[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
EXAMINING INITIATIVES TO ADVANCE PUBLIC HEALTH
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
MAY 17, 2017
__________
Serial No. 115-32
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
_________
U.S. GOVERNMENT PUBLISHING OFFICE
32-462 PDF WASHINGTON : 2018
COMMITTEE ON ENERGY AND COMMERCE
GREG WALDEN, Oregon
Chairman
JOE BARTON, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
FRED UPTON, Michigan BOBBY L. RUSH, Illinois
JOHN SHIMKUS, Illinois ANNA G. ESHOO, California
TIM MURPHY, Pennsylvania ELIOT L. ENGEL, New York
MICHAEL C. BURGESS, Texas GENE GREEN, Texas
MARSHA BLACKBURN, Tennessee DIANA DeGETTE, Colorado
STEVE SCALISE, Louisiana MICHAEL F. DOYLE, Pennsylvania
ROBERT E. LATTA, Ohio JANICE D. SCHAKOWSKY, Illinois
CATHY McMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina
GREGG HARPER, Mississippi DORIS O. MATSUI, California
LEONARD LANCE, New Jersey KATHY CASTOR, Florida
BRETT GUTHRIE, Kentucky JOHN P. SARBANES, Maryland
PETE OLSON, Texas JERRY McNERNEY, California
DAVID B. McKINLEY, West Virginia PETER WELCH, Vermont
ADAM KINZINGER, Illinois BEN RAY LUJAN, New Mexico
H. MORGAN GRIFFITH, Virginia PAUL TONKO, New York
GUS M. BILIRAKIS, Florida YVETTE D. CLARKE, New York
BILL JOHNSON, Ohio DAVID LOEBSACK, Iowa
BILLY LONG, Missouri KURT SCHRADER, Oregon
LARRY BUCSHON, Indiana JOSEPH P. KENNEDY, III,
BILL FLORES, Texas Massachusetts
SUSAN W. BROOKS, Indiana TONY CARDENAS, California
MARKWAYNE MULLIN, Oklahoma RAUL RUIZ, California
RICHARD HUDSON, North Carolina SCOTT H. PETERS, California
CHRIS COLLINS, New York DEBBIE DINGELL, Michigan
KEVIN CRAMER, North Dakota
TIM WALBERG, Michigan
MIMI WALTERS, California
RYAN A. COSTELLO, Pennsylvania
EARL L. ``BUDDY'' CARTER, Georgia
Subcommittee on Health
MICHAEL C. BURGESS, Texas
Chairman
BRETT GUTHRIE, Kentucky GENE GREEN, Texas
Vice Chairman Ranking Member
JOE BARTON, Texas ELIOT L. ENGEL, New York
FRED UPTON, Michigan JANICE D. SCHAKOWSKY, Illinois
JOHN SHIMKUS, Illinois G.K. BUTTERFIELD, North Carolina
TIM MURPHY, Pennsylvania DORIS O. MATSUI, California
MARSHA BLACKBURN, Tennessee KATHY CASTOR, Florida
CATHY McMORRIS RODGERS, Washington JOHN P. SARBANES, Maryland
LEONARD LANCE, New Jersey BEN RAY LUJAN, New Mexico
H. MORGAN GRIFFITH, Virginia KURT SCHRADER, Oregon
GUS M. BILIRAKIS, Florida JOSEPH P. KENNEDY, III,
BILLY LONG, Missouri Massachusetts
LARRY BUCSHON, Indiana TONY CARDENAS, California
SUSAN W. BROOKS, Indiana ANNA G. ESHOO, California
MARKWAYNE MULLIN, Oklahoma DIANA DeGETTE, Colorado
RICHARD HUDSON, North Carolina FRANK PALLONE, Jr., New Jersey (ex
CHRIS COLLINS, New York officio)
EARL L. ``BUDDY'' CARTER, Georgia
GREG WALDEN, Oregon (ex officio)
(ii)
C O N T E N T S
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Page
Hon. Michael C. Burgess, a Representative in Congress from the
State of Texas, opening statement.............................. 1
Prepared statement........................................... 3
Hon. Gene Green, a Representative in Congress from the State of
Texas, opening statement....................................... 4
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 6
Prepared statement........................................... 7
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 8
Prepared statement........................................... 9
Witnesses
Kevin B. O'Connor, Assistant to the General President,
International Association of Fire Fighters..................... 11
Prepared statement........................................... 13
Cheryl Watson-Levy, D.D.S., Member, American Dental Association.. 19
Prepared statement........................................... 21
Martin S. Levine, D.O., Intermin Clinical Dean, Touro College of
Osteopathic Medicine........................................... 36
Prepared statement........................................... 38
Jordan Greenbaum, M.D., Medical Director, Insitute for Healthcare
and Human Trafficking, Children's Healthcare of Atlanta, and
Medical Director, Global Initiative for Child Health and Well
Being, International Centre for Missing and Exploited Children. 42
Prepared statement........................................... 44
Submitted Material
H.R. 931, the Firefighter Cancer Registry Act of 2017, submitted
by Mr. Burgess................................................. 74
H.R. 1876, the Good Samaritan Health Professionals Act of 2017,
submitted by Mr. Burgess....................................... 83
H.R. 767, the SOAR to Health and Wellness Act of 2017, submitted
by Mr. Burgess................................................. 89
H.R. ___, the Action for Dental Health Act of 2017, submitted by
Mr. Burgess.................................................... 96
Letter of May 17, 2017, from Fire Chief John D. Sinclair,
President and Chairman of the Board, International Association
of Fire Chiefs, to Mr. Burgess and Mr. Green, submitted by Mr.
