[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
EVALUATING THE U.S. DEPARTMENT OF
VETERANS AFFAIRS' FOURTH MISSION
SUBCOMMITTEE ON OVERSIGHT AND
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
JUNE 23, 2010
Serial No. 111-86
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
Subcommittee on Oversight and Investigations
HARRY E. MITCHELL, Arizona, Chairman
ZACHARY T. SPACE, Ohio DAVID P. ROE, Tennessee, Ranking
TIMOTHY J. WALZ, Minnesota CLIFF STEARNS, Florida
JOHN H. ADLER, New Jersey BRIAN P. BILBRAY, California
JOHN J. HALL, New York
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C O N T E N T S
June 23, 2010
Emergency Preparedness: Evaluating the U.S. Department of
Veterans Affairs' Fourth Mission............................... 1
Chairman Harry E. Mitchell....................................... 1
Prepared statement of Chairman Mitchell...................... 29
Hon. David P. Roe, Ranking Republican Member..................... 2
Prepared statement of Congressman Roe........................ 29
U.S. Department of Health and Human Services, Kevin Yeskey, M.D.,
Director, Office of Preparedness and Emergency Operations,
Deputy Assistant Secretary, Office of Preparedness and
Emergency Response............................................. 15
Prepared statement of Dr. Yeskey............................. 43
U.S. Department of Homeland Security, Federal Emergency
Management Agency, Steven C. Woodard, Director of Operations
Division, Response Directorate................................. 17
Prepared statement of Mr. Woodard............................ 44
U.S. Department of Defense, Captain D.W. Chen, M.D., MPH, USN,
Director of Civil-Military Medicine, Force Protection and
Readiness Policy and Programs, Office of the Assistant
Secretary of Defense for Health Affairs........................ 18
U.S. Department of Veterans Affairs, Hon. Jose D. Riojas,
Assistant Secretary for Operations, Security, and Preparedness. 22
Prepared statement of Mr. Riojas............................. 48
American Legion, Barry A. Searle, Director, Veterans Affairs and
Rehabilitation Commission...................................... 7
Prepared statement of Mr. Searle............................. 37
American Red Cross, Washington, DC, Neal Denton, Senior Vice
President, Government Relations and Strategic Partnerships..... 9
Prepared statement of Mr. Denton............................. 40
bt Marketing, The Woodlands, TX, John N. Hennigan, President and
Chief Executive Officer........................................ 4
Prepared statement of Mr. Hennigan........................... 30
Healthcare Coalition for Emergency Preparedness, Washington, DC,
Darrell Henry, Executive Director.............................. 5
Prepared statement of Mr. Henry.............................. 32
EVALUATING THE U.S. DEPARTMENT OF
VETERANS AFFAIRS' FOURTH MISSION
WEDNESDAY, JUNE 23, 2010
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Oversight and Investigations,
The Subcommittee met, pursuant to notice, at 10:05 a.m., in
Room 334, Cannon House Office Building, Hon. Harry E. Mitchell
[Chairman of the Subcommittee] presiding.
Present: Representatives Mitchell, Adler, and Roe.
OPENING STATEMENT OF CHAIRMAN MITCHELL
Mr. Mitchell. Good morning, ladies and gentlemen. The
Committee on Veterans' Affairs, Subcommittee on Oversight and
Investigations, hearing on Emergency Preparedness: Evaluating
the U.S. Department of Veterans Affairs' (VA's) Fourth Mission
will come to order. This hearing is held on June 23, 2010. I
ask unanimous consent that all Members have 5 legislative days
to revise and extend their remarks, and that statements may be
entered into the record. Hearing no objection, so ordered.
I would also like to recognize Terry Araman, a veteran from
Arizona, who is in attendance today. I want to personally thank
Terry for your service and the good work you are doing to help
veterans, especially the homeless veterans back home in
Phoenix. Would you please stand, Terry? Thank you.
On September 11, 2001, we witnessed one of the greatest
tragedies in American history. Still today we all remember the
horrific scenes of these terrorist attacks. Four years later in
2005, the Gulf Coast was hit by one of the biggest natural
disasters the region has ever seen as Hurricane Katrina swept
through the region, killing thousands and leaving many homeless
and displaced. And sadly again, today, we see Gulf States
struggling with yet another major disaster as the oil continues
These types of events highlight the critical need for
Federal agencies to proactively prepare to effectively execute
their Federal obligation, especially when called upon during
emergencies. Today we will evaluate and examine the U.S.
Department of Veterans Affairs' emergency management,
preparedness security, and law enforcement activities to ensure
the Department can perform the mission essential functions
under all circumstances across the spectrum of threats,
including natural disasters.
With several health care facilities and hundreds of doctors
and health care professionals, the VA emergency preparedness
posture, also known as the Fourth Mission, must be able to
respond when needed and when called upon. The Federal Response
Plan (FRP) is an important mechanism for providing coordination
of Federal assistance and resources to areas that have been
overwhelmed by disaster and emergency situations while
supporting the implementation of the Robert Stafford Disaster
Relief and Emergency Assistance Act. The VA's Office of
Operations Security and Preparedness is responsible for
directing and providing oversight for the Department's
planning, response, and security programs in support of the
I am looking forward to hearing from the VA their emergency
preparedness plans and how they coordinate and communicate with
the other agencies, such as the Federal Emergency Management
Agency (FEMA) and the U.S. Department of Health and Human
Services (HHS), who are here today, to carry out their Fourth
Mission. Every day we are reminded of the potential threats
that are out there that may disrupt the American way of life
and the freedoms we enjoy each day. The VA must be prepared to
respond to these threats and offer their full support and
resources to ensure that their role in the Federal Response
Plan is integrated with other agencies to execute its mission.
[The prepared statement of Chairman Mitchell appears on p.
Mr. Mitchell. Before I recognize the Ranking Republican
Member for his remarks I would like to swear in our witnesses.
I ask that all witnesses from all three panels if they would
please stand and raise their right hand?
Mr. Mitchell. Thank you. I would now like to recognize Dr.
Roe for opening remarks.
OPENING STATEMENT OF DAVID P. ROE
Mr. Roe. Thank you, Mr. Chairman, and thank you for holding
this hearing today. Early in this decade, our country faced two
major incidents that reinforced the need for emergency
preparedness. On September 11, 2001, our country was attacked
in a blatant act of terrorism as the World Trade Centers in New
York fell and the Pentagon burned. The first responders were
called to action and a Nation mourned. Again in 2005, Hurricane
Katrina struck the Gulf Coast with an unprecedented fury.
People's homes were flooded or ripped apart and major
evacuations occurred. The Gulf Coast is still rebuilding today.
Since the attacks of 9/11, the Committee on Veterans'
Affairs has held four hearings on the subject of emergency
preparedness. The last hearing was held on August 26, 2004.
Today we will reexamine the role performed by the Department of
Veterans Affairs in emergency preparedness and its response to
national crises, whether the role continues to need serious
upgrading or updating and reform.
In particular we will focus on the VA's role during
wartime, natural disasters, or major terrorist attacks on U.S.
soil. While FEMA and the Department of Health and Human
Services tend to take the lead role when an emergency occurs,
one cannot deny the large importance of emergency preparedness
at the VA. With 153 hospitals and hundreds of outpatient
clinics spread across the country, VA stands in a unique
position to provide emergency medical assistance in the event
of an emergency.
VA has defined roles currently in both the National
Disaster Medical System (NDMS) and the National Response
Framework (NRF) in the event of national emergencies. Among the
specialized duties of the VA are conducting and evaluating
disaster and terrorist attack simulation exercises; managing
the Nation's stockpile of pharmaceuticals for biological and
chemical toxins; maintaining a rapid response team for
radiological events; and training public and private National
Disaster Medical Systems, medical center personnel in
responding to biological, chemical, or radiological events.
Among the emergency support functions (ESF) assigned to VA,
which relate directly to the mission of the VA, are ESF 6,
which includes mass care, emergency assistance,
housing and human serv- ices; and ESF 8, which includes public
health and medical services.
I am interested in discovering today what VA has learned
from the events of 9/11, Katrina, and Hurricane Isabel, and how
their roles relate to the overall emergency response
Following Hurricane Katrina in September of 2005, the
Speaker of the House called together a Select Bipartisan
Committee to Investigate the Preparation for and Response to
Hurricane Katrina. The report, ``A Failure of Initiative,'' was
issued on February 15, 2006. I understand that Ranking Member
Buyer was selected as a part of that Committee and worked on
the report, and one of our own Subcommittee staff, Mr. Wu, was
detailed to work on the Bipartisan Investigative Committee. I
expect that we will hear from the Department that improvements
have been made following this report as well as on
recommendations made by the report from the Office of Inspector
General (OIG) issued in January of 2006.
I am also curious as to what the VA commitment is to
emergency management with both dollars and manpower.
And again, Mr. Chairman, I appreciate your holding this
important meeting. And it is my hope that there will be good
news, this will be a good news hearing that the VA is much
better prepared to handle emergencies that come in the future.
And just as a point, both the Chairman and myself have been
Mayors of our respective cities at home. And after 9/11 as the
local City Commissioner and as a physician, and having a VA in
our community, we were assigned, or really I assigned myself,
to really evaluate local preparedness. And it was woefully
inadequate, I found out. Whether it be smallpox, when I got
myself immunized, whether it be H1N1, I know on a local level,
where the boots hit the ground, we have made huge strides in
being able to meet these needs. And I look forward today, Mr.
Chairman, I know you have dealt with this as the Mayor of
Tempe, and I look forward to hearing the testimony.
[The prepared statement of Congressman Roe appears on p.
Mr. Mitchell. Thank you, Dr. Roe. At this time I would like
to welcome Panel One to the witness table. Joining us on our
first panel is John Hennigan, President and Chief Executive
Officer for bt Marketing; Darrell Henry, Executive Director of
the Healthcare Coalition for Emergency Preparedness; Barry
Searle, Director of Veterans Affairs and Rehabilitation
Commission for the American Legion; and Neal Denton, Senior
Vice President for Government Relations and Strategic
Partnerships of the American Red Cross. And I ask that all
witnesses please stay within the 5 minutes of their opening
remarks, and your complete statements will be made part of the
First, I would like to recognize Mr. Hennigan.
STATEMENTS OF JOHN N. HENNIGAN, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, BT MARKETING, THE WOODLANDS, TX; DARRELL HENRY,
EXECUTIVE DIRECTOR, HEALTHCARE COALITION FOR EMERGENCY
PREPAREDNESS, WASHINGTON, DC; BARRY A. SEARLE, DIRECTOR,
VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN
LEGION; AND NEAL DENTON, SENIOR VICE PRESIDENT, GOVERNMENT
RELATIONS AND STRATEGIC PARTNERSHIPS, AMERICAN RED CROSS,
STATEMENT OF JOHN N. HENNIGAN
Mr. Hennigan. Thank you, Mr. Chairman. Chairman Mitchell
and Members of the Subcommittee, I would like to thank you for
the opportunity to come here today as a citizen who has been
involved with not just the medical industry here and abroad,
but as an elected official in Montgomery County, Texas.
I have been fortunate enough to travel extensively
throughout South America, Europe, and here in the States in the
health care arena. I have witnessed firsthand the differences
between government facilities and those in the private sector,
and can state without question the improvements I have seen in
the VA facilities. A perfect example is the Michael E. DeBakey
VA Medical Center (VAMC) in Houston, Texas. Prior to this
health care system being built, in my opinion, our facilities
were old and less than adequate for the veterans in our area.
Before going into my testimony I would like to give this
Subcommittee a brief background of myself for you to have a
better understanding of why I feel privileged to be able to
speak to the future needs of our veterans, and to offer a fresh
pair of eyes to emergency preparedness and planning within the
VA Department going forward.
I mentioned earlier that I am an elected official in
Montgomery County, Texas. I am a board member of the Montgomery
County Hospital District (MCHD) and have been since 2006. I am
currently serving as Vice Chair of this Board for my third
consecutive year and in addition Chair our Legislative
Committee. The Montgomery County Hospital District is the sole
provider of emergency ambulance service for Montgomery County,
Texas, serving a rapidly growing population of 460,000
residents. MCHD responds to 42,000 calls for service each year.
The Montgomery County Hospital District serves a pivotal
role during disaster response. The agency and staff have taken
a lead role in developing the tools to coordinate emergency
medical service (EMS) mass response for coastal community
evacuation and post-landfall response. MCHD's dispatch center
was the coordination point for the mass EMS response into East
Texas following Hurricane Rita. The lessons learned from that
incident contributed greatly to the statewide success during
Hurricane Ike, the largest EMS deployment in United States
MCHD coordinates public health preparedness and medical
branch operations in Montgomery County during large-scale
operations, including the 2009 H1N1. Currently, MCHD is
coordinating a regional effort to develop EMS mass response to
no-notice catastrophic situations as part of the Regional
Catastrophic Planning Grant program. Our Hospital District
Chief Executive Officer serves as the Chairman of the Southeast
Texas Regional Advisory Council. This organization is the grant
recipient and administrative entity overseeing hospital
preparedness using funding for the nine counties of the Houston
Mr. Chairman, Subcommittee Members, my company has been
involved with several startup organizations or corporations
that are attempting to rise to another level. These companies
have asked me to come in and assess current status, where they
have been, and set goals to achieve where they would like to
get. Through this process I have had clients who have benefited
by programs that were well intended but lacked long-range
planning. The reason I am here today is that I believe that I
can plant the seed for new ideas in the hope that this
Committee, and our Veterans Affairs Department, can nurture
those ideas to benefit our veterans.
And finally, I want to once again thank you for this
opportunity to testify before this Subcommittee.
[The prepared statement of Mr. Hennigan appears on p. 30.]
Mr. Mitchell. Thank you very much. Next, Mr. Henry.
STATEMENT OF DARRELL HENRY
Mr. Henry. Thank you for inviting us to testify today.
Natural disasters such as earthquakes, hurricanes, and floods
are often frequent reminders that we must be prepared when
disaster strikes. And since 2001 the Nation has understood the
importance of planning for acts of aggression against innocent
citizens. The Healthcare Coalition for Emergency Preparedness
was formed in an effort to raise awareness and educate people
about often overlooked issues in plans to maintain health care
facility operations during a crisis, and to develop efficient
methods to reduce health care costs in that area. One of the
largest hindrances to what we call operational security
revolves around transportation constraints to the hospital
itself, or such impacts on key suppliers and vendors.
While we address a lot of issues in our full testimony
today I would like to focus on one of the issues we have found
often overlooked in operational sustainable planning, and that
is adequate attention relating to the safe disposal of
regulated medical waste, also known as infectious waste.
Until the mid-1990s, most health care facilities
incinerated materials onsite, but the Federal Government banned
that practice. The current practice for most health care
facilities is to manage infectious and contagious waste by
transporting such materials over our Nation's highways, through
our cities and neighborhoods, by nonclinical commercial
truckdrivers to a regional facility to be treated and disposed
of. Under a widespread community emergency, facilities would be
inundated and supply management would be stressed.
The Joint Commission requires health care facilities to be
self-sufficient for 96 hours. However, the volume of hazardous
medical waste would dramatically increase when there is a surge
on a hospital's capacity due to a large population suddenly
contracting a contagious disease, such as in a pandemic, or a
natural, or manmade disaster. In addition, the U.S. Government
Accountability Office (GAO) and other reports have warned that
waste disposal would be near impossible for quarantined or
isolated health care facilities that have outsourced the
responsibility of sterilizing contagious materials.
Because the primary method of controlling the spread of
infection and avoiding pandemic is quarantining, the developing
of an onsite approach to waste disposal appears to be the most
appropriate one. Further, various reports by health officials
and other experts have recognized that onsite medical waste
treatment is the best practice for emergency preparedness and
Taking an onsite sustainability approach not only helps
address a hospital's ability to handle a crisis, but also
issues with offsite providers that would occur in the case of a
pandemic or crisis. Vendor problems, including transportation
constraints and staff shortages, would be out of control of a
health care facility. Fortunately, modern, affordable
technologies exist that can cleanly, safely, and economically
sterilize infectious and contagious medical waste on the
premises of health care facilities.
We would also like to point out that installing onsite
waste sterilization equipment at VA facilities would provide
ancillary and immediate benefits for the VA beyond emergency
preparedness, including cost savings and carbon emission
reductions. Expenditures for onsite treatment of infectious
waste is perhaps the only preparedness tool that would pay for
itself from the day of installation as this equipment often
produces a return on investment, a payback between 18 and 36
We estimate that onsite treatment using sterilization
equipment can produce an average cost savings of $1.6 million
per hospital, which would equate to about $190 million if
installed at all 117 VA Medical Center hospitals that are
currently relying on offsite vendors to haul and treat their
waste. Further, regarding the VA's ability to comply with
Executive Order 13514 to reduce carbon emissions, the Coalition
has developed a carbon footprint calculator that can calculate
in real numbers the reduction in pounds of CO2
emissions each year for those facilities that install onsite
We have constructively urged that onsite sterilization
capabilities be added to the VA's list of best standards and
practices, as well as to the list of mission critical
components in their emergency plan. Currently, 24 VA facilities
process their waste onsite. We know that many facilities would
like to add this component to their capital budgets but thus
far have not done so. We do know that there are groups within
the VA that are looking at this very issue and recognize that
onsite medical waste treatment could benefit VA facilities from
an everyday operational aspect as well as emergency
Our Nation remains vulnerable in the area of contagious
waste management during a pandemic or crisis. We have produced
alternatives that should be a best practice for emergency
preparedness and facility operations at the VA. Again, thank
you for the opportunity and I look forward to your questions.
[The prepared statement of Mr. Henry appears on p. 32.]
Mr. Mitchell. Thank you, Mr. Henry. Next, Mr. Searle.
STATEMENT OF BARRY A. SEARLE
Mr. Searle. Mr. Chairman and Members of the Subcommittee,
thank you for the opportunity to present the views of the
American Legion concerning this extremely important, but
sometimes neglected topic. The American Legion applauds the
foresight of this Subcommittee in bringing this topic back to a
place of importance.
As was seen during Hurricane Katrina, the flooding in
Oklahoma City and Nashville this year, as well as Iowa, and the
Dakotas last year, and tornadoes across the U.S., a natural
disaster is only days, hours, or minutes away. Additionally, a
weapon of mass destruction can turn an urban area into a mass
casualty area, crippling communications and overwhelming
traditional emergency services. Prior planning and coordination
are the difference between managing a disaster effectively and
adding to the chaos and suffering.
The Department of Veterans Affairs has developed policies
and has given guidance concerning emergency preparedness. There
is no question that the VA Central Office understands and
accepts its responsibility to prepare for and execute its
Fourth Mission, support of national emergency preparedness.
While the American Legion applauds VA for its approach to
preparedness, we are concerned that there may be a lack of
oversight and feedback at the regional office, Veterans
Integrated Service Network (VISN), and facility levels. The
American Legion is concerned that preparedness may be
overshadowed by primary day-to-day operations. This would
potentially lead to confusion and delay in a disaster situation
in an attempt to organize a response.
A January 2006 OIG report on emergency preparedness in
Veterans Health Administration (VHA) facilities stated that at
the national level VHA has developed comprehensive initiatives
and directives to address emergency preparedness training,
community participation, and decontamination activities.
However, at the facility level, VA employees do not
consistently receive emergency preparedness training and
emergency plans do not always include some critical training
elements as required.
VA's Emergency Management Strategic Healthcare Group has as
part of its mission statement an approach that, ``assures the
execution of VA's Fourth Mission, to improve the Nation's
preparedness for response to war, terrorism, national
emergencies, and natural disasters by developing plans and
taking actions to ensure continued service to veterans as well
as to support national, State, and local emergency management,
public health, safety, and homeland security efforts.''
