[House Hearing, 109 Congress]
[From the U.S. Government Publishing Office]
H.R. 2561, IMPROVING ACCESS TO WORKERS' COMPENSATION FOR INJURED
FEDERAL WORKERS
ACT AND H.R. 697, FEDERAL FIRE FIGHTERS FAIRNESS ACT OF 2005
=======================================================================
HEARING
before the
SUBCOMMITTEE ON WORKFORCE PROTECTIONS
of the
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
May 26, 2005
__________
Serial No. 109-20
__________
Printed for the use of the Committee on Education and the Workforce
Available via the World Wide Web: http://www.access.gpo.gov/congress/
house
or
Committee address: http://edworkforce.house.gov
______
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COMMITTEE ON EDUCATION AND THE WORKFORCE
JOHN A. BOEHNER, Ohio, Chairman
Thomas E. Petri, Wisconsin, Vice George Miller, California
Chairman Dale E. Kildee, Michigan
Howard P. ``Buck'' McKeon, Major R. Owens, New York
California Donald M. Payne, New Jersey
Michael N. Castle, Delaware Robert E. Andrews, New Jersey
Sam Johnson, Texas Robert C. Scott, Virginia
Mark E. Souder, Indiana Lynn C. Woolsey, California
Charlie Norwood, Georgia Ruben Hinojosa, Texas
Vernon J. Ehlers, Michigan Carolyn McCarthy, New York
Judy Biggert, Illinois John F. Tierney, Massachusetts
Todd Russell Platts, Pennsylvania Ron Kind, Wisconsin
Patrick J. Tiberi, Ohio Dennis J. Kucinich, Ohio
Ric Keller, Florida David Wu, Oregon
Tom Osborne, Nebraska Rush D. Holt, New Jersey
Joe Wilson, South Carolina Susan A. Davis, California
Jon C. Porter, Nevada Betty McCollum, Minnesota
John Kline, Minnesota Danny K. Davis, Illinois
Marilyn N. Musgrave, Colorado Raul M. Grijalva, Arizona
Bob Inglis, South Carolina Chris Van Hollen, Maryland
Cathy McMorris, Washington Tim Ryan, Ohio
Kenny Marchant, Texas Timothy H. Bishop, New York
Tom Price, Georgia John Barrow, Georgia
Luis G. Fortuno, Puerto Rico
Bobby Jindal, Louisiana
Charles W. Boustany, Jr., Louisiana
Virginia Foxx, North Carolina
Thelma D. Drake, Virginia
John R. ``Randy'' Kuhl, Jr., New
York
Paula Nowakowski, Staff Director
John Lawrence, Minority Staff Director
------
SUBCOMMITTEE ON WORKFORCE PROTECTIONS
CHARLIE NORWOOD, Georgia, Chairman
Judy Biggert, Illinois, Vice Major R. Owens, New York
Chairman Dennis J. Kucinich, Ohio
Ric Keller, Florida Lynn C. Woolsey, California
John Kline, Minnesota Timothy H. Bishop, New York
Kenny Marchant, Texas John Barrow, Georgia
Tom Price, Georgia George Miller, California, ex
Thelma Drake, Virginia officio
John A. Boehner, Ohio, ex officio
C O N T E N T S
----------
Page
Hearing held on May 26, 2005..................................... 1
Statement of Members:
Bishop, Hon. Timothy H., a Representative in Congress from
the State of New York, prepared statement of............... 44
Capps, Lois, a Representative in Congress from the State of
California, prepared statement of.......................... 43
Norwood, Hon. Charlie, Chairman, Subcommittee on Workforce
Protections, Committee on Education and the Workforce...... 2
Prepared statement of.................................... 2
Owens, Hon. Major R., Ranking Member, Subcommittee on
Workforce Protections, Committee on Education and the
Workforce.................................................. 3
``W. Plan Stiffs Heroes; Nixes WTC Comp Pay,'' New York
Post article........................................... 48
Statement of Witnesses:
Davis, Hon. Jo Ann, a Representative in Congress from the
State of Virginia.......................................... 6
Prepared statement of.................................... 8
Johnson, James B., 16th District Vice President,
International Association of Fire Fighters, Washington, DC. 9
Prepared statement of.................................... 11
Kohlhepp, William C., MHA, PA-C, Assistant Professor and
Associate Director, Physician Assistant Program, Quinnipiac
University, Hamden, CT..................................... 28
Prepared statement of.................................... 30
Shufro, Joel, Executive Director, New York Committee for
Occupational Safety and Health, New York, NY............... 15
Prepared statement of.................................... 17
Towers, Jan, PhD, NP-C, CRNP, FAANP, Director of Health
Policy, American Academy of Nurse Practitioners,
Washington, DC............................................. 36
Prepared statement of.................................... 37
Additional Materials Supplied:
American Nurses Association, statement submitted for the
record..................................................... 45
H.R. 2561, IMPROVING ACCESS TO WORKERS' COMPENSATION FOR INJURED
FEDERAL WORKERS ACT AND H.R. 697, FEDERAL FIRE FIGHTERS FAIRNESS ACT OF
2005
----------
Thursday, May 26, 2005
U.S. House of Representatives
Subcommittee on Workforce Protections
Committee on Education and the Workforce
Washington, DC
----------
The Subcommittee met, pursuant to notice, at 10:33 a.m., in
room 2175, Rayburn House Office Building, Hon. Charlie Norwood
[Chairman of the Subcommittee] presiding.
Present: Representatives Norwood, Kline, Marchant, Price,
Drake, Owens, Kucinich, Woolsey, and Bishop.
Staff present: Kevin Frank, Professional Staff Member; Ed
Gilroy, Director of Workforce Policy; Donald McIntosh,
Legislative Assistant; Jim Paretti, Workforce Policy Counsel;
Molly McLaughlin Salmi, Deputy Director of Workforce Policy;
Deborah L. Emerson Samantar, Committee Clerk/Intern
Coordinator; Kevin Smith, Senior Communications Advisor; Margo
Hennigan, Legislative Assistant/Labor; Marsha Renwanz,
Legislative Associate/Labor; Peter Rutledge, Senior Legislative
Associate/Labor.
Mr. Norwood. A quorum being present, the Subcommittee on
Workforce Protections of the Committee on Education and the
Workforce will now come to order.
We are meeting today to hear testimony on H.R. 697, the
Federal Fire Fighters Fairness Act of 2005, and H.R. 2561, the
Improving Access to Workers Compensation for Injured Federal
Employees Act.
Under Committee Rule 12(b), opening statements are limited
to the Chairman and Ranking Minority Member. If other Members
have statements, they, of course, will be included in the
record.
With that, I ask unanimous consent for the hearing record
to remain open for 14 days.
This will allow Members' statements and other extraneous
material referenced during the hearing to be included in the
hearing record.
Without objection, so ordered.
STATEMENT OF HON. CHARLIE NORWOOD, CHAIRMAN, SUBCOMMITTEE ON
WORKFORCE PROTECTIONS, COMMITTEE ON EDUCATION AND THE WORKFORCE
Both of these bills would amend the Federal Employees'
Compensation Act, otherwise known as FECA. FECA is the
comprehensive workers' compensation program for Federal
employees. The program provides important benefits and services
to Federal workers who have suffered economic hardship from a
work-related injury or death.
The Subcommittee has held a number of oversight hearings on
the FECA program over the past several years. The last hearing,
held in May of last year, provided a broad overview of the FECA
program.
We looked at what could be done to maximize the benefits
for workers and improve the efficiency and effectiveness of the
program.
Today's hearing reinforces those themes and will focus on
two proposals that would increase access to the program for
injured Federal workers.
Our first panel of witnesses will testify on H.R. 697, a
bipartisan bill introduced by Representative Jo Ann Davis. The
bill would create a presumptive disability under the law such
that certain diseases incurred by a Federal firefighter would
be presumed to be work-related.
Our second panel of witnesses will testify on H.R. 2561, a
bipartisan bill that Rob Andrews, my colleague on the Full
Committee, and I introduced earlier this week. H.R. 2561 would
allow injured Federal workers to submit medical documentation
signed by a physician assistant or a nurse practitioner in
support of a claim for benefits.
This is an important bill that would improve access to
compensation benefits for injured Federal workers, especially
those in rural areas with limited options for medical
treatment.
I would like to thank the witnesses for making themselves
available to share their expertise with us today. We appreciate
you taking time out of what we know is a busy schedule to
appear before the Subcommittee, and we look very forward to
your testimony.
I now yield to the distinguished gentleman from New York,
the Ranking Member on the Subcommittee, Major Owens, for his
opening statement.
[The prepared statement of Chairman Norwood follows:]
Statement of Hon. Charlie Norwood, Chairman, Subcommittee on Workforce
Protections, Committee on Education and the Workforce
The Subcommittee is meeting today to hear testimony on two bills:
H.R. 697, the ``Federal Firefighters Fairness Act of 2005,'' and H.R.
2561, the ``Improving Access to Workers' Compensation for Injured
Federal Workers Act.''
Both bills would amend the Federal Employees' Compensation Act,
otherwise known as ``FECA.'' FECA is the comprehensive workers'
compensation program for federal employees. The program provides
important benefits and services to federal workers who have suffered
economic hardship from a work-related injury or death.
This Subcommittee has held a number of oversight hearings on the
FECA program over the past several years. The most recent hearing, held
in May of last year, provided a broad overview of the FECA program. We
looked at what could be done to maximize the benefits for workers and
improve the efficiency and effectiveness of the program. Today's
hearing reinforces those themes, and will focus on two proposals that
would increase access to the program for injured federal workers.
Our first panel of witnesses will testify on H.R. 697, a bipartisan
bill introduced by Representative Jo Ann Davis. The bill would create a
``presumptive disability'' under the law, such that certain diseases
incurred by a federal firefighter would be presumed to be work-related.
Our second panel of witnesses will testify on H.R. 2561, a
bipartisan bill that my colleague on the full committee, Rob Andrews,
and I introduced earlier this week. H.R. 2561 would allow injured
federal workers to submit medical documentation signed by a physician
assistant or a nurse practitioner in support of a claim for benefits.
This is an important bill that will improve access to compensation
benefits for injured federal workers, especially those in rural areas
with limited options for medical treatment.
I would like to thank the witnesses for being available to share
their expertise with us today. We appreciate you taking time out from
your busy schedules to appear before the Subcommittee. We look forward
to your testimony.
I now recognize the gentleman from New York, the Ranking Member on
the Subcommittee, Major Owens, for his opening statement.
______
STATEMENT OF HON. MAJOR R. OWENS, RANKING MEMBER, SUBCOMMITTEE
ON WORKFORCE PROTECTIONS, COMMITTEE ON EDUCATION AND THE
WORKFORCE
Mr. Owens. Thank you very much, Mr. Chairman. I appreciate
the fact that today the task before us is a bipartisan and
positive one.
As we approach Memorial Day, I really thought that we are
going to do some positive things for working families. Working
families, of course, bear the brunt of the sacrifices in the
battlefields of the world for our nation. They are bearing that
burden in Iraq now, and they did so in Vietnam and on D-Day and
the Battle of the Bulge. Ninety-five percent of the people in
the armed forces are from working families, and we look forward
to the day when we have a Department of Labor and a government
and administration which cares more for our working families.
Certainly today is an unusual and very much appreciated
step in the direction of trying to improve things for working
families.
I am very pleased that this hearing focuses on bills
designed to strengthen protections for American workers, in
contrast to legislation that we often have which subverts or
undermines such safeguards. Both bills before us this morning
would enhance worker protections afforded by the Federal
Employees' Compensation Act, FECA.
The immediate aftermath of the devastating terrorist
bombing attacks on the Murrah Federal Building in Oklahoma City
and the World Trade Center in New York City remind us all of
just how crucial the FECA program can prove to be. Services
provided under FECA, for example, proved invaluable in
assisting surviving family members of those killed in the
Oklahoma City bombing.
Likewise, medical care tied to the FECA program helped make
the difference for some of the workers wounded during the
tragic events of 9/11 between a faster recovery and a series of
risky health setbacks.
In addition to providing critical assistance in the case of
national emergencies, over the years FECA has helped countless
other Federal works injured or made ill in the course of
carrying out their duties, as well as surviving family members
in the event of worker deaths.
Let me turn now to H.R. 697, the first bill before us at
this morning's hearing.
This bill would give Federal firefighters the same
presumptive disability protections already afforded
firefighters in 40 states. In other words, the disability or
death of Federal firefighters from a range of specified
diseases would be presumed as a direct result of occupational
exposure.
The exposure of firefighters to certain infectious diseases
include tuberculosis, HIV, hepatitis, rabies, has received more
press attention that some of the other diseases specified in
this bill.
Yet, the connections between the day-to-day duties of fire
protection personnel, including firefighters, paramedics,
emergency medical technicians, rescue workers, as ambulance and
hazardous materials workers, and there are increased risks of
exposure to infectious illnesses, a range of cancers, and heart
and lung diseases, have already been well documented.
I understand that the lead sponsor of H.R. 697,
Representative Jo Ann Davis, will testify on the first panel of
witnesses, and I ask her to add me as a cosponsor to this
important bill. The lead cosponsor of H.R. 697, Representative
Lois Capps, also wanted to be here today to testify, but she
had a scheduling conflict.
Mr. Chairman, I ask that a written statement by
Representative Capps be included in the record in its entirety.
Mr. Norwood. So ordered.
Mr. Owens. At this juncture, I would like to acknowledge
Mr. Joe Shufro, who is Mr. Occupational Health and Safety
himself in New York State, Mr. Shufro of the New York Committee
on Safety and Health, and I want to welcome him as an important
witness to this hearing.
Mr. Shufro and NYCOSH have played a pivotal role in
addressing the critical health problems for workers and
residents that emerge and are still emerging as a result of the
devastation wrought by the attacked of 9/11. The clean-up
workers of Ground Zero deserve the same presumptive disability
protections that H.R. 697 would grant to Federal firefighters.
We need to do much more than just wax eloquently about the
debt we owe these brave workers, many of whom volunteered to
clean up Ground Zero at great personal risk to themselves and
their families.
We need to provide these workers, a number of whom will
never be able to work again, with real medical relief and wage
replacement.
It is absolutely unconscionable that the Bush
administration in the fiscal 2006 budget request is attempting
to rescind more than $120 million in workers compensation funds
for the 9/11 workers. Furthermore, it is a disgrace that
Governor Pataki, Governor of New York, is refusing to sign
bills to afford presumptive disability protections to 9/11
workers. I do not know any issues that have more to do with
morality than these.
Until we address the critical needs of these brave workers,
as well as all the residents of Manhattan, Brooklyn, and other
New York City burroughs affected, we have failed to meet our
moral responsibility.
So, I commend Mr. Shufro and his great organization for
remaining on the front lines of this important fight.
I further ask, Mr. Chairman, that a New York Post article
of May 8, 2005, which was posted on the NYCOSH website, be
entered into the record its entirely. The article is entitled
``W plan stiffs heros.''
[The article referred to is on page 48 of this document.]
Mr. Norwood. Do we get a chance to look that over? I am
sure----
Mr. Owens. Yes.
Mr. Norwood [continuing]. That will not be any problem,
just give us a chance to look it over.
Mr. Owens. It is from the New York Post. It's a great
paper.
Mr. Norwood. I do not read any New York papers, you know.
I have enough trouble with the Atlanta Journal.
Mr. Owens. My time is almost up, but I would like to make a
few comments about H.R. 2561 before closing.
Mr. Chairman, your bill is an important piece of
legislation, as you know. I cosponsored it during the 108th
Congress.
However, the American Nurses Association and Service
Employees International Union recently pointed out to me that
the bill would be improved immeasurably by substituting a
broader category of, quote ``advanced practice registered
nurses'' for the narrow subset of nurse practitioners.
For example, certified nurse anesthetists administer some
65 percent of all anesthetics delivered to U.S. patients every
year, but they are precluded from FECA coverage in your bill.
Mr. Chairman, I request that a forthcoming written
statement by the American Nurses Association about this issue
be later included in the record.
In closing, I applaud you for holding this hearing.
I look forward to hearing the testimony of all the
witnesses.
Mr. Norwood. Thank you very much, Mr. Owens.
I am, frankly, delighted that you approve of this hearing.
I feel it incumbent upon me to make sure you got home for
this vacation in a good mood, so maybe this will start us off.
We, today, have two panels of witnesses.
Our first panel will testify on H.R. 697. We will begin
with testimony offered by the gentlelady from Virginia, the
Honorable Jo Ann Davis, the first elected female Republican to
the U.S. House of Representatives from the Commonwealth.
Representative Davis has represented the First District of
Virginia since she was elected in November of 2000. In addition
to her Committee work on the House Armed Services Committee,
International Relations, and the Permanent Select Committee on
Intelligence, Representative Davis serves as Chair of the
Intelligence Committee's Subcommittee on Intelligence Policy.
We look forward to hearing her insight, and as the sponsor of
H.R. 697, on the need for this important legislation.
Next, we will hear from Mr. James Johnson, 16th District
Vice President of the International Association of Fire
Fighters, located right here in Washington, D.C., and the final
witness on our first panel is Mr. Joel Shufro, executive
director of the New York Committee on Safety and Health.
Before the gentlelady from Virginia begins her testimony, I
would like to remind our Members that we will impose a 5-minute
limit on all questions. I understand Ms. Davis can only be with
us for a limited time today and must excuse herself after
offering her testimony. Therefore, if any of our Members have
questions for her, we will forward them to her and include the
answers and questions in the hearing record.
