Members of the audience began to laugh, because the program
that he had just described is the LEAP program. That year, OMB
had recommended not funding the program.
Mr. Chairman, that has been the general experience of
NASSGAP members, that people don't fully understand the
characteristics of the program. The more people learn about the
LEAP program, the more they realize that it is an excellent
resource to equalize college costs between the poor and the
wealthy. Currently, this highly successful partnership between
the States and the Federal Government is helping our Nation's
neediest students achieve their dream of post-secondary
education. These students not only qualify for and receive
Federal Pell Grants, but they must demonstrate exceptional need
to qualify for additional funds available through LEAP and also
through its component, referred to as the Special LEAP program.
Our purpose before your Committee today is to urge you to
fund $100 million to support LEAP for fiscal year 2003, a
funding level that is recommended by the National Student Aid
Alliance. Because of the unique matching requirements of the
program, that level of funding would result in an estimated
$270 million in need based student grants. By Congressional
design, every dollar for LEAP/SLEAP will go directly to
students, since neither these funds nor the State matching
funds may be used by States to cover administrative costs.
In addition, and this is key, the States must meet
maintenance of effort requirements which ensure that Federal
funds would not supplant existing State grant funds. States
have positively responded to the challenge and strongly support
the program.
States are struggling to deal with the economic
ramifications of the past year. Trends in the Nation's economy
which were further aggravated by the events of September 11th
have heavily strained States' budgets, many of which are
operating under a severe deficit. Many States are not in a
position to absorb the loss of the Federal portion of LEAP, and
some States will lose their entire need based grant programs.
With the current economic status of our Nation, now is the
best time for the Federal and State Governments to work
together to improve college access and degree of achievement.
No Child Left Behind is a wonderful national policy and LEAP is
a vital partnership program which enables the most needy of
these students to continue on and pursue their post-secondary
education goals.
Mr. Chairman, should the Federal budget be signed without
funding for the LEAP program, an estimated 61,000 financially
needy post-secondary students throughout the Nation will lose a
major source of their financial aid. This would leave many,
many children behind.
Thank you, sir.
[The prepared statement and biography of Mr. Garcia
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. We believe also that if a child excels
enough to be able to go to college or, not necessarily
academic, but even a work program, that they ought to have that
right. My wife is Special Assistant to the Secretary of
Education and Management, but you're going through the
Department of Education. Last year, the student direct program
had $50 million in student loans they couldn't even account
for, another $12 million that went to the wrong students, so
they had to reissue.
So I know that within the Department of Education, they're
going through to make sure that those dollars go to the
accurate finances. And I'm not going to smoke you, $100 million
is a lot of money when you have a limited budget in the first
place.
Mr. Garcia. Yes, sir.
Mr. Cunningham. And there's a lot of different loan
programs out there. I know the Chairman will take a look at it,
and we'll discuss it within the Committee.
Mr. Garcia. Thank you very much.
Mr. Cunningham. Thank you, Jim.
----------
Tuesday, April 23, 2002.
NATIONAL EDUCATION KNOWLEDGE INDUSTRY ASSOCIATION
WITNESS
GINA BURKHARDT, BOARD CHAIRMAN, NATIONAL EDUCATION KNOWLEDGE INDUSTRY
ASSOCIATION
Mr. Cunningham. Gina Burkhardt, Board Chairman, National
Education Knowledge Industry Association. Gina?
Ms. Burkhardt. Good afternoon, Mr. Cunningham.
Mr. Cunningham. If you would keep your comments within the
five minutes, we would appreciate it.
Ms. Burkhardt. My name is Gina Burkhardt, and I am the
Executive Director of NCREL, the regional education laboratory
that specializes in educational technology. We serve the States
of Ohio, Illinois, Indiana, Iowa, Wisconsin, Michigan and
Minnesota.
Today I'm speaking on behalf of the National Education
Knowledge Industry Association. NEKIA's members are dedicated
to expanding quality education research, development,
dissemination and technical assistance. I'm here to talk with
you about how we can together help schools successfully
implement the No Child Left Behind legislation.
I have three points to make, and I bet you can guess what
the fist one is. I'm here to request increased funding for
educational research development, dissemination and technical
assistance. Education R&D is severely under-funded, and that
needs to change, especially when you consider this is a
realized investment of dollars. We know there is a direct link
between scientifically based education research and development
and its application to proven results for students. Certainly
corporations get this. They invest up to 3 and a half percent
of their annual budget in R&D. Just imagine the health
profession without R&D behind drug and diagnostic testing.
In fact, this Subcommittee recognized the importance of
research and development when it decided some years ago to take
the aggressive step of doubling the far larger support for the
National Institutes of Health. Currently, R&D represents only
.03 percent of the education budget. That's three one-
hundredths of 1 percent. That's a pathetic statement.
We're asking the Subcommittee to apply the same approach
for educational research and double its funding over the next
three years. This is a solid and significant statement that
will take far fewer dollars than the NIH initiative.
Specifically, we propose that Congress increase funds for OERI
R&D by $82 million this year, or almost 33 percent, and commit
to similar increases over the next three years.
We are pleased to see that the Administration has proposed
increases in some programs that support research. But I am
extremely disappointed that you've decided to level fund
organizations like mine, the Regional Education Laboratories,
and eliminated funding for those research based technical
assistance programs.
My second point, an investment in education research,
development and technical assistance will get you a bang for
your buck, the bang the American people are demanding and our
students deserve. Reform that works is based on research taken
out of the controlled experimental setting and put to practical
use by all teachers for all our kids. When we do this
systematically, we learn about and can make what works
available to schools. Then we see all our children achieve to
world class standards.
My third point, for education research to make a difference
for all kids, you have to make it available and usable by all
teachers. Just imagine your fifth grade teacher reading an
article in the American Education Research Journal and going
into her classroom the next day with a new instructional
practice. That's an unreasonable expectation for our teachers.
It might help to give an example from the Chairman's State
of Ohio of how R&D has worked. Manchester High School is in the
southernmost portion of Adams County along the Ohio River. The
school district is one in the rural Appalachian region
designated as academic emergency and in danger of takeover by
that State. My lab, NCREL, worked with six of the districts to
improve the math and science learning of these students. We
found that teaching in schools covered only three of the seven
areas that were emphasized on the Ohio proficiency test. The
data showed that although six districts exceeded State averages
in three areas, they scored extremely poorly in the other four.
Once we knew this, we stepped in with significant
resources, provided 13 days of math and science professional
development to 115 teachers during the summer and the following
year. After one year, student achievement rose significantly in
four of the six districts. After two years, all six districts
were achieving, or had significantly increased their scores.