VA's 2009 Emergency Management Guidebook, a well-organized
framework identifying duties and responsibilities, goes into
great detail concerning training to include sample scenarios,
which cover a wide range of incidents including hurricanes,
earthquakes, multiple bus accidents involving numerous
injuries. What we were not able to determine is a feedback
mechanism to confirm implementation at the regional office,
VISN, or facility level. The American Legion's System Worth
Saving Task Force annually conducts site visits at VA Medical
Centers nationwide to assess the quality and timeliness of VA
health care. We have found there is a wide range of actual
response preparedness across VHA. We believe that this range is
symptomatic of the decentralized nature of VA.
The American Legion and other veterans service
organizations have been briefed on 38-foot vans primarily
tasked with providing veterans counseling outreach, but
specifically designed and adapted for medical purposes during
disaster relief efforts. In particular, each has satellite
communications capability critical in a disaster situation.
This is an excellent program that shows how a specific
component can be utilized to fulfill multiple roles when the
demand exists. During 2009, massive flooding which overwhelmed
portions of the Midwest, in Fargo, North Dakota, where regular
VA Medical Center operations were impacted by the flooding, VA
dispatched three mobile Vet Centers for use as triage clinics
to help bridge the gap for the community until regular
operations could be restored. However, during recent
discussions with a group of facilities directors it was found
that some had no knowledge of the mobile clinics' existence.
Such a valuable resource must be a part of an ingrained
knowledge of any facility director or the value of these tools
will be lost.
Also, the Atlanta Medical Center coordinated with and
utilized staff members at local hospitals to provide medical
services for individuals injured in the Haitian earthquake
under National Management Disaster Assistance Program.
Unfortunately, we have also found that at the local level there
is in some cases a lack of awareness of the responsibility of
facilities to prepare for non-veteran casualty assistance.
Additionally, it was discovered that turnover and shortage of
personnel at most facilities require emphasis on standardized
procedures, quality review, and individual training, as well as
documentation of that training.
Emphasis on rural health care clinics and telehealth in
order to assist veterans will continue to expand the VA's
outreach and disburse critical assets and make them available
in the case of an emergency. As was shown during the flooding
in Fargo, North Dakota, should a VAMC's operation be degraded
due to natural disaster, a relatively close rural clinic or
clinics with functional telecommunications could be developed
as a staging area for direct resources and to some degree
triage areas for evacuating casualties until the VAMC could
resume full operation.
In conclusion, the American Legion realizes the importance
of VA's Fourth Mission, not only to the veterans that the VA
serves but to the Nation as a whole. In our resolution in 2008
we urged the Secretary of Veterans Affairs to take an active
role in development and implementation of plans to enhance
Federal homeland security initiatives, and that Congress
provide VA with the funding necessary to further enhance its
capability to act as a backup to the U.S. Department of Defense
(DoD) and FEMA. We believe that at the national level VA is
serious in this mission. However, we feel that additional
followup and reporting on activities on the local level is
essential to ensure that Central Office policies actually are
Thank you again for the opportunity to provide insight and
analysis on this issue on behalf of the American Legion and its
more than 2.5 million members.
[The prepared statement of Mr. Searle appears on p. 37.]
Mr. Mitchell. Thank you, Mr. Searle. Mr. Denton.
STATEMENT OF NEAL DENTON
Mr. Denton. Good morning, Chairman Mitchell, Dr. Roe, Mr.
Adler, thank you for your attention to emergency preparedness
today. Your timing is impeccable. This is a critical time of
the year, as the Red Cross is currently responding to
tornadoes, floods, and wildfires. At the same time we are
preparing for what looks to be a very active hurricane season.
I am going to highlight three points in my written testimony
that speak a little bit to the partnership between the Red
Cross, the Department of Veterans Affairs, and others here in
this room when it comes to disaster response.
You are familiar with our mission to provide relief and
help communities prevent, prepare for and respond to
emergencies. What you may not know is that we meet our mission
through a national network of nearly 700 chapters that respond
to around 70,000 disasters annually. That is about 200
disasters every day. The Red Cross also provides support to
members of the military, veterans, and their families, and
supplies nearly half of the Nation's blood supply, and teaches
life-saving skills in communities across the country.
The Red Cross is a charitable organization, not a
government agency. We depend on volunteers, and the generosity
of the American public to perform our mission, including
donations of time, of money, and of blood. Whether it is a
hurricane, or a heart attack, a call for blood, or a call for
help, the American Red Cross is there. And that is my first
point. Trained and experienced Red Cross volunteers and staff
in your hometowns are on the front lines when emergencies occur
in their communities. Our national system supplements the local
chapter presence with staff or additional resources whenever
My second point speaks to the importance of strong
partnerships. Identifying new partners and strengthening
existing partnerships is a key priority for our organization.
We strive to be an effective leader and valuable partner
before, during, and after a disaster strikes. In recent years,
we focused more of our resources on coordinating and
strengthening key relationships with our Federal partners like
the VA and FEMA. With support from FEMA, we have full time Red
Cross employees to staff each of the FEMA regional offices, the
National Disaster Housing Task Force, and FEMA headquarters. In
a disaster response capacity, the American Red Cross sits at
the same table with the VA during planning and exercises and
operations. We both serve as a support agency for the National
Response Framework, and work closely together on ESF 6,
providing technical support for mass care, emergency
assistance, housing, and human services.
The VA and the Red Cross also are collaborating with the
DoD, HHS, and FEMA as we develop a more reliable patient and
evacuee tracking system. The Red Cross is also excited about a
possible opportunity with the VA to address the challenges of
caring for loved ones who suffer from chronic illness or
temporary or permanent disabilities. Red Cross Family
Caregiving and Nursing Assistant programs help develop skills
in personal care, nutrition, home safety, and legal and
financial issues. Training builds confidence and instills
knowledge that a caregiver will need when providing support to
Our partner outreach extends beyond traditional disaster
response agencies. We are committing to fostering a culture of
collaboration, diversity, and inclusion in all of our
partnering efforts. We continue to rely on a list of
longstanding partners in a disaster, such as Southern Baptist
Disaster Relief, Salvation Army, Catholic Charities, Hope
Worldwide, the National Association for the Advancement of
Colored People (NAACP), the National Council of La Raza, Legal
Services Corporation, the National Baptist Convention, National
Disabilities Rights Network, Save the Children, Tzu Chi
Buddhist Foundation, and on and on. These groups provide
invaluable expertise and together, as partners, we continue to
strengthen the country's capacity to better meet the needs of
the diverse communities we serve.
My last point, and perhaps the most important point, is
encouraging community and citizen preparedness. Last summer the
American Red Cross Emergency Preparedness Survey indicated that
half of Americans have experienced at least one significant
emergency where they have lost utilities for 3 days, they could
not return home, they were unable to communicate with family
members, or had to provide first aid to others. Although 89
percent of those surveyed believe it is important to be
prepared, far fewer are actually ready for an emergency.
Families need to gather together at the dinner table to make an
emergency communication plan and identify a meeting place
should they become separated during a disaster.
To help military families prepare for emergencies, the
American Red Cross, FEMA, ready.gov, and others co-hosted the
military family preparedness event held recently at Fort
Belvoir, June 5th. Together, we distributed some 1,500
preparedness kits to active duty, retired, Reserve soldiers and
their families in the parking lot at the Post Exchange (PX).
This September, as part of the National Preparedness Month, we
are planning to conduct similar events at three military
installations across the U.S. and two locations overseas in
order to raise awareness of being prepared and to help families
prepare for emergencies. It is a promising start but there is
still much more we can do.
In conclusion, as we enter this 2010 hurricane season we
are pleased to be working with FEMA's strong leadership team
with Administrator Fugate and the leadership in the executive
branch. The Red Cross stands ready to help those in need. We
are working hard to improve our efficiencies and to increase
individual community preparedness. Thank you for allowing us to
be here today. I look forward to any questions you may have.
[The prepared statement of Mr. Denton appears on p. 40.]
Mr. Mitchell. Thank you. I have a question for anybody who
would like to answer this. In reviewing the National Response
Plan there is a myriad of Federal resources called upon in
response to a crisis. How do we determine if the agencies will
be able to work together? Yes, just go ahead.
Mr. Hennigan. Thank you, Mr. Chairman. I can speak from
experience in Montgomery County when we had Ike occur. We first
had Rita hit the Gulf Coast and it was truly total confusion.
And what we found, contra lanes in the freeway to try to
evacuate people on the Gulf Coast, was a disaster. It was done
too late. Communications between EMS, fire stations, police,
sheriff, State police, were inappropriate.
Since that time, prior to Ike, we all went on the same
frequencies. We developed a program where contra flow of lanes
was done well in advance versus a 24-hour mandate, get out of
town. So I think a lot of it is can the communities, in this
case with the VA, can the community officials communicate to
the VAs and vice-versa on the same frequencies? Whether it is
radio, whether there is a set plan or one organization that
coordinates all the different entities as we are doing in
Montgomery County right now, can that happen? And when that
happens, it just makes life a lot easier for everybody because
you only have one source to go to and they will do the, they
will delegate the appropriate things to do.
Mr. Mitchell. You know, there is again a myriad of agencies
involved in all of the emergency preparedness. And again, let
me just ask others, how do we determine if these agencies are
able to work together? Sometimes I think there is a
miscommunication of who has what role to play. How can we
Mr. Searle. Well sir, as far as the DoD/VA interaction, one
of the things that we see that is very positive is on a day-to-
day basis now in the attempt to develop the lifetime virtual
records. It has established communications between DoD, VA, and
the public sector, actually, as far as transferring public
information on veterans. The hope of the American Legion is
that that will have started a crack in the dyke, if you will.
There is no question that stove piping exists and it has to be
broken down through the national framework, response framework.
And people have assigned positions, jobs and responsibilities.
For example, the American Legion is not telling VA how to do
that, but it is reasonable that they would be under the ESR 8
as a support function, that they would not be in a lead
function in this case. But there is a framework there for
telling people what they should be doing and feeding into it.
But I think that VA has taken some serious steps in making a
coordination with other entities, be it DoD and civilian
doctors, for example, which will eventually help with the
system. It is not going to solve the whole thing, but at least
it is a starting point.
Mr. Denton. Mr. Chairman, if you do not mind I would like
to say something on this, too. So much of this builds on
exercises, the national level exercises that bring groups
together for tabletop exercises in advance so that we get to
know who the players are and what their capacities are, what it
is they are going to bring to the table and what it is that
they thought we were going to bring. During these exercises, we
discovered, ``No, that is actually something we need to resolve
somewhere else.'' So much of this really happens on a local
You know, I mentioned in my testimony the event we just
held at Fort Belvoir, where we had a military family
preparedness event. At that parking lot there in the PX, all of
the players who would respond to a disaster at Fort Belvoir
were there. It was a bright, sunny day and we were handing out
preparedness kits. But the other thing that was going on was we
were meeting the others in the community who would be
responding to a disaster if something were to happen there.
Having a chance to talk to each other, connect with each other,
and talk a little bit about what our roles and responsibilities
are if something were to happen. The more of these that happen
on a local level, I think, the more success we are going to
Mr. Mitchell. I just was looking at the Federal Response
Plan and the VA has a support role, with four different
agencies that have the primary response. We have a support role
with DoD, there is one with the American Red Cross, there is
one with the General Services Administration (GSA), and also
HHS. And I just want to make sure that everybody understands
their role, in support of a primary role. Thank you. Dr. Roe.
Mr. Roe. Just a brief comment, Mr. Chairman. To start with,
I think in my background as a battalion surgeon in the
military, and as a physician, and we have a hospital, a VA
hospital, a mile from our main hospital, a 500-bed hospital
with a medical school in our community, and Mr. Denton, you are
absolutely right. I have participated as a surgeon in mass
casualties. And they will overwhelm any system. The planning
has to start at your house. In my home, we have a benevolent
dictator, that is my wife. But we have a communications plan in
our own family that we get together. As the Mayor of our city,
just as the Chairman did, we have a book that establishes
command and control. You have to know who is in charge when you
start. When a disaster occurs there has to be someone who is
responsible in a chain of command. Otherwise, it is a disaster.
So we very carefully in our city planned and had many training
exercises on what happens if we have a hazmat spill on the
interstate? What happens if we have a smallpox outbreak? I got
myself re-inoculated to participate in that because I had to go
down to the hospital and provide the health care that we need.
So you are absolutely right. All this nationally is good a
few days later. As I explained to the people at home, we have
150 police officers, we have 60,000 people in this town. You do
the math. We cannot get by your house every day. You are going
to have to make sure you have water, blankets, canned food, and
so on. And we go over that, and we sent a briefing packet out
to every family in our community that this is what you need to
plan for. And we have 110 firemen, and so on. So that is
These services come in later. And obviously what you learn
very quickly in a hospital is, is you do not, you know, your
bunion now is not an emergency. You put that off for 3 years,
you can put it off another 3 years. You stop all elective
procedures and you go strictly to your emergency. And even that
will be overwhelmed very quickly in a mass casualty of over 25
or 30 people. It does not take very many to overwhelm a system.
And I agree with the Chairman, very clearly you need to
know who supports what because this is a very complicated
national system and we found out the failures of it in Katrina.
And I think the local folks in New York City did an incredible
job on 9/11. I was absolutely amazed at how the local police,
fire, and EMS did their job.
A comment, Mr. Denton, on what you said. If you would just,
I will stop right there and let you make a comment, and then I
have one more question, Mr. Chairman.
Mr. Denton. Well, I agree entirely and I would take it one
step further. Once you have a plan for your family, once you
have a plan for your loved ones, think of your neighbors, like
the elderly resident across the street, or that person down the
road who may have some disability that requires some sort of
special attention. Are we thinking about those folks, too?
Because it might be 24, 48 hours before somebody can get down
your street, before one of those Red Cross emergency response
vehicles can come down the street. How folks are prepared to
take care of themselves and their community is the beginning of
this entire discussion.
Mr. Roe. I think you are right. I think you saw that in
Nashville, when folks did take care of their neighbors. That is
a great point, and you do that. I think, Mr. Henry, I mean just
a couple of questions on the waste. The reason I think hospital
systems have done this is that they feel like it can be more
efficiently done somewhere else. If they felt like it would
save them money I think they would do it. And I would like to
see some more data on that for VA because if 24 VAs are doing
that and I guess another 130 are not, then the question is if
it saves money why has VA not done that? I think local
hospitals, where we are typically, turf this out because it
saves them money. They do it for that reason. Not because of a
mass casualty, they do it just for the, I mean, you may deal
with one mass casualty or you may never deal with one.
Mr. Henry. And that is why we looked at the cost estimates
separately. We found that when you install the stuff onsite it
is about a third less cost than shipping it offsite. The
offsite came by accident, as a convenience when the Federal
Government pretty much, vis-a-vis the Environmental Protection
Agency regulations, banned onsite incineration. Most of the
facilities shut down their incinerators as a temporary fix.
They moved to bringing in haulers to take the stuff offsite and
treat it. Over time, that function kind of moved into the
environmental section of the hospital. And it just became more
of a janitorial exercise. And when you are looking at
installing this equipment, this is capital budget costs, and
the evaluation for purchasing capital budget costs are
different. And it is a multiple-year thing. And certainly on
the first-year basis to bring that in, the cost would be higher
to install the capital equipment than that budget line item for
that year to haul it offsite. However, when we are looking, you
know, over a 5-year payback period there is significant savings
for the facilities themselves.
Mr. Roe. I am going to just very briefly, I would, I agree
with that. I mean, but any business would look at not just the
first, if any business looked at capital costs the first year,
nobody would do anything, because nothing ever pays back, or if
you are the luckiest human being in the world, it pays you back
in the first year you have it. So I would like to look at that.
I think you said, I think we need further study on that. If it
saves the VA $190 million, we can look at the pros and cons of
Mr. Henry. Okay, right.
Mr. Roe. I yield back, and thank you.
Mr. Mitchell. Thank you very much. And I thank you for your
service to your communities, and for coming here today and
testifying at this important event. Thank you.
Mr. Hennigan. Mr. Chairman? With your indulgence?
Mr. Mitchell. Sure.
Mr. Hennigan. I was under the impression we would have an
opening statement, and come back and give testimony. I failed
to give you the testimony that I have brought forth to this
Committee. It is in writing, it will certainly be in the
record. But if you could allow me the 3 minutes remaining on
the time that I did not use to give my testimony?
Mr. Mitchell. Yes, go ahead.
Mr. Hennigan. Thank you very much. Mr. Chairman and
Committee Members, in evaluating the request to speak to you
today concerning emergency preparedness of the VA systems along
with the companies I am involved with in both the private and
public sector, I drew from our lessons learned in Montgomery
County, Texas. Those lessons taught us that there are key
topics necessary to address in preparation of such
catastrophes. Those areas include communications, action, and
review of the new programs available.
In our case in the Gulf Coast, hurricane season repeats
itself every year so that preparation becomes a fine tuning
issue versus starting from the unknown. In my review of the VA
Web site, I found it easy to find information and locate
facilities. This is a large part of the successes we have had
in Montgomery County, with the ability to communicate with our
residents and it falls under the communications necessary to
serve the people the VA is charged with caring for. The need
for our veterans to be able to communicate to the VA is
essential and in scrolling through the Web site there are
several toll-free numbers to do this. My question to this
Committee, and I do not know the answer, is are we doing enough
for them communicating using other forms of contact?
In addition, since every area of the country has known
weather disasters--fires, mudslides, earthquakes in the west,
tornadoes in the mid-section of our country, hurricanes and
flooding in the Southeast and Northeast--are there plans in
place through the Veterans Administration that educate our
veterans where to go and what to do to prepare? Since the
Veterans Administration has divided the country into what I now
know as 21 VISNs, would it be beneficial for each zone with
known potential catastrophic issues to communicate to their
constituency what to do, where to go, if such an issue occurs?
Are our facilities prepared in case of a catastrophic event
in each zone? An example, what we did after Rita was to
identify what went wrong, and there was plenty, to determine
how best to resolve those problems. A few problems MCHD
incurred during Rita that were addressed and solutions found:
power outages, no fuel, no refrigeration, evacuation problems.
Again, I believe advance solutions can be found with our
knowledge of weather-related issues in geographic areas in the
The new programs, does the VA integrate new communications
programs to benefit our veterans on an ongoing basis? Is it
working with local officials with this communication? Is there
a method that rewards staff members that create programs to
better serve our veterans? What is the mission of the VA, and
is it communicated with those who have to achieve it? There are
always entrepreneurs who can identify problems and create
solutions. Are we making the opportunities available to them to
introduce themselves and become a supplier to the VA? I was
pleased locally to find out that there was support from the
Veterans Affairs on H.R. 114, in assisting our veterans who
have been inside the ropes, understand the problems, and have
creative solutions. Are we listening to them?
And I will not go through the rest. I know it is on the
record, sir. But I wanted just to take a chance to thank you
again for allowing us to speak before this Committee, and
hopefully come up with some solutions.
Mr. Mitchell. I thank you, and those are very good
questions. Thank you very much.