Collins........................................................ 102
Statement of Michael K. Simpson, a Representative in Congress
from the State of Idaho, May 17, 2017, submitted by Mr. Burgess 104
Joint statement of the American Association of Neurological
Surgeons and the Congress of Neurological Surgeons, May 17,
2017, submitted by Mr. Burgess................................. 106
Statement of the American College of Surgeons, May 17, 2017,
submitted by Mr. Burgess....................................... 109
Letter of May 17, 2017, from Thomas P. Nickels, Executive Vice
President, American Hospital Association, to Mrs. Blackburn,
submitted by Mr. Burgess....................................... 112
Letter of May 17, 2017, from Brian K. Atchinson, President and
Chief Executive Officer, PIAA, to Mr. Burgess and Mr. Green,
submitted by Mr. Burgess....................................... 113
EXAMINING INITIATIVES TO ADVANCE PUBLIC HEALTH
----------
WEDNESDAY, MAY 17, 2017
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:17 a.m., in
Room 2322, Rayburn House Office Building, Hon. Michael C.
Burgess (chairman of the subcommittee) presiding.
Members present: Representatives Burgess, Guthrie, Upton,
Shimkus, Murphy, Lance, Griffith, Bilirakis, Bucshon, Mullin,
Collins, Carter, Walden (ex officio), Green, Schakowsky,
Butterfield, Matsui, Castor, Sarbanes, Schrader, Kennedy,
Cardenas, Eshoo, and Pallone (ex officio).
Staff present: Ray Baum, Staff Director; Paul Edattel,
Chief Counsel, Health; Blair Ellis, Press Secretary/Digital
Coordinator; Jay Gulshen, Legislative Clerk, Health; Katie
McKeough, Press Assistant; Kristen Shatynski, Professional
Staff Member, Health; Danielle Steele, Policy Coordinator,
Health; Hamlin Wade, Special Advisor for External Affairs;
Jacquelyn Bolen, Minority Professional Staff Member; Jeff
Carroll, Minority Staff Director; Waverly Gordon, Minority
Counsel, Health; Tiffany Guarascio, Minority Deputy Staff
Director and Chief Health Advisor; Una Lee, Minority Senior
Health Counsel; Samantha Satchell, Minority Policy Analyst; and
C.J. Young, Minority Press Secretary.
Mr. Burgess. Please take your seats. The Subcommittee on
Health will now come to order.
The Chair will recognize himself for 5 minutes for the
purpose of an opening statement. And Mr. Collins, I will be
coming to you at the end of my opening statement to recognize
you.
OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF TEXAS
This subcommittee has the responsibility of advancing
legislation to improve and strengthen public health policy for
all Americans. Today, we will examine four bipartisan bills
intended to improve public health for some of our most at-risk
populations.
In 2015, a 5-year study of nearly 30,000 firefighters found
that firefighters had a greater number of cancer diagnoses and
cancer-related deaths than the general population. While this
built upon prior studies that have examined the link between
firefighting and cancer, our understanding of this connection
is still limited.
To improve upon our ability to alleviate the health risks
that these public servants face, Representatives Collins and
Pascrell introduced H.R. 931, the Firefighter Cancer Registry
Act of 2017.