Congress created the No Child Left Behind Act that holds
schools to a higher standards of accountability than ever
before. To put these stringent requirements in place without
anteing up the funds that provide schools access to
scientifically based R&D, and the technical assistance that's
required to help them with the implementation is a real recipe
for failure. The good news is that you currently have an
infrastructure in place that can provide all schools, even the
most troubled ones, with knowledge and procedures.
My organization and the other federally funded research
development and technical organizations are ready to serve. We
believe that without a significant investment in R&D, an
increase of 33 percent each year over the next three years,
Congress will be back to ask, what went wrong, instead of
applauding your wisdom and foresight. Thank you.
[The prepared statement and biography of Ms. Burkhardt
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Thank you. And I'd say, Ms. Burkhardt, I
was a teacher and a coach at Hinsdale, Illinois, outside
Chicago.
Ms. Burkhardt. And your regional education laboratory is
West End. Thank you.
----------
Tuesday, April 23, 2002.
COALITION OF HIGHER EDUCATION ASSISTANCE ORGANIZATIONS
WITNESS
JEANNE DOTSON, PRESIDENT, COALITION OF HIGHER EDUCATION ASSISTANCE
ORGANIZATIONS
Mr. Cunningham. Jeanne Dotson, President, Coalition of
Higher Education Assistance Educations and Director of Student
Loan Account Repayment, Concordia College. Where is Concordia?
Ms. Dotson. Moorehead, Minnesota.
Mr. Cunningham. It gets cold up there.
Ms. Dotson. Good afternoon, Mr. Chairman, and thank you for
inviting me to testify today on behalf of the Coalition of
Higher Education Assistance Organizations regarding the fiscal
year 2003 appropriations for the Perkins Loan program, a
student aid program that has made a critical difference in the
lives of so many of our college students.
I am Jeanne Dotson, and I currently work as the Director of
Student Loan Accounts Repayment at Concordia College in
Moorehead, Minnesota. I've served in this capacity for 28
years. I also serve as the President of COHEAO, a unique
coalition composed of over 350 colleges and universities and
commercial organizations with a shared interest in this 40 year
old Perkins loan program. A student who attended Concordia for
four years was loaned the maximum amount allowed under the
Federal Perkins loan program. He happened to be a Native
American student. And he did graduate with the qualifications
to teach.
He told me that his dream was to go back and teach at his
high school, which is operated by the Bureau of Indian Affairs.
After graduation, he was able to secure employment at his
former high school. And he was very diligent in filing his
forms in a timely manner. And this past spring, I'm happy to
tell you that he submitted his final form allowing him to
cancel his entire Perkins loan.
He wrote me a letter to thank me for helping him attain his
dream and also to tell me how important it was that he canceled
his loan. Because as we would know, his salary was very low,
and he needed every penny just to pay his rent and just to
live. As a COHEAO member, Concordia College knows that the
Perkins loan program is critical to providing low income
students with access to higher education. Perkins loans provide
the lowest interest rate of all the Federal loan programs at a
5 percent fixed rate. In addition, borrowers find that Perkins
loans provide reasonable repayment terms, including a nine
month grace period, flexible deferment options, and
furthermore, Perkins loans are recycled. The schools
redistribute the funds to new borrowers that have been
collected from borrowers in repayment.
Significantly, the Perkins loan program also promotes
community service by offering loan forgiveness options for
students choosing work that benefits the community, such as
teaching and law enforcement. Of critical importance to the
success of the loan program is the risk sharing. This sits at
the core of the program structure. Participating schools are
required to match their allocated FCC or Federal Capital
Contribution by 25 percent, which is a substantial amount of
money for schools in this era of tightening State budgets and
dwindling non-Federal resources. In addition to the Federal
school partnership that is forged through this risk sharing,
students benefit because Perkins schools are given latitude in
which to operate this program on their respective campuses.
Since the inception of the program, Concordia College has
provided approximately $32 million in Perkins loans to 17,000
students. Last year, approximately 645 Concordia College
students received $1.3 million of which only $4,000 came from
FCC. Last year our Perkins loan borrowers who were eligible
received the benefit of over $116,000 in loan cancellations.
On behalf of all of the COHEAO members who are also
committed to this critical program, COHEAO is urging Congress
to increase funding in fiscal year 2003 for the FCC for Perkins
loans from $100 million to $140 million. And also to increase
from $67.5 million to $100 million the Federal Perkins loan
cancellation fund.
While the Perkins loan program has proven its worth, it has
been woefully under-funded. Over the last decade, funding for
new loan capital has decreased by over 75 percent and the
current FCC is now worth just 22 percent of its 1980 value in
constant dollars. In addition, the loan cancellation fund has
not been fully funded, leaving schools without the benefit of
full Federal reimbursement.
COHEAO works with other groups such as the Student Aid
Alliance to help ensure that all higher education funding is
sufficient to meet the needs of our Nation's students. Under
President Bush's fiscal year 2003 budget, most of the student
aid programs were level funded at fiscal year 2002 levels.
Campus based aid programs must grow if Congress and the
Administration intend to keep their promise to put students
first and ensure all students have access to higher education.
Thank you again for providing me with this opportunity. I
would be happy to answer any questions you might have.
[The prepared statement and biography of Ms. Dotson
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Ms. Dotson, one of the things that keys me
is when people say that something is level funded; quite often
we increase each year the amount of education dollars, Pell
Grants, Eisenhower Grants for teachers and so on. So a lot of
times when something is level funded it's because it had been
increased. We have a lot, if you see the people in here, we
have a lot of different areas where people need additional
dollars.
We are doubling education dollars over the next five years,
just like we kept our promise in medical research. And we're
going to do that. I don't know how we meet the needs of all the
programs. But I know I support Perkins and I support Pell and
Eisenhower grants and those things as well. When it breaks out,
I don't know how many dollars will be given to each thing, but
I know they're good programs.
Ms. Dotson. Thank you very much, and thank you for inviting
me here.
----------
Tuesday, April 23, 2002.
NATIONAL NUTRITIONAL FOODS ASSOCIATION
WITNESS
R. MARK STOWE, PRESIDENT, NATIONAL NUTRITIONAL FOODS ASSOCIATION
Mr. Cunningham. Next we have R. Mark Stowe, President,
National Nutritional Foods Association.
Mr. Stowe. Mr. Chairman and members of the Subcommittee,
thanks for the opportunity of being here today, it is my
pleasure. My name is Mark Stowe, and I am President of the
National Nutritional Foods Association, NNFA. We're a trade
association representing some 3,000 natural foods stores and
1,000 manufacturers and distributors and suppliers of natural
health products, including dietary supplements.