At this time I would like to welcome Panel Two to the
witness table. For our second panel we will hear from Captain
D.W. Chen, Director of Civil-Military Medicine, U.S. Department
of Defense, who is accompanied by Christy Music, Director of
Health Medical Policy, Office of Homeland Defense and Americas'
Security Affairs, U.S. Department of Defense. Also joining us
is Dr. Kevin Yeskey, Deputy Assistant Secretary and Director
for the Office of Preparedness and Emergency Operations,
Department of Health and Human Services, and Steve Woodard,
Director of Operations Division, Response Directorate, Federal
Emergency Management Agency, U.S. Department of Homeland
Because of a delay in DoD finding a witness that could
speak to their role amongst other Federal agencies in emergency
planning, they will not be giving an opening statement but will
be available for questions.
I would now like to recognize Dr. Yeskey for the Department
of Health and Human Services.
STATEMENTS OF KEVIN YESKEY, M.D., DIRECTOR, OFFICE OF
PREPAREDNESS AND EMERGENCY OPERATIONS, DEPUTY ASSISTANT
SECRETARY, OFFICE OF PREPAREDNESS AND EMERGENCY RESPONSE, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES; STEVEN C. WOODARD,
DIRECTOR OF OPERATIONS DIVISION, RESPONSE DIRECTORATE, FEDERAL
EMERGENCY MANAGEMENT AGENCY, U.S. DEPARTMENT OF HOMELAND
SECURITY; CAPTAIN D.W. CHEN, M.D., MPH, USN, DIRECTOR OF CIVIL-
MILITARY MEDICINE, FORCE PROTECTION AND READINESS POLICY AND
PROGRAMS, OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE FOR
HEALTH AFFAIRS, U.S. DEPARTMENT OF DEFENSE; ACCOMPANIED BY
CAPTAIN FRANCESCA C. MUSIC, MS, MT (ASCP) SBB, DIRECTOR OF
HEALTH MEDICAL POLICY, OFFICE OF HOMELAND DEFENSE AND AMERICA'S
SECURITY AFFAIRS, U.S. DEPARTMENT OF DEFENSE
STATEMENT OF KEVIN YESKEY
Dr. Yeskey. Chairman Mitchell and Dr. Roe, I appreciate the
opportunity to testify today on my Department's role in the
National Response Framework, and how we coordinate with the
Department of Veterans Affairs in our response efforts.
HHS supports DHS as the overall lead in the coordination of
incident response. The HHS Secretary leads all Federal public
health and medical response to emergencies and incidents
covered under Emergency Support Function 8 of the National
Response Framework. Within HHS, ASPR, the Assistant Secretary
for Preparedness and Response, coordinates the national ESF 8
preparedness and response actions, including medical care,
public health surveillance, patient movement, and fatalities
management. In carrying out this responsibility, we depend on
support from our interagency partners, including the Department
of Veterans Affairs.
There is a longstanding tradition of collaboration between
HHS and VA staff in emergency preparedness activities,
beginning with extensive collaboration on the creation and
management of the National Disaster Medical System. HHS deploys
public health and medical assets to an affected area utilizing
personnel from NDMS. When NDMS Disaster Medical Assistance
Teams that provide acute care for victims need to be augmented
with additional clinicians, we have turned to the VA and they
have provided us with appropriate personnel. Most recently, the
VA provided three surgeons and two anesthesiologists for our
medical teams deployed in response to the earthquake disaster
in Haiti. In the hurricane season of 2008 VA provided personnel
to completely staff two of our Federal medical stations.
HHS, Department of Defense, and VA all have key functions
in moving patients through the management of Federal
Coordinating Centers (FCC), which recruit hospitals to
participate in the NDMS and coordinate in the receipt of
evacuated patients in host cities. FCCs are critical to both
patient movement and definitive care for those evacuated in a
public health emergency. During the 2008 hurricane season VA-
managed FCCs coordinated the receipt of medically evacuated
patients in Arkansas and Oklahoma. When NDMS was activated for
the Haiti earthquake, VA personnel coordinated the receipt and
distribution of patients evacuated to Florida and Georgia to
receive life-saving definitive care.
HHS has developed playbooks for 14 of the 15 national
planning scenarios as a guide to our response to disasters such
as earthquakes and hurricanes. The VA provides significant
input into these playbooks as they are developed and revised.
At the request of the VA, HHS has placed a full-time liaison in
the VA's Office of Public Health and Environmental Hazards to
provide continuity of communications between the two
Departments in the area of preparedness and response.
Similarly, the VA provides liaison officers to the HHS
operations center when HHS responds to events. Finally, HHS and
VA participate in joint training exercises at a variety of
levels. Our regional emergency coordinators and VA area
emergency managers participate in exercises at the State and
local levels. VA staff participate in tabletop exercises at the
HHS headquarters level, and VA and HHS jointly participate in
national level exercises. VA staff also participate in our
annual ESF 8 Integrated Training Summit.
In conclusion, HHS regards the VA as an integral partner in
our preparedness and response activities. The VA has provided
expertise in the development of our preparedness plans and
clinical support needed for crucial medical care required by
victims of disasters. HHS's partnership with the VA is strong
and extremely cooperative. It is one that enables both
Departments to serve our Nation in times of emergency.
Thank you for the opportunity to testify today, and I will
be happy to answer questions that you may have.
[The prepared statement of Dr. Yeskey appears on p. 43.]
Mr. Mitchell. Mr. Woodard.
STATEMENT OF STEVEN C. WOODARD
Mr. Woodard. Yes, good morning, sir. Chairman Mitchell, and
Ranking Member Roe, and other Members of the Subcommittee, I am
Steve Woodard, Director of Response Operations within the
Response Directorate at the Federal Emergency Management
Agency. And we would look forward to our continuing work with
Congress to ensure that our Nation is prepared for all
As you all know, incidents begin and end locally, and most
are wholly managed at the local level. Cognizant of this, we
must manage these events at the lowest possible jurisdiction,
supported by additional capabilities when needed. State and
local governments are closest to those impacted by incidents,
and have always had the lead in response and recovery. During
response, States play a key role coordinating resources and
capabilities throughout the State, and in obtaining resources
and capabilities from other States. Many incidents require a
unified response from local agencies, nongovernmental
organizations, and the private sector, and some require
additional involvement from neighboring jurisdictions or the
A small number require Federal support. To be most
effective, disaster response must be quickly scalable,
flexible, and adaptable. To meet the challenge of that
uncertainty, we have developed the National Response Framework
with our Federal partners. The Framework is a guide for how the
Federal, State, local and tribal governments, along with
nongovernmental and private sector entities, will collectively
respond to and recover from all disasters, particularly
catastrophic disasters, regardless of their cause. The
Framework recognizes the need for collaboration among the many
entities and personnel involved in response efforts at all
levels of government, nonprofit organizations, and the private
The Department of Veterans Affairs, the second largest
Federal department, is one of the many agencies supporting the
Framework. VA is a supporting agency for public works and
engineering, emergency management, mass care, logistics, public
health, and medical services. VA can provide available
resources requested directly by FEMA, or by the primary
agencies in charge of the emergency support functions, most
frequently from Dr. Yeskey and the Department of Health and
Human Services, the primary agency for Emergency Support
During disasters, VA can assist the Secretary of HHS by
coordinating available hospital beds, and providing additional
personnel, supplies, technical assistance. VA also provides
technical assistance to FEMA in support of the housing task
forces established in response to a disaster. VA has also
provided staffing assistance to call centers.
Our Nation must be prepared to meet all challenges. I want
to assure you that we are committed to further improving the
Nation's response capabilities and to strengthening the
coordination with the interagency at all levels of government.
FEMA recognizes that disaster events, regardless of magnitude,
can be devastating to the people and communities affected. We
appreciate the support and look forward to our continued
partnership with VA, and thank you for the opportunity to
testify, and look forward to any questions the Subcommittee may
[The prepared statement of Mr. Woodard appears on p. 44.]
Mr. Mitchell. Thank you, Mr. Woodard. I would like to ask a
couple questions of Captain Chen. Captain, could you please
explain to us a situation where the VA would support you in the
VA's Fourth Mission, and walk us through the process?
STATEMENT OF CAPTAIN D.W. CHEN, M.D., MPH, USN
Captain Chen. Mr. Chairman and distinguished Members of the
Committee, I would also like to thank you very much for
inviting us to participate in this panel this morning.
In response to your question, the VA and the DoD have a
long history of working together collaboratively on emergency
preparedness and response. One of the areas that is a key area
that we work with them day-to-day is wartime casualty care. By
statute from Congress, a Memorandum of Understanding (MOU) or
interagency agreement was signed in 2006 between the Department
of Veterans Affairs and DoD whereby the Department of Veterans
Affairs sets aside beds and care for a potential surge in
combat casualties. And as part of that MOU, the VA and DoD work
together on Patient Receiving Centers, PRCs. These are PRCs at
VA Medical Centers where there are training and teams available
in the event of patient receipt and regulation and transport to
VA Medical Centers. And a lot of work is put into developing
these PRCs and tracking systems through USTRANSCOM to make sure
that potential patients are assigned to appropriate hospitals
in the VA system. Part of the spinoff of that is that
collaborative work also has benefit in terms of our continuing
work with the VA in terms of domestic national preparedness and
in supporting our Federal partners and leads, such as HHS and
We also have a national disaster medical assistance
participation through DoD where the DoD and the VA work
together with HHS, both in patient transport using our
transport capabilities. And also DoD hospitals and VA Medical
Centers serve as FCCs, as Dr. Yeskey mentioned, Federal
Coordinating Centers. And we work very closely together with
community hospitals in recruiting them to set aside beds in
private hospitals in the event of, one, wartime casualty surge,
and number two, national emergencies.
Mr. Mitchell. Excuse me, Captain Chen. Let me just go back
a second. There is the Stafford Act. And let me just read part
of this. The Robert T. Stafford Disaster Relief and Emergency
Assistance Act is the principal legislation governing the
Federal response to disasters within the United States. And you
are talking about wartime casualties. What I am asking you is,
how often do the VA and DoD coordinate for this Fourth Mission
of the VA, which is to coordinate and be a support to DoD? Is
there any coordination at all in this Fourth Mission? And
second, could you give me the last time when DoD called upon
the VA to activate this Fourth Mission?
Captain Chen. The Fourth Mission is something that both the
DoD and the VA, as support agencies to the National Response
Framework and ESF 8, when requests for assistance are actually
tendered to the Department of Defense, we support the States
and localities and our Federal partners and HHS in providing
assets and capabilities if they are available at that time. DoD
and VA work very, very closely on the domestic national
preparedness activities vis-a-vis our work through the National
Disaster Medical System and through the wartime casualty care
because work on those things actually is relevant and has
benefit back to the Fourth Mission that you mentioned.
Mr. Mitchell. I understand about the wartime again. But I
am asking about the natural disasters, where DoD is part of the
response team, and they are, the Fourth Mission of the VA is to
work in support with DoD. And I am asking again, how often do
you coordinate with the VA? And when was the last time that the
DoD called upon the VA to activate this?
Captain Music. I would like to take that, if you do not
mind, Chairman Mitchell. For natural disaster response through
the National Response Framework, where HHS is the lead of
Emergency Support Function 8, Public Health and Medical
Response, we and the VA are supporting Departments as you are
well aware. We work almost daily with Health and Human
Services, DHS, and the VA, the other three partners of the
National Disaster Medical System. Through the National Disaster
Medical System, directorate staff as well as their senior
policy group, as well as the Emergency Support Function 8
Senior Leader Council for Patient Movement, wherein we discuss
the role of patient movement, as well as definitive care, the
transport of the civilian populations that we aeromedically
transport from a military airfield or civilian airfield to a
point of debarkation, another airport. And we, in conjunction
with the Veterans Affairs Federal Coordinating Centers, arrange
for ambulance or other medical transport of those patients into
civilian National Disaster Medical System hospitals, of which
there are about 1,800, that we have under memorandum of
agreement, along with the VA, for medical treatment as
So to answer your question more specifically, we coordinate
with them daily, certainly two to three times a week.
Mr. Mitchell. With the VA?
Captain Music. Yes.
Mr. Mitchell. Thank you. My time has expired. Dr. Roe.
Mr. Roe. Thank you, Mr. Chairman, and to Mr. Woodard's
response, is that you are right. If you are in a local natural
disaster, look out the window, and FEMA is not going to be
there. The local troops are going to be there, and you are
going to have to take care of yourself. Once again, I think one
of the things that we saw was we had planned exactly 30 years
ago for one of the biggest emergencies that I have seen to move
a hospital, to move everyone in a hospital, when you have to
evacuate. That is one of the biggest disasters that can occur
on a local level. And we took months planning to move a
hospital, people on ventilators, and critically ill people, and
so forth. And we are going to do it again in our community in
about 2 weeks. So that planning is going on now. When you have
to do that in an emergency basis, I guess the question I have,
do all the VAs across the country, the 154 hospitals, have a
plan where if you had to do an emergency evacuation, can they
do that? Are there plans in place to do that?
Dr. Yeskey. Yes, I mean I think we have to let the VA
answer the question about the specific hospitals. We agree with
you that moving patients is extraordinarily difficult to do,
particularly the critical care patients. When we do have to do
that, if those hospitals are in harm's way and they cannot
shelter in place and safely take care of those patients, we
have worked on exercises and plans at the local level to
support the State and locals in that process utilizing Federal
resources. We have used NDMS personnel to do that. DoD has
provided the critical care transport with the medical personnel
on their aircraft, and then VA supports the receipt of those
patients in the host cities by being able to arrange the ground
transportation and distribution of those patients to the host
Mr. Roe. I know we had, I know before Katrina there was a
tabletop exercise on that. And did we act on any of that? Dr.
Yeskey, you may not know. But I know there was a tabletop
exercise about a year ahead. Was there anything done? Because
it certainly looked like it was not, or nothing was acted on.
Of course, that was a disaster that just overwhelmed all of the
local and State agencies.
Dr. Yeskey. Yes, sir. A couple of things have been done in
response to some of those lessons learned from Katrina. One is
in preparation for the 2006 hurricane season, we went to
Louisiana, then over the subsequent years went to the Gulf
Coast States, and then to hurricane prone States, to look at
hospitals' and nursing homes' capabilities of sheltering in
place versus evacuation. And we looked at those capabilities
and determined in a number of areas that they had the
capability to shelter in place, or the localities through
mutual aid, Emergency Management Assistance Compact (EMAC), had
the ability to do that through agreements among hospitals and
State planning. We also noted that in some cases States did
not, and localities did not, have the ground transportation
capability to do that. So FEMA and HHS worked together on
developing a first regional ambulance contract, then a national
ambulance contract, that provided ambulances, air ambulances,
and paratransit seats for people who did not quite need an
ambulance but could not go by regular conveyance. We set that
up. That contract has been utilized several times in the past
couple of seasons very successfully. That is a very tangible
effect of joint planning and working with the States and locals
on assessing their needs and trying to determine a way forward
Mr. Roe. I think Katrina was certainly a template and if we
study that, probably those lessons learned during Katrina have
prevented things in the future. I know certainly in Tennessee
with our floods in Nashville, and Clarksville where I am from,
it worked very well. It was obviously a loss of life,
unfortunate, but less than it would have been, I think. And I
think those agencies all worked very well. I am not even sure
that the national agencies even got involved until later in the
Mr. Chairman, I have no further questions. I yield back.
Mr. Mitchell. I would like to ask a question of Dr. Yeskey.
In the event of a national emergency or a terrorist attack, how
many beds are available currently? And in addition to this,
does HHS in conjunction with the primary and support agencies
have enough stockpiled items to carry out its mission?
Dr. Yeskey. Sir, I will try and answer the first question
at least completely. I may have to get back to you for the
second question because that somewhat varies on scenario. We,
through our hospital preparedness program--it is a cooperative
agreement program managed at HHS that provides States with
funding to develop hospital preparedness--we have developed a
system called HAvBED. It is Hospital Available Beds in
Emergencies and Disasters. Every State implements that and they
have reporting requirements that within a couple of hours they
need to report back the status of the hospital beds that would
be available. In any event, and also in the National Disaster
Medical System, those participating hospitals are required to
provide bed counts for us and we test that quarterly for bed
So in the event of a national emergency like that, we would
go ahead and we would start HAvBED bed counts and we would also
look at the NDMS bed counts as well. In addition, we work with
the American Burn Association to look at burn centers to see
where those beds are available. Those numbers fluctuate on a
daily basis. I cannot give you an exact number on how many beds
we have, but those are the processes by which we would
determine what beds are available. Then we would work on how,
with DoD and VA through the Federal Coordinating Centers, how
we would distribute those patients to hospitals that were able
to accept them.
Mr. Mitchell. And one last question. Can HHS tell us right
now whether any of the medications in the pharmaceutical
stockpile is expired?
Dr. Yeskey. That, I will have to get back to you with a
formal answer on that. But we try and make sure that as many of
the medications that we have in the stockpile, that we can
rotate through their shelf life, we do. But I can get back to
you with a formal answer on that, sir.
[Dr. Yeskey subsequently provided the following
Within HHS, the Strategic National Stockpile (SNS) is managed
by the Centers for Disease Control and Prevention (CDC). The
SNS is a repository of antibiotics, chemical antidotes,
antitoxins, vaccines, antiviral drugs and other life-saving
medical materiel. The SNS mission is to deliver critical
medical assets to the scene of a national emergency. During a
public health emergency, State and local public health systems
may be overwhelmed. The SNS is designed to supplement and re-
supply State and local public health agencies within the United
States or its territories in the event of an emergency.
Medical countermeasures held in the SNS expire on a routine
basis. However, the SNS is managed to maintain minimum levels
of each product in viable, ready to use condition. Depending on
several cost and inventory management factors, expiring medical
countermeasures may be tested for shelf life extension,
disposed of and replaced with new product, or disposed of
without replacement. These actions are undertaken by CDC to
maintain the Federal capability to support State and local
response while seeking maximum value for the funds appropriated
to the SNS.
Mr. Mitchell. Thank you all very much for your service, and
thank you for your testimony.
At this time I would like to welcome Panel Three to the
witness table. Joining us on our third panel is the Honorable
Jose Riojas, the Assistant Secretary of Operations, Security,
and Preparedness, U.S. Department of Veterans Affairs. He is
accompanied by Kevin Hanretta, Deputy Assistant Secretary for
Emergency Management, Office of Operations, Security, and
Preparedness; and Dr. Gregg Parker, Chief Medical Officer for
the South Central VA Healthcare System, VISN 16.
Mr. Riojas, you have 5 minutes if you would. And I will let
you know that your testimony is part of the record. Thank you.
STATEMENT OF HON. JOSE D. RIOJAS, ASSISTANT SECRETARY FOR
OPERATIONS, SECURITY, AND PREPAREDNESS, U.S. DEPARTMENT OF
VETERANS AFFAIRS; ACCOMPANIED BY KEVIN T. HANRETTA, DEPUTY
ASSISTANT SECRETARY FOR EMERGENCY MANAGEMENT, OFFICE OF
OPERATIONS, SECURITY, AND PREPAREDNESS, U.S. DEPARTMENT OF
VETERANS AFFAIRS; AND GREGG SCOTT PARKER, M.D., CHIEF MEDICAL
OFFICER, VETERANS INTEGRATED SERVICE NETWORK 16, VETERANS
HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Riojas. Thank you, Mr. Chairman. Mr. Chairman, Ranking
Member Dr. Roe, we appreciate the opportunity to appear before
you today and provide an overview of the Department of Veterans
Affairs state of preparedness in carrying out our Fourth
Mission, that being to provide service to the Nation when
needed while continuing to maximize service to our Nation's
I am accompanied today by two outstanding professionals,
Mr. Kevin Hanretta, Deputy Assistant Secretary for Emergency
Management; and Dr. Gregg Parker, who is our Chief Medical
Officer for our South Central Veterans Integrated Service
Network, VISN 16, whose geographical area of responsibility
includes New Orleans, Louisiana. Both officials served in VA
during Hurricane Katrina, Mr. Hanretta at the headquarters
level and Dr. Parker on the ground in New Orleans. They are key
leaders today that bring a perspective of experience, lessons
learned, and improvements that have occurred within the
Mr. Chairman, you and this Committee have a history of
supporting VA and we appreciate that support. I have dedicated
my adult life to preparedness. In my experience there are three
critical elements to a good preparedness program: people,
plans, and practice. We are fortunate in VA today to have all
three. Dedicated people, ranging from our Secretary of Veterans
Affairs who takes preparedness extremely seriously and
participates in our training exercises personally, to our
youngest volunteers, newest volunteers, who have placed
themselves in our volunteer program in the event of an
emergency. We have robust plans that cover intra-VA
organizations and are interlinked with those of our sister and
brother agencies across our government. And we have practical
experience as well as exercises. Practical experience through
our support during Katrina, Hurricanes Gustav, Ike, and more
recently support that was mentioned in Panel Two, during relief
operations for Haiti. We do not practice in isolation and we
ensure that both our plans and our execution are done in a
crosscutting manner with other stakeholders involved.