I would like to point out the timer system up there. Red
means time's up. Green means it's time to start. Yellow gives
you a little notion that we are getting close.
We all have a copy of your testimony.
I would ask you to summarize in that 5-minute period so we
can run a orderly hearing here.
Representative Davis, you are recognized for 5 minutes.
STATEMENT OF HON. JO ANN DAVIS, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF VIRGINIA
Ms. Davis. Thank you, Mr. Chairman, and Mr. Owens, we will
make sure you are a cosponsor right away.
Mr. Chairman and Members of the Subcommittee, I want to
thank you for the opportunity to discuss with you an issue that
is very important to me and even more important to the brave
men and women who defend Federal installations around the
country.
As the wife of a now-retired municipal battalion fire
chief, I know the dangerous work that our firefighters do, and
we owe them a tremendous debt of gratitude. That is why I am
proud to sponsor H.R. 697, the Federal Firefighters Fairness
Act of 2005.
Federal firefighters risk their lives protecting our
nation's most vital interest.
They face some of the most difficult and hazardous working
conditions in the country, guarding military installations,
nuclear facilities, VA hospitals, and the like.
As such, they are daily exposed to stress, smoke, heat,
toxic substances that greatly increase their chances to
contract heart disease, lung disease, and various types of
cancer. May I point out that many times they do not even know
when they are being exposed to these hazardous materials.
A paper by the International Association of Fire Fighters
states that during the latest 10-year period, professional
firefighters experienced 342 line-of-duty deaths, 502
occupational disease deaths, 343,861 injuries, and 6,632 forced
retirements due to occupationally induced diseases or injuries,
and almost monthly, my husband calls me to tell me about a
young fellow or a young woman from our local fire department
that has either contracted cancer or heart disease or some
disease that they should not have contracted at an early age,
and we are losing firefighters much more quickly than we should
be.
The IFF report continues that, of the injuries reported,
approximately 80 percent occur while at the emergency scene.
Data shows that more than 40 percent of all firefighters can be
expected to be injured at least once during the course of the
year. Occupational diseases such as heart disease and cancer
constitute more than 90 percent of all reported firefighter
deaths when their occurrences are combined. Additionally, the
IFF reports that technology has created a distinct difference
in the modern firefighting environment. The report explains
that firefighters are often exposed to extremely high
concentrations of a large number of toxic and carcinogenic
chemical compounds.
Chemicals such as carbon monoxide and soot are natural
products of combustion and have always been present at fires.
However, the combustion of modern synthetic and plastic
material produces many highly toxic and carcinogenic compounds
that were not found in fires three or four decades ago.
As a result, the modern firefighter faces a number of
potentially serious new health threats, including many that can
develop over several years of exposure.
Currently, 40 states have presumptive disability laws that
presume that cardiovascular diseases, certain cancers and
infectious diseases are job-related for purposes of workers
compensation and disability retirement unless proven otherwise,
but our Federal firefighters' compensation and retirement
benefits are not provided with the same benefits that these 40
states provide.
This requirement places a substantial burden on Federal
firefighters who suffer from occupational diseases, because
they have to, by Federal law, prove that they came into contact
with these substances, which is--and specify where the precise
cause of the injury or illness comes from. It is very hard to
do, because firefighters do not know, many times, when they are
exposed to these substances.
To give you a for-instance, when I was pregnant with our
first child, my husband contracted hepatitis. It has stayed
with him forever, and it has caused a lot of problems for him,
and he contracted it, we think, on an ambulance. We do not know
from who, what, when, where.
This happens even more so to our Federal firefighters
because of the types of buildings and types of fires and
incidences that they have to go on.
The burden of proof is unacceptably high for firefighters
to meet, because they are constantly exposed to a myriad of
harmful substances and dangerous conditions. Working in such a
hazardous environment, it is often impossible to precisely
identify when and where a firefighter contracted a certain
disease.
My legislation, H.R. 697, simply creates the presumption
that Federal firefighters who become disabled by heart and lung
disease, certain cancers, and certain other infectious diseases
contracted the illness on the job. Additionally, if a
firefighter contracts an illness that is clearly not caused by
his or her firefighting duties, my bill recognizes that the
Federal Government should not be responsible for covering those
costs, and I have much more to say here, Mr. Chairman, but I
know how important and how vital the time is, and like you say,
you have my written statement.
I just cannot stress enough how important it is that our
Federal firefighters get the same benefits that are offered to
firefighters in 40 other states.
Our Federal firefighters, in my opinion, are put at much
more risk, especially since 9/11, than many of our state and
local firefighters.
I hope that the Committee will read my complete statement,
that you will listen carefully to the testimonies today, and
that if you have any questions, you will contact me, and I may
be a little prejudiced, because I'm married to a firefighter,
but after 30 years of being married to him, I have seen what
happens with our firefighters, and I just ask for your
consideration of the bill.
Thank you, Mr. Chairman.
[The prepared statement of Hon. Davis follows:]
Statement of Hon. Jo Ann Davis, a Representative in Congress From the
State of Virginia
Mr. Chairman, and Members of the Subcommittee, I want to thank you
for the opportunity to discuss with you an issue that is very important
to me, and even more important to the brave men and women who defend
federal installations around the country. As the wife of a now-retired
municipal battalion fire chief, I know firsthand the vital and
dangerous work that our nation's firefighters perform every single day.
We all owe them a tremendous debt of gratitude. That is why I am proud
to sponsor H.R. 697, the Federal Firefighters Fairness Act of 2005.
Federal firefighters risk their lives protecting our nation's most
vital interests. They face some of the most difficult and hazardous
working conditions in the country guarding military installations,
nuclear facilities, and VA hospitals. As such, they are daily exposed
to stress, smoke, heat, and toxic substances that greatly increase
their chances to contract heart disease, lung disease, and various
types of cancer.
A paper by the International Association of Fire Fighters (IAFF)
states that during the latest ten year period, professional
firefighters experienced 342 line-of-duty deaths, 502 occupational
disease deaths, 343,861 injuries and 6,632 forced retirements due to
occupationally induced diseases or injuries. The IAFF report continues
that of the injuries reported, approximately 80 percent occur while at
the emergency scene. Data shows that more than 40 percent of all
firefighters can be expected to be injured at least once during the
course of a year. Occupational diseases such as heart disease and
cancer constitute more than 90 percent of all reported firefighter
deaths when their occurrences are combined.
Additionally, the IAFF reports that technology has created a
distinct difference in the modern firefighting environment. The report
explains that firefighters are often exposed to extremely high
concentrations of a large number of toxic and carcinogenic chemical
compounds. Chemicals such as carbon monoxide and soot are natural
products of combustion and have always been present at fires. However,
the combustion of modern synthetic and plastic materials produces many
highly toxic and carcinogenic compounds that were not found in fires
even three or four decades ago. As a result, the modern firefighter
faces a number of potentially serious new health threats, including
many that can develop over several years of exposure.
Currently, 40 states have presumptive disability laws that presume
that cardiovascular diseases, certain cancers and infectious diseases
are job-related for purposes of workers compensation and disability
retirement unless proven otherwise. However, under federal law,
compensation and retirement benefits are not provided to federal
employees who suffer from occupational illnesses unless they can
specify the precise cause of their illness. This requirement places a
substantial burden on federal firefighters who suffer from occupational
diseases, to receive fair and just compensation or retirement benefits.
Federal firefighters currently must identify the precise cause of a
disease in order for it to be considered job-related. This burden of
proof is unacceptably high for firefighters to meet because they are
constantly exposed to a myriad of harmful substances, and dangerous
conditions. Working in such a hazardous environment, it is often
impossible to precisely identify when and where a firefighter
contracted a certain disease.
My legislation, H.R. 697, simply creates the presumption that
federal firefighters who become disabled by heart and lung disease,
certain cancers, and certain other infectious diseases contracted the
illness on the job. Additionally, if a firefighter contracts an illness
that is clearly not caused by his or her firefighting duties, my bill
recognizes that the federal government should not be responsible for
covering those costs. However, in the case of the vast majority of
federal firefighters who contract certain illnesses, it should be
presumed that their illness is a result of their service to our country
by running into burning buildings while others are running out of them.
The Federal Firefighters Fairness Act will bring federal law in
line with state laws that afford a majority of municipal firefighters a
presumptive disability benefit. This bill will help our nation's
federal firefighters receive fair and equitable compensation or
retirement benefits as a result of workplace illnesses. There is no
reason why the federal government cannot treat its firefighters with
the same respect as 40 states now treat their municipal firefighters.
We owe our federal first responders the same occupational safeguards
and benefits our civilian firefighters enjoy.
Mr. Chairman, thank you for holding this hearing today on
legislation pertaining to compensation for injured federal workers, and
for including the Federal Firefighters Fairness Act of 2005. As I have
stated before, the unique hazards associated with firefighting demand
that federal firefighters are afforded a presumptive disability benefit
similar to laws already on the books in 40 states. As you consider
these issues, I urge you and your fellow Committee Members to act on
H.R. 697, in order to provide our brave federal firefighters with the
support that they deserve. Thank you again for including this important
issue with today's hearing.
______
Mr. Norwood. Thank you, Ms. Davis.
It is all right for you to be prejudiced if you are married
to a firefighter.
I think that makes sense.
We appreciate your coming this morning, and you are now
excused.
Ms. Davis. Thank you.
Mr. Norwood. Mr. Johnson, you are now recognized for 5
minutes.
STATEMENT OF JAMES B. JOHNSON, 16TH DISTRICT VICE PRESIDENT,
INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS, WASHINGTON, DC
Mr. Johnson. Thank you, Mr. Chairman, Ranking Member,
Members of the Committee.
I am James Johnson, and I am the 16th District vice
president of the International Association of Fire Fighters. I
represent the Federal firefighters for the IFF. On behalf of
General President Jake Berger and the 267,000 men and women of
the IFF, it is my honor to testify before you today regarding
H.R. 697, a bipartisan bill which was introduced by
Representatives Jo Ann Davis and Lois Capps. This bill would
bring a much needed benefit to the firefighters that I
represent in the Federal sector.
Federal firefighters, although not as visible to the public
eye as their counterparts in the municipal sector, play an
essential role in protecting the vital interests of the United
States.
Over 15,000 Federal firefighters face some of the most
difficult and hazardous working conditions in the country
guarding military installations, VA hospitals, and other
Federal assets and lands.
Without their dedicated service, our nation would be less
secure.
The job of a Federal firefighter is unique in many ways.
When compared to other occupations in the Federal civil
service, they are routinely exposed to carcinogens, infectious
diseases, and other occupational hazards. Federal firefighters
respond to all the same types of emergencies as their
counterparts in the cities, including medical emergencies,
hazardous materials incidents, structural fires, and aircraft
emergencies, but they also face unique hazards involving
incidents at weapons depots, facilities that conduct classified
work and research, and emergencies aboard naval vessels.
They respond to these incidents often without adequate
information about the dangers they may encounter. For instance,
an EMS call can involve a chemical spill, and a structural fire
can actually be the result of an ammunition test failure.
Although firefighters take precautions and wear protective
gear, as with all aspects involving occupational hazards,
exposures do and can happen. As a result, they are far more
likely to suffer from heart disease, lung disease, and cancer
than other workers, and as firefighters, increasingly assume
the role of the nation's leading providers of emergency medical
services, they are also exposed to infectious diseases. These
illnesses are now among the leading causes of death and
disability for firefighters.
Mr. Chairman, in the interest of time, I will not go into
great detail, but as my written testimony will indicate, there
is an abundance of medical reasons why firefighters acquire
these illnesses and diseases at a higher level and a higher
rate than the average person.
It is important, however, to note that, under the Federal
Employees' Compensation Act, compensation and/or retirement
benefits are not provided to Federal employees who suffer from
occupational illnesses unless they can specify the conditions
and the exact situation in their employment to which the
disease is attributed.
In order to qualify for these benefits under current law,
Federal firefighters must be able to pinpoint the precise
incident or exposure that caused the disease in order for it to
be determined job-related.
This burden of proof is extraordinarily difficult for
firefighters to meet, because they respond to a variety of
emergency calls, constantly working in different environments
under varied conditions.
H.R. 697 was named the Federal Firefighter Fairness Act
because the main reason for the legislation is to treat Federal
firefighters fairly.
H.R. 697 would create a presumption that firefighters who
become disabled because of heart or lung disease or certain
cancers or infectious diseases contracted their illness on the
job. H.R. 697 would shift the burden of proof from the employee
to the employer to prove that the illness was caused by some
factor other than the duties of a firefighter.
It is important also to note that Congress has enacted
legislation with presumptive benefits in the past. The 108th
Congress passed the Hometown Heroes Act, and under this law,
the public safety officers benefit is paid to families of
firefighters who died as a result of a heart attack or a stroke
while they are on duty.
So, we are assuming that the death was a direct and
proximate result of their duties.
However, currently, if a firefighter does not succumb to a
heart or stroke on duty, it is presumed not to be job-related.
In conclusion, Mr. Chairman, while we believe the merits of
H.R. 697 warrant Congressional action, we are also mindful
that, in this tight budget environment, we must be sensitive to
the cost of even the most compelling initiatives. Although no
formal cost estimate has been done by the Congressional Budget
Office, we believe the cost of implementing H.R. 697 will be
minimal.
Mr. Chairman, that concludes my statement, and I would like
to thank you and the Committee for the opportunity to be here
today, and would welcome any questions you may have.
[The prepared statement of Mr. Johnson follows:]
Statement of James B. Johnson, 16th District Vice President,
International Association of Fire Fighters, Washington, DC
Mr. Chairman, Ranking member and members of the committee, my name
is James Johnson, and I am the 16th District Vice-President of the
International Association of Fire Fighters (IAFF), representing federal
fire fighters.
On behalf of General President Harold A. Schaitberger and the
267,000 men and women of the IAFF it his my honor to testify before you
today on H.R. 697, The Federal Fire Fighters Fairness Act, a bipartisan
bill introduced by Representatives Joann Davis and Lois Capps. The bill
would bring a much-needed benefit to the fire fighters that I represent
in the federal sector.
Introduction
Since the events of September 11, 2001, Americans have become
increasingly aware of the role that fire fighters serve as our nation's
domestic defenders. These courageous men and women protect the lives
and property of their neighbors in communities throughout the country.
Federal fire fighters, although not as well known as their
counterparts in the municipal sector, play an essential role in
protecting the vital interests of the United States. The over 15,000
federal fire fighters face some of the most difficult and hazardous
working conditions in the country guarding military installations,
nuclear facilities, and VA hospitals. And their 72 hour work week is
unparalleled. Without their dedicated service, our nation would be less
secure.
The job of federal fire fighters is unique in many ways. Far more
often than other occupations within the federal sector, they are
routinely exposed to carcinogens, infectious diseases, and other
occupational hazards.
Federal fire fighters respond to all of the same types of
emergencies as their counterparts in the municipal sector including
medical emergencies, hazardous material incidents, structural fires,
and aircraft emergencies. But they also face unique hazards involving
incidents at weapons depots, facilities conducting classified work and
research, and emergencies aboard naval vessels.
And they respond to these incidents often without adequate
information about the dangers they may encounter. An EMS call can
actually turn out to involve a chemical spill, and a structural fire
can be the result of a research or ammunition test failure. Although
fire fighters take precautions and wear protective gear, as with all
aspects involving occupational protection, exposures happen.
Fire fighters are exposed on an almost daily basis to stress,
smoke, heat and various toxic substances. As a result, they are far
more likely to contract heart disease, lung disease and cancer than
other workers. And as fire fighters increasingly assume the role of the
nation's leading providers of emergency medical services, they are also
exposed to infectious diseases.
Heart disease, lung disease, cancer, and infectious disease are now
among the leading causes of death and disability for fire fighters, and
numerous studies have found that these illnesses are occupational
hazards of fire fighting.
Under the Federal Employees' Compensation Act (FECA), compensation
and/or retirement benefits are not provided to federal employees who
suffer from occupational illnesses unless they can specify the
conditions of employment to which the disease is attributed. In order
to qualify for these benefits under current law, federal fire fighters
must be able to pinpoint the precise incident or exposure that caused a
disease in order for it to be determined job-related.
As I will explain further in my testimony, this burden of proof is
extraordinarily difficult for fire fighters to meet because they
respond to a wide variety of emergency calls, constantly working in
different environments under varied conditions.
As a result, very few cases of occupational disease contracted by
fire fighters have been deemed to be service connected.
State Laws
In recognition of the linkage between firefighting and certain
diseases, 40 states have enacted some sort of ``presumptive
disability'' laws, which presume that cardiovascular diseases, certain
cancers and infectious diseases are job-related for purposes of workers
compensation and disability retirement unless it can be shown
otherwise.
For example, Mr. Chairman, in your home state of Georgia fire
fighters are protected by a presumptive disability law that covers
heart disease, lung disease, and certain infectious diseases.
Many of the illnesses covered by state presumptive disability laws
are debilitating and often fatal. They place a great strain on the fire
fighter and his/her family. Knowing that they will not have to fight
their state Worker's Compensation offices during trying times for them
and their families provides a degree of security for those who place
themselves in harm's way to protect the rest of us.
While presumptive laws are now the norm for municipal fire
fighters, no such protection exists for fire fighters employed by the
federal government.