NNFA supports increased funding levels for both the
National Institutes of Health, the Office of Dietary
Supplements and the National Center for Complementary and
Alternative Medicine in the 2003 fiscal year. National interest
and access to and reliable information on safe, effective
vitamins, minerals, herbs and other dietary supplements has
grown steadily since the Dietary Supplement Health and
Education Act unanimously passed the House and Senate in 1994.
Americans are obviously looking toward safe, natural
alternatives to maintain good health by supplementing
inadequate diets with vitamins and minerals.
It is estimated that nearly three-quarters of the U.S.
population are taking dietary supplements, spending by some
estimates as much as $17 billion a year. Dietary supplements
are only beginning to get the research and attention that they
deserve. Each year, major medical journals publish studies that
support the use of supplements for the treatment of specific
conditions, prevention of disease, offer general nutritional
enhancement. Studies sponsored by the National Institutes of
Health are also being conducted and published. I have included
several samples of these in my written testimony and would be
happy to arrange to have them provided to the Subcommittee if
they are interested in receiving them.
NNFA believes these studies are only the tip of the iceberg
of potential benefits such as reduced health care costs, that
additional research into dietary supplements can bring to the
American public. It is critical that Government sponsored
research levels continue to expand so that more is learned
about these natural pathways to good health and wellness.
This is especially true in light of reports from the
National Center for Health Statistics, showing that only 9
percent of American adults consume enough healthy foods to
reach even their minimum recommended daily intake. Supporting
additional research can reduce health care costs by billions.
For instance, a study in the Western Journal of Medicine
reported that increased intakes of vitamin E, folic acid and
zinc alone could save at least $20 billion in hospital costs by
reducing the instance of heart disease, birth defects and
premature death.
The Office of Dietary Supplements, ODS, was established at
the National Institutes of Health in 1995 under DSHEA to
stimulate, coordinate and disseminate the results of research
on the benefits and safety of dietary supplements and the
treatment and prevention of chronic diseases. To meet its
strategic goals, ODS has held conferences on dietary supplement
use in children, metals in medicine, and identifying and
qualifying botanicals, among others.
In fiscal year 2002, Congress approved $17 million for ODS.
This was a $7 million increase over the previous year's funding
level, and a $16 million increase over its first appropriation
in 1995. The President's budget request for the ODS in 2003 is
$18.5 million. NNFA members not only support this funding
level, but would urge the Subcommittee to increase that funding
level to at least $25 million.
In 1992, also, Congress directed NIH to establish the
Office of Alternative Medicine, with the express task of
assuring objective, rigorous review of alternative therapies to
provide consumers with safe and reliable information. Funding
for this office, now known as the National Center for
Complementary and Alternative Medicine, or NCCAM, is an
infinitesimal percentage of the overall NIH budget.
Furthermore, the Center's budget is insignificant in comparison
to the dramatic growth of the American public's interest in and
use of complementary and alternative therapies, including
supplementation.
Keeping with its strategic plan in 2003, NCCAM will expand
investigations into some of the most complex and sought after
applications of alternative therapies to human health. This
includes such areas as neurosciences, cancer, HIV-AIDS,
international health, and women's health at mid-life. We're
pleased to see that the President asked for $113.8 million for
NCCAM in 2003 to help meet its goals. This represents an
increase of $9.2 million in fiscal year 2002.
Science and experience ably demonstrate a wealth of
benefits attendant to the regular use of dietary supplements.
They allow millions of Americans to take charge of their own
good health by safely and effectively using them in preventing
and treating a host of illnesses and other conditions. The body
of research supporting the use of products like this is very
impressive, but sorely requires Government support to ensure
its expansion. Members of the National Nutritional Foods
Association urge the Subcommittee to fulfill the Congressional
mandate expressed in DSHEA by investing in the scientific
research which holds the key to our knowledge of the remarkable
importance and value of dietary supplements.
Mr. Chairman, thank you very much.
[The prepared statement and biography of Mr. Stowe follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. As I mentioned, we've doubled the medical
research, a lot of that in NIH. And I know a lot of it, I'm a
cancer survivor, so I understand lycopene and cooked tomatoes
and cook books and so on.
One of the concerns I have, I visited some of the lunch
rooms of our children. When I interview the children, they say,
well, these healthy foods don't taste good, so what they do is
go down and get a double egg, double cheese, double fry burger.
I think that's one of the things we have to do, is come up with
some kind of nutritional basis for our students today that
they'll eat.
Then secondly, these supplements are very, very important.
Just look at diabetes, look at cancer, look at the other things
that you said. With the genome program, and the research that's
going on, I think it's going to be the way of the future.
Mr. Stowe. Absolutely. Particularly if we're concerned
about controlling health care costs. This is a good way to be
able to do it.
Mr. Cunningham. That's right.
Mr. Stowe. Thank you, Mr. Chairman.
----------
Tuesday, April 23, 2002.
COLLEGE ON PROBLEMS OF DRUG DEPENDENCE
WITNESS
WARREN BICKEL, PUBLIC POLICY OFFICER, COLLEGE ON PROBLEMS OF DRUG
DEPENDENCE, AND PROFESSOR, PSYCHIATRY AND PSYCHOLOGY, INTERIM-CHAIR
OF THE DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF VERMONT
Mr. Cunningham. Dr. Warren Bickel, Policy Officer, College
on Problems of Drug Dependence. Mine is coffee.
Dr. Bickel. Good afternoon, Mr. Chairman.
My name is Warren Bickel, and I am the Public Policy
Officer of the College on Problems of Drug Dependence,
otherwise known as CPDD. The CPDD has been in existence since
1929, and is the longest standing group in the United States
addressing problems of drug dependence and abuse. Presently,
CPDD functions as an independent scientific organization
representing a broad range of scientific disciplines concerned
with researching and understanding the causes and consequences
of drug abuse and developing effective prevention and treatment
interventions.
Mr. Chairman, the College on Problems of Drug Dependence
respectfully seeks yours and your Subcommittee's strong support
for the President's fiscal year 2003 budget request for the
National Institutes of Health totaling $27.3 billion. This
level represents a $3.7 billion increase over current year
levels, which is the increase necessary to complete the
national campaign to double the NIH budget by fiscal year 2003.
Within that overall increase, we are specifically requesting a
19.8 percent increase for the National Institute on Drug Abuse,
for a total of $1,063,702,000. This figure would keep NIDA on
track to double its budget, consistent with the doubling of the
overall NIH budget.