We will continue to assess and improve our preparedness
efforts, but I am confident that we are prepared now to respond
to our Nation's call as needed during this hurricane season or
in response to any other national emergency. Again, thank you
for your support, time, and interest in this very important
topic, and for providing the best for our Nation's veterans,
who deserve nothing less. I look forward to your questions.
[The prepared statement of Mr. Riojas appears on p. 48.]
Mr. Mitchell. Thank you. I have just a couple of quick
questions. First, how would you rate the management of the
pharmaceutical stockpile that the VA has?
Mr. Riojas. Mr. Chairman, with your permission, I would
like to offer a couple of different layers of response to these
Mr. Mitchell. Sure.
Mr. Riojas. Because we have experts that can tell you from
a practical than kind of a top level assessment, give you on
the ground assessment. And then I can offer a Department-level
Mr. Mitchell. Sure.
Mr. Riojas. Dr. Parker.
Dr. Parker. Good morning, Mr. Chairman, and thank you for
the opportunity. I have a 25-year history as a naval officer,
and during the course of that I had the responsibility for war
planning and disaster planning in Southeast Asia. So I can
contrast and compare the DoD system as well as the VA system.
I am pleased to say that I have not seen better management
on the ground and in the field for the disaster medical
management of the caches. They were predeployed in all of our
areas. We have a couple of areas in my region that because of
space and post-Katrina disasters we have not yet replaced the
caches. But we have them pre-staged and co-located with other
facilities so they can be responded in a timely manner.
The drugs are rotated on a periodic basis so that as they
come up for expiration they are used. There are a few classes
of drugs, like Chloride and Atropine, that we do not have a
daily use for. They are strictly for biomedical disasters. And
so they do expire and we replace them. But I would say with all
honesty in having been there that this is an excellent program.
It, I am not sure that it could be better managed. It has been
very well done.
Mr. Mitchell. Very good. And a question maybe as kind of a
followup, in the event of a national emergency or attack, how
many beds does the VA have right now? Not only just the number
that are authorized but the number that are operational?
Mr. Riojas. Mr. Chairman, I would offer that, that is a
dynamic figure. I did not bring one with me today. I do not
know if you have a rough order of magnitude. But what we would
do is we assess the probability of them being utilized. We have
a robust dialogue and a line of communications with the VISNs
and with the Medical Center directors to be able to give that
on a short notice basis. I do not have that answer today.
[The VA subsequently provided the following information:]
To provide the Committee/Congressman more insight into the
availability of VA hospital beds, the Department's Veterans Health
Administration (VHA) staff reviewed statistics spanning Fiscal Year
2010 (Oct 2009-Sept 2010).
As detailed in the chart below, during Fiscal Year 2010, VA had
approximately 5,000+ available hospital operating beds that could be
used during an emergency at any given time.
Please reference the notes related to the below table for details
regarding the beds.
The Department of Veterans Affairs anticipates having a real-time
capability to track, manage and report bed capacities when the VHA Bed
Management System is implemented systemwide.
The following chart represents the average beds among all VA
Medical Centers. We're providing totals for all of FY10 to give you an
idea of the month-to-month variation.
Time Period (FY-Month) 10- OCT 10- NOV 10- DEC 10- JAN 10- FEB 10- MAR 10- APR 10- MAY 10- JUN 10- JUL 10- AUG 10- SEP
Hospital--Avg Operating Beds 17,259.6 17,270.5 17,276.9 17,277.6 17,276.8 17,266.4 17,260.9 17,257.3 17,258.1 17,257.8 17,260.6 17,263.4
Hospital--Avg Daily Census (ADC) 11,942.4 11,689.6 11,522.0 11,592.7 11,630.9 11,677.7 11,650.6 11,616.6 11,595.4 11,756.0 11,972.2 12,195.2
Hospital--Avg Daily Available 5,317.2 5,580.9 5,754.9 5,684.9 5,645.9 5,588.7 5,610.3 5,640.7 5,662.7 5,501.8 5,288.4 5,068.2
Methodology: The average monthly hospital ADC subtracted from the average monthly hospital operating beds will result in the estimated average available
beds by month.
(1) ADC = Average Daily Occupied Beds (Census).
(2) Hospital Beds include only the following bed services: Blind Rehabilitation, Intermediate Medicine, Internal Medicine, Neurology, Psychiatry, Rehab
Medicine, Spinal Cord Injury and Surgery.
VHA anticipates having a real-time capability to track, manage and
report bed capacities when the Bed Management System is implemented
Mr. Mitchell. Fine. And a question about your budget, which
maybe you do not want to answer this. But is your budget
sufficient? And secondly, what would you do with another $20
Mr. Riojas. Mr. Chairman, we are able to execute the plans
that we have in place right now with the resources that we have
been given. Should we be given more money I would sit down with
our, we have an integrated process team that is looking at our
initiative and how we are expanding several of our
capabilities. And I would offer that opportunity to the team as
a whole, because it is a blend of people, technology. It could
be something along the lines of training or exercises. And
today I would not exactly know where to put that without
dialogue with the entire team. I have the personal assessment
that it would probably go in the realm of technology but I
would like to confer with all of those stakeholders across the
Department before I put a requirement on the table.
Mr. Mitchell. And the last question, I assume that the VA
has an emergency response plan. And if you do, when was it
updated? And how often do you update it?
Mr. Riojas. I will let you----
Mr. Hanretta. Mr. Chairman, we review it, the last formal
plan that was signed was signed by Secretary Nicholson in 2005.
We review it, update it every year. And we follow it. The
biggest revision, of course, came with the National Response
Plan being revised to the National Response Framework, where VA
now has responsibility to support seven of those fifteen
emergency support functions. And so we continue to update our
plans. And with the Office of Operations, Security, and
Preparedness we are able to do that and focus on a daily basis.
Mr. Mitchell. And one last thing. In the first panel, Mr.
Henry talked about, and Mr. Roe even mentioned it again, about
infectious waste. And I would assume that you would be looking
at this, if it is a cost savings, and take a look at what was
presented from the first panel. And Mr. Henry had also talked
about weather related emergencies. And we all know that there
is a hurricane season, and tornado, and flood season. And I
assume you do not wait for these to happen. You know, I live in
an area where we do not have, knock on wood, many of these
natural disasters in the Phoenix area. But there are some that
continually have them, year after year. And I would hope that
these are well on the radar for your response?
Mr. Riojas. Mr. Chairman, absolutely. We try to predict as
much as we can, that is a function of our Integrated Operations
Center, to take a look at the seasons. And there are cycles,
obviously. There are several wildfires that we have been
tracking in Arizona right now. So on a daily basis we track not
only their distance from our own facilities but the impact on
the veteran populations in those areas. So we do take a very
deep look at natural occurrences, be they hurricanes,
tornadoes, wildfires, or even earthquakes, and take a serious
look at how we can preposition and be prepared to serve
veterans, or if needed beyond, in those areas.
Mr. Mitchell. And if Dr. Roe would just indulge me just a
second, I want to talk to Dr. Parker. Since you are the one
that is on the ground, what was the VA's involvement with
Dr. Parker. If I might make it a little more personal, I
grew up on the Mississippi Gulf Coast and my parents lived in
Gulfport at the time. My father has since died, but my mother
lives there now. On a personal level I insisted on being there
because they were not able to evacuate, or would not evacuate.
So I was in the storm, in Katrina, rode it out. And as part of
the VA as soon as we got them settled, I immediately went back
up to the regional office and then we deployed many personnel.
And I believe it was 1,200 VA personnel into the field, into
the South Louisiana, South Mississippi area. I oversaw the
deployment of 13 mobile medical clinics over a period of at
least 6 to 8 weeks, some of which actually operated on a near
permanent basis in Southeast Louisiana while those clinics were
then stood up, if you will, under the Capital Asset Realignment
for Enhanced Services (CARES) System. We opened up additional
community outpatient clinics at some of those sites, in
Hammond, Louisiana, in particular.
So the VA was very, very involved. When we went to the
field we were going to support veterans. But with the mobile
medical clinics, and having grown up there and lived there, and
also deployed into other areas across the world, I knew that we
were not going to be able to go and support just veterans. And
as part of the response plan we supported anybody who came into
the clinic. And as some of you are aware, I believe during that
6- to 8-week period we saw about 15,000 patients in those
clinics. About 11,000 of those were not veterans. Most of the
care that we provided were pharmaceuticals and immediate
So in summary, a robust response on the part of the VA,
well coordinated, well coordinated with the local activities.
Every clinic that we put in place was coordinated with either
the local Mayor or the community leaders.
Mr. Mitchell. One last question about that, what is the
status of the VA hospital now? I understand that it really had
a lot of damage during Katrina.
Dr. Parker. There were two hospitals that suffered
significant damage during Katrina. There was the second
facility in the Gulfport-Biloxi area, the one on the beachfront
was essentially wiped out. And the New Orleans Hospital, which
is in Downtown New Orleans, it remains closed. There is, are
two major construction projects at each of those locations. In
fact, groundbreaking will take place Friday for the new New
Orleans Hospital, the replacement hospital. And construction is
underway at the moment where the Gulfport campus was
consolidated to the Biloxi campus, and all of the beds that
were lost in the Biloxi-Gulfport area are being reconstructed
on one campus. That was part of the CARES plan before Katrina
and it was accelerated post-Katrina.
Mr. Mitchell. Thank you. Dr. Roe.
Mr. Roe. First of all, thank you all in general for your
service to our country, and Dr. Parker, and all of you for
service as veterans and then as public servants now. So thank
you for that. And I know Dr. Parker, I understand by reading
your bio, you are a VISN Director also?
Dr. Parker. VISN Chief Medical Officer.
Mr. Roe. Chief Medical Officer?
Dr. Parker. There is somebody that bosses me around, too.
Mr. Roe. Probably, and in my case more than one. At your
end, when the OIG issued his report in 2006 on the VA and
Katrina, there is specific training that is supposed to take
place. Is that documented in each, so that is done every year?
Because I know sometimes you get so busy in patient care you
put off the plans for doing something else. You are working
Dr. Parker. Dr. Roe, I appreciate the question and I share
some of the concerns that the American Legion expressed. Let me
say within our region, post-Katrina and to this day, all of the
senior leadership and mid-level management leaders in the
facilities have undergone incident command system training.
They are well versed in it. We hold at least annual training.
The most recent training that we held was in, the week of March
25-26, the coordinated VISN 8, 7, 17, and 16 where we trained
people in Atlanta. I can assure you that within our region the
training is ongoing. The formal training is scheduled, the
informal training is on a daily basis. Each of the facilities
has emergency managers. We at the VISN have one full-time
person managing the emergency preparedness.
Mr. Roe. Now, just a comment, one of the things we have to
do as a Nation, and we are seeing it again expose itself in the
Gulf, is that people in this country are losing faith in the
ability of those of us who are in these positions to be able to
handle an emergency. And I think obviously when it goes well,
nobody notices as much. When it goes poorly, everybody notices,
it is on TV 24 hours a day. But Katrina could have been done
much better. I think we could say the Gulf could have been done
much better, and we will learn from that experience in the
But I think to be able now, because I know that in my own
practice the last thing you did was plan for another train
wreck. You were having it hard enough just doing your job
everyday. But I think there has to be time put aside, and the
VA is a huge, 300,000 employees, and I do believe Secretary
Shinseki is very sincere. I have spoken to him about doing
this. But there has to be time put aside, even though the
employees want to get down and take care of patients, and see
people, and they have more demands on them than they have time,
I think this is extremely important to be sure we are
documenting this across the VA system. That is a system we do
have some control over and we will make it work well. And I do
think there have been tremendous improvements. I know locally
at our own VA certainly there have been since 9/11.
And Mr. Chairman, I yield back.
Mr. Mitchell. Thank you, Dr. Roe. Well, you know, the issue
that we have been talking about will require some appropriate
followup. And I ask for all agencies to work with the VA so
that we can better serve our Nation's homeland security
interests. And did you have one other thing?
Mr. Roe. Mr. Chairman, just one brief question. I am sorry.
But during Katrina, and this probably has been addressed, but
patients were moved all over the country, and have done very
well. But we did not notify their next of kin. They did not
know where they were. Have we resolved that problem? Because,
you know, that is your biggest fear. You know? When someone in
your family is gone somewhere, it is the unknown. They may be
fine, but if you do
not know that they are not fine, your mind will tell you a lot
Mr. Hanretta. Dr. Roe, may I address that? You are
absolutely right. During Katrina, because of the magnitude of
the disaster, we were not able to do all of the identification
and notification necessary. Since Hurricane Katrina, HHS, under
HHS' leadership under the National Disaster Medical System, has
really focused on patient tracking. They have come up with a
system, the Joint Patient Assessment and Tracking System, that
is being used, and the most recent example was during the Haiti
earthquake evacuation. VA was activated, set up the Federal
Coordinating Centers in Tampa, Florida and then in Atlanta,
Georgia. And HHS used the patient tracking system during that
evacuation. And we did track over 100 patients successfully.
And so we think in place now is the system that can handle the
Mr. Roe. Thank you. And Mr. Chairman, I do want to thank
each of them, and all the folks that have testified today. I
believe we are better prepared. But you have to continually do
that. And that is the, I mean I know we are better prepared
than we were for 9/11. We certainly are in our local community
and in our State. It showed during this last disaster down in
Nashville. But it is an ongoing mission. Because you can never
prepare for all the contingencies. I can promise you, you think
you thought of them, you have not.
But I want to thank you all for being here today. Mr.
Chairman, I want to thank you for holding this meeting.
Mr. Mitchell. Thank you. And again, I would reiterate what
Dr. Roe says. Thank you all for your service, and your
continuing service. And as a result of that, this hearing is
[Whereupon, at 11:29 a.m., the Subcommittee was adjourned.]
A P P E N D I X
Prepared Statement of Hon. Harry E. Mitchell,
Chairman, Subcommittee on Oversight and Investigations
Thank you to everyone for attending today's Oversight and
Investigations Subcommittee hearing entitled, Emergency Preparedness:
Evaluating the U.S. Department of Veterans Affairs' Fourth Mission.
On September 11, 2001, we witnessed one of the greatest tragedies
in American history. Still today, we all remember the horrific scenes
of these terrorist attacks. Four years later, in 2005, the Gulf Coast
was hit by one of the biggest natural disasters the region has ever
seen, as Hurricane Katrina swept through the region, killing thousands
and leaving many homeless and displaced. And sadly again, today, we see
Gulf States struggling with yet another major disaster, as the oil
continues to spill. These types of events highlight the critical need
for Federal agencies to proactively prepare to effectively execute
their Federal obligations, especially when called upon during
Today, we will evaluate and examine the U.S. Department of Veterans
Affairs emergency management, preparedness, security, and law
enforcement activities to ensure the Department can perform the mission
essential functions under all circumstances across the spectrum of
threats, including natural disasters. With several health care
facilities, and hundreds of doctors and health care professionals, the
VA's emergency preparedness posture, also known as the Fourth Mission,
must be able to respond when needed and when called upon.
The Federal Response Plan (FRP) is an important mechanism for
providing coordination of Federal assistance and resources to areas
that have been overwhelmed by disaster and emergency situations, while
supporting the implementation of the Robert Stafford Disaster Relief
and Emergency Assistance Act. The VA's Office of Operations, Security
and Preparedness (OSP) is responsible for directing and providing
oversight for the Department's planning, response and security programs
in support of the FRP.
I am looking forward to hearing from the VA their emergency
preparedness plans and how they coordinate and communicate with other
agencies such as FEMA and HHS, who are here today, to carry out their
Every day, we are reminded of the potential threats that are out
there that may disrupt the American way of life and the freedoms we
enjoy each day. The VA must be prepared to respond to these threats and
offer their full support and resources to ensure that their role in the
Federal Response Plan is integrated with other agencies to execute its
Prepared Statement of Hon. David P. Roe, Ranking Republican Member,
Subcommittee on Oversight and Investigations
Thank you, Mr. Chairman, for holding this hearing.
Early this decade, our country faced two major incidents that
reinforced the need for emergency preparedness. On September 11, 2001,
our country was attacked in a blatant act of terrorism, as the World
Trade Centers in New York fell, and the Pentagon burned. First
responders were called to action, and a Nation mourned. Again in 2005,
Hurricane Katrina struck the Gulf Coast with an unprecedented fury.
People's homes were flooded or ripped apart, and major evacuations
occurred. The Gulf Coast is still rebuilding today.
Since the attacks of 9/11, the Committee on Veterans' Affairs has
held four hearings on the subject of emergency preparedness. The last
hearing was held on August 26, 2004. Today, we will reexamine the role
performed by the Department of Veterans Affairs (VA) in emergency
preparedness and its response to national crises and whether that role
continues to need serious updating and reform. In particular, we will
focus on the VA's role during wartime, natural disasters, or major
terrorist attacks on U.S. soil.
While the Federal Emergency Management Administration (FEMA) and
the Department of Health and Human Services (HHS) tend to take the lead
role when an emergency occurs, one cannot deny the large importance of
emergency preparedness at the VA. With 153 hospitals, and hundreds of
outpatient clinics spread across the country, VA stands in a unique
position to provide emergency medical assistance in the event of an
VA has defined roles currently in both the National Disaster
Medical System and the National Response Framework (NRF) in the event
of national emergencies. Among the specialized duties of the VA are
conducting and evaluating disaster and terrorist attack simulation
exercises, managing the Nation's stockpile of pharmaceuticals for
biological and chemical toxins, maintaining a rapid response team for
radiological events, and training public and private National Disaster
Medical System (NDMS) medical center personnel in responding to
biological, chemical or radiological events. Among the Emergency
Support Functions (ESF) assigned to the VA, which relate directly to
the mission of the VA, are ESF #6, which includes mass care, emergency
assistance, housing, and human services; and ESF #8, which includes
public health and medical services. I am interested in discovering
today what VA has learned from the events of 9/11, Katrina and
Hurricane Isabel, and how their role relates to the overall emergency
Following Hurricane Katrina in September 2005, the Speaker of the
House called together a Select Bipartisan Committee to Investigate the
Preparation for and Response to Hurricane Katrina. The report, A
Failure of Initiative, was issued on February 15, 2006. I understand
that Ranking Member Buyer had been selected as part of the Committee
that worked on the report, and one of our own Subcommittee staff, Mr.