Fairness
HR 697 was named the Federal Fire Fighters Fairness Act because the
main impetus for the legislation is to treat federal fire fighters
fairly. It is simply not right that federal fire fighters are denied an
important workplace protection that is routinely provided in the
municipal sector. This inequity is especially egregious in communities
where federal fire departments maintain a mutual aid agreement with a
neighboring municipality.
In such instances, federal fire fighters work side-by-side with
municipal fire fighters during mutual aid responses and are subject to
the same occupational hazards as the municipal fire fighter. However,
if two fire fighters both contract an illness due to their mutual
exposure at an incident, the municipal fire fighter in most instances
would be covered by workers compensation but the federal fire fighter
would not.
There simply is no valid justification for denying federal fire
fighters comparable protections.
Recruitment and Retention
In order for the federal government to adequately protect our
nation's domestic military installations, nuclear facilities and other
sensitive agencies, the government must offer fire fighters benefits
that are competitive with those that are provided by municipalities.
Often, federal fire fighters leave the federal service for work in a
municipal department because the benefits are superior. For those same
reasons, municipal departments also have a competitive advantage over
the federals in the recruitment of new hires.
Being at a competitive disadvantage to recruit and retain fire
fighters harms the federal government in two ways. First, it makes it
more difficult to recruit and keep the very best our profession has to
offer. Considering the vital national security role played by the
nation's fire fighters, it is important that the federal government is
able to recruit and retain the elite of the firefighting world.
Second, the federal government invests a significant amount of
money to uniquely train federal fire fighters, and it costs taxpayer
dollars each time a federal fire fighter leaves for the municipal
sector. High turnover is costly and wasteful.
In order to address these problems, the federal government must
offer a competitive benefits package, and that includes having
occupational illness covered by workers compensation.
Case Studies
Admittedly, there are few examples of the Department of Labor's
Office of Worker's Compensation (OWCP) rejecting applications for
occupational illnesses, but that is due to the fact that fire fighters
simply do not apply for benefits they have been told are not available
to them.
When a fire fighter contracts a career-ending illness, they are
given paperwork by their local personnel office and told what benefits
they are or are not eligible to receive. Those who are suffering from
diseases that have been linked to fire fighting are informed that such
illnesses are not considered duty-related for Workers Comp purposes.
For example, Fire Fighter Leon Tukes of Warner Robins Air Force
Base in your home state of Georgia suffered a heart attack while on
duty. After his heart attack, Fire Fighter Tukes went to the Personnel
Office at Warner Robins to enquire about receiving a presumptive
disability retirement. He was told to not even bother because no claim
has ever been granted for a heart attack. He never filed a claim and
accepted the retirement benefits provided to people who retire for non-
work related reasons.
Unable to work and with no protection under FECA, Fire Fighter
Tukes had to rely on his fellow fire fighters to donate leave to him so
he could retire with a full pension. He was lucky to be near retirement
age; most are not when they are stricken with these occupational
illnesses.
Occasionally an instance occurs in which the service connection is
so apparent that OWCP has little choice but to award benefits. But the
absence of a presumptive disability law means that in even these cases
the fire fighter must spend years fighting the bureaucracy to get what
they are rightfully entitled to.
Fire Fighter Rick LeClair provides a tragic example of this delay.
LeClair spent his career protecting the critical naval facility in San
Diego, California until he was diagnosed with lung cancer. Doctors
discovered that his cancer was caused by mesothilioma, which was
attributed to the asbestos suits that fire fighters once wore. Fire
Fighter Leclair filed a claim with the Office of Workers' Compensation.
Before the claim was decided fire fighter LeClair succumbed to the
cancer that was ruled to be caused by an occupational hazard. If this
law would have been in place for fire fighter Leclair, his illness
would have been presumed and he would have received the benefit he died
waiting years to receive.
It is for fire fighters Tukes, LeClair, and many others whose names
we don't know, that we urge passage of the Federal Fire Fighters
Fairness Act.
Firefighter Health and Safety
The IAFF has been actively involved in the health and safety of
fire fighters for more than seventy years. Each year the IAFF conducts
an annual death and injury survey with the cooperation and
participation of various fire department administrators. This survey
has shown that fire fighting is the most hazardous occupation in the
United States. During the latest ten-year period (1990-2000), the Death
and Injury Survey has found that professional fire fighters experienced
342 traumatic-injury deaths, 502 occupational disease deaths, 343,861
injuries and 6,632 forced retirements due to occupationally induced
diseases or injuries.
Occupational diseases such as heart disease and cancer constitute a
majority of all reported fire fighter deaths.
Heart Disease
The very nature of firefighting places extraordinary strain on
cardiovascular systems. Fire fighters are constantly making transitions
from the calm, peaceful environment of the firehouse to the hostility
presented by fire. Within 15-30 seconds after the fire alarm sounds,
research studies have found that a fire fighter's heart rate can
increase by as much as 117 beats per minute. In addition, a fire
fighter's heart can beat at twice its normal rate throughout the entire
fire fighting operation. These extreme physiological stresses lead to
severe coronary problems, which have been documented by numerous
authorities.
Fire fighting involves stressful and strenuous physical activity
that is made more burdensome by the fact that the protective clothing
and breathing apparatus a fire fighter wears adds 45 to 65 pounds. The
working environment can also mean a transition from below freezing
temperatures to temperatures between 100 degrees and 500 degrees
Fahrenheit at the fire itself.
The strain placed on the heart by this unique combination of
factors is unlike that of any other occupation, and leads to heightened
risk of heart disease.
Cancer
Technology has created a distinct difference in the modern fire
environment. Fire fighters are exposed in their work to extremely high
concentrations of a large number of toxic and carcinogenic chemical
compounds.
Some of these chemicals--for example, carbon monoxide and soot
containing polycyclic aromatic hydrocarbons--are natural products of
combustion and have always been present at fires. However, the
combustion of modern synthetic and plastic materials produces many
highly toxic and carcinogenic compounds that were not found in fires
even three or four decades ago. Exposures today commonly include
benzene, formaldehyde, polycyclic aromatic hydrocarbons (PAH), asbestos
and the complex mix of carcinogenic products that arise from combustion
of synthetic and plastic materials.
These chemical compounds are commonplace ingredients in our
environment as components of household furniture, plastic pipes, wall
coverings, automobiles, buses, airplanes, and coverings for electrical
and other insulation materials.
While the initial health effects of such exposures can be short-
term or even nonexistent, these exposures can and do result in long-
term illnesses involving the cardiovascular system, the respiratory
system, the central nervous system and other body organs.
Practically every emergency situation encountered by a fire fighter
has the potential for exposure to carcinogenic agents. However, fire
fighters can also be exposed to carcinogenic agents when the protective
clothing they wear is exposed to high heat or burns. Fire fighters have
even been exposed to carcinogens through the fire-extinguishing agents
they utilize. The list of potential carcinogenic agents that fire
fighters can be exposed to is almost as long as the list of all known
or suspected carcinogens. Nevertheless, fire fighters constantly enter
potential toxic atmospheres without adequate protection or knowledge of
the environment.
Research has clearly shown the following specific linkages
established between cancer and chemicals encountered in fire fighting:
Leukemia is caused by benzene and 1,3-butadiene.
Lymphoma and multiple myeloma are caused by benzene and
1,3-butadiene.
Skin cancer is caused by soot containing PAH.
Genitourinary tract cancer is caused by gasoline and PAH.
Gastrointestinal cancer is caused by PCBs and dioxins.
Angiosarcoma of the liver and brain cancer are caused by
vinyl chloride.
Leukemia, lymphoma, multiple myeloma, cancer of genitourinary
tract, prostate cancer, gastrointestinal cancer, brain cancer and
malignant melanoma are among the cancers that have been observed
consistently with increased frequency in epidemiologic studies of fire
fighters. It is likely that additional associations will be identified
between chemicals encountered in the fire environment and cancer in
fire fighters. Nevertheless, the available data are sufficient to
conclude that excess risk of cancer is a distinct hazard of fire
fighting.
Lung Disease
In the course of their work, fire fighters are exposed to numerous
substances that irritate the respiratory tract-ammonia, chlorine,
formaldehyde, hydrogen sulfide and hydrogen chloride to name just a
few. Toxic substances can cause acute (immediate) effects, chronic
effects noted months or years afterwards, or both. The acute effects of
inhaling smoke are familiar to every fire fighter. Some of these agents
may not cause immediate irritation, but instead, cause damage that
doesn't become apparent until years later when it may be difficult to
prove cause and effect.
Infectious Diseases
Infectious diseases have become a hazard to fire fighters too big
to ignore. Fire fighters and emergency medical responders can be
exposed during motor vehicle accidents in which blood and sharp
surfaces often are present, by rescuing burn victims, and through the
administration of emergency care. The victim may require extrication
from a difficult-to-access accident scene, such as a motor vehicle
accident or poorly accessible building. There may be broken glass or
other sharp objects at the scene that are poorly visualized, and the
lighting at the scene may be minimal. In addition, if the victim is
exsanguinating and needs to be extricated quickly to save his life, the
emergency provider may act in haste, with disregard for his or her own
safety. Fire fighters are also involved in emergency medical treatment
at the scene, including intravenous line insertion and blood drawing.
The fire fighter almost never knows the infectious disease status of
the victim while he or she is rendering emergency services. All of
these factors combine to place the fire fighter at increased risk of
contracting a blood borne contagious disease through a puncture wound,
skin abrasion or laceration that becomes contaminated with infected
blood from the victim.
Every fire fighter's education now includes use of Universal
Precautions, such as the wearing of protective gloves, safety glasses,
and masks. But in the chaotic environment of an emergency scene, these
precautions can and do fail. Exposures happen. A government study
conducted during the development of the federal OSHA Blood borne
Pathogen Standard found that 98 % of EMT's and 80% of fire fighters are
exposed to blood borne diseases on the job.
Next Steps
Mr. Chairman, as I have previously stated, nearly 40 states have
some form of a presumptive disability law on the books. There is no
such law for federal fire fighters.
In order to qualify for a disability retirement, a fire fighter who
suffers from an occupational illness must specify the precise exposure
that caused their illness. As my testimony indicates those are nearly
insurmountable odds.
H.R. 697, The Federal Fire Fighters Fairness Act would create a
rebuttable presumption that fire fighters who become disabled by heart
and lung disease, certain cancers and infectious diseases contracted
the illnesses on the job. H.R. 697 would shift the burden of proof to
the employer to prove that the illness was caused by some factor other
than the duties of the fire fighter.
This does not mean that every fire fighter who contracts a disease
named in the legislation automatically would qualify for benefits under
FECA. For example, lung cancer is unlikely to be determined to be
occupational if it is contracted by a fire fighter who was also a long-
term smoker. But the burden of proof would no longer be placed on the
fire fighter to prove the cause of the disease.
Precedent
Although FECA currently does not provide presumptive disability
benefits, Congress has enacted such presumptions in other benefit
programs. Peace Corps volunteers, military veterans, and public safety
officers who die in the line of duty are all covered by presumptive
laws.
Service-connected disability is provided to Vietnam veterans whose
cancers are presumed to be caused by herbicide exposure. Like fire
fighters, Vietnam Veterans found it extremely difficult to pinpoint
precise exposures, and as a result, thousand of veterans were denied a
benefit to which they were entitled. After years of lobbying by veteran
groups, Congress responded by enacting a law that established a
presumption of service-connection for certain diseases.
More recently, the Congress passed and President Bush signed into
law the Hometown Heroes Act (PL 108-182). Under the new law, Public
Safety Officer Benefit (PSOB) will be paid to the families of fire
fighters and police officers who die as a result of heart attack or
stroke suffered within twenty-four hours of responding to an emergency
call or participating in a training exercise involving ``unusual
physical exertion.'' It is now presumed that the death was ``a direct
and proximate result'' of the emergency response.
Cost
While we believe that the merits of the Federal Fire Fighters
Fairness Act warrant congressional action, we are mindful that in this
tight budget environment we must be sensitive to the cost of even the
most compelling initiatives. Although no formal cost estimate has been
done by the Congressional Budget Office, we believe the cost of
implementing H.R. 697 will be minimal.
The number of federal fire fighters is relatively small compared
with other occupations in the federal sector, and the vast majority do
not retire due to an illness. Based on the experience of states with
similar presumptive disability laws, as few as 15-20 people are likely
to qualify for the benefit each year.
Moreover, because fire fighters are generally on the lower end of
the GS pay scale, benefits based on their salary would not have a
significant impact on FECA's balance sheet.
In short, an important protection can be provided to the nation's
federal fire fighters at little expense to the federal treasury.
In conclusion, Mr. Chairman, I would like to thank you and the
Committee for holding this hearing today. I look forward to working
with the committee to see this legislation move forward.
______
Mr. Norwood. Thank you very much, Mr. Johnson, and now, Mr.
Shufro, you are recognized for 5 minutes.
STATEMENT OF JOEL A. SHUFRO, EXECUTIVE DIRECTOR, NEW YORK
COMMITTEE FOR OCCUPATIONAL SAFETY AND HEALTH (NYCOSH), NEW
YORK, NY
Mr. Shufro. Thank you very much. I appreciate the
opportunity to testify.
The New York Committee for Occupational Safety and Health
is a nonprofit educational organization composed of 200 local
unions and 300 individual members dedicated to promoting every
worker's right to a safe and healthful work place.
I am here to support H.R. 697, which creates the legal
presumption that certain diseases are considered work-related
when they cause the disability or death of Federal fire
protection employees.
Many states, including New York, have created such
presumptions as a reasonable and rational method of providing
those workers who are routinely exposed to hazardous substances
and conditions at work and who are disabled as a result with
medical and financial benefits.
This year, the New York State legislature, in its current
session, passed legislation establishing presumptions that
disability is work-related among certain public employees who
were exposed to hazardous conditions in connection with the
World Trade Center tragedy of September 11, 2001. The bill,
which provides disability retirement, is currently sitting on
Governor Pataki's desk, and we are hoping that he will sign the
bill this year. The need, however, goes far beyond public
sector workers and disability retirements.
It is estimated that 30 to 35 thousand workers worked
directly on the pile at Ground Zero. Countless others worked to
clean up the buildings of lower Manhattan and Brooklyn.
Six thousand of the 12,000 workers who have been seen at
the World Trade Center worker and volunteer medical screening
program at Mt. Sinai Medical Center have respiratory symptoms
that require medical treatment.
For some, symptoms have abated. Others have symptoms that
have reemerged after abating, and still others have symptoms
that are appearing only now, nearly 4 years after exposure.
Similar numbers of workers have been diagnosed with mental
problems requiring psychological counseling, and of course, it
is too early to know how many workers will develop diseases
such as cancers with latency periods as long as 40 years.
To receive medical treatment, workers and volunteers must
apply for workers compensation.
In the aftermath of 9/11, Congress allocated $175 million
over 4 years to assist New York State's workers compensation
board.
In his latest budget proposal, the President eliminates
$125 million which has not yet been spent. If the funding is
not restored, there will be no source of funds to pay future
claims of volunteers and uninsured workers who have been made
ill as a result of their exposure at Ground Zero, as well as
the ongoing claims of those workers who have already been able
to establish them.
This is extremely unfortunate.
While we do not know how many workers are eligible for
benefits, we do know that there are many impediments for
workers to file and that large numbers of individuals who
should receive medical attention and possibly wage replacement
are not receiving them.
For example, many immigrant workers and volunteers who
participated in the rescue efforts and cleanup of office
buildings in lower Manhattan were never informed of their right
to access the New York State workers compensation program.
My organization, through funding from the Red Cross and the
United Church of Christ World Services, has been reaching out
to the immigrant organizations and has begun to identify large
numbers of workers who are sick and have not received any
benefits.
In addition, we have a case known as medical-only cases,
claims where workers need medical treatment but have not lost
time at work, and they cannot get legal representation. Lawyers
do not get paid in this process, and so, our system, which is
very arcane and complicated, especially for immigrant workers,
to navigate without a lawyer--many of the workers just drop
out.
Many workers' compensation claims have been contested and
remain unresolved.
Many workers who participated in the rescue and clean-up at
the World Trade Center site, who have experienced the onset of
respiratory illness and other diseases, have not been able to
establish claims, thereby preventing them from receiving timely
medical treatment and medication, as well as receiving wage
replacement benefits. This has meant real hardship for the many
who heroically attempted to rescue those who were buried in the
rubble of the collapse or who worked in the vicinity of Ground
Zero.
There are many reasons workers have not received benefits.
In part, the difficulty has arisen because there are no
presumptions in the law.
In the remaining time, I would just like to say that we
urge that the Congress restore the funding for workers'
compensation payments to workers who were made ill in New York
City.
[The prepared statement of Mr. Shufro follows:]
Statement of Joel A. Shufro, Executive Director, New York Committee for
Occupational Safety and Health, New York, NY
My name is Joel Shufro. I am the executive director of the New York
Committee for Occupational Safety and Health, a non-profit educational
organization. We are a coalition of 200 local unions and 300 individual
members dedicated to promoting every worker's right to a safe and
healthful workplace. We have a twenty-six year history of providing
safety and health training and technical assistance to working people,
community organizations and employers in the New York Metropolitan
area.
I am here to support H.R. 697, which creates the legal presumption
that certain diseases are considered work-related when they cause the
disability or death of federal fire protection employees. Many states,
including New York, have created such presumptions to as a reasonable
and rational method of provide those engaged in hazardous activities
with medical and financial benefits to workers who are routinely
exposed to hazardous substances and conditions at work and who are
disabled as a result.