NIDA is the Federal Government's lead agency for research
on all drugs of abuse, both legal and illegal, with the
exception of a primary focus on alcohol. NIDA's mission of
bringing the power of science to bear on drug abuse and
addiction is accomplished through a dedicated cadre of
scientists who are working to understand and find solutions to
the Nation's drug abuse problem.
Full funding of NIDA would yield scientific advances in
knowledge that will have impact on everyone and ease the
financial health and social burden of drug abuse. A 19.8
percent increase would allow NIDA first to continue to expand
the clinical trials network, or CTN, to become a truly national
research and dissemination infrastructure. The CTN is helping
to dramatically improve the quality of drug addiction treatment
throughout this country, enabling rapid concurrent testing of a
wide range of promising science based treatments across
community environments.
Second, to move ahead with NIDA's national prevention
research initiative, NIDA will call upon a broad range of
disciplines to inform the development of innovative and proved
prevention interventions. NIDA will establish community multi-
site prevention trials similar to the CTNs to enhance the
Nation's prevention efforts.
Third, to continue to have a pipeline of safe and effective
medication through NIDA's medication development program.
NIDA's role in testing medications for substance abuse is
critical, because few pharmaceutical companies are willing to
develop medications for such indications.
Fourth, to increase NIDA's research portfolio on stress as
well as its research on post-traumatic stress disorder and
substance abuse. Stress plays a major role in the initiation of
drug use, its continued use and relapse to addiction. This
research area is even more crucial given the increase in stress
that Americans have experienced in the aftermath of September
11th.
Fifth, to continue NIDA's support of a comprehensive
research portfolio in nicotine addiction. Tobacco accounts for
20 percent of all U.S. deaths. To address this public health
problem, NIDA has formed a partnership with the National Cancer
Institute and the Robert Wood Johnson Foundation. Supporting
research such as we have outlined here will further improve our
ability to prevent and treat the problems of drug abuse and
will pay handsome dividends both financially and for the morale
of our country. Thank you.
[The prepared statement and biography of Dr. Bickel
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Did I hear you right, Dr. Bickel, tobacco
accounts for 20 percent of all U.S. deaths?
Dr. Bickel. That's my understanding, sir.
Mr. Cunningham. I know it does a lot, but that seems awful
high when you look at all the other. I'd like to see
documentation on that.
Dr. Bickel. Sure, we can provide that for you.
Mr. Cunningham. I empathize with the problem. My own son,
who is adopted, was on drug dependence. Hopefully, he's doing
well now.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Tuesday, April 23, 2002.
NATIONAL ASSOCIATION OF CHAIN DRUG STORES
WITNESS
CARLOS ORTIZ, VICE PRESIDENT, GOVERNMENT AFFAIRS, CVS CORPORATION
Mr. Cunningham. Finally, we got an Irish guy to testify.
Carlos Ortiz----
[Laughter.]
Mr. Cunningham. Vice President of Government Affairs for
CVS Corporation, Woonsocket, Rhode Island. Thank you, Mr.
Ortiz.
Mr. Ortiz. Good afternoon, Mr. Cunningham. As you said, my
name is Carlos Ortiz, and I'm Vice President of Government
Affairs for CVS Pharmacy. I'm here to testify on behalf of the
National Association of Chain Drug Stores and CVS Pharmacy. CVS
operates approximately 4,000 pharmacies in 31 States.
I want to also express my thanks to Chairman Regula for
this opportunity to testify. I'm especially thankful that I'm
going before Elmo, because I certainly don't want to go after
him, he's going to be a tough act to follow.
I'm here specifically to talk about two issues. I am a
pharmacist, and I'm very proud of my profession. Community
pharmacists operate in every State and every community in the
United States. We're open, the most successful member of
America's health care team, available 7 days a week, 365 days a
year often 24 hours a day without an appointment.
However, in delivering those pharmacy services, we're
facing two major issues. The first is the explosion in
prescriptions and prescription services that has occurred in
the United States because of the aging of the American
population, mainly. And that's that in the last 10 years, we've
seen an increase from 2 billion outpatient prescriptions to 3
billion in 2001. That's a 50 percent increase in the last 10
years. It's expected that that increase is going to go to 4
billion by 2004, another huge increase.
At the same time that that's happening, we have a
significant shortage of pharmacists in the United States. A
study that was done by HRSA at the request of Congress and was
issued in December of 2000 showed at that time that there were
7,000 unfilled pharmacist positions in the United States, an
increase from 2,800 in just 1998. It's estimated today that 11
to 29 percent of hospital pharmacist positions are unfilled,
and in community chain pharmacies, there are 6,000 unfilled
pharmacist positions.
With that in mind, to try and combat the shortage, NACDS
and the community pharmacy has endorsed House Bill 2173. This
is a bipartisan bill entitled the Pharmacists Education Aid
Act. In fact, two of the members of your Subcommittee are co-
sponsors on that bill, Representatives Kennedy and Peterson are
both on that piece of legislation.
This legislation would do four things. One, it would
provide student loan programs for the education of pharmacists.
It would provide funding for pharmacy school modernization. It
would provide incentives to place pharmacists in rural and
under-served areas. And finally, it would provide faculty loan
repayment to help with the shortage in pharmacy school
faculties. We have urged the House Energy and Commerce
Committee to pass this important legislation, and I would also
urge the Labor HHS Subcommittee to co-sponsor this important
piece of legislation.
However, because it is going to be some time before this
legislation can be enacted, we would urge you to increase the
funding, continue and increase the funding for the current
programs that are available for student loans for pharmacists,
one, the scholarships for disadvantaged students, loans for
disadvantaged students, health profession student loans, the
faculty loan repayment program, and health career opportunity
grants.
I would also urge the Committee to look at the immigration
status of pharmacists and urge you to move pharmacy to a
schedule A group one shortage occupation. We think that would
be important in addressing the shortage of pharmacists.
The second issue I would like to urge the Committee to take
some action on is the prescription, Medicaid prescription drug
co-payments. Many of the States are facing fiscal crisis.
Toward that end, they have implemented or are increasing co-
payments for Medicaid prescriptions. Those co-payments can
range from 50 cents to $3 and are a way of both controlling the
costs and encouraging prudent purchasing on the part of
Medicaid recipients of prescription drugs.
However, there is a Federal regulation, not statute, but a
regulation, that says that a pharmacy cannot deny a Medicaid
recipient service because of their ability to pay a co-payment.
Additionally, this regulation prohibits the States from making
pharmacists whole or reimbursing pharmacists for any refusal by
a Medicaid beneficiary to pay their co-payment, or inability of
the Medicaid beneficiary to pay their co-payment. So basically
what the implementation of co-payments for Medicaid
prescriptions results in is a reduction in reimbursement to
pharmacies in the community.