Wu, had been detailed to work on the Bipartisan Investigative
Committee. I expect that we will hear from the Department that
improvements have been made following this report, as well as on the
recommendations made by the report from the Office of Inspector General
issued in January 2006. I am also curious as to what VA's commitment is
to emergency management in both dollars and manpower.
Again, Mr. Chairman, I appreciate you holding this important
hearing. It is my hope that this will be a good news hearing, and that
the VA is much better prepared to handle emergencies that come up in
the future. I yield back my time.
Prepared Statement of John N. Hennigan,
President and Chief Executive Officer, bt Marketing, The Woodlands, TX
Opening Statement to Committee:
Chairman Mitchell and Members of the Committee, I would like to
thank you for the opportunity to come to you today as a citizen who's
been involved with not just the medical industry here and abroad, but
as an elected official in Montgomery County, Texas.
I have been fortunate enough to travel extensively throughout South
America, Europe and here in the States in the health care arena. I have
witnessed firsthand differences between government facilities and those
in the private sector, and can state without question the improvements
I've seen in our VA facilities. A perfect example is the Michael E.
DeBakey VA Medical Center in Houston, Texas. Prior to this health care
system being built, in my opinion, our facilities were old and less
then adequate for the veterans in our area.
Before going into my testimony I would like to give this Committee
a brief background of myself for you to have a better understanding of
why I feel privileged to be able to speak to future needs of our
veterans and to offer a fresh pair of eyes to the emergency
preparedness and planning within the VA Department going forward.
I mentioned earlier that I am an elected official in Montgomery
County, Texas. I am a board member of the Montgomery County Hospital
District and have been since 2006. I am currently serving as Vice Chair
of this Board for my third consecutive year and in addition Chair our
The Montgomery County Hospital District is the sole provider of
emergency ambulance service for Montgomery County, Texas. Serving a
rapidly growing population of 460,000, MCHD responds to 42,000 calls
for service each year.
MCHD serves a pivotal role during disaster response. The agency and
its staff have taken a lead role in developing the tools to coordinate
EMS mass response for coastal community evacuation and post-landfall
response. MCHD's dispatch center was the coordination point for the
mass EMS response into East Texas following Hurricane Rita. The lessons
learned from that incident contributed greatly to the statewide success
during Hurricane Ike--the largest EMS deployment in United States
MCHD coordinates public health preparedness and medical branch
operations in Montgomery County during large-scale operations,
including the 2009 H1N1 pandemic. Currently, MCHD is coordinating a
regional effort to develop EMS mass response to no-notice catastrophic
situations as part of the Regional Catastrophic Planning Grant program.
Our Hospital District CEO serves as the Chairman of the Southeast
Texas Regional Advisory Council. This organization is the grant
recipient and administrative entity overseeing hospital preparedness
using funding for the nine counties in the Houston region.
Mr. Chairman, Committee Members, my company has been involved with
several startup organizations or corporations that are attempting to
rise to another level. These companies have asked me to come in and
assess current status, where they have been, and set goals to achieve
where they would like to get. Through this process I have had clients
who have benefited by programs that were well intended but lacked long-
The reason I'm here today is that I believe that I can plant the
seed for new ideas in the hope that this Committee, and our Veterans
Affairs Department, can nurture these ideas to benefit our veterans.
Finally, I want to once again thank you for this opportunity to
testify before this Committee.
Mr. Chairman, Committee Members, in evaluating the request to speak
to you today concerning emergency preparedness of the VA system along
with my company's involvement in both private and public sector, I drew
from our lessons learned in Montgomery County, Texas. Those lessons
taught us that there are key topics necessary to address in preparation
of such catastrophes. Those areas include Communications, Action and
review of New Programs available.
In our case (Gulf Coast) hurricane season repeats itself every year
so that preparation becomes a fine-tuning issue versus starting from
the unknown. In my review of the VA Web site I found it easy to find
information and locate facilities. This is a large part of the success
we've had in Montgomery County with the abilities to communicate with
our residents and it falls under the communications necessary to serve
the people the VA is charged with caring for.
The need for our veterans to be able to communicate to the VA is
essential and in scrolling through the Web site there are several toll-
free numbers to do this. My question to this Committee, and I do not
know the answer, is: Are we doing enough for them in communicating
using other forms of contact?
In addition, since every area of the country has known weather
disasters (fires, mudslides and earthquakes in the west, tornadoes in
the mid-section of our country, hurricanes and flooding in the
Southwest and Northeast, these include 8 zones of the 21 listed:
Questions 7, 8, 15, 16, 17, 19, 21 and 22), are there plans in place
through the Veterans Administration that educate our veterans where to
go and what to do to prepare?
Since the Veterans Administration has divided the country into 21
separate zones would it be beneficial for each zone with known
potential catastrophic issues to communicate to their constituency what
to do and where to go if such an issue occurs?
Are our (VA) facilities prepared in case of a catastrophic event in
What we did after Rita was to identify what went wrong (and there
was plenty) to determine how best to resolve that problem.
A few problems MCHD incurred during Rita that were addressed and
1. Power outage
a. No fuel
b. No refrigeration
c. Not enough generators for those homebound
2. Evacuation of population
a. Freeways and city streets were at a standstill
b. No electricity, no communications (i.e.: phones, television,
Again, I believe advance solutions can be found with our knowledge
of weather-related issues in geographic areas of the United States.
Does the VA integrate new communication programs to benefit our
veterans on an ongoing basis? Is it working with local officials for
Is there a method that rewards staff members when they create a
program to better serve our veterans?
What is the mission of the VA and is it communicated with those who
have to achieve it?
There are always entrepreneurs who can identify problems and create
solutions. Are we making an opportunity available to them to introduce
themselves and become a supplier to the VA? I was pleased to see the VA
supported bill H.R. 114 in assisting our veterans who have been
``inside the ropes,'' understand the problems, and have creative
solutions. Are we listening to them?
Currently, my company has been involved with a program that was
specifically geared for the benefit of the medical needs in Haiti.
There, medical needs include requiring operating rooms that are not
under tents. The company I'm working with is owned by a veteran who
developed and patented a mobile hospital that in fact has the highest
medical standard (Joint Commission Inspected) we live by here in
America. This is a private sector opportunity that could very well be
integrated into the VA system. It's cost effective and mobile in case
of catastrophic events.
My question again is: If I have a company who's created solutions
to problems, imagine how many other veteran-owned companies or simply
private entities are out there with solutions to problems.
No different from our current disaster in the Gulf, when the
private sector is given the opportunity to create solutions it will. My
message to this Committee is to assure our veterans the best care
possible and in order to do that we need to listen to the private
sector and develop internal solutions through our public entities.
Finally I want to again express my gratitude for the opportunity to
speak before this Committee today. It's my hope that my testimony today
will inspire thoughts for solutions.
I'll be happy to answer any questions you have.
Prepared Statement of Darrell Henry, Executive Director,
Healthcare Coalition for Emergency Preparedness, Washington, DC
The Healthcare Coalition for Emergency Preparedness was formed in
an effort to raise awareness and educate people where two of the most
relevant issues facing health care providers today intersect--what
health care facilities have to do to maintain operations during a
crisis, such as a pandemic, and develop efficient methods to reduce
health care costs. We call it operational sustainability.
The Coalition consists of health care facilities, equipment
providers, and industry experts stationed across the country.
The Coalition believes that a key component of hospital readiness
lies in the ability of medical centers to maintain sustainable
operations to meet public health needs and a patient surge on heath
care facilities in all circumstances. Surge capacity is defined as the
ability of a health care system to adequately care for increased
numbers of patients while also having the ability to treat the unusual
or highly specialized medical needs produced as a result of surge
A lot of work has been done on the topic of emergency preparedness
and what hospitals and medical centers can and should do. The Coalition
is looking at questions like, `What isn't occurring?' `What are the
systemic weaknesses?' `Where are the vulnerabilities?'
The Coalition is committed to achieving the following goals for its
Highlight vulnerabilities in operational sustainability
during a crisis or emergency, including medical waste treatment.
Promote new best practices to help sustain hospital
operations during a pandemic or other crisis situation.
Provide expertise and education on hospital preparedness
and operational sustainability.
With looming threats of pandemic/epidemic, bioterrorism and
everyday disease exposure, it is imperative that we utilize today's
technology to ensure that our hospitals and health care centers have
the ability to sustain operations in the event of such a crisis or
One of the largest hindrances to operational security revolves
around transportation constraints to the hospital itself or such
impacts on key suppliers and vendors that a hospital relies upon.
Transportation constraints not only involve passable road conditions to
access the health care facilities and vendor facilities, but they are
just as likely to be vendor staffing issues, quarantined facilities,
availability of transportation fuels, and other nonroad related issues.
One of the issues we've found that is most often overlooked when
dealing with transportation constraints, and emergency preparedness
over all, are adequate provisions and planning relating to regulated
According to Walter Reed Army Medical Center (WRAMC) regulation,
medical waste (aka infectious waste) is any waste that is potentially
capable of causing disease in man. Such waste would likely contain
pathogens in sufficient quantity to result in disease, including
microbiological wastes; blood and blood products; surgical and autopsy
wastes; and sharps (i.e. needles). Pathological waste is also a
regulated medical waste, but it is treated differently than infectious
After recognizing that so many medical centers, including VA
facilities, did not have appropriate processes set up to address the
disposal of waste during a crisis and that Federal, State and local
entities do not adequately address the issue, infectious waste disposal
became one of the first issues identified and addressed by the
Coalition. In addition, the Coalition is also looking at supply chain
management and other issues, which are all inter-related.
The H1N1 swine flu and previous issues, such as SARS, have
highlighted the vulnerability our health care system faces from serious
tests of preparedness in the area of operational sustainability in the
time of a crisis. The ability for our private and government run health
care facilities to maintain operations during times of crisis is a
matter of interest for every American and should be a priority for
Federal and State policymakers.
Paramount to emergency preparedness and pandemic containment is the
need for full hospital operational sustainability of hospitals and
treatment centers. Creating medical centers that can sustain a surge in
the event of a crisis and continue operations must become a priority
during a pandemic or other crisis (such as a natural disaster or bio-
The bipartisan Pandemic and All-Hazards Preparedness Act of 2006
has helped us prepare for the current crisis and deal with future
crises. There are many sectors of hospital operational sustainability
that desperately need experienced solution management, but we have
found the disposal of infectious waste is not being addressed
adequately by health care emergency preparedness planning, best
practices and guidance, or resources, and have focused our initial
efforts on it.
A 2003 GAO study concluded that many hospitals lack the capacity to
respond to large-scale infectious disease outbreaks and most hospitals
lack adequate equipment for a patient surge on a medical facility.
Further, many reports cite the challenges of medical supply chains,
both inbound and outbound, to deal with waste products that will
accumulate in a pandemic or natural disaster.
In the mid-90's, new regulations made onsite hospital incinerators
uneconomic due to the restrictions placed on them because of the
harmful emissions they released in the air. Most hospitals could not
afford to keep up with the new standards and thus, out of convenience
for a temporary fix, they resorted to hiring contracted service
providers who gather waste and truck it offsite to be discarded
elsewhere. Unfortunately, this temporary solution is still the way most
hospitals discard their infectious medical waste today.
With real threats of pandemics, transporting infectious and
contagious medical waste is no longer prudent. There are modern,
affordable technologies that can cleanly, safely, and economically
sterilize infectious and contagious waste on the premises of health
care facilities. Treating hazardous materials on site is also a
cleaner, greener, less costly, and, most importantly, safer option.
Since the mid-90's, 90 percent of our hospitals have chosen to
export their infectious waste through their local communities and over
our roads and highways. However, during an outbreak, infectious waste
should not be allowed to leave the realm of the clinical experts of
disease control at our Nation's hospitals.
Various reports by the Center for Disease Control staff, Federal
health officials, and other experts have recognized the practice of
inactivating amplified cultures and stocks of microorganisms onsite (as
a medical waste treatment) is the best practice for emergency
preparedness and pandemic response. Taking an onsite sustainability
approach helps address this looming issue of hospital preparedness in
the case of a pandemic or other crisis. Under such a scenario, the
volume of hazardous materials would dramatically increase when a large
population suddenly contracted a contagious disease or incurred a
disaster and surged a hospital's capacity. Further, because the primary
method of controlling the spread of infection and avoiding a pandemic
is quarantining, the development of an onsite approach to waste
disposal appears to be the most appropriate one.
Our country has begun to apply stringent actions to avoid some
catastrophic health threats. The United States Department of
Agriculture demands that food waste is sterilized at ports of entry to
avoid agriculture contamination. A logical next step in our efforts to
polarize waste and keep our country healthy would argue that we should
sterilize medical waste at the point of generation as well.
Clearly the operational sustainability advantage is to sterilize
the infectious waste onsite, but there are other notable benefits with
regards to treating infectious waste onsite--namely, disease
prevention, economics, and an environmentally green alternative
(including reduced truck traffic, no incineration, and clean energy
power). It also provides a safer option than the current practice of
hauling medical waste many miles through our neighborhoods and over our
Nation's roads to be treated offsite, which is particularly dangerous
in the instance of a pandemic or other dangerous and exotic disease
outbreak, such as H1N1 or the Ebola virus.
Expenditures for onsite treatment of infectious waste are perhaps
the only preparedness tool that would begin to pay for itself from the
day of installation. Waste treatment systems are custom designed and
manufactured for each application. Users range from small clinics,
hospitals, to large commercial processing centers. Prices for these
systems range from about $150,000 to $1M+. Average health care clients,
300-400 bed hospitals, will purchase a system that is about $450,000.
This equipment often produces a return on investment (ROI/payback)
between 18 and 36 months.
We have also identified that the development of mobile units can
give the Federal Government the tools to eliminate infections or
disease at the source and provide the necessary containment to help
eliminate pandemic threat and improve public health and safety.
We remain vulnerable in the area of contagious waste management and
the threat of pandemics, bioterrorism, and natural disasters are very
real. There appears to be no rational logic for hospitals not to
sterilize their infectious waste onsite during a pandemic crisis other
than the lack of equipment and a lack of incentive to install such
equipment. However, we must ensure the burden to implement safer and
greener waste disposal options doesn't fall solely on the hospitals.
Pandemic and Medical Waste Issues
Last year, the Coalition developed a comprehensive pandemic
preparedness plan, and has developed a six point action plan for
medical waste sustainability during a pandemic. The Coalition urged the
Department of Health and Human Services to consider this plan as a part
of its response to the recent H1N1 swine flu outbreak.
We called for the newly confirmed Secretary Kathleen Sebelius to
adopt onsite sterilization capacity as a best practice as a part of
health care facility operational sustainability in a crisis and
dedicate the resources necessary to improve onsite infectious waste
We have learned a lot from the SARS outbreak on how hospitals adopt
Universal Precautions regarding infectious waste classification at
hospitals. Studies showed that during the SARS outbreak infectious
waste volumes increase by as much as 500 percent due to the
reclassification of ``infectious'' waste.
Joint Commission's new mandate for hospitals to be free-standing
entities for a minimum of 96 hours does not address a pandemic, which
could last up to 18 months. The only viable solution is to treat
infectious waste onsite with equipment that has the surge capacity to
function in a Universal Precautions work environment.
During the last pandemic in 1968, medical waste management was not
an issue since nearly all hospitals were treating onsite (incineration)
and were already commingling the medical and solid waste streams. It is
a shame to think that this is one area (infectious waste management) of
hospital preparedness where we have actually made our hospitals more
vulnerable compared to just 15 years ago.
If the scope of the pandemic threat is truly global, an outbreak
would dwarf our already strained resources, which is why it should be a
priority for the Federal Government to address commonsense solutions
and resources for onsite infectious waste treatment now in order to
help ensure the health and safety of every community throughout the
Federal Support for Health Care Emergency Preparedness
In particular, the Coalition stresses the vital role of Federal
funding. We are trying to make sure Congress continues to allocate
funding to support hospital preparedness programs.
For the private sector, the current Hospital Preparedness Program
(HPP), which was funded at $375 million in FY09, provides a ready-made
avenue to offer the financial incentive for medical facilities to
transition over to onsite methods of infectious medical waste
treatment. The HPP awards competitive grants or cooperative agreements
to the States to enable eligible entities to improve surge capacity and
enhance community and hospital preparedness for public health
Currently disaster relief operations lack efficient means to
dispose of infectious medical waste, including most VA facilities. The
Federal Government should look at research, development, and deployment
of mobile sterilization units capable of being deployed to areas
affected by a pandemic, natural disaster or bio-terrorism attacks.
The recently released FY10 Hospital Preparedness Program Funding
Opportunity Announcement clarified onsite waste treatment as an
appropriate project for HPP funding, which was prompted in part by the
House Appropriations Committee's FY-10 report language to mandate U.S.
Department of Health and Human Services (HSS) look at onsite medical
waste treatment procedures. This guidance is a major victory for
hospitals that would like to use this grant to help fund this type of
VA Emergency Preparedness
We know that the VA has worked to be in compliance with the
Homeland Security Presidential Directive, The Joint Commission, the
National Incident Management System, National Fire Protection
Association, and other recognized standards, guidance and procedures as
well as Federal laws such as the Pandemic and All-Hazards Preparedness
Act (PAHPA). The VA's progress and plans can be reviewed in the VA's
updated emergency management guidebook.
While our testimony highlight's our findings and work with private
hospitals, the principles and findings we've discuss in this testimony
must also be considered for VA facilities. One of the VA's missions is
to serve as a safety net when DoD, public health facilities, and
private hospitals fail or are overburdened. The impacts to private
hospitals and critical supplies due to such events would likely
spillover to the VA--especially if we are talking about a serious
medical surge event or transportation constraint. In such an event, it
is easy to assume that VA facilities would experience similar
disruptions in medical waste removal and other services whether or not
it is providing mutual aid.
We believe it is important that the VA evaluate each facilities
management of medical waste and what plans and procedures are in place
for a crisis and any accompanied disruption in waste management
services. A simple review of the VA's Pandemic Influenza Plan shows
that hospitals should plan for transportation difficulties and be
prepared for alternative routes for additional staff and supplies. In
regard to supplies, they should have alternative vendors or have
established agreements in case of emergency, but it does not address
their supplier's transportation issues. The plans says to handle
medical waste as it normally would (via the WRAMC policy), but they
don't deal with contingencies of increased volumes of medical waste,
the costs of such an increase, staffing shortages, and the many other
vulnerabilities we've identified in this testimony. We are merely using
this example to point out that there are a few key points missed in
this plan and pandemic preparedness could easily be improved by adding
onsite sterilization equipment.
We'd also like to point out that installing onsite sterilization of
medical waste at VA facilities would also provide ancillary and
immediate benefits for the VA beyond emergency preparedness, including
cost savings and carbon emission reductions. In regard to cost saving,
we estimate that onsite waste treatment using sterilization equipment
can provide an average cost savings of $1.63 million per hospital,
which would equate to $190.71 million if installed at all 117 VA
Medical Center hospitals that are currently relying upon offsite
vendors to haul and treat their waste. Further, regarding the VA's
ability to comply with Executive Order #13514, the Coalition has
developed a carbon footprint calculator that can calculate the savings,
in real numbers of reductions in x pounds of CO2 emissions
each year, for those facilities with onsite waste processing and
estimate the savings for those facilities who switch from off-site to
We have constructively urged that onsite sterilization capabilities
should be added to the VA's list of best standards and practices as
well as a mission critical component to their emergency management
plan. Currently, twenty four VA facilities process their waste onsite.
We know that other facilities would like to add this component to their
capital budgets, but have thus far not done so.