This year the New York state legislature, in its current session
passed legislation establishing the presumption that disability is
work-related among certain public employees who were exposed to
hazardous materials presumptive accidental disability in connection
with the World Trade Center tragedy of September 11, 2001. The
legislature passed the same bill last year and the year before that,
but the first two times it was vetoed by Governor Pataki. In so doing,
the legislature recognized that public employees including police,
fire, correction and sanitation rendered rescue, recovery and clean up
at and around the World Trade Center site and were exposed to numerous
hazards which may have, and may, impact their health in years to come.
The bill is currently sitting on Governor Pataki's desk. We are
hoping that he will not veto the bill for the third time.
The need, however, goes far beyond public sector workers and
disability retirements. It is estimated that 30-45,000 workers worked
directly on the pile at Ground Zero; countless others worked to clean
up the buildings of Lower Manhattan. Still others returned to work and
live in buildings which were either not or inadequately cleaned up and
still contaminated after the EPA and OSHA assured the public that the
air was safe. The consequence has been that workers and community
residents are sick--and in large numbers.
Six thousand of the 12,000 workers who have been seen at the World
Trade Center Worker and Volunteer Medical Screening Program at Mt.
Sinai Medical Center have respiratory symptoms that require medical
treatment. For some, symptoms have abated; others have symptoms that
re-emerge after abating and still others have symptoms that are
appearing only now, nearly four years after exposure. Similar numbers
of workers have been diagnosed with mental problems requiring
psychological counseling. Many of the workers will never be able to
work again; others will not be able to pursue their chosen careers.
And, it is, of course, too early to know whether and how many workers
will develop diseases such as cancers with latency periods as long as
40 years.
To receive medical treatment workers and volunteers must apply for
workers' compensation. In the aftermath of 9/11, Congress allocated a
total of $175 million over four years to the New York State Workers'
Compensation Board. Of the money allocated, $125 million was earmarked
for the processing of claims; $50 million to reimburse the state
Uninsured Employers Fund for benefits paid to volunteers and to
employees of companies that did not have workers' compensation
insurance.
According to a recent GAO report (GAO-04-1013T) entitled
``September 11, Federal Assistance for New York Workers' Compensation
Costs,'' the New York State Workers' Compensation Board has spent $50
million of the $175 million that has been provided by the federal
government. In his latest budge proposal, the President calls for
taking back the remaining $125 million. If the president's proposal is
agreed to there will be no source of funds to pay future claims of
volunteers and uninsured workers who have been made ill as a result of
exposure to toxic substances during the September 11th cleanup.
This is extremely unfortunate. While we do not know how many
workers are eligible for benefits, we do know that there are many
impediments for workers to file and that large numbers of individuals
who should receive medical attention and possibly wage replacement are
not receiving them.
For example, many immigrant workers and volunteers who participated
in the rescue efforts and cleanup of office buildings in Lower
Manhattan were never informed of their right to access the New York
State Workers' Compensation System. NYCOSH has recently received grants
from the Red Cross and the United Church of Christ World Services to
inform organizations that are active in the immigrant community about
the eligibility of workers who have developed occupational disease
related to work at the World Trade Center.
In addition, many workers have what are known as ``medical-only
cases''--claims where the worker needs medical treatment but has not
lost time at work. In these cases, lawyers in New York State most
lawyers are unwilling to take medical-only cases, because there is no
mechanism to pay lawyers for work on such cases. The Workers'
Compensation System in New York State is too complicated and arcane for
any worker, but especially an immigrant worker, to navigate workers'
compensation system without a lawyer. As a result, far too many workers
who would be entitled to medical treatment do not pursue their cases.
Many workers' compensation claims have been contested and remain
unresolved. Despite a request from the then chair of the New York State
Workers' Compensation Board, Robert Snashall, that claims for workers'
compensation arising out of the World Trade Center tragedy be
expedited, many workers who participated in the rescue and cleanup at
the World Trade Center site and have experienced the onset of
respiratory illness and other diseases have been unable to establish
claims thereby preventing them from receiving timely medical treatment
and medication as well as receiving wage replacement benefits. This has
meant real hardship for many who heroically attempted to rescue those
who were buried in the rubble of the collapse or who worked in the
vicinity of Ground Zero cleaning up the toxic dust which covered Lower
Manhattan.
There are many reasons workers have not received benefits. In part,
the difficulty has arisen because there are no presumptions in our
workers' compensation law that associate the adverse health effects
that workers at the Trade Center experienced with their exposure to the
toxic substances. Given the witches brew of toxic substances and
chemicals to which workers were exposed, it is virtually impossible for
a worker to prove the onset of symptoms was caused by any given
chemical or combination of chemicals. However, there is evidence that
insurance companies are contesting claims of 9/11 victims, according to
some sources, at a rate ten times greater than that of the normal
population of injured workers. This has led programs that have provided
needed medicines to injured workers while their cases are being
adjudicated, to stop providing assistance until workers claims have
been established, leaving workers without access to prescribed
medications while they await a determination.
Consequently, we are here to urge Congress should restore funding
to cover the future workers' compensation costs associated with
illnesses arising out of the rescue, cleanup of Ground Zero and return
to workers to workplaces throughout Lower Manhattan. This is
particularly important since we have do not know whether additional
workers will develop illnesses in years to come nor do we know how long
the symptoms workers are currently experiencing will persist. The
funding should be used to:
1) create a medical trust fund so workers can get needed medical
treatment while they are waiting for their claims to be established;
2) finance a outreach campaign to special populations such as
immigrant workers and volunteers to inform them of their rights to
benefits under New York State's Workers' Compensation Law.
3) fund Medical Centers of Excellence which would develop
expertise in dealing with the complex, multiple medical issues which
workers who worked at the World Trade Center site are experiencing.
As our state legislature noted in passing its bill for disability
retirements for public-sector workers who participated in the rescue
and clean up at the World Trade Center, ``It is beyond question that
the State must recognize the services that these individuals provided
not only to the victims and their families, but to all citizens of the
City and the State of New York and the United States of America.'' We
believe that all workers who participated in the rescue and clean up or
have become ill as a result of exposure to the toxic substances from
the collapse of the World Trade Center should receive appropriate
benefits and that the funding should be restored to the President's
budget.
______
Mr. Norwood. Thank you, Mr. Shufro.
I recognize Mr. Kline for 5 minutes.
Mr. Kline. Thank you, Mr. Chairman.
Thank you, gentlemen, for being here today.
I want to try to get a better handle in my own mind on the
scope of the problem in terms of numbers, and I know, Mr.
Johnson, you mentioned the number of Federal firefighters.
Could you give that to us again and tell us what percentage of
that that your union represents?
Mr. Johnson. Overall, there are approximately--depending on
at which time you actually work, because of the hiring
processes, between--approximately 15,000 Federal firefighters.
That includes overseas sites, Guam, Puerto Rico, and
throughout the continental United States.
A portion of those Federal firefighters are also--are
military, however.
My understanding is there's about 4,000 military
firefighters between the different agencies, and then the
remainder are civilians.
Mr. Kline. How many of those are in the union?
Mr. Johnson. The IFF represents approximately 4,000 Federal
firefighters.
There are several other unions that represent a number of
firefighters, also.
Mr. Kline. OK. Thank you very much.
Continuing on the--getting a handle on the scope of the
problem, the--looking at my notes here, the FECA is set up as a
non-adversarial program, and according to my notes here, the
Department of Labor has told us that approximately 65 percent
of all claims for occupational diseases are ultimately
approved.
Is the issue with firefighters out of proportion with that,
or is there a higher number approved or disapproved? Do you
know?
Mr. Johnson. We feel that there are a higher number
disapproved.
As an example, I will use hepatitis exposures, which Jo Ann
Davis mentioned.
The problem that we're seeing specifically with those type
of exposures, infectious diseases, is the employees are being
told that unless they can specifically point out the patient
that they acquired the disease from, they are not going to be
covered, their claims are denied, and basically--it comes down
to basically a blood test issue, and OWCP is looking for
something that they can actually sink their teeth into and say,
OK, you acquired this infectious disease from this person, and
it's nearly impossible for a firefighter to be able to pin that
down, because a firefighter may go on 25 or 30 calls a month,
medical calls, and--and obviously we do not know who is
carrying those diseases when they respond.
Mr. Kline. OK.
One final question, then I will yield back, but along the
same lines as trying to get a feel for the difference between
the firefighters population and the general population,
obviously in the general population, people die from cancer and
heart disease and so forth. On an age-equal basis, could you
give me a sense of the percentage or number of deaths from
heart disease, for example, for firefighters versus the general
population, say, for 45-year-olds?
Mr. Johnson. I believe we have that data in the full
testimony that we submitted, and I cannot recall it off the top
of my head, but it is in the report that we submitted. Overall,
from my experience working in the Federal sector for 27 years,
there is, I believe, a higher rate of heart attack and strokes
specifically with Federal firefighters because of the exposures
and the stress in the job. There are also--I've been actually
witness to several instances with employees I have worked with
where they have tried to file claims through OWCP related to
these incidences, and they have been denied.
Mr. Kline. I see, and those numbers are in the testimony?
Mr. Johnson. Yes.
Mr. Kline. OK.
Thank you very much.
Mr. Chairman, I yield back.
Mr. Norwood. The gentleman yields back.
Mr. Bishop, you are recognized for questioning for 5
minutes.
Mr. Bishop. Thank you, Mr. Chairman, and thank you for
holding this hearing.
I have a written statement, and I would ask unanimous
consent that it be inserted into the record.
Thank you, Mr. Chairman.
First, let me start by commending Representatives Davis and
Capps for filing this legislation.
I think it is very good and very important legislation. I
am proud to be a cosponsor of it, and I hope that we can see
that this legislation becomes law.
Mr. Johnson, several states already have the presumption of
disability, and my question is, what experiences can you cite
for us that would help inform the Federal Government with
respect to how that presumption has worked? For example, how
often is the presumption challenged? How often is that
challenge successful?
Mr. Johnson. From the data that we reviewed involving the
separate states that have presumptive-type disability for
firefighters, we actually find that there are relatively few
firefighters that actually apply for disability under the
presumption.
So, I do not think the numbers are really that great for us
to actually look at.
Most of the instances that we see are related to heart
attack and stroke issues, and I think a lot of that was
channeled into the Public Safety Officers Death Benefit, which
was a lot of the impetus behind that.
Mr. Bishop. If we are successful in passing this law, do
you have any sense of what its impact would be on the ability
to both recruit or retain Federal firefighters? Is this
something that would be attractive?
Mr. Johnson. It would definitely be a benefit. As we see
right now, we have a lot of problems in the Federal sector as
far as Federal firefighters currently, as far as recruiting new
hires and retaining those individuals throughout their career.
Obviously, when the cities are offering better pay and better
benefits, better compensation, and better health care and this
presumptive disability that most of them offer, it becomes a
challenge for the Federal sector to recruit and retain
employees through an entire career. We do experience, as I have
seen, employees coming into the system, gaining experience, and
then seeing an opportunity to move to the municipal sector, and
they definitely will take that road if they get the
opportunity. So, improving the benefits within the Federal
sector, I think, would be a great help.
Mr. Bishop. One more question for Mr. Shufro. You cited
that at least $125 million that is proposed to be cut from
workers' compensation claims. Can you walk us through the human
implications of that if we are unsuccessful in having that
money restored? How many people are we talking about? What
types of disabilities would go uncompensated?
Mr. Shufro. Well, workers who worked on the pile are
suffering from respiratory problems, many of whom are no longer
able to work at all, many of whom go in and out of experiencing
symptoms.
We have large numbers of workers who worked on the pile who
currently are not able to work.
To eliminate this funding will mean that workers who are
currently collecting will not be able to collect, and in New
York, the maximum benefit level is the lowest of any state in
the country, $400 a week, and--but more importantly--and I
guess as importantly, I would say--workers who will become
ill--there will be no funding for them, and especially for
those people who are--were volunteered to work on the pile, for
whom our workers compensation system has no provision. So, this
will mean very real hardship for workers.
It is hardship enough to live on $400 a week, let alone if
there is no funding at all.
Mr. Bishop. Thank you very much.
Thank you, Mr. Chairman. I yield back.
Mr. Norwood. Thank you very much. The gentleman yields
back.
Dr. Price of Georgia, you are recognized for 5 minutes for
questioning.
Dr. Price. Thank you, Mr. Chairman.
I, too, want to thank you all for coming and giving your
testimony today, and just simply want to echo what others have
said, and that is that we certainly, all of us, appreciate the
work that firefighters do, our Federal firefighters, and want
to recognize that and recognize that they are true heroes on
the front lines.
As a physician, I know that firefighters are oftentimes the
first folks there on medical tragedies and crises when, in
fact, there is no fire around. They get involved in many
medical emergencies.
So, I appreciate the work that they do.
I would like to ask a couple specific questions. I am
interested in the list in the bill of diseases, and understand
through your statement, Mr. Johnson, about some of the
correlation of exposure to certain chemicals and the like.
How did you all come up with this list?
Mr. Johnson. The data that is included in the report is
obviously the result of years and years of research and
statistical studies that the IFF and medical professionals have
developed over a period of time. The IFF itself conducts annual
surveys regarding deaths and injury for firefighters, and we
tried to delve in detail into what the causes of injuries in
firefighters are, and based on that data, we maintain a
reporting system that we can extract that data from and come up
with the diseases and specific illnesses that are affecting
firefighters.
Dr. Price. That gets to, I think, the crux of the issue
that I think Mr. Kline tried to touch on, and that is whether
the actuarial data will give any difference--show any
difference between firefighters and the general public, and you
mentioned that the numbers were in your testimony, and I may
have missed it, but I did not see it.
Mr. Johnson. I will check to see. If it is not, then we
will make sure that that is provided to you.
Dr. Price. I think that would be of great help to all
Members of the Committee to see that.
I also wanted to just point out one item in your--and ask
you to comment on it, one item in your--in your written
testimony, Mr. Johnson. That is in the area of cancer, and it
lists the exposure and the--and how certain leukemias and
lymphomas and skin cancers can be a result of certain exposure,
but the final line in this paragraph here is that,
``Nevertheless, the available data are sufficient to conclude
that the excess risk of cancer is a distinct hazard of
firefighting,'' and that is the kind of data that I think we
are interested in, and I do not see that here.
Finally, I would like to have each of you comment on the
cost.
Your summary says that this would probably affect 15 to 20
people a year.
So, I am curious about that, given the scope of what you
all seem to say today is much larger than that, but your
written testimony is 15 to 20 a year.
So, would you comment on the cost--I know CBO has not
scored it, but what you all believe is the cost?
Mr. Johnson. Just briefly to try to summarize that, I think
what we were looking at is what we actually see from the states
currently that have this type of presumption, and we tried to
look at how many claims are actually filed and go through the
system successfully, because it is still important to remember
that, even in the states that have a presumptive disability,
there is still the ability on the states' part, or the
employer, to controvert that claim. So, it is not a given that
just because the presumption is there initially that the
employee is going to receive the benefit permanently.
So, we looked at those numbers, and based off those numbers
from the states, we tried to equate what we thought is a best
estimate.
Dr. Price. Have you got a guess?
Mr. Johnson. Pardon me?
Dr. Price. Do you have a guess?
Mr. Johnson. Within the Federal sector?
Dr. Price. Yes.
Mr. Johnson. My best guess would probably be 30 to 40
employees a year.
We really do not see that many----
Dr. Price. In a line item per----
Mr. Johnson. Well, it is also important to remember that
this is broken down into different categories.
Some employees may acquire a disease that only requires two
or 3 months of treatment and they are back on the job, and that
is what we see the majority of the time, are limited illnesses
to where the employee is off for a short duration.
Occasionally there will be--obviously there is occasions
when an employee's illness requires a disability retirement.
Dr. Price. If I may, Mr. Chair, do Federal firefighters
have access to any other disability that they can purchase on
their own for those kinds of instances?
Mr. Johnson. There are private avenues that--obviously,
they could pursue private disability-type insurance or
something of that nature.
The only other compensation that they can receive is
directly through OWCP.
Dr. Price. Thank you, Mr. Chairman.
Mr. Norwood. Thank you very much. The gentleman's time is
expired.
Ms. Woolsey, you are now recognized for 5 minutes for
questioning.
Ms. Woolsey. Thank you, Mr. Chairman, and this is a great
bipartisan bill. It is good to be working on something like
this.
I was a city council member in Petaluma, California, for 8
years, and the mayor used to say, oh, do not even ask Woolsey
about her vote on the--for our local firemen, because she is
always going to say yes, because you are absolutely my heroes,
and he is right, I always did say yes, and the same thing goes
here.
So, I do not understand why we have left the firefighters
out of this disability coverage, and if you have some--you
know, if you want to tell us why you think that happened, that
is fine, that and I would like you both to look at both of
these ideas.
You know, your list of dangerous chemicals and all that,
which is important to have, but we are finding that our world
changes so quickly, and we manufacture new products, and we do
not even have any idea what is in the product, like in our
carpeting, where you go--you know, when it starts burning, and
then our furniture, and you are in there saving people, and the
furniture is setting off gases and things. Whoever knew that
that is what we would be up against?
I hope, in your lists, that it is not all inclusive. You
have got to leave room for what is coming up next, because you
know, we sometimes react backwards and get rid of things that
are toxic, but we are always adding more. So, please--OK.
Mr. Johnson. I think that is also important to remember.