In the State of New York, we have a situation where 35
percent of the people who have Medicaid co-payments on
prescriptions are refusing to honor or are unable to honor
their co-pay obligation. What we would like you to do is urge
CMS to change this regulation prohibiting the States from
making pharmacists, or reimbursing pharmacists. It would not
require the States to reimburse pharmacies. It would simply
allow them to. We would then lobby or take a petition to the
States for reimbursement. If the States were economically
unable to reimburse pharmacists or providers for the co-
payment, then they would not have to. In and of itself, our
proposal would have no budgetary implications.
Thank you very much for this opportunity to testify.
[The prepared statement and biography of Mr. Ortiz follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Cunningham. Just a quick question. What's the main
reason you have such a low number of pharmacists? Is it pay? Is
it lawsuits? Is it schools?
Mr. Ortiz. Certainly it's not the pay. Fresh out of
pharmacy school, at CVS they'll probably be earning $80,000 to
$85,000 a year. So it's not pay.
What's happened is that pharmacy has gone from a five year
entry level degree to a six year entry level degree. That's the
entry level for pharmacy. That's happening at this time. So
many schools have missed the class. There was one year that
every school, as they converted from a five year to a six year
program, missed the class.
There's also been a significant increase in the number of
opportunities for pharmacists because of the explosion in the
number of outpatient prescriptions that has occurred. So those
are the two main reasons.
Mr. Cunningham. There are members on this Committee, if you
would bad mouth insurance companies, the only thing left is
Government health care. If you bad mouth biotech communities,
the only thing left for prescription drugs is Government
controlled prescription drugs, which I do not believe in either
one of the two.
But we do plan on bringing up a prescription drug program
prior to the Memorial recess, which I think you owe you
livelihood to prescription drugs, and we owe our health to them
as well.
Mr. Ortiz. Absolutely.
Mr. Cunningham. But we will do it, we'll do it efficiently
and we'll do it so that it makes it affordable for more people.
I didn't listen to President Clinton very much, but he did
say one thing in one of his speeches that struck me. First of
all, he told a story about a young girl that told her mother
that she was sorry for being sick, because she knew her mother
couldn't afford the doctor's visit nor the prescription drugs.
No child should have to apologize for being sick.
Thank you.
Mr. Ortiz. I agree. I can tell you, as a pharmacist, I hear
stories every day of people who are making tough decisions
between whether they were going to buy food or buy
prescriptions or whether they were going to cut their
prescriptions in half or how are they going to pay for their
prescriptions. Representative Cunningham, I agree with you
totally on that. Thank you.
Mr. Cunningham. Thank you.
Mr. Regula [resuming chair]. A question. You mentioned
about the fact that the reimbursement doesn't always cover the
total costs. But isn't that also true of hospital bills,
physicians' bills, where the reimbursement for Medicare and I
assume Medicaid does not equal what the charge is? In most
cases the hospital and/or the physician accepts whatever
Medicare pays.
Mr. Ortiz. You're absolutely right. I don't know that----
Mr. Regula. Why should drugs be different, is what I'm
saying?
Mr. Ortiz. Well, I guess there's two things. One is that
often, well, and I can't speak for hospitals or other
physicians' services. But we have a product that we have to buy
and pay for. It's not just our time that's involved, if in fact
the reimbursement from Medicaid or Medicare doesn't equal the
product cost of what we're actually paying money to buy.
It's more than our time. We have to be able to buy that
product in order to be able to dispense that product. And if
the coverage of the prescription repayment doesn't cover the
product cost, we can't replenish that product.
Mr. Regula. Well, probably if you take out your profit, you
get the cost paid. Medicare and Medicaid must have some yard
stick that they use to determine what they're willing to pay.
Mr. Ortiz. And I can tell you that we most often, I'm not
saying that we lose money on Medicaid, that's not what I'm
saying. I'm saying that we operate on a pretty razor thin net
margin. The average net margin for our industry is 2 percent
net margin. And it doesn't take a lot of prescriptions where
you lose money on to throw that 2 percent over into the
negative.
Mr. Regula. Well, I was just curious as to how Medicare and
Medicaid arrived at the amount they're going to pay you.
They're reimbursed, the same thing is true of physicians' fees.
I'm not sure how they arrive at saying, we'll only pay this
much money for that service.
Mr. Ortiz. And we're not asking for any increase in
reimbursement. What we're saying is, on the co-payment amount,
which is currently, if somebody refuses to pay, we have to
deduct that from the reimbursement. If it's a $3 reimbursement
and you're getting a $4 dispensing fee, it means that you're
losing money on that particular prescription.
Mr. Regula. Do I understand you to say that you're mandated
by law to deliver the service even though you may not get paid?
Mr. Ortiz. Even though they may not pay the co-payment. I
want to stress, there is still, there is payment above and
beyond the co-payment that the Government, State Medicaid
program reimburses us. But if the end pay is a $3 co-payment,
that co-payment and if somebody says, I can't afford to pay
that co-payment, we have to provide the service. We cannot deny
service to a Medicaid recipient simply because they cannot pay.
And the State right now under CMS regulations is prohibited
from reimbursing us for that $3 co-payment that they refuse to
pay.
Mr. Regula. So if somebody walks in that does not have
Medicaid nor Medicare or any type of insurance, can you refuse
to fill a prescription for them?
Mr. Ortiz. We can refuse. I can tell you that at CVS, if
someone comes in and says they need a prescription and they
can't afford to pay, we're going to work with them and see if
there's some way we can make sure that they don't go without.
Mr. Regula. Would that be true of a lot of seniors? They're
not being reimbursed under Medicare.
Mr. Ortiz. Of all our business, uninsured senior citizens
represent about 4 percent of our total business.
Mr. Regula. In other words, they're insured by other than
Medicare?
Mr. Ortiz. Yes, retired General Motors, retirees program or
some other program like that.
Mr. Regula. I'm surprised it's such a small percentage.
Mr. Ortiz. It's down to 4 percent of our business now. It
might be higher in some other areas of the country, where there
isn't a--we operate mainly in the northeast and the midwest
where you have a lot of unions that cover their retirees as
part of their pension package.
Mr. Regula. I know in the case of LTV in Cleveland, their
retirees are not covered any longer for their medical. So they
fit in the category probably of having to pay themselves.
Mr. Ortiz. That's happening, in some of the companies that
had lucrative pension plans, when retirees coverages are
dropping.
Mr. Regula. Gone.
Mr. Ortiz. Yes.