We do not intend to be critical of the VA in this testimony, as we
haven't audited individual hospital preparedness plans. We do know that
there are groups within the VA looking at this very issue and recognize
that onsite medical waste treatment could benefit VA facilities from an
everyday operational aspect as well as for emergency preparedness.
Additional VA Emergency Preparedness Considerations
As the one of the missions of the VA is to provide assistance to
other Federal, State, and local agencies as outlined in the Department
of Homeland Securities National Response Plan, issues that affect
private hospitals may also impact the VA. In addition to the medical
waste issues we've discussed in this testimony, here are other several
areas of concerns of health care emergency preparedness that have been
identified by the Coalition.
Vaccines--currently only one of the five companies producing
vaccines used in the U.S. for the H1N1 virus are domestically located.
The majority of vaccines used are produced overseas and then shipped to
the U.S. The H1N1 virus has helped to unveil severe issues with
vaccination production and distribution issues inherent with needing to
ship in vaccines. The Issue of production and distribution of vaccines
has drawn attention at the Federal level, prompting a hearing in the
House Energy and Commerce, Subcommittee for Oversight and
Investigation. While the issues facing the production and supply of the
H1N1 are important, they only serve to highlight an even more severe
unpreparedness for a greater virus requiring even more vaccine.
Surge Capacity--In March of 2008 the House Oversight Committee
performed a survey of surge capacity in the event of a terrorist attack
like the commuter train attacks in Madrid, Spain in 2004 that injured
over 2000 people. The survey was conducted for a similar event in seven
cities most likely to experience a terrorist attack: New York City, Los
Angeles, Washington DC, Houston, Chicago, Denver and Minneapolis.
Results of these surveys demonstrated that none of the hospitals
surveyed had sufficient emergency capacity to absorb a surge of that
magnitude. The survey results showed that the average emergency room in
each hospital was operating at 115% capacity. Surge sustainability is a
key component of emergency preparedness, terrorist attacks and
epidemics are examples of an unexpected surge in emergency room need.
The tragedy that took place in New York on September 11, 2001, the
collapsing of the overpass in Minnesota, the flooding in North Dakota,
the hurricanes in Louisiana and Mississippi, and now, the current H1N1
pandemic are realities of unexpected events we must always be
expecting. None of the areas surrounding these events were logistically
prepared to handle the surge capacity or long term sustainability
needed. These are the sort of unpredictable event that we must prepare
our health care community to be able to withstand in all areas of the
country. Protections must be instituted to be able to respond to any
event in a moment's notice or be equipped to handle long term
sustainability needs if needed.
Supply and Services--a key component of maintaining emergency
preparedness at all times is ensuring that hospitals have enough supply
capability on hand to withstand a major surge and also sustain an
extended lapse in re-supply availability. Most hospitals and medical
centers across the country lack sufficient supplies or systems to
enable them to handle a sustained surge in patients like would be seen
in the event of a crisis. A shocking example of hospitals dependence on
offsite aid can be seen in the fact that most hospitals do not even
treat their own laundry on the hospital grounds. It is a common
practice for hospitals to outsource laundry services creating an
Gap Analysis--one of the most common suggestions for health care
organizations is to perform a complete ``Gap Analysis'' as part of
their Emergency Management Program (EMP). There are four major
components to a thorough Gap Analysis: (1) Identification of planning
scenarios along with the number of anticipated casualties for each
planning scenario; (2) Requirements development; (3) A listing of
current resources and capabilities; and (4) Identification and
forwarding to the next higher support agency, the gap between current
resources and capabilities and the total requirements needed for each
With a well-defined Gap Analyses, VA can then analyze, plan,
program, budget, procure and pre-position additional resources and
capabilities needed to close Gaps and sustain and fortify the VAMC's
hospitals during future emergencies and disasters requiring Federal
support. Further, gap analysis at the VA should consider needs and
planning done with DoD, and local and State Emergency Management
Agencies so it can program for the entire array of ``unmet
requirements'' including mobile medical units, as well as a full
complement of staffing by facilities and vendors, medical and
nonmedical supplies, equipment and services required to support State/
territory and local governments during future disasters and public
We encourage VA emergency managers work extraordinarily closely in
identification of all gaps in resources and capabilities and forward
the appropriate unmet requirement gaps up the support chain in order to
ensure the health care and public health needs of veterans and
communities reliant on VA support are met.
Our Nation remains vulnerable in the area of contagious waste
management during a pandemic or crisis and we need to highlight the
benefits of prudent alternatives, such as onsite sterilization
capacity, as a best practice for emergency preparedness and health care
facility operational sustainability and be considered a mission
critical system for VA hospitals.
The Coalition believes that it is imperative that we use technology
to ensure dangerous medical waste is disposed of in a safe and sanitary
way, and that the VA is prepared to do so in an emergency. We encourage
the VA implement appropriate programs that address onsite waste
disposal for both emergency/crisis, which is important as the most
hectic periods for health care providers are also the periods that
typically produce the most waste, and during every day operations where
it can show cost saving and other benefits.
Congress should dedicate some of the current Federal funding to
help cover the initial installation costs of implementing onsite
technology at VA facilities, which will save the government money in
the long term. Offering such Federal funding for the implementation of
a more common sense and cost effective approach for government owned
health care facilities to deal with infectious waste, and it will set a
precedent for private hospitals to adopt and deploy such technologies.
Only scarce funds within the HPP are eligible to hospitals or medical
facilities transitioning to onsite medical waste treatment in
preparation for pandemic or other emergency preparedness.
Furthermore, congress shall appropriate sufficient funding for the
research, development, and deployment of mobile sterilization units
capable of being deployed to areas affected by a pandemic, natural
disaster or bio-terrorism attacks that could be used by multiple
jurisdictions, including the VA and the National Guard. Currently, our
Nation's disaster relief operations lack efficient means to dispose of
infectious medical waste.
The Coalition believes that a few simple changes in policy,
including legislative and appropriation efforts by Congress, would help
improve the methods and best practices by which infectious medical
waste is handled by VA in this country every day and, as we are
discussing today, in emergency situations.
Prepared Statement of Barry A. Searle, Director,
Veterans Affairs and Rehabilitation Commission, American Legion
Mr. Chairman and Members of the Subcommittee.
Thank you for the opportunity to present the views of the American
Legion concerning this extremely important, but sometimes neglected
topic. The American Legion applauds the foresight of this Committee in
bringing this topic back to a place of importance. As we discuss this
issue today, I am reminded that on the morning of September 11, 2001,
then-National Commander of the American Legion, Rick Santos, was
preparing to deliver the Legislative Priorities of the American Legion
for FY 2002 in this very room. How quickly the priorities of our Nation
changed that fateful morning. Today, after almost 10 years, we, as
veterans' advocates still have priorities that affect the lives of
America's veterans and their families. Perhaps lulled into a sense of
security since September 11, 2001, we are now focused on the extreme
disability claims back log, increased employment opportunities for
veterans, and better access to quality health care for veterans. While
these concerns are of great importance, it is equally important that we
do not lose sight of the fact that our world, and priorities, could
once again change just as quickly.
As was seen during Hurricane Katrina in 2005, the recent flooding
in Oklahoma City and Nashville this year as well as Iowa and the
Dakotas last year, the earthquake in Haiti, and tornadoes across the
southern U.S., a natural disaster can be only days, hours, or minutes
away. Additionally, a weapon of mass destruction can turn an urban area
into a mass casualty area, crippling communications and overwhelming
traditional emergency services. Prior planning and coordination are the
difference between managing a disaster effectively or adding to the
chaos and suffering.
The Department of Veterans Affairs (VA) has published policies and
given guidance concerning emergency preparedness. There is no question
that VA's Central Office understands and accepts its responsibility to
prepare for and execute its ``Fourth Mission'' in support of National
Emergency Preparedness. In VA's 2009 Performance and Accountability
Report, ``Strategic Goal 4, Contributing to the Nation's Well-Being,''
the strategic goal for emergency preparedness addresses Continuity of
Operations (COOP) at the Under Secretary and Assistant Secretary levels
as 100 percent prepared.
While the American Legion applauds VA for its approach to
preparedness, we are concerned that there may be a lack of oversight
and feedback concerning preparedness at the Regional Office, VISN and
facility levels. The American Legion is concerned that the
participation and preparedness at the Regional Office, VISN and
facility may be overshadowed by primary day-to-day operations. This
would potentially lead to confusion and delay in a disaster situation
in the attempt to organize a response.
In a January 2006 VA Office of Inspector General (VAOIG) report on
Emergency Preparedness in Veterans Health Administration Facilities, it
was reported that ``At the national level, VHA had developed
comprehensive initiatives and directives to address emergency
preparedness training, community participation, and decontamination
activities. However, at the facility level, VA employees did not
consistently receive emergency preparedness training, and emergency
plans did not always include some critical training elements as
VA's Emergency Management Strategic Health Care Group (EMSHG) has
as part of its mission statement an approach that ``. . . assures the
execution of VA's Fourth Mission to improve the Nation's preparedness
for response to war, terrorism, national emergencies, and natural
disasters by developing plans and taking actions to ensure continued
service to veterans, as well as to support national, State, and local
emergency management, public health, safety and homeland security
The EMSHG publication, ``Legal Authorities of the Veterans Health
Administration Emergency Management Program'' states, in support of
Emergency Mobilization Preparedness, ``VA participates in emergency
medical response measures with other Federal, State, and local agencies
by providing assistance in seven support functions outlined in the
Department of Homeland Security's National Response Plan. For example,
if requested, the types of support VA would provide include public
health and medical services, emergency management, and public safety
The American Legion has also studied VA's 2009 Emergency Management
Guidebook, a well organized framework identifying duties and
responsibilities. The Guidebook goes into great detail concerning
training, to include sample scenarios which cover a wide range of
incidents including hurricanes, earthquakes, and relatively small
incidents such as a multiple bus accident involving numerous injuries.
What we were not able to determine is a feedback mechanism to confirm
implementation at the Regional Office, VISN, or facility level. The
American Legion believes that disaster preparedness and response cannot
be trained and implemented in a short period of time. Effective
communication networks and routine relationships are critical to
efficient response. For this reason we feel a greater emphasis on
requiring reporting for annual exercises and training at the local
level is necessary to insure the proper networks are in place to ensure
a quick and effective response.
The American Legion's System Worth Saving Task Force annually
conducts site visits at VA Medical Centers nationwide to assess the
quality and timeliness of VA health care. In follow-up conversations we
have found there is a wide range of actual response preparedness across
VHA. We believe that this range is symptomatic of the decentralized
nature of VA. As with other programs there appears to be limited
follow-up on compliance by Central Office.
For example, the American Legion and other VSOs have been briefed
on VHA's pandemic preparedness efforts; in particular, the District of
Columbia VA Medical Center's preparations for a forecasted H1N1 flu
epidemic last fall. The facility should be complimented on its
proactive approach to stockpiling vaccine and its preparedness for the
potential epidemic. Also during various briefings VSO's were advised of
the existence of 50 vehicles, 6 of which are specifically allocated to
VHA, the remainder controlled by VBA. These 38-foot vans are primarily
tasked with providing veteran counseling outreach, but were
specifically designed to be adapted for medical purposes during
disaster relief efforts. In particular, each has satellite
communications capability critical in a disaster situation. This is an
excellent program that shows how a specific component can be utilized
to fulfill multiple roles when the demand exists.
During 2009, massive flooding overwhelmed portions of the Midwest.
In Fargo, North Dakota, where regular VA Medical Center operations were
impacted by the flooding, VA dispatched three mobile Vet Centers for
use as triage clinics to help bridge the gap for the community until
regular operations could be restored. The use of these vehicles in a
successful manner demonstrates that VA's mission as a Support Agency as
part of Emergency Support Function #8 in the National Incident
Management System (NIMS) works. However, on the other end of the
spectrum, during recent discussions with a group of facility directors
it was found that some had no knowledge of the mobile clinics'
existence. Such a valuable resource must be part of the ingrained
knowledge of any facility director or the value of these tools will be
Another demonstration of how advanced preparation can be invaluable
was pointed out during a recent American Legion staff visit to the
Atlanta VAMC. Legion staff was briefed about how the facility
coordinated with local hospitals and DoD personnel to provide medical
services for individuals injured in the Haiti earthquake under the
National Management Disaster Assistance program. Several VAMC staff
members worked at local hospitals to provide assistance as needed for
the situation. Atlanta VAMC emergency management personnel were the
team lead for the disaster assistance.
Unfortunately, we have also found during our followup to our System
Worth Saving facility visits that at the local level there is in some
cases a lack of awareness of the responsibility of facilities to
prepare for non-veteran casualty assistance. The primary focus is on
mutual support of VA facilities for assisting veterans in a disaster.
Additionally it was discovered that turnover and shortage of personnel
at most facilities require renewed emphasis on standardized procedures,
quality review and individual training, as well as documentation of
that training. The American Legion has concerns that if not properly
prepared and trained to respond, these facilities will be quickly
overwhelmed and unable to support the ``4th mission'' as effectively as
needed in a time of emergency.
To further examine the specific, local level of disaster
preparedness, it is important to go out into the field to assess
exactly what those levels are, and how they differ from the expected
and dictated policies.
The American Legion conducts Quality Review audits of Regional
Offices across the country to identify issues relating to veterans
claims. During the 2009 visit to the VA Regional Office (VARO) in New
Orleans 4 years after the hurricane it was found that the VARO was only
just starting to approach a sense of normalcy. Interviews with the
workforce who had been present through the entire ordeal revealed two
important facts. Every employee felt that the office did the best that
they possibly could under unimaginable circumstances. However, they
also felt that there were many failures and there was a hope that the
lessons learned would be captured. The number one complaint with the
response to the disaster of Katrina was the poorly defined lines of
communication. The lesson that must be captured is that a clear-cut
disaster protocol, with clear lines of communication, must be second
nature in its actual application.
Some areas of concern regarding the VA's emergency response mission
are actually being addressed indirectly by the day-to-day improvements
VA is implementing in assisting veterans. For example, cited in the
Department of Health and Human Services (HHS) Medical Surge Capacity
and Capability Handbook when discussing disaster assistance is, ``many
of the tenets of the MSCC Management System are not easily achieved.''
For example, garnering support and participation from medical clinics
and private physician offices, while laudable, is by no means a simple
task to accomplish. Because the private medical community is so diverse
and disconnected, there is wide variation in motivation and constraints
to implementing these processes. There is an effort to develop Lifetime
Virtual Electronic Records (LVER), which will cover an individual from
``the day you raise your hand till after you are laid to rest.'' This
system will not only involve DoD/VA participation but in an effort to
assist with VHA's responsibilities it will also entail establishing
networks with private physicians to share information. This network
will, we believe, assist in the communications issues raised in the HHS
handbook by establishing the Internet connections and bridging
firewalls between VA/DoD and civilian practices and developing mutual
understanding of required information.
Additionally, the emphasis on rural health care clinics and
telehealth in order to assist veterans will continue to expand the VA's
outreach and disburse critical assets and make them available in case
of emergency. For example, should a VAMC's operations in a relatively
urban area be degraded due to a natural disaster, a relatively close
rural clinic or clinics with functional telecommunications could be
developed as staging areas for directing resources and, to some degree,
triage areas for evacuating casualties until the VAMC could resume full
In conclusion, the American Legion fully realizes the importance of
VA's Fourth Mission, not only to the veterans that VA serves, but to
our Nation as a whole. In a resolution approved in 2008 we urged the
Secretary of Veterans Affairs to take an active role in the development
and implementation of plans to enhance Federal homeland security
initiatives and that Congress provide VA with the funding necessary to
further enhance its capacity to act as a back-up to DoD and FEMA. We
believe that at the national level VA is serious in this mission.
However, we feel additional follow-up and reporting on activities on
the local level is essential to ensure that the Central Office policies
actually reach the ground level.
Thank you again for the opportunity to provide insight and analysis
on this issue on behalf of the American Legion and its more that 2.5
Prepared Statement of Neal Denton, Senior Vice President,
Government Relations and Strategic Partnerships, American Red Cross,
Good morning Chairman Mitchell, Ranking Member Roe and
distinguished Members of the Subcommittee. My name is Neal Denton and I
serve as the Senior Vice President for Government Relations and
Strategic Partnerships at the American Red Cross. We salute your
attention to emergency preparedness and appreciate the opportunity to
join with our partners to share our work when preparing for and
responding to large-scale disasters. Particularly, I am grateful for
this opportunity to speak to the partnership between the American Red
Cross and the Department of Veterans Affairs when it comes to disaster
For more than 125 years, the American Red Cross has provided relief
to victims of disaster and helped families and individuals prevent,
prepare for, and respond to emergencies. Our Congressional Charter
mandates that the Red Cross carry out a system of national and
international relief. We meet our mission through a national network of
nearly 700 chapters that respond to approximately 70,000 disasters
annually--about 200 disasters each day. From single family house and
apartment fires to large scale disasters such as hurricanes and floods,
the Red Cross works to provide essential lifesaving and sustaining
services to those in need. We shelter, feed, and provide critical
supplies and emotional support to those impacted by disasters in
communities across our country. The Red Cross also provides support to
members of the military, veterans and their families, supplies nearly
half of the Nation's blood supply, and teaches lifesaving skills in
communities across the country. As you know, the Red Cross is a
charitable organization--not a government agency--and depends on
volunteers and the generosity of the American public to perform its
mission, including donations of time, money and blood.
Whether it is a hurricane or a heart attack; a call for blood or a
call for help, the American Red Cross is there.
Red Cross volunteers and staff are on the frontlines when
emergencies occur in their communities. Our national system builds upon
our local chapter presence to supplement staff and to provide
additional resources when necessary. Together, we offer immediate
emergency assistance to those in need during disasters of all sizes.
The Red Cross is committed to delivering the best possible response,
and we strive to continuously improve our operations and services.
Our organization operates in a constant cycle of responding to
disasters and preparing for the future. The Red Cross--at the local and
national levels--regularly participates in activities to build
capacity, partner, plan, prepare, exercise, and evaluate our
capabilities. We periodically review and, when necessary, refine our
roles and responsibilities. This is a critical time of the year, as the
Red Cross is currently responding to tornadoes, floods and wildfires at
the same time that we are preparing for the potential demands of what
is predicted to be a very active hurricane season.
In preparation for disasters large and small, we carefully analyze
data and project potential needs for shelters, food, personnel, and
other operational functions. To meet expected needs, material resources
have been pre-positioned in warehouses across the country for easy
access and prompt mobilization. We also have completed a detailed
assessment of our communication equipment inventory and have verified
and pre-positioned our Nationwide disaster fleet of more than 300
vehicles. This fleet includes emergency response vehicles,
communication vehicles, tractor trailers, and utility vehicles.
In addition, the National Shelter System (NSS), which tracks
potential shelter locations and capacities, is populated with up-to-
date data. It now contains location and capacity information for over
55,000 buildings that could potentially be used as shelters across the
country. The system, used for both planning and operational decisions,
records all shelter openings, closings and overnight populations on a
daily basis. The NSS is available to FEMA and to all States free of
charge and it is currently being used by 12 additional national
nongovernment partners. I also am happy to report that the American Red
Cross features a link to the NSS and shelter locations on the home page
of our Web site, www.redcross.org.
Staffing of relief operations is a critical function that requires
advance planning. We focus on the use of local volunteers whenever
possible, and also have more than 50,000 trained volunteers who are
available to travel outside of their home communities. These disaster
workers are trained for specific jobs, and we are assessing their
availability for disaster assignments during this hurricane season.