The list is as concise as it can be at this point in time,
because it basically covers those incidences or those diseases
that we see affecting firefighters the majority of the time.
There are always unknowns out there that we do not know
about, and they will continue, and the firefighters respond to
incidences, especially on Federal installations, and I think
that is important to point out, because you clued in on some of
the hazards that are out there that we know about. The Federal
firefighters on some of these Federal installations get
involved in things that they have no idea what it is, and in
some cases, they will not be told what it is, because it is
classified, and I have personally been in incidences that
involve classified issues and materials, and it is really an
unknown, and it is an unknown that you will never get any
information on, and that is, you know, important to note.
Ms. Woolsey. Joel, do you want to respond?
Mr. Shufro. No.
Ms. Woolsey. OK.
You know, in private--as long as I have a couple of seconds
left, in private industry--I was a human resources
professional, and we have our protocols in manufacturing. We
knew what--our local firefighters knew if they came into our
plant--it was an electronics company--and there was a fire,
which we never had one, but if there was, they would know what
they were looking for. You do not have that, do you, in Federal
buildings.
Mr. Johnson. Most of the Federal installations have
inspection procedures and parameters, and inspections are
conducted.
So, in most of your administrative-type buildings, the
firefighters are well aware of what are in those buildings, the
office-type buildings and things of that nature. When you get
into the facilities that are involved in research and depot
work and things of that nature, there are a lot of instances
where we are prohibited from actually even touring the building
or having any idea whatsoever what is in there.
So, when you show up, if there is an incident on the scene,
you really are at peril, because you have no idea whatsoever
what you're getting into or what is in the building or what is
involved.
Ms. Woolsey. Well, we ought not to be treating you as our
stepchildren because you are Federal, and I think this bill is
a step in the right direction, Mr. Chairman.
Mr. Norwood. The gentlelady's time is expired.
Mrs. Drake, you are recognize for 5 minutes for
questioning.
Mrs. Drake. Thank you, Mr. Chairman.
First of all, I would like to thank both of you for being
here.
I think this is an important discussion, and we certainly
are very grateful for the work of our firefighters.
I have many friends who are firefighters, and I did serve
in the Virginia legislature when we passed what we called the
heart-lung bill to deal with what you have just mentioned about
heart and lung diseases, and in Virginia, we have a much more
limited list of cancers that are covered with a presumption. We
cover no infectious diseases, and a big part of my concern is
how we determine where they actually got exposed to that
disease.
I have family members who have died of meningitis. I have
family members who have had hepatitis that had nothing to do
with any occupation at all. What I wonder is, when you treat
someone who might have a disease--hepatitis, HIV, any of the
diseases--is there any reporting system back to you that you
would know you had had that exposure, or is that allowed to
take place?
Mr. Johnson. Well, the first step is that you would have to
be aware that the patient you were treating was infected.
In some instances, the patient may state to the responder
that they are carrying an illness or a disease such as
hepatitis or something of that nature. In most cases, they do
not state that, or they may not even be aware themselves.
Mrs. Drake. I mean from the medical facility that you are
transporting them to, is there a reporting back to you that
there may have been an exposure?
Mr. Johnson. Normally not. Because of patient privacy
issues, normally the firefighters themselves will not get any
type of notification back from a medical facility that a
patient was or was not carrying an infectious disease.
Mrs. Drake. I mean I think you can understand the concern
that we may giving someone a presumption that, by their own
particular lifestyle, has caused themselves to be exposed to
certain diseases, and maybe that is an avenue we need to look
at for these infectious diseases, is some sort of reporting
requirement.
Mr. Johnson. I would say that is a possibility. I think
from my position, I think because of the nature of the job and
the work that the firefighters are doing, that at the very
least they deserve the benefit of the doubt.
Mrs. Drake. OK. I would like to thank you. I know we have
to go vote.
Thank you, Mr. Chairman. I yield back my time.
Mr. Norwood. Thank you. The gentlelady yields back.
Mr. Owens, you are now recognized.
Mr. Owens. That last questions--have any patterns been
established showing that firefighters do come down with an
appreciable number of infectious diseases, any kind of research
done to document that, more so than other occupations, you have
a pattern where large numbers of firefighters have some of
these infectious diseases?
Mr. Johnson. Yes, we do.
Mr. Owens. Documented?
Mr. Johnson. Yes.
Mr. Owens. Mr. Shufro, thank you again for being here,
Joel. The Mount Sinai Medical Center study was financed by the
Federal Government, right?
Mr. Shufro. Yes, that is correct. It financed screening but
not medical treatment. All the workers who are going through
the program were screened, but they rely on workers'
compensation for treatment. There is no treatment funded by the
Federal Government.
Mr. Owens. You say 6,000 of 12,000 who were screened were
found to have problems related to 9/11.
Mr. Shufro. That is correct.
Mr. Owens. That is 50 percent, a pretty high rate.
Mr. Shufro. It is a very high rate.
Mr. Owens. Then the old moribund inefficient workers'
compensation board was given the money, Federal money, also,
right, to deal with the problems of individual workers,
correct?
Mr. Shufro. The workers' compensation board is giving Mount
Sinai money?
Mr. Owens. No.
Mr. Shufro. I am sorry.
Mr. Owens. The Federal Government gave $175 million, and
part of that went to the New York State workers' compensation
board.
Mr. Shufro. Yes, that is correct. The Federal Government--
--
Mr. Owens. That is the money that the President, the
administration is seeking to take back, is money that that
workers' compensation board did not spend, correct?
Mr. Shufro. That is correct.
Mr. Owens. So, we are penalizing future workers because of
the lack of efficiency of that board. I mean they have a
reputation for being slow, and they have a mind-set of sort of
suspecting workers and safeguarding employers, and all that
went into play, I am sure, and so, you have unspent $120
million.
Mr. Shufro. Unspent $120 million. Some of it I would not
lay totally at the foot of the board. I think that the board
worked to try and deal with many cases that came in front of
it.
The Chairman of the workers' compensation board at that
time, Robert Snashall, put out a statement urging that the
insurance carriers expedite all the cases, but really, what has
happened has been that the carriers have treated this as
business as usual and contested an extremely high rate of--high
number of the cases.
In fact, one of the companies, called IWP, has been
providing free medicine to workers while their cases have been
adjudicated in front of the board, because workers were not
entitled to medication until their cases were established.
That company has just written a letter deciding not to
provide anymore medicine, because the--it has not been--they
have found that the cases that are being contested are
contested at a rate 10 times higher than the normal rate of
contest for other workers.
So, it may not be the board's fault here but the insurance
companies' fault.
Mr. Owens. Are we getting any help from OSHA and EPA in
terms of scientific technical assistance? That 9/11 situation
produced something that never existed before, ashes which
consist of glass, lead, metal. All kinds of things were in that
toxic brew that the workers were breathing. Are we getting any
kind of help to pinpoint the fact that, you know, this is an
ongoing mystery, they are still trying to sort it out, and not
enough time has passed for us to be dismissing workers as
having no relationship between what happened.
Mr. Shufro. The EPA is yet to finalize a sampling program
for--to determine the extent and scope of contamination of
lower Manhattan. That battle is still going on, and they put
forth one plan which was found totally inadequate, and now they
have proposed a second, which members of the community and many
of the unions representing workers in lower Manhattan have
criticized, also.
So, we are still not at a point where the dust--the toxic
nature of that dust has been characterized, and so, we do not
know the exposures of all that people were subjected to.
Mr. Owens. Thank you.
Mr. Norwood. Well, I think everybody has asked questions
but the Chairman.
I would like to ask a few and then put a number of them in
writing.
Mr. Johnson, you mentioned that 40 states, which I find
very interesting, have enacted presumptive disability laws.
Can you provide the Subcommittee with a list of those
states?
Mr. Johnson. Absolutely, yes.
[The information referred to appears on page 35 of this
document.]
Mr. Norwood. Can you clarify for me whether these
presumptive disability laws have been added to the various
state workers' compensation systems, or are these presumptive
disability laws that is part of a separate disability and
retirement program for firefighters, or are there states out
there, for example, that have multi-purpose broad disability
retirement programs that are specific to firefighters?
Mr. Johnson. My understanding is that it varies, that some
states have included the presumptive issue for firefighters
into their current programs and that there are also states that
have created a separate program just for public safety or
firefighters.
So, there is both.
Mr. Norwood. So, like in so many other things, states do
things separately.
I guess that would--the presumptive disability provisions
would vary, you know, the types of illnesses or disease.
I guess that would vary state by state, too?
Mr. Johnson. It is my understanding, yes, it does.
Mr. Norwood. Well, one more little question about that.
These disability--presumptive disability laws have been
added to various state workers' compensation systems, or are
these presumptive disability laws part of a separate
disability?
You are telling me that all the states do this differently
in so many different ways.
Mr. Johnson. There are differences out there, yes. I think
the norm is for them to be included in the current programs,
but there--there are also states that have created a separate
program just for firefighters that covers just workman's comp
for firefighter issues.
Mr. Norwood. I presume that information or, certainly, we
could get that information.
Mr. Johnson. We can get that information, yes, sir.
Mr. Norwood. Yes. We would love to take a really good look
at that.
I thank both of you for your time and your valuable
testimony, and we will dismiss you as a panel, and I will ask
that the second panel of witnesses come forward and take your
seats at the table.
Mr. Johnson. Thank you.
Mr. Norwood. Thank you very much.
The second panel will address H.R. 2561, the Improving
Access to Workers' Compensation for Injured Federal Workers
Act.
Our first witness today will be Professor William Kohlhepp,
associate director of the physician assistant program at
Quinnipiac University in Hamden, Connecticut. Professor
Kohlhepp is testifying on behalf of the American Academy of
Physician Assistants.
Our final witness today is Dr. Jan Towers. Dr. Towers is
the director of health policy at the American Academy of Nurse
Practitioners, located right here in Washington, D.C.
I would like for you both to know we truly appreciate you
taking the time and coming to help teach us something.
With that, Mr. Kohlhepp, I will recognize you for 5
minutes.
STATEMENT OF WILLIAM C. KOHLHEPP, MHA, PA-C, ASSISTANT
PROFESSOR AND ASSOCIATE DIRECTOR, PHYSICIAN ASSISTANT PROGRAM,
QUINNIPIAC UNIVERSITY, HAMDEN, CT
Mr. Kohlhepp. Good morning. Thank you, Chairman Norwood,
for the opportunity to present testimony this morning on behalf
of the American Academy of Physician Assistants.
I am here to discuss the need to update the Federal
Employees' Compensation Act to allow PAs to diagnose and treat
Federal workers who are injured on the job.
I request that my written statement be included in the
hearing record.
Mr. Norwood. So ordered.
Mr. Kohlhepp. My name is Bill Kohlhepp, as you said, and I
have been a physician assistant for 25 years. As you said, I am
the associate director of the Quinnipiac University physician
assistant program.
For the past 15 years, I have continued my clinical
practice at Saint Raphael's Occupational Health Plus in New
Haven, Connecticut.
I am a past president of the AAPA and current chair of the
National Commission on Certification of PAs, which is the
certifying body for PAs.
What I would like to do this morning is to provide a brief
overview of PA education, and I would like to share our
perspective on why it is important to update FECA to allow PAs
to diagnose and treat Federal employees who are injured on the
job.
PA programs are located at schools of medicine or health
sciences, universities, teaching hospitals, and the armed
services.
All PA programs are accredited by the Accreditation Review
Commission on Education for the Physician Assistant, an
organization composed of representatives from national
physician groups and PAs.
The average PA program is 26 months and is characterized by
a rigorous competency-based curriculum with both didactic and
clinical components.
The first phase of the program consists of an intensive
classroom and laboratory study providing students with an in-
depth understanding of the medical sciences.
The second year of PA education consists of clinical
rotations.
On average, PAs devote more than 50 to 55 weeks to clinical
education.
The overwhelming majority of PA programs offer master
degrees.
After graduation, PAs must pass a national certifying exam.
PAs maintain their certification through required CME and
re-certification by exam every 6 years.
PAs are licensed health-care professionals who practice
medicine, as delegated by and with the supervision of a
physician.
PAs are legally regulated in all states.
Forty-eight states, the District of Columbia, and Guam
authorize physicians to delegate prescriptive privileges to
PAs.
In 2004, an estimated 206 million patient visits were made
to the 55,000 PAs in clinical practice. Approximately 250
million medications were prescribed or recommended by those
PAs.
PAs always work with physicians. However, this does not
mean that the physician is necessarily onsite, nor does it
suggest that PAs do not make autonomous medical decisions. For
example, PAs employed by the State Department may be--may work
with a physician who is a continent away and available for
consultation by telecommunication.
It has been said that every workers' compensation case is a
failure of prevention, and PAs as a profession have a
particular focus in prevention. PAs' versatility, competencies,
and interpersonal skills are well suited to the demands of
occupational medicine.
PAs participate in the promotion of employee health,
including the treatment of occupational injuries and illnesses,
preventive and pre-placement exams, health maintenance
activities, immunization programs, Department of Transportation
exams, workers' compensation case management follow-up, and
health and safety education.
What does it mean for my practice that I cannot sign FECA
claim forms as a PA? The bottom is that, unless the physician
signs the form, the claim is not paid.
In letters responding to Congressional inquiries on PAs and
FECA, the DOL's Office of Workers' Compensation has taken the
position that claims or reports are not acceptable if they have
been signed by a PA, because PAs are not included in the FECA's
definition of physician.
PAs currently jump through hoops to ensure that physicians
sign the workers' compensation claims in order to make the
system work for the injured employee and the practice.
Waiting for a physician's signature is not the best use of
the physician's time, my time, or the time of the injured
worker, and physicians are not always available, particularly
in rural and urban medically under-served communities where PAs
may be the only licensed health care professionals serving the
community or in clinics staffed by PAs that provide care during
evenings and weekends or at other times without a physician
present.
We believe that it makes good sense and good public policy
to update FECA to allow PAs to diagnose and treat Federal
employees who are injured on the job. The current restriction
limiting PAs' abilities to provide care to Federal workers adds
unnecessary cost to the system, limits Federal workers' access
to quality medical care, restricts Federal workers' choice of a
preferred health care professional, and may result in problems
related to continuity of care.
There is another good reason to update FECA to allow PAs
the ability to diagnose and treat injured workers, the shortage
of physicians in occupational medicine. The 1,500 to 1,800
occupational medicine physicians in practice today falls far
below the need.
We believe these are compelling reasons to update FECA to
recognize PAs.
Thank you for the opportunity to present testimony before
the Subcommittee. I look forward to responding to your
questions.
[The prepared statement of Mr. Kohlhepp follows:]
Statement of William C. Kohlhepp, MHA, PA-C, Assistant Professor and
Associate Director, Physician Assistant Program, Quinnipiac,
University, Hamden, CT
Good Morning. Thank you, Chairman Norwood and Representative Owens,
for the opportunity to present testimony this morning before the
Subcommittee on Workforce Protections. On behalf of the American
Academy of Physician Assistants (AAPA), I also wish to thank you for
your interest and leadership in updating the Federal Employees'
Compensation Act (FECA) to allow PAs to diagnose and treat federal
workers who are injured on the job.
My name is Bill Kohlhepp. I am a graduate of the University of
Medicine and Dentistry of New Jersey's PA Program, and I have been a
physician assistant for the past 25 years. I hold a master's degree in
health administration and am currently enrolled in a doctoral program
in health science.
I am the Associate Director of the Quinnipiac University Physician
Assistant Program, where I am also a professor. For the past 15 years,
I have practiced clinically on a part-time basis for Saint Raphael's
Occupational Health Plus, which is an occupational medicine practice
affiliated with Saint Raphael's Hospital in New Haven, Connecticut. I
was the founding Administrative Director of the practice. I am also a
co-author of an article on the role of PAs in occupational medicine
that was published in the Journal of the American Academy of Physician
Assistants.
I am a member of the AAPA and the American Academy of Physician
Assistants in Occupational Medicine (AAPA-OM). I am a former president
of AAPA, as well as a former Speaker of the AAPA's House of Delegates.
I am the current Chair of the National Commission on Certification of
Physician Assistants (NCCPA), which is the certifying organization for
PAs in the United States.
On behalf of the more than 55,000 clinically practicing physician
assistants in the United States who are represented by the American
Academy of Physician Assistants, I am pleased to submit comments on the
need to update the Federal Employees Compensation Act (FECA) to allow
PAs to diagnose and treat federal workers who are injured on the job.
Overview of Physician Assistant Education
Physician assistant programs provide students with a primary care
education that prepares them to practice medicine with physician
supervision. PA programs are located at schools of medicine or health
sciences, universities, teaching hospitals, and the Armed Services. All
PA educational programs are accredited by the Accreditation Review
Commission on Education for the Physician Assistant, an organization
composed of representatives from national physician groups and PAs.
The average PA program is 26 months and is characterized by a
rigorous, competency-based curriculum with both didactic and clinical
components. The first phase of the program consists of intensive
classroom and laboratory study, providing students with an in-depth
understanding of the medical sciences. More than 400 hours in classroom
and laboratory instruction are devoted to the basic sciences, with over
70 hours in pharmacology, more than 149 hours in behavioral sciences,
and more than 535 hours of clinical medicine.