Mr. Regula. Okay. Thank you for coming. I think this covers
witnesses. We're going to go into recess while we set up here
for Elmo. The only instruction I have is no cameras while they
set up. While Elmo is testifying, no flash. So turn it off,
fellows.
Mr. Regula. Mr. Cunningham, you're going to introduce
Elmo's friend.
----------
Tuesday, April 23, 2002.
NAMM: INTERNATIONAL MUSIC PRODUCTS ASSOCIATION
WITNESS
JOE LAMOND, PRESIDENT AND CEO, NAMM: THE INTERNATIONAL MUSIC PRODUCTS
ASSOCIATION AND ELMO MONSTER, SESAME STREET MUPPET
Mr. Regula. Okay, Mr. Cunningham, I understand you'll
introduce our next witness.
Mr. Cunningham. Well, I'm going to introduce the friend of
Elmo. Mr. Joe Lamond is President and Chief Executive Officer
of International Music Products Association. What do they do?
They basically create more music makers worldwide. Mr. Lamond
oversaw a number of innovative programs including Sesame Street
Music Works, a joint initiative with Sesame Workshop that
focuses on music among children.
The Einstein Advocacy kit, which is an extraordinary
information package that brings music and brain research
together to show how music does help with children. The
expansion of the Weekend Warrior program which is designed to
bring baby boomers--I don't know what effectiveness that has,
Joe--but back to active music making. He's got a partnership
with the Smithsonian Institute, lasting partnerships with
Disney, Miramax, Proctor and Gamble, Texaco, VH1 Save The
Music, Grammy Foundation, Carnation as well as a host of
others.
And they're here to bring the message that music plays a
role in intelligence and wellness, not only of children but
everyone else. I know all of us have our own personal stories.
I listened to music before every mission when I went into
combat in Vietnam, just to learn how to focus.
Mr. Monster. Wow. [Laughter.]
Mr. Cunningham. Music has brought tears and laughter to all
of us. Joe and Elmo, we welcome you to the Committee. You can
have more than the traditional five minutes if the Chairman
will let you.
Mr. Monster. Well, thank you.
Mr. Cunningham. I yield back, Mr. Chairman.
Mr. Lamond. Thank you, Mr. Cunningham. Thank you, Mr.
Chairman and members of the Subcommittee.
I am Joe Lamond from NAMM: The International Music Products
Association. I'd like to first introduce my co-witness, Elmo
Monster.
Mr. Monster. Elmo's testifying on Capitol Hill. Elmo's so
nervous. What does Elmo do?
Mr. Lamond. Why don't you start by introducing yourself,
Elmo?
Mr. Monster. Okay. Elmo is Elmo. Thank you.
Mr. Lamond. Very good job, Elmo.
Mr. Monster. Elmo's been practicing all morning. And all
day, too.
Mr. Lamond. Elmo and I met through a music education
outreach program with Sesame Workshop.
Mr. Monster. That's right. Mr. Joe taught Elmo lots of
stuff about music.
Mr. Lamond. Why don't you show us some of the things you've
learned?
Mr. Monster. Elmo learned all kinds of things about music,
like anyone can make music. The whole world is full of music.
And best of all, Elmo learned how to dance to music like this.
[Demonstrating.]
Mr. Monster. This is Elmo's favorite. [Laughter.]
Mr. Lamond. We also learned that Elmo looks pretty darned
good in Armani, don't you think?
Mr. Monster. Yes. Elmo got this from Barney's.
Mr. Lamond. Thank you, Elmo.
NAMM is an international, not for profit organization made
up of nearly 8,000 manufacturers and retailers of musical
instruments and music products. NAMM members range from small,
family owned music stores that you can find in every town to
large instrument manufacturing companies and publishing houses.
These companies make and sell the instruments that allow people
to make music.
And just like any other in the business community, NAMM
members understand that a quality education is the primary
means of preparing our young people in the business world and
success in life. Like parents everywhere, we are committed to
making sure no child is left behind.
Mr. Monster. And no monsters.
Mr. Lamond. And no monsters left behind either, Elmo.
Mr. Monster. Good.
Mr. Lamond. We have the best education system in the world,
but we all know that there are some serious challenges. Our
part of the solution is based on what we know best and were our
passion lies, which is in music. In our own lives and in the
experiences of the children we reach every day, NAMM members
have seen first hand the power of music to touch the soul and
lift a struggling child to great heights. There is a growing
body of scientific research that attests to this power. Study
after study is demonstrating an unmistakable connection between
music education and success in school.
Mr. Monster. Yes, music helped Elmo learn the alphabet. If
it wasn't for the ABC song, Elmo would be lost, people. Hello.
Mr. Lamond. Research indicates that music education
dramatically enhances a child's ability to solve complex math
and science problems. Scientists believe that there is a link
to literacy skills as well. Students who participate in music
programs score significantly higher on standardized tests,
while at the same time developing self-discipline,
communication and teamwork skills. They are also less likely to
be involved in gangs, drugs or alcohol abuse, and have better
attendance in school.
Mr. Monster. Elmo is in the music program, and Elmo isn't
in a gang. No. Elmo's not in a gang.
Mr. Lamond. Let's keep it that way.
In addition to controlled scientific settings, this effect
is replicated in classrooms all over the country. For example,
in 1999, Public School 96 in East Harlem was one of the lowest
performing schools in the State of New York. Only 13 percent of
the students were performing at grade level in reading or math.
Eighteen months after the music program was restored, 71
percent of the students were performing at grade level.
Attendance is sky high, and the school is now a model
turnaround school for the city of New York. The principal,
Victor Lopez, attributes this astounding success to the
restoration of the music programs through the efforts of one of
our partners, VH1's Save The Music Foundation.
We were able to save the music in PS 96. But what about the
other schools? We are very concerned about the loss of school
music programs throughout the country. Only 25 percent of all
eighth graders have the opportunity to participate in a music
class, according to the most recent Department of Ed studies.
When we were in school, that figure was close to 100 percent.
We must make certain that all children, especially those at
risk, will be given opportunities to reap the benefit of music
education. For these children, if music education is not
offered in school, they will likely never receive it and will
be at a disadvantage throughout their academic lives.
Mr. Monster. Boy, that would be terrible, Mr. Joe.
Mr. Lamond. Yes.
Mr. Monster. Elmo doesn't know what he'd do without music.
Mr. Lamond. Well, NAMM and its partners are working on a
two-pronged approach to give every child a chance to make
music.
Mr. Monster. Oh, good.
Mr. Lamond. First, since education is essentially a local
issue, we need to help inform local decision making. We intend
to do this with more science based research on the link between
music education and learning, so that parents, teachers and
local officials can make the best case for funding school music
programs. We are seeking $1 million for the International
Foundation for Music Research for the purpose of funding this
research.