Including locally available disaster-trained volunteers, the Red Cross
has more than 90,000 volunteers--a considerable increase from the
23,000 that were available prior to Hurricane Katrina nearly 5 years
Working With Partners--U.S. Department of Veterans Affairs
While service delivery happens at the local level, it is supported
by a national system. Our disaster field structure is aligned by State
and provides a point of contact and integration of plans with Federal,
State and local officials across the nation. In recent years, the
American Red Cross has focused more resources on coordination with
Federal, State, and local government. This increased presence has
improved coordination and is strengthening key relationships with our
Federal partners like the Department of Veterans Affairs (VA).
With support from FEMA, we have full-time Red Cross employees to
staff each of the ten FEMA regional offices and the two area offices in
the Caribbean and Pacific. We also have one full-time representative to
the National Disaster Housing Taskforce and two additional full-time
staff positions to represent our organization at FEMA National
Headquarters. We continue to be closely aligned with FEMA and are
currently collaborating on how to ensure even more information sharing
and situational awareness during operations as we prepare for what is
predicted to be a higher-than-average hurricane season.
In a disaster response capacity, the American Red Cross sits at the
same table with the Department of Veterans Affairs during planning,
exercises and operations. With FEMA as the lead agency for
synchronizing the Federal support to tribal, State and local partners,
we coordinate closely before, during and after a disaster. Both the VA
and the Red Cross work in close coordination to identify assets,
capabilities, and plans with the Federal interagency community. The Red
Cross and the VA both serve as a support agency for the National
Response Framework and work closely together on Emergency Support
Function #6 (ESF #6), providing technical support for Federal mass care
activities, emergency assistance, housing and human services. During a
Weapons of Mass Destruction (WMD) incident, both agencies work within
the ESF #15 External Affairs coordination structure to ensure unity of
effort on public communication and guidance.
The VA and the Red Cross also are collaborating with the Department
of Defense, the Department of Health and Human Services and FEMA as we
develop a reliable patient and evacuee tracking system. While this long
term project is in its initial phases, VA hospitals have participated
in patient evacuation as receivers of medical transferees. Red Cross
tries to help nonmedical evacuees co-locate in shelters near their
loved ones and assists in connecting families by using the Safe & Well
notification system, which is an effective online communication tool
that helps those affected by the disaster alert family and friends
outside the immediate area that they are ``safe and well.''
The American Red Cross is also excited about a possible opportunity
that will allow us to train and provide resources to the families of
veterans. In partnership with the VA, the Red Cross can assist families
through the delivery of Red Cross Family Caregiving and Nursing
Assistant programs, which will enable them to address the challenges of
caring for their loved ones. These programs will help participants
develop skills in personal care, nutrition, home safety and legal and
financial issues. We believe this information is vital to those caring
for loved ones who suffer from chronic illness and temporary or
permanent disabilities. Training builds confidence and instills
knowledge a caregiver will need when providing support to a veteran.
Identifying new partners and strengthening existing partnerships is
a key priority for our organization. We strive to be an effective
leader and valuable partner before, during and after a disaster. Our
outreach, however, extends beyond traditional disaster response
agencies. We continually seek and engage organizations that possess a
particular critical expertise, community trust, or credibility that can
greatly expand and improve a community's response. Organization-wide,
we are committed to fostering a culture of collaboration, diversity and
inclusion in our partnering efforts.
On the local level, chapters partner with local community, faith-
based and civic organizations. We also have stepped up efforts to
ensure that community 2-1-1 organizations have current disaster
information. On a national level, we continue to rely on our long
standing partners in disaster, such as Southern Baptist Disaster
Relief, The Salvation Army, and Catholic Charities. In addition, we are
cultivating and strengthening more diverse partnerships with groups
like HOPE worldwide, the NAACP, Legal Services Corporation, National
Baptist Convention and Tzu Chi Buddhist Foundation. We work closely
with disability rights groups, immigration rights groups, and language
interpretation and translation groups such as the National Association
of Judiciary Interpreters and Translators, the National Virtual
Translation Center, the National Council of La Raza, National
Disability Rights Network, Save the Children, and tribal organizations.
Our work with pet rights groups such as the U.S. Humane Society has
also been important. All of these groups provide invaluable expertise
to help clients, in particular diverse clients and those with unique
Together with our partners, we can continue to strengthen the
country's capacity to better meet the needs of the diverse communities
Encouraging Community and Citizen Preparedness
Individuals and families across this nation rely upon the American
Red Cross to deliver on our promise--provide for emergency needs in
times of disaster. However, the system of relief will not work well
without continued emphasis on community and personal preparedness. One
Red Cross national survey last summer showed that approximately 68
percent of individuals and families have not made an emergency
communications plan and 79 percent have not identified a meeting place
should family members become separated during a disaster.
In August 2009, the American Red Cross Emergency Preparedness
Survey indicated that approximately half of Americans (51 percent) have
experienced at least one significant emergency where they have lost
utilities for at least three days, had to evacuate, could not return
home, were unable to communicate with family members or had to provide
first aid to others. More than a third (37 percent) lost utilities for
at least 3 days. Although 89 percent of those surveyed believe it's
important to be prepared, far fewer are ready for an emergency.
American Red Cross preparedness programs and tools help to save
lives and empower people to prepare for and respond to disasters and
other life-threatening emergencies. Just as every disaster is
ultimately an intensely personal experience; the American Red Cross has
found that a commitment to making our homes and communities safer also
must be personal. Therefore, preparedness staff members work closely
with local, State and national partners to help people personalize
their risk to natural hazards and make preparedness and mitigation a
personal priority. The overall goal is to build a ``culture of
preparedness'' by encouraging Americans to understand their individual
risk and geographical threats and then take action to adopt specific
preparedness behaviors. The American Red Cross is playing a leadership
role in hundreds of communities across the nation that has made a
commitment to be more disaster resistant.
Conveying a single national message of preparedness is critical.
Our ``Be Red Cross Ready'' campaign, which parallels the Department of
Homeland Security's Ready Campaign, offers three important steps: (1)
Get a Kit; (2) Make a Plan; and (3) Be Informed. This message serves as
our public call to action for citizen preparedness.
The valuable partnership among the American Red Cross, FEMA,
Ready.gov and others was showcased at the Military Family Preparedness
Event hosted at Fort Belvoir earlier this month. Together, on June 5,
we distributed approximately 1,500 preparedness kits to military
families including active duty, retired and reserve soldiers. This
September, as part of National Preparedness Month, we are planning to
conduct similar events at four military installations across the United
States and two locations overseas in order to raise awareness of being
prepared and to help many families be better prepared for emergencies.
The locations for the September Military Family Preparedness Events
are: Fort Drum (Jefferson County, NY); Joint Base Lewis-McChord (Pierce
& Thurston County, WA); Fort Polk (Vernon Parish, LA); Garrison
Grafenwoeher (Vilseck, Germany); and Garrison Yongsan (Seoul, South
Korea). While this is a promising start, there is much more we can do
to help military families prepare for emergencies.
Thank you again for this opportunity to be before you today. As we
enter the 2010 hurricane season and communities across our country are
already dealing with floods, wildfires and tornadoes, the American Red
Cross stands ready to help those in need. We are working hard to
improve efficiencies, and to increase individual and community
preparedness. Our work would not be possible without a powerful corps
of volunteers supported by thoughtful and effective partnerships.
We are especially pleased to be working with FEMA's strong
leadership team, with Administrator Fugate, and with the leadership in
the executive branch. The American Red Cross is our Nation's largest
mass care provider, and we stand ready to work with our partners in
government, in the nonprofit sector, and in the private sector to
ensure that the country is as prepared as possible to respond to
disaster of any kind.
And finally, a crucial part of our mission at the American Red
Cross is to create a culture of preparedness prior to a disaster to
ensure communities are better prepared to take care of themselves,
their families and their neighbors in the wake of a disaster. We simply
cannot fail in this mission.
I am happy to address any questions you may have.
Prepared Statement of Kevin Yeskey, M.D.,
Director, Office of Preparedness and Emergency Operations,
Deputy Assistant Secretary, Office of Preparedness and Emergency
Response, U.S. Department of Health and Human Services
Thank you, Mr. Chairman and Members of the Subcommittee. My name is
Dr. Kevin Yeskey, and I am the Deputy Assistant Secretary for
Preparedness and Response, in the Office of the Assistant Secretary for
Preparedness and Response (ASPR), at the Department of Health and Human
Services (HHS). I direct ASPR's Office of Preparedness and Emergency
Operations, which oversees the medical planning and operations for the
Department. I appreciate the opportunity to comment on the Department's
role in the National Response Framework, and specifically about how we
coordinate with and utilize the U.S. Department of Veterans Affairs in
our response efforts.
HHS adheres to the National Response Framework which establishes a
comprehensive, national, all-hazards approach to domestic incident
response. Within the NRF are 16 Emergency Support Functions. The
Secretary of Health and Human Services leads all Federal public health
and medical response to emergencies and incidents covered by the NRF,
known as Emergency Support Function or ESF #8. Within HHS, and on
behalf of the Secretary, ASPR coordinates national ESF #8 preparedness
and response actions.
Among the ESF #8 functions are medical care, public health
surveillance, patient movement, and fatalities management. In carrying
out this responsibility, HHS depends on public health and medical
resources from within HHS, including the National Disaster Medical
System (NDMS), the Commissioned Corps of the U.S. Public Health
Service, and civilians from our component agencies, such as the Centers
for Disease Control and Prevention and the U.S. Food and Drug
Administration. Additionally, we request assistance and support from
our interagency partners, including the Department of Veterans Affairs
As we develop our plans and execute our response to disasters, HHS
and the VA work closely together. In my remaining testimony, I would
like to discuss areas where HHS and VA collaborate in support of our
common goal of providing high quality public health and medical care to
those in their time of greatest need.
With regard to our relationship with the U.S. Department of
Veterans Affairs, there is a long standing tradition of collaboration
between the staffs of the two Departments. Consequently, we have shared
a lengthy history in health related efforts, including emergency
preparedness activities, beginning with extensive collaboration on the
creation and management of the National Disaster Medical System. HHS
has developed ``playbooks'' for 14 of the 15 national planning
scenarios. These playbooks serve as a guide to our response to
disasters, such as earthquakes and hurricanes. The VA and other ESF #8
partners provide significant input into each of the playbooks as they
are developed and revised. Additionally, at the request of the VA, HHS
has placed a liaison in the VA's Office of Public Health and
Environmental Hazards. This liaison provides continuity of
communications between the two Departments in the area of preparedness
When HHS responds to an event, the VA provides liaison officers to
the HHS operations center. When HHS deploys public health and medical
assets to an affected area, we use personnel from the NDMS, a
partnership between the VA, Department of Defense, Department of
Homeland Security, and HHS. Disaster Medical Assistance Teams provide
acute care for victims, often at or near the area of the disaster. When
these teams need to be augmented with additional clinicians, we have
turned to the VA for them and they have provided appropriate personnel.
Most recently, the VA provided three surgeons and two anesthesiologists
for our medical teams deployed in response to the earthquake disaster
in Haiti. These clinicians immediately integrated into the teams and
provided outstanding care. In the hurricane season of 2008, VA provided
personnel to completely staff two of our Federal Medical Stations and,
in past hurricane seasons, the VA has provided VA hospital sites for us
to set up Federal Medical Stations. They have willingly provided staff
and space when HHS has had the need for such support.
Through the NDMS, HHS has responsibility for transporting patients
from disaster sites. HHS, DoD, and VA have key functions in moving
patients. One of their key functions in patient movement is managing
the Federal Coordination Centers (FCCs). These FCCs are critical to our
role in both patient movement and the provision of definitive care to
patients evacuated during a public health emergency. FCCs recruit
hospitals to participate in the NDMS and coordinate the receipt of
patients in host cities. Nationwide, we have 62 FCCs, two-thirds of
them are managed by the VA. DoD manages the other one-third. NDMS has
over 1600 participating hospitals nation-wide. In the 2008 hurricane
season, VA-managed FCCs coordinated the receipt of medically evacuated
patients in Arkansas and Oklahoma. When NDMS was activated for the
Haiti earthquake, VA personnel coordinated the receipt and distribution
of patients evacuated to Florida and Georgia to receive life-saving
HHS regards the VA as an integral partner in our preparedness and
response activities. The VA has provided expertise in the development
of our preparedness plans. The clinical support provided by VA has
provided HHS with crucial medical care to victims of disasters.
We greatly respect the work the VA does in its support to veterans
on a daily basis. We also appreciate the breadth and depth of clinical
expertise the VA provides our medical response teams.
During emergencies, whenever HHS has asked for assistance, VA has
reliably stepped up to the plate and provided the requested support. I
believe that HHS's partnership with VA is a strong and extremely
cooperative one that enables both Departments to serve our Nation in
times of emergency.
Again, thank you for the opportunity to be here today. At this
time, I will be happy to answer any questions you may have.
Prepared Statement of Steven C. Woodard,
Director of Operations Division, and Response Directorate, Federal
Emergency Management Agency, U.S. Department of Homeland Security
Good afternoon, Chairman Mitchell, Ranking Member Roe and Members
of the Subcommittee. Thank you for inviting me to appear before you
I am Steven Woodard, Director of Response Operations within the
Response Directorate at the Federal Emergency Management Agency (FEMA).
We look forward to working with Congress to ensure that our Nation is
prepared for all disasters. It is often difficult to know if an event
might be the initial phase of a larger, rapidly growing threat.
Response must be quickly scalable, flexible and adaptable. To meet the
challenge of that uncertainty, we have developed the National Response
Framework (Framework) with our Federal partners. The Framework is a
guide for how the Federal, State, local, and tribal governments, along
with nongovernment organizations (NGOs) and private sector entities,
will collectively respond to and recover from all disasters,
particularly catastrophic disasters, regardless of their cause. The
Framework details a dynamic and flexible response--one that can evolve
to address new challenges we may face in the future.
Incidents begin and end locally, and most are wholly managed at the
local level. Cognizant of this, we must manage these events at the
lowest possible jurisdiction, supported by additional capabilities when
needed. State and local governments are closest to those impacted by
incidents, and have always had the lead in response and recovery.
During response, States play a key role coordinating resources and
capabilities throughout the State and obtaining resources and
capabilities from other States. Many incidents require unified response
from local agencies, NGOs, and the private sector, and some require
additional involvement from neighboring jurisdictions or the State. A
small number require Federal support.
National response protocols recognize this and are structured to
provide additional, tiered levels of support when there is a need for
more resources or capabilities to aid and sustain the response and
initial recovery. All levels should be prepared to respond, as well as
have the capacity to anticipate resources that may be required. The
number, source, and type of resources must be able to expand rapidly to
meet the needs of a given incident. Layered, mutually supporting
capabilities at Federal, State, tribal, and local levels allow for
strategic collaboration during times of calm, as well as an effective
and efficient response in times of need.
The Framework recognizes the need for collaboration among the
myriad of entities and personnel involved in response efforts at all
levels of government, nonprofit organizations, and the private sector.
The Department of Veterans Affairs (VA), which is the second largest of
all Federal departments, is one of many agencies serving as
cooperating/support for the Framework. Specifically, the VA is a
Support Agency for five ESFs: ESF 3 (Public Works and Engineering), ESF
5 (Emergency Management), ESF 6 (Mass Care, Emergency Assistance, and
Housing & Human Services), ESF 7 (Logistics Management and Resource
Support) and ESF 8 (Public Health and Medical Services). In my
testimony, I will outline the different mechanisms available in order
to create the most effective, cohesive, and efficient response
capability to mitigate the damage caused by disasters.
Coordination of Federal Responsibilities
The President leads the Federal Government response effort to
ensure that the necessary coordinating structures, leadership, and
resources are applied quickly and efficiently to large-scale
catastrophic incidents. The President's National Security Staff, which
brings together Cabinet officers and other department or agency heads
as necessary, provides strategic policy advice to the President during
large-scale incidents that affect the nation.
Federal disaster assistance is often thought of as synonymous with
Presidential declarations and the Stafford Act; however, Federal
assistance can also be provided to State, tribal, and local
jurisdictions, as well as to other Federal departments and agencies,
through various mechanisms and authorities. Often, Federal assistance
does not require coordination by the Department of Homeland Security
(DHS) and can be provided without a Presidential major disaster or
emergency declaration. Examples of these types of assistance include
those described in the National Oil and Hazardous Substances Pollution
Contingency Plan, the Mass Migration Emergency Plan, the National
Search and Rescue Plan, and the National Maritime Security Plan. These
and other supplemental agency or interagency plans, compacts, and
agreements may be implemented concurrently with the Framework, but are
subordinated to its overarching coordinating structures, processes, and
When the overall coordination of Federal response activities is
required, it is implemented through DHS, consistent with Homeland
Security Presidential Directive (HSPD) 5. Other Federal departments and
agencies carry out their response authorities and responsibilities
within this overarching construct. Nothing in the Framework alters or
impedes the ability of Federal, State, tribal, or local departments and
agencies to carry out their specific authorities or perform their
responsibilities under all applicable laws, executive orders, and
directives. Additionally, it does not impact or impede the ability of
any Federal department or agency to take an issue of concern directly
to the President or any member of the President's staff.
Robert T. Stafford Disaster Relief and Emergency Assistance Act
When it is clear that State capabilities will be exceeded, the
Governor can request Federal assistance, including assistance under the
Robert T. Stafford Disaster Relief and Emergency Assistance Act
(Stafford Act). The Stafford Act authorizes the President to provide
financial and other forms of assistance to State and local governments,
certain private nonprofit organizations, and individuals to support
response, recovery, and mitigation efforts following presidential
emergency or major disaster declarations.
The Stafford Act is invoked when an event causes damage of
sufficient severity and magnitude to warrant Federal disaster
assistance to supplement the efforts and available resources of States,
local governments, and disaster relief organizations in alleviating
damage, loss, hardship, or suffering.
Other Federal Departments and Agencies
Under the Framework, various Federal departments or agencies may
play primary, coordinating and support roles based on their authorities
and resources, and on the nature of the threat or incident.
In situations where a Federal department or agency is responsible
for directing or managing a major aspect of a response coordinated by
DHS, that organization is part of the national leadership for the
incident. In addition, several Federal departments and agencies have
their own authorities to declare disasters or emergencies. For example,
the Secretary of Health and Human Services can declare a public health
emergency. When those declarations are part of an incident requiring a
coordinated Federal response, departments or agencies act within the
overall coordination structure outlined in the Framework.
FEMA and DHS engage the Federal interagency on a daily basis
through numerous channels. Formally, we do so through a Disaster
Resilience Group (DRG), which is composed of cabinet level departments
and agencies, including the Department of Veterans' Affairs, and is
hosted by the National Security Staff. The DRG serves as a forum for
interagency planning, discussion and policy formation with respect to
In the event of, or in anticipation of, an incident requiring a
coordinated Federal response, the FEMA National Response Coordination
Center (NRCC) notifies other Federal departments and agencies of the
situation and specifies the level of activation required. After being
notified, departments and agencies:
Identify and mobilize staff to fulfill their department's
or agency's responsibilities, including identifying appropriate subject
matter experts and other staff to support department operations
Identify staff for deployment to the DHS National
Operations Center (NOC), the NRCC, FEMA Regional Response Coordination
Centers (RRCCs), or other operations centers as needed, such as the
FBI's Joint Operations Center. These organizations have standard
procedures and call-down lists, and will notify department or agency
points of contact if deployment is necessary.
Identify staff that can be dispatched to the incident
Joint Field Office (JFO), including Federal officials representing
those departments and agencies with specific authorities. They must
also identify lead personnel for the JFO sections (Operations,
Planning, Logistics, and Administration and Finance) and the Framework
Emergency Support Functions (ESF).