The second year of PA education consists of clinical rotations. On
average, students devote more than 2,000 hours or 50-55 weeks to
clinical education, divided between primary care medicine and various
specialties, including family medicine, internal medicine, pediatrics,
obstetrics and gynecology, surgery and surgical specialties, internal
medicine subspecialties, emergency medicine, and psychiatry. During
clinical rotations, PA students work directly under the supervision of
physician preceptors, participating in the full range of patient care
activities, including patient assessment and diagnosis, development of
treatment plans, patient education, and counseling.
After graduation from an accredited PA program, the physician
assistant must pass a national certifying examination jointly developed
by the National Board of Medical Examiners and the independent National
Commission on Certification of Physician Assistants. To maintain
certification, PAs must log 100 continuing medical education credits
over a two-year cycle and reregister every two years. Also to maintain
certification, PAs must take a recertification exam every six years.
A growing number of PAs possess master's degrees, and the majority
of PA educational programs now offer master's degrees. According to
data collected by the AAPA, 61.7 percent of PAs graduating from a PA
educational program in 2004 received a master's degree. Approximately
80 percent of the 137 PA educational programs currently offer master's
degrees.
Physician Assistant Practice
Physician assistants are licensed health care professionals
educated to practice medicine as delegated by and with the supervision
of a physician. In all states, physicians may delegate to PAs those
medical duties that are within the physician's scope of practice and
the PA's training and experience, and are allowed by law. Forty-eight
states, the District of Columbia, and Guam authorize physicians to
delegate prescriptive privileges to the PAs they supervise.
PAs always work with physicians. However, this does not mean that
the physician is necessarily on site, nor does it suggest that PAs do
not make autonomous medical decisions. PAs employed by the State
Department, for example, may work with a physician who is a continent
away and available for consultation by telecommunication.
PAs are located in almost all health care settings and in every
medical and surgical specialty. Nineteen percent of all PAs practice in
non-metropolitan areas where they may be the only full-time providers
of care (state laws stipulate the conditions for remote supervision by
a physician). Approximately 41 percent of PAs work in urban and inner
city areas. Approximately 44 percent of PAs are in primary care. Nearly
one-quarter practice in surgical specialties. Roughly 80 percent of PAs
practice in outpatient settings. In 2004, an estimated 206 million
patient visits were made to PAs and approximately 250 million
medications were prescribed or recommended by PAs.
PAs are covered providers within Medicare, Medicaid, Tri-Care, and
most private insurance plans. Additionally, PAs are employed by the
federal government to provide medical care, including the Department of
Defense, the Department of Veterans Affairs, the Public and Indian
Health Services, the State Department, and the Peace Corps. PAs are
designated as covered providers in the overwhelming majority of State
workers' compensation programs. (A chart is attached to the testimony,
summarizing coverage of medical services provided by PAs in the State
workers' compensation programs.)
Physician Assistants in Occupational Medicine
Physician assistant versatility and interpersonal skills are well
suited to the demands of occupational medicine. Working as part of a
medical team, physician assistants participate in the promotion of
employee health, including the treatment of occupational injuries and
illnesses, preventive and pre-placement examinations, health
maintenance activities, immunization programs, Department of
Transportation exams, workers' compensation case management follow-up,
and health and safety education.
PAs deliver employee health services in diverse settings--corporate
medical offices, occupational medicine clinics, private physician
offices, hospital employee health departments, clinics for production
plants or mines, remote pipeline locations, aboard ship, on military
bases, and on the White House medical staff.
The US Department of Transportation allows PAs to perform and sign
truck driver physicals. The regulations identify the responsibilities
of the medical examiner in performing and recording the physical
examination (49 CFR, Part 391.43) and define physician assistants as
medical examiners. PAs are employed in occupational medicine roles by
numerous federal agencies, including the Department of Veterans Affairs
and the Department of Defense. OSHA recognizes PAs as qualified
occupational medicine providers able to ``perform physical
examinations, identify health problems, and plan therapeutic
interventions.''
Following are a few examples of PAs who practice in occupational
medicine.
PA Fills Diverse Role with Occupational Med Company
A PA working for Mercy Occupational Health--a clinic providing
occupational medicine services to a diverse range of employers
including General Motors, Wal-Mart, Lear Jet, local school districts,
and service industry employers--treats patients with a wide range of
work-related injuries, including strains, lacerations, and repetitive
stress ailments. After diagnosis, she equips employees with detailed
written instructions concerning all aspects of their recovery,
including the use of prescribed medications and how to best protect
injured areas against further damage. She consults with managers about
lighter duty assignments during employee recovery. Follow-up visits
help to ensure a full and well-coordinated recovery.
The PA administers a range of pre-placement physicals for
employers, including fitness tests and drug screenings tailored to
reflect the physical demands of the work to be performed. In addition,
she performs DOT physicals for employers including the local school
district and Federal Express.
This physician-PA team effectively increases patient access to care
by sending the PA off-site to provide care at a laboratory equipment
factory four hours a week. The physician is available for consultation
by phone if necessary while the PA sees the workers, many of whom have
no other medical provider. By answering their medical questions and
providing general health education, the PA helps keep the factory
workers well and able to work in a physically demanding setting.
PA Care at Los Alamos
The workers and researchers of Los Alamos Nuclear Laboratory
receive their occupational health services from a physician assistant.
This PA specializes in the prevention, diagnosis, and referral of
radiation-related conditions. To help Los Alamos fulfill strict
Occupational Safety and Health Administration (OSHA) regulations
concerning radiation exposure, he conducts rigorous medical exams for
employees on a yearly basis. The PA also treats the researchers
employed by the facility who travel to remote locations and return with
ailments related not only to radiation exposure but also more mundane
problems such as stomach ailments. A physician is always on-site at the
facility and coordinates care with the PA.
PA Versatility Shows at New York Presbyterian Hospital
A PA employed by New York Presbyterian Hospital treats a diverse
population of hospital employees and Cornell University researchers.
Her versatility is impressive, ranging from pre-placement exams to
developing preventive worker safety measures. In conducting pre-
placement examinations for candidates offered employment by the
hospital, she tests for TB, illegal substances, and HIV, and gauges
applicants' physical fitness to perform job duties. This PA also serves
as a main contact person for impaired employees, making referrals to
drug and alcohol treatment centers.
As a certified New York state HIV educator, the PA at New York
Presbyterian Hospital conducts employee safety training for hospital
employees at risk for HIV exposure through blood or body fluid
exposure. This PA also oversees a program addressing the special health
needs of Cornell researchers working in a Biosafety Level 3 Lab. Here
researchers are exposed to a variety of health risks through their
contact with lab animals, including rare viruses. To protect against
these hazards, the PA has devised and implemented lab safety measures
in cooperation with the New York State Department of Health and
laboratory and hospital officials.
CDC Employs Occupational Medicine PAs
At the federal Centers for Disease Control and Prevention (CDC), a
PA cares for researchers who typically spend a month at a time in ``hot
spots'' or disease outbreak areas around the world. His practice
combines travel medicine with infectious disease medicine. Researchers
generally return with at least one ailment, ranging in seriousness from
digestive problems to malaria. One of the PA's specialty areas is the
testing of researchers' fitness for the use of physically demanding
protective gear. Cardiopulmonary tests gauge employees' fitness for use
of protective gear used in highly toxic environments. Working closely
with his supervising physician, he coordinates the annual bioterrorism
fitness exams required of CDC researchers.
His other large patient base consists of CDC office workers who
typically suffer from carpal-tunnel syndrome and similar repetitive
stress injuries. In these cases, the PA collaborates with the CDC's
industrial hygienist to restructure employees' workstations along
ergonomic standards and trains employees in preventive measures against
repetitive stress.
State Department Counts on Versatility
The U.S. Department of State employs occupational medicine PAs to
provide medical care to State Department employees and their families
overseas. For example, a PA working for the State Department manages
family medicine as well as emergency medical crises. In addition, he
serves as the medical liaison between employees and host country
medical personnel and facilities, inspecting local hospitals to
determine their quality of care. In countries where acceptable
inpatient care is not available, he has developed alternative sites
where patients can be stabilized prior to airlift to hospital. This
PA's work epitomizes the clinical range and organizational versatility
of PAs in occupational medicine.
PA Practice at Saint Raphael's Occupational Health Plus
The hospital-based occupational medicine practice where I work has
300 clients. For our federal clients, like the FBI and the Post Office,
we perform pre-employment physicals and treat injuries that are covered
by FECA. With respect to the workers on the merchant ships arriving in
New Haven Harbor, virtually all illnesses and injuries are covered
under workers' compensation. We do a lot of work with employees who
have back, shoulder, and knee injuries. In order to be most effective
as a clinician, it is important for me to be familiar with the
workplace and know about the workers' compensation system so that
informed decisions can be made about returning employees to work.
My day at Saint Raphael's Occupational Health Plus is typically
divided between seeing employees with work-related injuries and doing
examinations on individuals who are being hired or employees who need
periodic screening. Injuries are generally musculoskeletal sprains and
strains, but may also involve lacerations, burns, fractures, or eye
injuries. Evaluating and treating employee exposures to infectious
agents like tuberculosis or bloodborne pathogens (i.e., Hepatitis B or
HIV) may also be involved. Pre-placement examinations are performed
immediately before the employee is hired. Periodic examinations are
performed to evaluate potential health effects of exposures to
chemicals or other things in the worker's environment. They are also
completed to evaluate the worker's continuing ability to safely perform
their jobs, such as DOT physicals for truck drivers or respirator
examinations for firefighters.
What does it mean for my practice that I can not sign FECA claims
forms as a PA? The bottom line is that unless the physician signs the
form, the DOL's Office of Workers' Compensation will not honor the FECA
claim. At a minimum, this means that the physician can not make the
maximum use of my skills and must sign every workers' compensation
form. Quite frankly, this is not the best use of the physician's time
and expertise. The problem is exacerbated when I'm performing on-call
services for the practice or if I'm providing after-hours care at the
practice. Physicians hire PAs to extend their reach and to extend
access to care. Many physicians also hire PAs to make life a little
easier for them--to share on-call duties and to provide after-hour
care.
The Problem with the Federal Employees Compensation Act
In letters responding to congressional inquiries on PAs and FECA,
the Office of Workers' Compensation has taken the position that claims
or reports are not acceptable if they have been signed by a PA, because
PAs are not included in FECA's definition of ``physician'' (section
8101 (2)).
In a December 2001 letter to Senator Gramm, the Director of the
Office of Workers' Compensation Program wrote:
OWCP is responsible for the administration of the Federal
Employees' Compensation Act (FECA). In Section 8101(2) of this Act,
physicians are defined as
surgeons, podiatrists, dentists, clinical psychologists,
optometrists, chiropractors, and osteopathic practitioners
within the scope of their practice as defined by State law.
Since Physician's [sic] Assistants are not included in this
definition, we are unable to accept their clinical reports as medical
evidence unless these reports are countersigned by a physician.
Why It Makes Good Sense and Good Public Policy to Update
FECA to Allow PAs to Diagnose and Treat Federal
Employees who are Injured on the Job
Simply put, the current restriction limiting PAs ability to provide
care to federal workers who are injured on the job results in added
costs to the system, unnecessarily limits federal workers' access to
quality medical care, restricts federal workers' choice of preferred
health care professional, and may result in problems related to
continuity of care.
PAs currently jump through hoops to ensure that physicians sign the
workers' compensation claim in order to make the system work for the
injured employee and the practice. However, physicians aren't always
available--particularly in rural and urban medically underserved
communities where PAs may be the only health care professional serving
the community or in clinics staffed by PAs that provide care during
evenings and weekends. Following are a few of the personal examples
that we've heard from PAs regarding the FECA problem.
A PA in Georgia informed us that federal workers were
advised to use hospital emergency rooms for non-emergency care, rather
than receiving care after-hours at local clinics where PAs were the
only health care professional on-site. Ironically, the care provided in
the emergency room could be provided by a PA--at 4-5 times the cost.
A federal worker in Massachusetts recently asked a PA in
a surgical practice where he had undergone surgery to suture a
laceration on his leg that occurred while on the job. The physician was
not in the office that day, and the PA had two choices--to send her
patient to the emergency room or to provide the care, knowing that the
practice wouldn't be reimbursed. She chose continuity of care and
sutured his leg.
Every rural community in the nation has at least one
employee of the U.S. Postal Service. A PA from Iowa commented that it
made no sense that she could provide medical care to this employee on
an ongoing basis, but not be able to collect reimbursement for
attending to a dog bite or other injury that occurred on the job.
We also understand that the FECA issue is particularly troublesome
in the Peace Corps and State Department where many injuries and
illnesses are covered under the Federal Workers' Compensation Program.
As federal employees, Subcommittee Members and staff have the
option of seeing a PA through your Federal Employee Health Benefit
Plan. But, you may not be able to see the PA if you're injured during
working hours.
There is also another very good reason to update FECA to allow PAs
the ability to diagnose and treat injured workers--the shortage of
physicians in occupational medicine. According to the American Board of
Preventive Medicine, only 3,332 physicians have been certified in
occupational medicine since 1955, and only 1,500 -1,800 of these
physicians are actually in practice today. This number falls far below
the Bureau of Health Professions' estimated need of 4,830 physicians
certified in occupation medicine or the Institute of Medicine's need
estimate of 3,100 -5,500 occupational medicine physicians.
We believe that expanded access to care and continuity of care for
federal workers are compelling reasons to update FECA to recognize PAs,
as are potential cost savings and meeting the need that is created by
the physician workforce shortage in occupational medicine. After all,
that's why the physician-PA team concept was created--to expand the
physician's ability to provide care.
Thank you for the opportunity to present testimony before the
Subcommittee. I look forward to responding to your questions.
[An attachment to Mr. Kohlhepp's statement follows:]
[GRAPHIC] [TIFF OMITTED] T1548.001
------
Mr. Norwood. Thank you very much.
Having spent 45 days in the hospital last year, I got to
know your crowd pretty well.
I know what you guys do.
Mr. Kohlhepp. I am happy to hear that we played an
important role in your recovery.
Mr. Norwood. They did, indeed.
Dr. Towers, you are now recognized for 5 minutes for
testimony.
STATEMENT OF JAN TOWERS, PhD, NP-C, CRNP, FAANP, DIRECTOR OF
HEALTH POLICY, AMERICAN ACADEMY OF NURSE PRACTITIONERS,
WASHINGTON, DC
Dr. Towers. I am here representing the American Academy of
Nurse Practitioners, which is the full-service organization
that represents over 90,000 nurse practitioners of all
specialties throughout the United States. I am the director of
health policy, but I am also a family nurse practitioner, and I
am here to speak to the proposed amendment to the Federal
Employees' Compensation Act.
Certified registered nurses are advanced practice nurses
who have completed a formal nurse practitioner program
culminating in a minimum of a Master's education beyond their
4-year baccalaureate education in professional nursing. This
means they have a total of 6 years of preparation in the
medical and health care field.
Most, in addition, are seasoned nurses before they go back
for their graduate degree to become a nurse practitioner, and
we then become educated by specialty, and our specialties
follow along the same lines as the physician specialties, with
family, internal medicine, pediatrics, gerontology, etcetera.
Nurse practitioners are prepared to be primary care
providers in today's health care arena, and they have been
recognized as medical providers in the Federal employee health
insurance program since the 1980's.
As the Committee knows, nurse practitioners are highly
qualified health care providers who have demonstrated their
skill in providing primary care to individuals in both rural
and urban settings, regardless of age, occupation, or income.
The quality of their care has been well documented over the
years.
With their advanced preparation, they are able to manage
the medical and health problems seen in the primary care and
acute care settings in which they work.
Nurse practitioners constitute an effective body of health
care providers that may be utilized as a cost savings in both
fee-for-service and managed care arenas in the country.
Recent managed care data reports an aggregate patient-per-
month cost savings of over 50 percent among patients seen by
nurse practitioners when compared to similar patients being
seen by physicians, and I did bring a document here that has a
number of citations that speaks to similar kinds of findings
and studies.
Other cost savings realized when nurse practitioners are
properly utilized include savings due to reductions in
emergency room visits and hospitalizations.
In relation to cost, not recognizing nurse practitioners as
attending providers for Federal employees in the Federal
employees compensation program actually creates a cost for the
Federal Government, because the patient is required to see a
physician for any work related to a work-related medical
problem.
This potentially increases the number of medical encounters
incurred by patients who will continue to see their regular
health care provider for other medical problems while seeing
the required physician provider for the problem coming under
the aegis of the Federal employees compensation program.
Nurse practitioners diagnose and treat patients of all ages
and walks of life. This includes taking patient histories,
conducting physical examinations, ordering and interpreting
their diagnostic tests, and prescribing medications and other
treatments for their medical problems.
Nurse practitioners are often the only provider in a
particular health care setting. In rural areas, it means that
patient have to travel distances to see other providers when
that is required.
The inability of nurse practitioners to serve their
patients when an occupationally related injury or illness
occurs not only creates additional cost by forcing patients to
go elsewhere for the care of these conditions, often to the
more expensive emergency rooms, but also creates fragmentation
of care that can have implications for other health care
outcomes.
Nurse practitioners are covered medical providers in
Medicare, Medicaid, Tricare, and private insurance plans, as
well as the Federal employees health insurance program. They
serve as medical providers in the VA, the Department of
Defense, and the Indian Health Service.
They are capable of performing services for workman's
compensation patients in state programs but are still excluded
from doing the same for Federal employees who are under their
care.
Nurse practitioners are licensed to practice in all 50
states and the District of Columbia.
They are authorized to diagnose, treat, and prescribe
medications under their own signatures.