The second part seeks to provide immediate help to
children. We are seeking $1 million to support VH1 Save The
Music Foundation's efforts to provide instruments to schools
where there is no access to music learning. In the education
arena, I can think of no other initiative that can do so much
for so many children with so small an investment.
So how will you measure the success of this investment? You
will know the answer when you look into the eyes of one of your
littlest constituents playing their violin with pure joy,
devotion and a sense of accomplishment.
Mr. Monster. Elmo plays the violin.
Mr. Lamond. And you will know it when you see their parents
swell with pride during their first orchestra concert.
Mr. Monster. Elmo's parents swell with pride when they hear
Elmo sing.
Mr. Lamond. And mark my words, you will see it in the
soaring test results and attendance records of the schools to
whom you have given the simple gift of music.
Mr. Monster. Elmo scored a 1550 on his SATs. All because of
music, yeah! Oh, okay, Elmo made up that one. [Laughter.]
Elmo just wants you nice Congress people to please, please,
please, oh, please give the kids the gift of music, please?
Mr. Lamond. I hope the Subcommittee will support our modest
request. Thank you very, very much for your time and
consideration.
Mr. Monster. Yes, thanks, House Labor Subcommittee. Elmo
loves you. Thank you. Thank you.
[The prepared statement and biography of Mr. Lamond
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Regula. Elmo, why is music so important that you came
all the way here from Sesame Street to talk to our Committee
today?
Mr. Monster. Music is a big part of Elmo's life. Elmo uses
music all the time to sing and dance and learn and even to
remember stuff. Like the time Elmo had to remember what to buy
at the store. Elmo remembers it with music like this, ``Elmo
needs a little Swiss cheese, needs some frozen broccoli, and he
needs a jar of pickles now.'' See, that's why music is so
important to Elmo. [Laughter.]
Elmo's not making a mockery of this place, no. It's very
important.
Mr. Cunningham. We've got a hostile witness. [Laughter.]
Mr. Monster. No, Elmo's not hostile, he's just a monster.
[Laughter.]
Mr. Regula. Elmo, what is the best part about making and
listening to music?
Mr. Monster. Well, music really helps Elmo express how Elmo
feels. Like if Elmo's happy, Elmo plays hip-hop. If Elmo's sad,
Elmo plays the blues. And if Elmo's feeling extra saucy, Elmo
likes that word, saucy, Elmo plays show tunes like this:
``Elmo's pretty, oh, so pretty, that the city gave Elmo this
key, House Committee, can't you see how Elmo be. La, la. la,
la.'' That was terrible. But Elmo loves music.
Mr. Regula. Elmo, if you could be any musical instrument,
which one would you be?
Mr. Monster. Boy, that's a hard question. Elmo loves all
kinds of musical instruments. Maybe a harpsichord, a
glockenspiel. Wait, wait, Elmo got it--Elmo would be a drum
set. Because then Elmo could lay down his fat beats like this,
phhtt, phhhtt, phhtt. Oops. Elmo just got spittle all over the
House floor. [Laughter.]
Mr. Regula. That's why we have those white cloths on the
table today.
Mr. Monster. It doesn't help.
Mr. Regula. Elmo, how can Congress help you and all your
friends?
Mr. Monster. Boy, you have a really bassy voice. It's nice.
[Laughter.]
It's nice. That's not funny. Elmo spent all his life
listening to and playing and loving music. That's because music
is in Elmo. Music is Elmo. And Elmo knows that there is music
in Elmo's friends all over the country. But some of them just
don't know it yet. They don't know how to find their music.
So that's why Elmo needs Congress to help. Please,
Congress, help Elmo's friends find the music inside them. Thank
you. And Elmo loves you very much.
Mr. Regula. And my grandchildren love you, too, Elmo.
Mr. Monster. Ah, get out of here. [Laughter.]
Mr. Regula. Mr. Cunningham, do you have any questions for
our witness today?
Mr. Cunningham. Elmo, you have one person I think I'd be
remiss, actually, two. Mrs. Bell in San Diego, California, her
husband started Taco Bell.
Mr. Monster. Really? You mean that little chihuahua?
Mr. Cunningham. Yes. It should have been a Jack Russell.
But they have donated scores of money through their
foundation to enhance music in the Encinido Union School
District in San Diego. There's groups like that. We want to
thank you on this Committee, as well as Mr. Lamond, who's a
musician himself, for appearing before us.
Music does have an important part in life. All of us have
cried at funerals, we get tears in our eyes at the Star
Spangled Banner. I do believe that it enhances a child's
education.
When I mentioned I flew in combat, I listened to music.
Music has a rhythm to it. And whether you're flying an airplane
or what, that rhythm helps in the functions. So I think if they
even did some studies on outside of education, athletes, things
like that, I think they'd find it very rewarding.
Thank you, Mr. Lamond.
Mr. Monster. Thank you very much. From all of us at Sesame
Street, we thank you. You're very important to us.
Mr. Regula. Well, thank you for coming, Elmo. You have an
important message, and I know you have a great friend here in
Mr. Cunningham.
Mr. Monster. Yes. Thank you.
Mr. Regula. Thank you, Mr. Lamond.