Begin activating and staging Federal teams and other
resources in support of the Federal response as requested by DHS or in
accordance with department or agency authorities.
Execute pre-scripted mission assignments and readiness
contracts, as directed by DHS.
Some Federal departments or agencies may deploy to an incident
under their own authorities. In these circumstances, Federal
departments or agencies will notify the appropriate entities such as
the NOC, JFO, State Emergency Operation Centers (EOC), and the local
Federal departments and agencies execute interagency or intra-
agency reimbursable agreements, in accordance with the Economy Act or
other applicable authorities. The Framework's Financial Management
Support Annex outlines this process. Additionally, a Federal department
or agency responding to an incident under its own jurisdictional
authorities may request DHS coordination to obtain further Federal
In such cases, DHS may activate one or more ESF to coordinate
required support. Federal departments and agencies must plan for
Federal-to-Federal support missions, identify additional issues that
may arise when providing assistance to other Federal departments and
agencies, and address those issues in the planning process. When
providing Federal-to-Federal support, DHS may designate a Federal
National Response Coordination Center (NRCC)
The NRCC is FEMA's primary operations management center, as well as
the focal point for national resource coordination. As a 24/7
operations center, the NRCC monitors potential or developing incidents
and supports the efforts of regional and field components.
The NRCC also has the capacity to increase staffing immediately in
anticipation of or in response to an incident by activating the full
range of ESFs and personnel as needed to supply resources and policy
guidance to a JFO or other local incident management structures. The
NRCC provides overall emergency management coordination, conducts
operational planning, deploys national-level entities, and collects and
disseminates incident information as it builds and maintains a common
operating picture. Representatives of nonprofit organizations may also
participate in the NRCC to enhance information exchange and cooperation
between these entities and the Federal Government.
Emergency Support Functions (ESFs)
FEMA coordinates response support from across the Federal
Government and certain NGOs by activating, as needed, one or more of
the 15 ESFs. The ESFs are coordinated by FEMA through its NRCC. During
a response, ESFs are a critical mechanism to coordinate functional
capabilities and resources provided by Federal departments and
agencies, along with certain private-sector and NGOs. They represent an
effective way to bundle and funnel resources and capabilities to local,
tribal, State and other responders. While these functions are
coordinated by a single agency, they may rely on several agencies to
supply resources for each functional area. The mission of the ESFs is
to create an efficient, interagency channel to access the vast disaster
response capabilities of the Federal Government. During large
disasters, FEMA hosts video teleconferences with over 200 departments
and agencies to synchronize response efforts between Federal
responders, States impacted by the disasters, the JFO, the NRCC and the
RRCCs. During these video teleconferences, approximately 30-40
agencies, including the VA, provide updates on the situation.
The ESFs serve as the primary operational-level mechanism to
provide assistance in functional areas such as transportation,
communications, public works and engineering, firefighting, mass care,
housing, human services, public health and medical services, search and
rescue, agriculture and natural resources, and energy.
Each ESF is comprised of an overall coordinator as well as primary
and support agencies. The Framework identifies primary agencies on the
basis of authorities, resources and capabilities. Support agencies are
assigned based on resources and capabilities in a given functional
area. The resources provided by the ESFs are consistent with resource-
typing categories identified in the National Incident Management System
As stated earlier, the VA is a Support Agency for five ESFs: 3, 5,
6, 7 and 8. The VA can provide available resources requested directly
by FEMA or by the primary agencies in charge of the ESFs--most
frequently from the Department of Health and Human Services, the
primary agency for ESF 8. During a presidentially declared disaster,
the VA assists the Secretary of HHS with numerous ESF 8
responsibilities. These include coordinating available hospital beds,
additional personnel and supplies, and providing technical assistance.
In addition, FEMA has a Pre-Scripted Mission Assignment for the VA to
provide technical assistance to FEMA in support of Housing Task Forces
established in response to a disaster. Other resources the VA has
provided during recent disasters include staffing assistance to call
ESFs may be selectively activated for both Stafford Act and non-
Stafford Act incidents under circumstances as defined in HSPD-5. Not
all incidents requiring Federal support result in the activation of
ESFs. FEMA can deploy assets and capabilities through ESFs into an area
in anticipation of an approaching storm or other event that is expected
to cause significant harm. The coordination between ESFs allows FEMA to
position Federal support for a quick response, though actual assistance
cannot normally be provided until the Governor requests and receives a
Presidential major disaster or emergency declaration. Many States have
also organized an ESF structure along this approach.
When ESFs are activated, they may have a headquarters, regional,
and field presence. At FEMA headquarters, the ESFs support the strategy
and coordination of field operations within the NRCC. The ESFs deliver
a broad range of technical support and other services at the regional
level in the RRCCs, and in the JFO and Incident Command Posts, as
required by the incident. At all levels, FEMA issues mission
assignments to obtain resources and capabilities from across the ESFs.
The ESFs also plan and support response activities. At the
headquarters, regional, and field levels, ESFs provide staff to support
the incident command sections for operations, planning, logistics, and
finance/administration, as requested. The incident command structure
enables the ESFs to work collaboratively. For example, if a State
requests assistance with a mass evacuation, the JFO would request
personnel from ESF 1 (Transportation), ESF 6 (Mass Care, Emergency
Assistance, Housing, and Human Services), and ESF 8 (Public Health and
Medical Services). These would then be integrated into a single branch
or group within the Operations section to ensure effective coordination
of evacuation services. The same structures are used to organize ESF
response at the field, regional, and headquarters levels.
To support an effective response, all ESFs are required to have
strategic and highly detailed operational plans that include all
participating organizations, and engage both the private sector and
NGOs as appropriate. The ongoing support, coordination, and integration
of ESFs and their work are some of FEMA's core responsibilities in its
response leadership role for DHS.
NRF Support and Incident Annexes
In addition to the ESFs, support is harnessed among Federal,
private sector and NGO partners in the NRF Support and Incident
Annexes. By serving as coordinating or cooperating agencies for various
Support or Incident Annexes, Federal departments and agencies conduct a
variety of activities to include managing specific functions and
missions or providing overarching Federal support within their
functional areas. For example, the Department of Veterans Affairs
serves as a Cooperating Agency for the Critical Infrastructure and Key
Resources Support Function.
Our Nation must be prepared to meet all challenges. FEMA recognizes
that disaster events, regardless of magnitude, can be devastating to
the people and communities affected. The Framework establishes a
comprehensive, national all-hazards approach to domestic incident
response that brings together all levels of government and private-
sector businesses and organizations. The Framework integrates our
Nation's response plans, capabilities, and preparedness activities
around common principles, and allows FEMA and its Federal colleagues to
be more agile and responsive partners with the States and the public
following a disaster. Thank you for the opportunity to testify and I
look forward to any questions the Committee may have.
Prepared Statement of Hon. Jose D. Riojas,
Assistant Secretary for Operations, Security, and Preparedness,
U.S. Department of Veterans Affairs
Mr. Chairman, Members of the Subcommittee, I appreciate the
opportunity to appear before you today and provide an overview of the
Department of Veterans Affairs' (VA) state of preparedness. In carrying
out its ``Fourth Mission,'' VA supports national efforts to prepare
for, respond to, and recover from natural disasters, acts of terrorism,
and man-made catastrophes. While serving in this capacity, VA must
continue to maximize its service to Veterans. Today, I will describe
for you the strategic planning, preparation, and exercises that take
place across the Department, enabling VA to be a national asset while
at the same time keeping our promise to our Nation's Veterans. I also
will share specific examples of VA preparedness efforts, how VA applies
lessons learned, how VA planned for the H1N1 influenza pandemic, how it
responded after the earthquake in Haiti, and how we have prepared for
the upcoming hurricane season.
I am accompanied today by Mr. Kevin Hanretta, Deputy Assistant
Secretary for Emergency Management, and Dr. Gregg Parker, Chief Medical
Officer for Veterans Integrated Service Network (VISN) 16, Veterans
Health Administration (VHA), which includes the parish of New Orleans.
Both VA officials served during Hurricane Katrina--Mr. Hanretta in
Headquarters operations and Dr. Parker on the ground in New Orleans.
Together they can provide a firsthand account of VA's performance
during that crisis from a Department-wide and local perspective. More
importantly, each can attest to the knowledge gained through that
experience and the ways in which VA has applied those lessons learned
to enhance its preparedness.
Since joining the VA team just over a year ago, I have been
increasingly impressed with the quality of our dedicated professionals
who work to ensure that VA's preparedness is continuously improved. The
team within the Office of Operations, Security, and Preparedness (OSP)
provides an excellent example. OSP's mission is to coordinate the
Department's emergency management, preparedness, security, and law
enforcement activities to ensure VA can continue to perform its
mission-essential functions under all circumstances across the spectrum
of threats. OSP's success in fulfilling these responsibilities enhances
the Department's capabilities to support our Veterans and the Nation.
President Obama has charged Secretary Shinseki to transform VA into a
21st century organization that is ``people-centric, results-driven, and
forward-looking.'' Enhancing VA's preparedness is essential to this
Preparedness involves using VA's capability to maximize our ability
to prevent, protect against, mitigate the effects of, respond to, and
recover from natural disasters, acts of terrorism, and man-made
disasters. VA's ability to assist, in case of a national emergency or
act of terrorism, depends on how well we anticipate needs, plan for
evolving scenarios, and respond with agility to the disaster or threat.
This means positioning personnel and equipment in anticipation that
routine modes of transport and communications may be compromised, as
well as having contingency plans and mapping out next steps. It also is
important to practice emergency response procedures. Through training
exercises, senior leaders and other responsible personnel gain
confidence in knowing what is required to support the mission and to
Maximizing preparedness requires the attention of leadership. VA's
Secretary, Deputy Secretary, and senior leaders take preparedness very
seriously and are committed to investing the time, training, and
resources necessary to ensure that VA can step up when called to
action. Through his personal participation in national training
exercises, Eagle Horizon 2009 and 2010, Secretary Shinseki set the
example. Secretary Shinseki has established three ``Fourth Mission''
priorities for VA: personnel accountability, improved communications,
and increased capability to serve as a national resource. These
priorities are reinforced with senior leadership on a regular basis
during briefings and meetings about operations and have been
communicated to every level of the Department. Additionally, I am
pleased to report that, ``Ensure Preparedness to meet emergent national
needs'' is one of the 13 Department-Level Initiatives within VA's
Strategic Plan for FY 2010-2014.
The Integrated Operations Center (IOC), established in June 2009,
continues to evolve and will allow for more comprehensive and active
participation by internal VA stakeholders.
The IOC is the cornerstone of VA's preparedness effort and serves
as the Department's fusion point for unified command, integrated
planning, data collection, and predictive analysis. OSP Watch Officers
staff the VA IOC 24/7. Each of the administrations--Veterans Health
Administration, Veterans Benefits Administration and National Cemetery
Administration--along with the Office of Information and Technology
provide 24-hour coverage as well. The Office of Human Resources and
Administration and the Office of Public and Intergovernmental Affairs
provide coverage to the IOC on a daily basis during business hours. All
other VA staff offices and organizations are available on-call. The IOC
is the focal point within VA for the receipt, analysis, and
dissemination of information related to developing and ongoing events
that potentially affect VA. It forms a nexus that allows for
situational awareness, coordinated recommendations, and feedback to VA
senior leaders in real time so that they can make timely and proactive
decisions. The IOC also serves as the central point for coordination
with interagency stakeholders at the Federal, State, and local levels.
VA is an active member of the Federal planning community and has
senior representatives on a variety of interagency planning
initiatives. VA plays a key role in national level training exercises
and serves as a ready resource for interagency partners.
The Exercise, Training and Evaluation team in OSP coordinates VA
participation in all national level exercises. In addition, this group
conducts monthly preparedness and planning meetings with all
Departmental Emergency Coordinators, maintains an ongoing comprehensive
National Incident Management System (NIMS) training initiative,
conducts quarterly Line of Succession Training, and provides real time
guidance on all Emergency Management issues to the IOC.
VA recently implemented WebEOC, which is an emergency management
National Incident Management System-based collaborative operating
platform. WebEOC further enhances intra- and interagency communications
and information sharing and provides VA, through the VA IOC, with real
time situational awareness of the Department's operational status.
Furthermore, in the past year OSP has developed, coordinated, and
published Department policy and plans that address VA Continuity, the
IOC, VA Serious Incident Reports, VA Devolution, and VA Reconstitution.
Having such plans in place allows for more efficient and effective
coordination within the Department. It also can facilitate
communications with external agencies and stakeholders.
I am proud to report that the involvement of VA senior leaders in
training and exercises is comprehensive and thorough. Our training and
exercise planning includes full-scale participation and after action
reviews that involve all Under Secretaries, Assistant Secretaries, and
other Key Officials. Continuity of Operations and Continuity of
government are fundamental objectives of these planning and exercise
programs. The focus is employee accountability, communications, and
increasing our capability to provide services to Veterans as we support
In the past 12 months, VA has participated in two national
exercises: Eagle Horizon '09 and Eagle Horizon '10. We deployed more
than 200 people during each exercise to our alternate and
reconstitution locations. VA personnel deployed to these sites
represent our Emergency Relocation Group, whose components are the
Crisis Response Team, the Continuity of Operations Team, and the IOC.
VA participation in this year's Eagle Horizon exercise was
evaluated by the Department of Homeland Security (DHS). DHS has not
published the results of that review. However, I am confident that the
VA team effectively demonstrated our capability to continue operations,
and carry out the Department's primary and supporting mission essential
In January 2010, we conducted a comprehensive devolution exercise
ensuring that when needed, Department-level command and control could
be transferred. This exercise was important to validate our procedures
and led to publication of the first VA Devolution Plan.
Some of the strategies written into OSP policy and practiced during
VA and national training exercises are the direct application of
lessons learned from our experience with Hurricane Katrina. Although
VHA did not suffer any loss of life resulting from the 2005 hurricane
season, and all inpatients affected by the storm were accounted for, VA
did have to close two major medical centers (Gulf Port and New Orleans)
and evacuate hundreds of patients, staff and family members from them.
Katrina caused significant disruption to health care operations
throughout the entire Gulf Coast region. Yet, through alternate venues,
we were able to continue providing care to Veterans. For example, VA
deployed a system of 12 ``mobile clinics'' to various sites across the
region in coordination with local authorities and expanded the capacity
of our Community-Based Outpatient Clinic in Baton Rouge, Louisiana. A
key element of our success in this regard was VA's electronic health
record, which enabled VA clinicians across the U.S. to access the
medical records of VA patients displaced by Hurricane Katrina. VHA also
took on a significant role in providing care to non-VA beneficiaries in
keeping with VA's ``Fourth Mission.''
In the aftermath of Katrina, VHA deployed 1,300 volunteers and
staff in a series of 14-day rotations to:
Operate two Federal Medical Stations (FMS) providing
medical services to hundreds of non-VA beneficiaries under the National
Response Plan's Emergency Support Function 8.
Operate VHA mobile medical clinics.
Deliver food, water, fuel and supplies to affected
Augment command and control internal and external to VHA.
Medical Emergency Preparedness
Important lessons learned from Katrina that VHA applies today
Conduct a comprehensive assessment of all VA Medical
Centers (VAMC) preparedness to operate independently.
Provide equipment and supplies, as well as funds to train
and exercise Federal Coordinating Centers (FCC).
Train and prepare cadres to support future FMS
Provide an internal VHA patient evacuation system that
does not rely on external resources.
Procure deployable command and control, medical,
pharmacy, housing and hygiene units.
Enhance the registry and abilities of the Disaster
Emergency Medical Personnel System (DEMPS).
Since 2005, VA has taken a number of steps to improve our medical
emergency preparedness. After Katrina, VA conducted a business impact
analysis and is now nearing completion of a comprehensive 3-year
assessment of the readiness of all 153 VA Medical Centers. We provided
$2 million for FCC patient reception team caches that can be used to
support receipt of patients under the Department of Defense (DoD)-VA
Contingency Plan as well as the National Disaster Medical System
(NDMS). In addition, VA has procured and tested prototype Dual-Use
Passenger/Patient Vehicles capable of transporting various
configurations of ambulatory, wheelchair and litter-borne patients. We
have an agreement with the General Services Administration to procure
over 130 of these vehicles, beginning this year. Finally, VHA procured
25 mobile command and control, medical, pharmacy, housing and hygiene
units to support internal continuity operations, as well as external
taskings under the National Response Framework. We also have recruited
additional DEMPS volunteers and are working on enhancing VA's ability
to identify and deploy volunteers more efficiently in support of both
internal and external taskings.
Returning to Secretary Shinseki's three ``Fourth Mission''
priorities of accountability, improved communications and increased
capability, I would like to highlight certain other accomplishments and
emphasize VA's preparedness should we be called upon to act.
In 2009, the Assistant Secretary for Human Resources and
Administration, John Sepulveda, convened a Departmentwide Employee
Accountability Task Force. Recommendations from that Task Force have
resulted in development of the Emergency Employee Information Database
(EEIDB). The EEIDB is a new tool for identifying employee status during
an emergency. Mr. Sepulveda continues to lead the effort to test and
refine this important tool that facilitates employee accountability.
H1N1 Influenza Pandemic
From the onset, VA carefully monitored the progression of the H1N1
influenza virus. VHA tracked patient information in order to forecast
where and when we would need vaccines. The receipt and movement of
vaccines was carefully managed. Fortunately, the virus did not manifest
as predicted. Nonetheless, VA continuously responded to the needs of
our veterans and employees, and was prepared to respond as a national
asset, if we had been called upon to do so.
Haiti Earthquake Relief
In preparation to provide support during the Haiti earthquake
relief effort, VA quickly validated the list of individuals registered
within the DEMPS. In support of the Department of Health and Human
Services (HHS), five VA medical personnel were deployed to Haiti. VA
had a list of available volunteers and was prepared to provide more
VA has the responsibility to operate up to 57 FCCs located
throughout the United States to transfer civilian patients to civilian
hospitals. At the request of HHS, which is responsible for the NDMS, VA
operated two FCCs; one in Tampa, Florida, and one in Atlanta, Georgia.
VA processed more than 100 patients from Haiti. We used this experience
as another opportunity to refine our policies, plans, and procedures.
This hurricane season, VA again will focus on serving Veterans,
saving lives, protecting property, and ensuring public health and
safety. VA has performed admirably during previous hurricane seasons.
In 2005, following Hurricane Katrina, VA operated 17 of the 18 FCCs
activated by HHS; supported 89 military aero-medical missions and
processed 2,830 displaced non-VA beneficiary patients to 220 non-
Federal hospitals in support of the NDMS. Additionally, in 2008,
following Hurricanes Gustav and Ike, VA operated three FCCs and two HHS
Federal Medical Stations.
The National Oceanic and Atmospheric Administration has forecast
increased hurricane activity this year in the Atlantic. We believe we
are well positioned and prepared to continue to serve Veterans and
execute our ``Fourth Mission'' should we be called upon to perform.
Secretary Shinseki is committed to transforming VA into a ``People-
centric, Results-driven, and Forward-looking'' Department. Maximizing
our preparedness to execute our ``Fourth Mission'' priorities is a
significant element of this transformation. The Secretary and all
senior VA leaders continue to give close attention to preparedness as
we continue to invest, plan, train and exercise.
VA will continue assessing and improving its preparedness
procedures. Nonetheless, I am confident that we have the capability to
respond to our Nation's call as needed during this hurricane season or
in response to any other threat or national emergency.
Thank you for your support, time, and interest in providing the
best for our Nation's Veterans who deserve nothing less. I look forward
to your questions.