They are board-certified.
They carry malpractice insurance.
They are capable of making medical judgments related to
occupational hazards, diseases, and injuries.
They have an outstanding record for providing high-quality
care, and they are cost-effective.
According to the current statute, Federal employees come
under the jurisdiction of the Federal Employees' Compensation
Act, have the right to choose their own health care provider
for the treatment of their condition. Yet if their health care
provider is a nurse practitioner, they are forced to go
elsewhere for that part of their medical care, even though the
nurse practitioner is perfectly qualified to provide the care
they need.
It is for this reason that we are asking the Federal
Employees' Compensation Act be amended to include nurse
practitioners as medical providers in that act, and we thank
you for the opportunity to speak with you, and I will be glad
to answer any questions.
[The prepared statement of Dr. Towers follows:]
Statement of Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health
Policy, American Academy of Nurse Practitioners, Washington, DC
My name is Jan Towers. I am here representing the American Academy
of Nurse Practitioners, the full service organization representing over
90,000 nurse practitioners of all specialties throughout the United
Sates. I am the Director of Health Policy and a family nurse
practitioner. I am here to speak to the proposed amendment to the
Federal Employees' Compensation Act that would allow nurse
practitioners and physician assistants to be covered providers under
that act.
Certified registered nurse practitioners are advanced practice
nurses who have completed a formal nurse practitioner program
culminating in a minimum of a Master's education beyond their four-year
baccalaureate education in professional nursing. They are prepared to
be primary care providers in today's health care arena. As the
committee knows, nurse practitioners are highly qualified health care
providers who have demonstrated their skills in providing primary care
to individuals in both rural and urban settings regardless of age,
occupation or income. The quality of their care has been well
documented over the years. With their advanced preparation, they are
able to manage the medial and health problems seen in the primary care
and acute care settings in which they work.
Nurse practitioners constitute an effective body of health care
providers that may be utilized at a cost savings in both fee for
service and managed care arenas in this country. Recent managed care
data reports an aggregate patient per month cost savings of over 50%
among patients seen by nurse practitioners when compared to similar
patients being seen by physicians. Other cost savings realized when
nurse practitioners are properly utilized include savings due to
reductions in emergency room visits and hospitalizations.
Not recognizing nurse practitioners as attending providers for
federal employees in the Federal Employees' Compensation Program
actually creates a cost for the federal government because the patient
is required to see a physician for any work related medical problem.
This potentially increases the numbers of medical encounters incurred
by patients who will continue to see their regular health care provider
for other medical problems while seeing the required physician provider
for the problem coming under the aegis of the Federal Employees'
Compensation Program.
Nurse practitioners diagnose and treat patients of all ages and
walks of life. This includes taking patient histories, conducting
physical examinations, ordering and interpreting their diagnostic tests
and prescribing medications and other treatments for their medical
problems. Nurse practitioners are often the only provider in a
particular health care setting. In rural areas this means that patients
have to travel distances to see other providers. The inability of nurse
practitioners to serve their patients when an occupationally related
injury or illness occurs, not only creates additional costs by forcing
patients to go elsewhere for the care of theses conditions (often to
more expensive emergency rooms), but also creates fragmentation of care
that can have implications for other health care outcomes.
Nurse practitioners are covered medical providers in Medicare,
Medicaid, Tri-care and private insurance plans. They serve as medical
providers in the Veterans Administration, the Department of Defense and
the Indian Health Service. They are capable of performing services for
worker's compensation patients in state programs, but are still
excluded from doing the same for federal employees who are under their
care.
Nurse practitioners are licensed to practice in all fifty states
and the District of Columbia. They are authorized to diagnose, treat
and prescribe medications under their own signature. They are Board
certified. They carry malpractice insurance. They are capable of making
medical judgments related to occupational hazards, diseases and
injuries. They have an outstanding record for providing high quality
care.
According to the current statute, federal employees coming under
the jurisdiction of the Federal Employees' Compensation Act, have the
right to choose their own health care provider for the treatment of
their condition. Yet, if their health care provider is a nurse
practitioner, they are forced to go elsewhere for that part of their
medical care, even though the nurse practitioner is perfectly qualified
to provide the care they need. It is for this reason that we are asking
the Federal Employees Compensation Act be amended to include nurse
practitioners as medial providers in the act.
We thank you for the opportunity to discuss this issue with you. I
will be glad to answer questions or provide you with further
information that you may need.
______
Mr. Norwood. Thank you, Dr. Towers.
Mr. Kline, you are recognized for 5 minutes for questions.
Mr. Kline. Thank you, Mr. Chairman.
I would like to thank the witnesses for being here today.
We discovered in the earlier panel that the occupation of
one's spouse may sometimes indicate a level of interest. I
would have to admit that my spouse has spent 30 years as a
registered nurse, so I have been following the testimony of Dr.
Towers very closely, and it does seem to me we have a serious
disconnect here. I have got a couple of notes here, and some
questions, and I will direct them to you, if I could, Dr.
Towers.
You mention that the nurse practitioners are board
certified and carry liability insurance. Is there a difference
in that insurance between a nurse practitioner and a physician
both in coverage and cost?
Dr. Towers. In coverage, we cover 1 million/3 million,
generally, which is about the same as a physician, and the cost
right now is considerably less than a physician. We still pay
less than $1,000 a year for malpractice insurance. So, we have
been very well protected.
Our malpractice rate is quite low, less than 1 percent, and
that has not changed.
We did studies in 1989 and in 1999 and just completed
another study, national study, last year, and that rate is just
about the same as where it was in 1989.
Mr. Kline. Thank you.
You also mentioned that nurse practitioners are covered
medical providers under Medicare, Medicaid, Tricare, I think
you said, and some others. Do you know--are nurse practitioners
and physicians treated the same, exactly the same, in those
programs, and if not, what the differences might be?
Dr. Towers. The difference in some of the programs, such as
Medicare, is a difference in reimbursement. For every 100
percent of the physician payment, where you have $100, the
nurse practitioner's reimbursement would be 85. It's 85 percent
of the physician cost. The activities are the same within the
primary care piece. Nurse practitioners are not in surgery, but
they do work in sub-specialties in relation to things like
orthopedics.
Mr. Kline. OK. Thank you.
I will ask one more question and yield back.
Do you know, yourself, if state workers' compensation
programs allow nurse practitioners to be designated as medical
providers?
Dr. Towers. Yes, they do, and this is not 100 percent at
this point, but I think one of the reasons this came to the
surface, because we were doing workman's comp for other things
in the state, and then you would get a Federal employee in your
practice come to you, and suddenly you could not sign something
that you have been signing for everybody else, and that is how
we became aware that we were beginning to have a problem with
this.
Mr. Kline. That there was a discrepancy?
Dr. Towers. Yes.
Mr. Kline. Would you say that was true in most of the
states?
Dr. Towers. I would say, at this point, we are probably
around half or over half.
We are doing it--it is something that has grown over the
past several years.
More and more states are recognizing nurse practitioners to
do this.
I certainly do it in Maryland.
Mr. Kline. Well, thank you for the questions. I do see a
very serious disconnect here, and I was interested in your
testimony talking about how you have someone whose primary care
provider is a nurse practitioner, they are injured, and
suddenly they have to go someplace else, and it looks like we
ought to be able to fix that.
Thank you, Mr. Chairman.
I yield back.
Mr. Norwood. The gentleman yields back.
Dr. Price, you are recognized.
Dr. Price. Thank you, Mr. Chairman, and I want to thank you
all for coming, as well. I am sorry that I was not here for
your testimony. We had a vote on the floor, and I apologize.
As you may know, I am an orthopedic surgeon from Georgia,
and we have some interesting scope-of-practice issues in that
state, as you know. It is always a challenge, and the challenge
that we have as policymakers is to make certain that patients
are provided quality care, and I know that you concur with
that.
Dr. Towers. That is correct.
Dr. Price. That is your goal, as well.
Professor, I am interested in--and I am sorry I did not
hear your testimony, but I am interested in kind of the history
of PAs and how they relate to physicians and how you see that
relationship changing, if at all, if we were to adopt this
legislation.
Mr. Kohlhepp. Well, thank you very much for that question.
Certainly, the history of the physician assistant
profession started in the mid-1960's at a time of significant
shortage of particularly primary care physicians, was the
specialty that was really lacking, and physician assistants
that came out of the Duke University system--Dr. Eugene Stead
started the profession, and it started with three Navy
corpsmen.
So, it has a long history both with physician education,
physician educators, a commitment to the physician-PA team, and
I do not see that commitment ever changing, and certainly, this
legislation will allow physicians to better use PAs and to more
efficiently and seamlessly see a series of patients in their
practice, rather than trying to say which patient has what kind
of insurance when they are coming in the door. That makes a
great deal of difficulty for a practice.
Dr. Price. As a physician extender, if you will? Is that
fair to say?
Mr. Kohlhepp. Personally, I like to refer to both
professions as physician assistants and advanced practice
registered nurses and nurse practitioners, whatever they
prefer, but it certainly is a role that we play, where we
extend the ability of physicians to provide access, quality of
care, and cost-effective care.
Dr. Price. How close is the physician physically to PAs
when they are practicing?
Mr. Kohlhepp. As I mentioned in my testimony----
Dr. Price. I am sorry.
Mr. Kohlhepp. I recognize that you needed to vote.
PAs are in a variety of settings, and the presumption is
that supervision is active and that the physician is
supervising the PA, providing conversations before patient
care, quality checks after patient care, and availability
during patient care, but availability can be via
telecommunication, particularly in rural sites or inner city
communities, was the two examples I used in my testimony, where
a physician may not be physically present. That does not mean
that supervision is not effective.
Dr. Price. I understand.
Dr. Towers--and again, I am sorry, I missed the beginning
of your statement, but tell me about the numbers of APNs across
the nation.
Dr. Towers. There are 106,000 nurse practitioners at this
point in time in the United States.
Dr. Price. Is there any evidence that they practice in
settings--any objective evidence where--that they practice in
settings where physicians do not?
Dr. Towers. Oh, yes.
Dr. Price. Is that in your testimony?
Dr. Towers. I do not know that we put it quite that way,
but nurse practitioners are often utilized in areas, and your
state is one of them, where there are no physicians available,
and you have got one of the most interesting states in terms of
how they manage to function with some of the things they have
to deal with in the state as far as statute and regulation is
concerned, but nurse practitioners will be sole providers in
consultation with other health care providers, including
physicians in many areas, and in our rural areas, it is
particularly prevalent.
Dr. Price. I suspect you all have data on that, do you not?
Dr. Towers. Yes, we do.
Dr. Price. Would you be able to provide that?
Dr. Towers. We certainly can, and we can tell you there are
some states that do not have requirements for physicians to be
hooked into--for them to be hooked into a physician in a formal
manner.
That does not mean that they do not consult and that they
do not have their network of health care providers, which
include physicians, that they utilize regularly, and so, we
have about 13 states that--where nurse practitioners actually
function that way at this point in time.
Dr. Price. Do you see this legislation resulting in a
collaborative relationship between APNs and physicians in a
structured way or just----
Dr. Towers. I think it would be according to how the state
laws establish the relationship. What would be required of them
in the state in terms of their license and how they function
under their license would be the way that--it would be
consistent with this. In terms of collaborating with
physicians--if you are thinking about are there things that get
out of their scope, every nurse practitioner has to have a way
to deal with things that are outside their scope, and so, you
have a referral network that you utilize, or consulting
network. That is what the collaboration word means for us.
Dr. Price. Us, as well.
Thank you so much.
I yield back.
Mr. Norwood. The gentleman yields back.
Mr. Owens, you are recognized.
Mr. Owens. Mr. Chairman, I just have one brief question,
and that is for Dr. Towers.
Would you agree that nurse anesthetists should be able to
provide services under FECA as part of an advanced practice
category?
Dr. Towers. Yes. We do not see any problem with that. The
reason this became--was a nurse practitioner issue is because
we are the ones that are generally hit with not being able to
function with our patients in relation to this. When a patient
can choose a--their attending provider, why that attending
provider is generally not going to be an anesthetist or, you
know, some of the other advanced practice groups.
The nurse practitioners are the ones that are sitting in
the position where, when it comes to documenting and
recognizing that someone has a problem and determining what
needs to be done about it, they are the ones that are finding
that they cannot provide that service, unless they want to do
it free, and even then it does not work, even if they do it for
free, because you have to have that physician's signature on
these documents, which means you have to go find a physician to
do it.
So, that is why this has been focused mainly on nurse
practitioners, but we have no problems with other kinds of
advanced practice nurses being included. We need to look and
see how they would fit into the pattern.
Mr. Owens. I have no further questions, Mr. Chairman.
I want to thank the witnesses and apologize for the fact
that we had to go to vote, but I have your written testimony.
Thank you.
Mr. Norwood. Thank you, Mr. Owens.
I will just quickly follow up. Is there anybody who opposes
that, that Mr. Owens just suggested?
Dr. Towers. I do not think so.
Mr. Norwood. Mrs. Drake, I think you are recognized next.
Mrs. Drake. Thank you, Mr. Chairman, and again, thank you
for being here.
I am just trying to understand the issue in my mind,
because in Virginia, nurse practitioners do work under a
physician, and I have used a nurse practitioner. It was a
wonderful person, did a good job.
I am not familiar with physician assistants personally, but
when you reference these 13 states that--where nurse
practitioners can work, do you mean they are completely on
their own?
There is no physician overseeing them in any form at all?
Dr. Towers. According to state statute, that is correct,
yes, and they function in rural areas. They are in rural health
clinics, and if you have Federal clinics--I mean there is
always a physician around some way, but not in a formalized
manner, and in those states, they could have their own
practices, and they do.
Mr. Owens. Medicaid/Medicare would pay them directly with
no physician in the middle.
Dr. Towers. Right.
Mr. Owens. I had wondered if part of the reason that their
liability insurance was so low was because there was a
physician also responsible, but the answer to that would be no.
Dr. Towers. No. That is right.
Mr. Owens. All right. Well, thank you very much.
I yield back, Mr. Chairman.
Mr. Norwood. The lady yields back.
I have a question for one of the Members.
Dr. Price, do physicians usually only cover themselves up
to a million dollars in malpractice?
Dr. Towers. 1 million/3 million.
Dr. Price. It depends on the state or the hospital in which
they practice. Many hospitals have their own levels.
1/3 is customary, 2/6 in some areas, but depending on your
style of practice----
Mr. Norwood. Surgeons get it up as high as they can.
Dr. Price. We, at one point, had 15 million/30 million,
because we had a fellow who was taking care of professional
athletes.
Mr. Norwood. Would any Members like to ask additional
questions?
We thank you very much for the time that you have given us
and your expertise on this subject. You have done very well,
and we appreciate it. We may follow up with some written
questions, if that is all right, that we would like to put in
the record, and with that, this hearing is now adjourned.
[Whereupon, at 11:55 a.m., the Subcommittee was adjourned.]
[Additional material submitted for the record follows:]
[The prepared statement of Mrs. Capps follows:]
Prepared Statement of Hon. Lois Capps, a Representative in Congress
From the State of California
Thank you for holding this hearing.
Mr. Chairman, America's fire fighters are the best trained and best
equipped in the world. And they provide unparalleled service to our
communities.
They do their job as well in large part because of their bravery
and skill. And, they are helped along in this job by some of the
prevention measures for which they have tirelessly advocated. With the
help of better safety equipment, such as flame retardant suits, fire
fighters can get to the heart of fires quicker and pull more victims to
safety.
All Americans benefit from that.
But I don't need to tell anyone that fire fighting continues to be
extremely dangerous. More than ever, fire fighters are working longer,
harder hours, uncertain of what dangers lay ahead.
After September 11th, America needs its firefighters to be better
prepared to respond to deliberate acts of terror and destruction. The
fire service needs to be better prepared to deal with bioterrorism and
it needs to be prepared to help save people who have been attacked with
toxic chemical weapons.
In short, America's fire departments need to be prepared for what
once seemed unthinkable.
I think most people don't understand--until they go through a fire
or an emergency--exactly how many roles firefighters play, and how
dangerous there job often is.
As a public health nurse, I know it is critical to provide adequate
presumptive disease coverage, especially coverage that extends beyond
respiratory disease.
Science tells us that when we combine high levels of stress with
environmental exposure to toxins, serious ailments can result. Fire
fighting is hazardous enough--the least we can do is to extend
presumptive coverage to these work-related illnesses.
For that reason, my colleague Jo Ann Davis and I have introduced
H.R. 697, the Federal Fire Fighters Fairness Act of 2005.
This legislation creates a presumptive disability for Federal fire
fighters who become disabled by heart or lung disease, cancers such as
leukemia or lymphoma, and infectious diseases like tuberculosis and
hepatitis.
We introduced this bipartisan legislation on behalf of thousands of
Federal fire fighters.
At great personal risk, these men and women protect America's
defense installations, our veterans, Federal wild lands, and other
national treasures. Yet when they present with work-related illnesses,
Federal law denies them compensation and retirement benefits unless
they can point to the specific conditions that caused their disease.
This onerous requirement makes it nearly impossible for Federal
fire fighters to receive fair and just compensation or retirement
benefits. The bureaucratic nightmare they must endure is burdensome,
unnecessary, and in many cases, overwhelming.
It's ironic and unjust that the very people we call on to protect
us are not afforded the health care and retirement protection that they
deserve.