Okay, the Committee is adjourned.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
ORGANIZATIONAL INDEX
----------
Part 7A
Page
Academy of Radiology Research.................................... 620
ADAP Working Group............................................... 476
Alzheimer's Association.......................................... 1177
American Academy of Family Physicians............................ 456
American Academy of Ophthalmology................................ 693
American Association of Dental Research.......................... 172
American Council on Education.................................... 202
American Dental Association...................................... 122
American Dental Education Association............................ 190
American Electronics Association................................. 931
American Federation of Medical Research.......................... 726
American Foundation for the Blind................................ 950
American Heart Association....................................... 1258
American Liver Foundation........................................ 1166
American Lung Association of Rhode Island........................ 1206
American Psychiatric Nurses Association.......................... 406
American Psychological Society................................... 431
American Public Health Association.............................559, 683
American Society of Transplant Surgeons.......................... 1070
American Speech-Language Hearing Association..................... 849
American Trauma Society.......................................... 806
American Urological Association.................................. 1289
Association of Academic Health Centers........................... 826
Association of Maternal and Child Health Programs................ 496
Association for Persons in Support Employment.................... 1015
Association for Research in Vision and Ophthalmology............. 710
Association of Schools of Allied Health Professions.............. 396
Association of Schools of Public Health.......................... 520
Association of State and Territorial Health Officials............ 543
Association of Tech Act Projects................................. 241
Association of Public Health Laboratories........................ 531
Bassett Healthcare............................................... 566
Big Brothers Big Sisters of America.............................. 887
Caduceus Outreach Services....................................... 134
Carnegie Hall.................................................... 1184
The Carolinas Center for Hospice and End of Life Care............ 753
Charlie Foundation to Help Cure Pediatric Epilepsy............... 677
Chronic Fatigue and Immune Immune Dysfunction Syndrome
Association.................................................... 763
Citizens United for Research in Epilepsy......................... 677
Coalition for Community Schools, Institute for Educational
Leadership..................................................... 227
Coalition of Higher Education Assistance Organizations........... 302
Coalition for International Education............................ 202
Coalition of Patients Advocates for Skin Disease Research........ 700
College on Problems of Drug Dependence........................... 319
Columbia University............................................145, 620
Committee for Education Funding.................................. 1097
Communities Advocating Emergency AIDS Relief Coalition........... 506
Concordia College................................................ 302
Cooley's Anemia Foundation....................................... 1146
Cornell University, Weill College of Medicine.................... 744
Council for Opportunity in Education............................. 215
Crohn's and Colitis Foundation of America........................ 1120
CVS Corporation.................................................. 329
Developmental Disabilities Research Center Association........... 978
Dystonia Medical Research Foundation............................. 1281
Emory Healthcare................................................. 1082
Emory University, Woodruff Health Sciences Center................ 1082
Facioscapulohumeral Muscular Dystrophy (FSH) Society, Inc........ 1227
Fairleigh Dickinson University................................... 466
Family Resources................................................. 485
Federation of American Societies for Experimental Biology........ 668
Fight Crime: Invest in Kids...................................... 895
Friends of National Institute of Child Health and Human
Development Coalition.......................................... 835
Friends of NIOSH Coalition....................................... 577
Harvard Medical School........................................... 406
HCR Manor Care................................................... 877
Heinz C. Prechter Fund for Manic Depression...................... 629
Horizon Health Care, Inc......................................... 415
The Hospices of the National Capital Region...................... 753
Houston Works USA................................................ 861
Howard University................................................ 735
International Foundation for Functional Gastrointestinal
Disorders...................................................... 816
International Hyperbaric Medical Association..................... 589
International Reading Association................................ 905
International Rett Syndrome Association.......................... 1129
Jeffrey Modell Foundation........................................ 939
Johns Hopkins University......................................... 710
Joslin Diabetes Center........................................... 1215
LIFEbeat, the Music Industry Fights AIDS......................... 424
Lymphoma Research Foundation..................................... 1275
March of Dimes................................................... 966
Maryland Technology Assistance Program........................... 241
Massachusetts General Hospital................................... 717
MCP Hahneman University, HIV/AIDS Medicine Division.............. 506
Melwood.......................................................... 1015
Michigan Governor's Council on Physical Fitness, Health and
Sports......................................................... 440
Mississippi Department of Rehabilitation Services................ 991
NAMM: International Music Products Association................... 342
National Alliance for Nutrition and Activity..................... 559
National Area Health Centers Organization........................ 447
National Association of Anorexia Nervosa and Associated Disorders 1308
National Association of Chain Drug Stores........................ 329
National Association of Community Health Centers, Inc............ 415
National Association of Developmental Disabilities Councils...... 1003
National Association of Foster Grandparent Program Directors..... 1041
National Association of Rural Mental Health...................... 551
National Association of School Nurses............................ 1297
National Association of State Student Grant and Aid Programs..... 281
National Association of State Workforce Agencies................. 1050
National Campaign for Hearing Health............................. 112
National Center for Health Education............................. 145
National Coalition for Osteoporosis and Related Bone Diseases.... 1107
National Council for Community and Education Partnerships........ 259
National Council on Independent Living........................... 386
National Council of Mathematics.................................. 913
National Council Social Security Management Association, Inc..... 1061
National Disease Research Interchange............................ 744
National Education Knowledge Industry Association................ 290
National Hospice and Palliative Care Organization................ 753
National Job Corp Association.................................... 877
National Kidney Foundation....................................... 1266
National Minority AIDS Council................................... 351
National Network to End Domestic Violence........................ 364
National Network for Youth....................................... 485
National Neurofibromatosis Foundation, Inc....................... 1241
National Nutritional Foods Association........................... 309
National Organization of Rehabilitation Partners................. 991
National Youth Employment Coalition.............................. 861
Nebraska State Legislature, Public Policy Committee.............. 1003
Newport County Community Mental Health Center, Inc............... 156
North American Association for the Study of Obesity.............. 639
Ohio Department of Natural Resources, Ohio Civilian Conservation
Corps.......................................................... 861
Ohio State University, School of Allied Medical Professions...... 396
Oklahoma Employment Security Commission.......................... 1050
Oregon Health and Sciences University............................ 783
Pancreatic Cancer Action Network................................. 773
Pennsylvania Association for Individuals with Disabilities....... 1233
Philadelphia, City of, AIDS Activities Coordinating Office....... 506
Polycystic Kidney Disease Foundation............................. 1156
The Prostatitis Foundation....................................... 1304
The Providence Center............................................ 161
Public/Private Ventures.......................................... 272
Research Society on Alcoholism................................... 649
Residential Care Consortium...................................... 1031
Rust College..................................................... 215
Safeway.......................................................... 1015
The San Francisco AIDS Foundation................................ 374
Scleroderma Foundation........................................... 1193
Sesame Street.................................................... 342
Social Security Administration................................... 991
Society of Gynecologic Oncologists............................... 1250
Society for Investigative Dermatology............................ 700
St. Joseph's Indian School of South Dakota....................... 923
Texas Instruments................................................ 931
Thomas Jefferson University...................................... 700
United Negro College Fund........................................ 250
University of Akron.............................................. 101
University of Alabama at Birmingham, Rett Center for Excellence.. 1129
University of Cincinnati, Department of Communication Sciences
and Disorders.................................................. 849
University of Cincinnati, School of Medicine..................... 726
University Hygienic Laboratory................................... 531
University of Iowa............................................... 577
University of Iowa College of Dentistry.......................... 190
University of Missouri-St. Louis, College of Education........... 1304
University of North Carolina School of Dentistry, Center for Oral
and Systemic Diseases.......................................... 172
University of Texas, Houston School of Public Health............. 520
University of Vermont............................................ 319
ViA Company...................................................... 1015
Vocational Rehabilitation Services............................... 991
Wilberforce University........................................... 250
Women's Health Research Coalition................................ 735
Yale University School of Medicine, Department of Psychiatry..... 649