Too frequently, the poisonous gases, asbestos and other hazardous
substances that Federal fire fighters and emergency response personnel
come in contact with, rob them of their health, livelihood, and
professional careers.
The Federal Government should not rob them of necessary benefits.
The Federal Fire Fighters Fairness Act will help protect the lives
of our fire fighters and it will provide them with a vehicle to secure
their health and safety.
In recent years, there has been a greater appreciation for the
risks fire fighters and emergency response personnel face every day.
Thirty-eight states have already enacted similar disability presumption
laws for state and local fire fighters. It's time to provide the same
protection for Federal fire fighters.
Recently, I learned of a case involving one of the Federal fire
fighters in my district at Vandenberg Air Force Base. He's been
fighting brain cancer for the past six months and continues radiation
treatment. This father of three is responsible for $14,000 in co-pays
for his treatment.
Without presumptive care protection he has only limited Federal
insurance coverage and must rely on the support of his fellow
firefighters. I applaud his fellow firefighters for stepping up to the
challenge--but it's the Federal government's responsibility.
We need to secure presumptive rights for Federal Firefighters now.
This bill is the right thing to do and we should make every effort
to pass it.
Thank you again for having this hearing, and I wish to thank all of
our nation's firefighters and emergency response personnel for
everything they do.
______
[The prepared statement of Mr. Bishop follows:]
Prepared Statement of the Hon. Timothy H. Bishop, a Representative in
Congress From the State of New York
Mr. Chairman, thank you for calling this important hearing to
examine how we can make the Federal Employees' Compensation Act a
better law.
In particular, I think it's important that we are taking this
opportunity to acknowledge how fire fighters who have sustained
injuries or illnesses in the line of duty--while protecting federal
property--have experienced difficulty receiving disability benefits.
Federal fire fighters have some of the most dangerous
responsibilities in the country. Protecting our national interests on
military bases, nuclear plants, and other federal facilities often
expose them to toxic substances, temperature extremes and stress.
Since September 11, they have assumed a greater responsibility to
prepare for emergencies and stand ready to place their lives on the
line to protect our families and our communities.
It's regrettable that while 38 states have passed laws shifting the
burden to the government to disprove a fire fighter's claim that he or
she was disabled on the job, this same standard does not apply to
claims filed by federal fire fighters.
Cutting through the red tape in order to receive the compensation
they deserve is a tremendous burden, unnecessary, and in many cases,
overwhelming.
It's ironic that the very people we call on to protect our Nation's
interests are not afforded the very best health care and retirement
benefits our government has to offer.
That is why yesterday I cosponsored the legislation introduced by
our colleague from Virginia, Mrs. Davis (H.R. 697, the Federal Fire
Fighters Fairness Act)--to shift the burden of proof in disability
claims to the federal government and make it easier for our brave fire
fighters to claim the fair and just compensation they deserve.
I am very pleased to add my name to H.R. 697, and once again thank
our fire fighters for their courage and service to our country.
______
[The American Nurses Association statement follows:]
Advanced Practice Registered Nursing: A Solution for FECA
Thank you for the opportunity to provide a statement for the record
regarding the Federal Employees Compensation Act (FECA). ANA is the
only full-service national association representing registered nurses
(RNs). Through our 54 constituent nursing associations, we represent
RNs across the nation in all practice settings. Our membership includes
advanced practice registered nurses who have been unable to treat
patients covered by FECA.
The mission of American College of Nurse-Midwives is to promote the
health and well-being of women and infants within their families and
communities through the development and support of the profession of
midwifery as practiced by certified nurse-midwives, and certified
midwives.
The American Psychiatric Nurses Association (APNA) represents
approximately 4900 psychiatric nurses in 50 states, with one
international chapter. Our mission is to promote psychiatric-mental
health nursing, improve mental health care for individuals, families
and communities, and to inform health policy for the delivery of mental
health services. APNA represents the largest group of psychiatric
nurses serving as direct care providers, researchers, educators, and
administrators. Our members specialize in the full range of mental
health care and substance abuse treatment to adults, children,
adolescents, and the elderly in rural and urban healthcare settings.
The National Association of Clinical Nurse Specialists, founded in
1995, exists to enhance and promote the unique, high value contribution
of the clinical nurse specialist to the health and well-being of
individuals, families, groups, and communities, and to promote and
advance the practice of nursing. Members of NACNS benefits from
national, regional, and local efforts of the Association to make the
contributions of CNSs more visible.
Innovative advances in health care make frequent headlines, but
there is an equally innovative, if somewhat misunderstood, treatment
for the cost and accessibility woes plaguing the Federal Employees
Compensation Program. The Health Resources and Services Administration
reports that 196,279 advanced practice registered nurses (APRNs) are
prepared to serve the American populace. These APRNs are carving out a
new role in delivering timely, cost-effective, quality health care,
especially to chronically underserved populations such as the elderly,
the poor, and those in rural areas.
Some 60 to 80 percent of primary and preventive care traditionally
done by doctors can be done by a nurse for less money. This is not to
say nurses work cheaper, but their cost-effectiveness reflects a
variety of factors related to the employment setting, liability
insurance, and the cost of education.
With an emphasis on health promotion and disease prevention and a
proven record of providing excellent primary care in diverse settings,
advanced practice nurses form a critical link in the solution to
America's health care crisis. Removing the barriers to APRNs would pay
a healthy dividend now and in the future.
Who Are APRNs?
The advanced practice registered nurse (APRN) is an umbrella term
given to a registered nurse (RN) who has attained advanced expertise in
the clinical management of health problems. Typically, an APRN holds a
master(s degree with advanced didactic and clinical preparation beyond
that of the RN. Most APRNs have extensive practice experience as RNs
prior to entering graduate school. Practice areas include, but are not
limited to: family, gerontology, pediatrics, women's and adult health,
neonatology, mental health, midwifery, and anesthesiology. Beginning in
2003, APRNs must hold a master's degree to bill Medicare for their
services. Under this umbrella fall four principal types of APRNs.
Nurse Practitioner (NP)
Number: 102,829; of which 14,643 are also trained as CNSs.
Education: According to the American Association of
Colleges of Nursing, there are 329 schools in the US offering a
master's or post-master's level NP programs.
What they do: Working in clinics, nursing homes,
hospitals, or their own offices, NPs are qualified to handle a wide
range of basic health problems. Most have a specialty--for example,
adult, family, pediatric, psychiatric health care. NPs conduct physical
exams, take medical histories, diagnose and treat common acute minor
illnesses or injuries, order and interpret lab tests and X-rays, and
counsel and educate clients. In all 50 states, and D.C., they may
prescribe medication according to state law. Some work as independent
practitioners and can be reimbursed by Medicare or Medicaid for
services rendered. Others work for hospitals, health maintenance
organizations (HMOs), or private industry.
Certified Nurse Midwife (CNM)
Number: 9,232.
Education: An average one and one-half years of
specialized education beyond nursing school, either in an accredited
certificate program, or like NPs, increasingly at the master's level.
There are currently 43 nurse-midwifery programs in the U.S accredited
by the American College of Nurse Midwives. Four of these are post-
baccalaureate certificate programs and 39 are graduate programs.
What they do: CNMs provide well-woman gynecological and
low-risk obstetrical care including prenatal, labor and delivery, and
post-partum care. In 2002, the most current year which data is
available from the National Center for Health Statistics, there were
307,527 CNM-attended births in the U.S. This accounts for over 10
percent of all vaginal births that year. An ANA meta-analysis of CNM
care found that nurse-midwives performed fewer fetal monitors,
episiotomies, and forceps deliveries, administered fewer IVs, delivered
fewer low birth weight and premature infants, and had shorter patient
hospital stays. CNMs have prescriptive authority in 48 states, D.C.,
American Samoa, and Guam.
Clinical Nurse Specialist (CNS)
Number: 69,017; of which 14,643 are also prepared as NPs.
Education: Registered nurses with advanced nursing
degrees--master's or doctoral--who are experts in a specialized area of
clinical practice defined in terms of population (e.g.pediatrics,
geriatrics, womens health), type of problem (e.g. pain, wound
management, stress), setting (e.g. critical care unit, operating room,
community clinic, emergency room) type of care (e.g. rehabilitation,
end-of-life) or disease (e.g. diabetes, oncology, psychiatry). There
are 218 U.S. schools offering master's or post-master's degrees for
CNSs.
What they do: CNSs practice in hospitals, clinics, nursing
homes, their own offices, and other community-based settings, such as
industry, home care and HMOs. CNSs have clinical nursing expertise in
diagnosis and treatment to prevent, remediate or alleviate illness and
promote health within a defined specialty population. Besides
delivering direct patient care, CNSs work in consultation, research,
education, and administration. Some work independently or in private
practice and can be reimbursed by Medicare, Medicaid, Tri-Care, and
private insurers.
Certified Registered Nurse Anesthetist (CRNA)
Number: 29,844.
Education: Registered nurses who complete 2-3 years higher
education beyond the required four-year bachelor's degree, as well as
meeting national certification and recertification requirements.
What they do: In this oldest of the advanced nursing
specialties, CRNAs administer more than 65 percent of all anesthetics
given to patients each year, and are the sole providers of anesthetics
in 85 percent of rural hospitals. Working sometimes with an MD
anesthesiologist, but frequently independently, these nurse specialists
work in almost every setting in which anesthesia is given operating
rooms, dentist's offices, and ambulatory surgical settings.
APRNs Are Accessible
They provide pre-employment physicals for employers, home health
care to the elderly, health education in hospitals, schools, and
community clinics, geriatric care in nursing homes, infectious disease
control in prisons, pre- and post-natal care in inner-city and rural
clinics, and psychotherapy in public and private practices. A study
published in the July/August 2003 issue of the Annals of Family
Medicine found that physician assistants, nurse practitioners and nurse
midwives are more likely to work in underserved communities than are
general internists, pediatricians, and obstetricians. This held true in
both rural and inner city areas.
APRNs Deliver High Quality Health Care
All advanced practice registered nurses must meet rigorous
education, certification, and continuing education requirements.
Standards of practice are set and monitored by nursing professional
organizations. APRNs work collaboratively with physicians and other
health professionals to coordinate health services for the best outcome
for the patient.
More than three decades of research have documented the high
quality of care provided by APRNs. In 1986, The Congressional Office of
Technology Assessment released a report requested by the Senate
Appropriations Committee. This report, ``Nurse Practitioners, Physician
Assistants, and Certified Nurse Midwives: A Policy Analysis,'' stated
that NPs are ``especially valuable in improving access to primary care
and supplementary care in rural areas and in health programs for the
poor, minorities and people without health insurance.'' OTA found the
quality of NP care to be ``as good as or better than care provided by
physicians,'' and found NPs had ``better communication, counseling and
interviewing skills than physicians have.''
A study published in the January 5, 2000 Journal of the American
Medical Association attests to the high quality services provided by
APRNs. This study, entitled ``Primary Care Outcomes in Patients Treated
by Nurse Practitioners or Physicians,'' compared the outcomes of
patients randomly assigned to MDs and NPs within the same managed care
organization. The authors found that patient outcomes and satisfaction
were equivalent for NPs and MDs.
A large-group study of patients seeking care for minor emergencies
was published in the Lancet in 1999. The study compared the outcomes of
patient's whose care was managed by NPs and physicians. The authors
found that NPs were better than MDs in recording medical histories and
that fewer patients seen by an NP sought unplanned follow-up for advice
about their injury. There were no significant differences between NPs
and MDs in the accuracy of examinations, adequacy of treatment, planned
follow-up or requests for medical imaging.
In June of 2002, the Medicare Payment Advisory Committee (MedPAC's)
issued a report titled ``Medicare Payment to Advanced Practice Nurses
and Physician Assistants.'' In its recommendation to Congress, MedPAC's
reported that, ``.research studies show quality and outcomes of care
[provided by CNMs] at least comparable to obstetricians and
gynecologists.''
A case in point is a May 1998 study from the National Center for
Health Statistics (NCHS), Centers for Disease Control and Prevention
(CDC) that was published in the Journal of Epidemiology and Community
Health. It examined all single, vaginal births in the United States in
1991 delivered at 35-43 weeks of gestation by either physicians or
CNMs. After controlling for a wide variety of social and medical risk
factors, the risk of experiencing an infant death was 19 percent lower
for births attended by CNMs than for births attended by physicians. The
risk of neonatal mortality (an infant death occurring in the first 28
days of life) was 33 percent lower, and the risk of delivering a low
birth weight infant was 31 percent lower. Mean birth weight was 37
grams heavier for the CNM attended than for the physician-attended
births. Low birth weight is a major predictor of infant mortality,
subsequent disease, or developmental disabilities.
The study also found that CNMs attended a greater proportion of
women who are at higher risk for poor birth outcome: African Americans,
American Indians, teenagers, unmarried women, and those with less than
a high school education. Physicians attended a slightly higher
proportion of births with medical complications. However, birth
outcomes for CNMs were better even after socio-demographic and medical
risk factors were controlled for in statistical analyses.
APRNs Are Cost-Effective
Advanced practice nurses aren't low-priced doctor substitutes. They
are first and foremost registered nurses, a profession with its own
educational and licensing requirements, overseen by boards of nursing
in all 50 states, that meet competency standards and continuing
education requirements. APRNs are skilled in performing a wide range of
health services, especially screening and preventive services, that if
ignored, can lead to far more serious and costly health problems.
A seminal study published in the Yale Journal on Regulation in 1992
reviewed two decades of research on APRN services. The author found
that the evidence is clear that APRNs provide care of comparable
quality and lower cost than physicians. The study asserts that APRNs
tend to prescribe fewer drugs, use less expensive tests, and select
lower-cost treatments than MDs.
In 1995, the Journal of the American Academy of Nurse Practitioners
published the results of a year-long study that compared a family
physician's managed practice with an NP's practice within the same
managed care organization. The authors found that the NP's total
annualized per member cost was approximately 50 percent less than the
physician's. The NP practice resulted in far fewer emergency room
visits and inpatient days.
A study published in the June, 2003 issue of the American Journal
of Public Health contained the results of a two and one-half year
cohort study funded by the Agency for Health Care Research and Quality
(AHRQ). The AHRQ researchers found that low-risk patients receiving
midwifery care had birth success rates comparable to those who saw only
physicians. In addition, the patients who received midwifery care
experienced fewer cesarean sections, spent fewer days in the birth
center/hospital, experienced less induction of labor, and received less
technical intervention. The study also revealed similar morbidity,
preterm birth, and low-birth weights among women receiving midwifery
care and those seeing physicians.
Based on a comparison of 1988 data from St. Paul Fire and Marine
Insurance Company (then the country's largest provider of liability
insurance for CRNAs), and 2004 data from CNA Insurance Company
(currently the largest insurer of CRNAs) insurance premiums for nurse
anesthetists have decreased nationally a total of 39 percent in the 88-
'04 time span. The decrease in CRNA malpractice insurance premium rates
demonstrates the superb anesthesia care that CRNAs provide. The rate
drop is particularly impressive considering inflation, an increasingly
combative legal system, and generally higher jury awards.
Conclusion
The Federal Employees Compensation Program is one of the last major
health care programs to deny patients' access to APRNs. APRNs are
covered medical providers in Medicare, Medicaid, Tri-Care and private
insurance plans. They serve as medical providers in the Veterans
Administration, the Department of Defense and the Indian Health
Service. In fact, most federal employees have access to APRNs through
their federal employee health benefit plan.
Decades of research have shown that APRNs provide high quality
services that often incur fewer costs than care provided by physicians
alone. In addition, APRNs are more likely to provide services in
medically underserved areas.
For these reasons, the undersigned organizations urge the Committee
to support efforts to provide Federal workers full access to the wide
compliment of services provided by APRNs.
American College of Nurse-Midwives.
American Nurses Association.
American Psychiatric Nurses Association.
National Association of Clinical Nurse Specialists.
______
[From the New York Post, May 8, 2005]
W. Plan Stiffs Heroes; Nixes WTC Comp Pay
By Sam Smith
The Bush administration is reneging on its pledge of $175 million
to fund workers' compensation claims for uninsured Ground Zero
responders, The Post has learned.
In its proposed 2006 budget, the administration says it will take
back $120 million in funds granted in 2002 that have yet to be spent.
``These particular funds were set aside for workers' compensation
needs that have not turned out to be as large as expected,'' said
federal Office of Management and Budget spokesman Scott Milburn. ``The
initial need for the funds has been met.''
But advocates say the federal decision will leave workers in the
lurch as they continue to get sick from their time at Ground Zero, and
that the money may well be needed to pay future claims.
``I'm disgusted,'' said Joseph Pecuro, 38, of Toms River, N.J., a
Ground Zero volunteer who filed for workers' compensation last August
and is worried that the Bush administration's proposal will leave him
without benefits.
``I can't even believe they would actually do that. They should be
ashamed,'' he said.
Pecuro, an ironworker, says his ailments forced him to quit working
two years ago. ``I can't afford to buy my groceries,'' he said.
Health professionals were concerned about the government's
decision.
``We don't know what the long-term health effects will be,'' said
Dr. Robin Herbert, director of Mount Sinai hospital's World Trade
Center health-monitoring program.
So far, the New York Workers' Compensation Board has paid out
roughly $52 million in benefits to 113 claimants from the federal
funding. Of those, 37 are receiving biweekly payments because of the
severity of their injuries.
All those payments--along with 94 claims currently being processed,
another 400 filed with the state in anticipation of future health
problems, and any future complaints--are jeopardized by the Bush
administration's proposal.