This bill would authorize funding for the Centers of
Disease Control and Prevention to create a national registry
for the collection of data pertaining to cancer incidence among
firefighters.
We are anxious to hear more from our witnesses about how
H.R. 931 will fill the void in our understanding of the health
risks that our Nation's firefighters face.
Another bill being considered today seeks to ensure that
victims in federally declared disasters have access to medical
care by establishing uniform good Samaritan standards for
volunteer healthcare professionals.
Federal and State laws have developed to encourage
healthcare professionals to volunteer by providing limited
liability protection and recent events have exposed gaps in
those laws that led to delays in the ability of volunteers to
provide care. To prevent this from happening in the future,
Representatives Blackburn and Ruppersberger have introduced
H.R. 1876, the Good Samaritan Health Professionals Act of 2017.
This bill would provide limited civil liability protection
to licensed healthcare providers during a declared disaster.
I certainly want to hear from our witness today about the
importance of H.R. 1876 to disaster victims.
We will also discuss legislation to strengthen the ability
of our healthcare workforce to recognize and care for victims
of human trafficking. Identifying victims of trafficking is a
crucial first step in getting them the support that they need
but it is an incredibly challenging task. A reported 68 percent
of trafficking victims end up at a healthcare setting at some
point. And this can serve as an important chance for providers
to step in and help.
Having spent my time practicing medicine, I know that
feeling prepared to handle difficult situations does require
adequate training and protocols. However, the vast majority of
providers do not have access to such resources.
To address this gap, Representatives Cohen and Kinzinger
have introduced H.R. 767, the SOAR to Health and Wellness Act
of 2017.
This bill would build upon a pilot program underway at the
Department of Health and Human Services that has enhanced the
capacity of communities to identify victims and survivors.
I certainly also want to hear from our witness today about
how this bill will address an unmet need for trafficking
victims and help healthcare providers throughout the United
States of America.
Finally, we will learn about the Action for Dental Health
Act of 2017 authored by Representative Kelly, who has joined us
this morning.
Welcome to you.
This bill would take several steps to support and improve
dental health for some of our most vulnerable populations,
including children and the elderly. I look forward to learning
more from our witness about the importance of the initiatives
of this bill to the dental health of all Americans but
especially those known to be underserved.
I thank all of our witnesses for being here. I look forward
to hearing from each of you, and I will yield the balance of my
time to the gentleman from New York, Mr. Collins.
[The proposed legislation appears at the conclusion of the
hearing. The statement of Mr. Burgess follows:]
Prepared statement of Hon. Michael C. Burgess
This subcommittee has the responsibility of advancing
legislation to improve and strengthen public health policy for
all Americans. Today, we will examine four bipartisan bills
intended to improve public health for some of our most
vulnerable, at-risk populations.
In 2015, a 5-year study of nearly 30,000 fire fighters
found that fire fighters had a greater number of cancer
diagnoses and cancer-related deaths than the general
population. While this built upon prior studies that have
examined the link between firefighting and cancer, our
understanding of this connection is still limited.
To improve upon our ability to alleviate the health risks
these public servants face, Representatives Collins and
Pascrell introduced H.R. 931, the Firefighter Cancer Registry
Act of 2017. This bill would authorize funding for the Centers
for Disease Control and Prevention to create a national
registry for the collection of data pertaining to cancer
incidence among firefighters. I look forward to hearing more
from our witness about how H.R. 931, will fill the void in our
understanding of the health risks our Nation's firefighters
face.
Another bill we will consider seeks to ensure that victims
in federally declared disasters have access to medical care by
establishing a uniform Good Samaritan standard for volunteer
health care professionals. Federal and State laws have
developed to encourage health care professionals to volunteer
by providing limited liability protection-recent events have
exposed gaps in in those laws that led to delays in the ability
of volunteers to provide care.
To prevent this from happening in the future,
Representatives Blackburn and Ruppersberger introduced H.R.
1876, the Good Samaritan Health Professionals Act of 2017. This
bill would provide limited civil liability protection to
licensed healthcare providers during a declared disaster. I
look forward to hearing from our witness about importance of
H.R. 1876 to disaster victims.
We will also discuss legislation to strengthen the ability
of our healthcare workforce to recognize and care for victims
of human trafficking. Identifying victims of trafficking is a
crucial first step in getting them the support they need, but
it is an incredibly challenging task. A reported 68 percent of
trafficking victims end up in a health care setting at some
point, and this can serve as an important chance for providers
to step in and help. Having spent nearly three decades
practicing medicine, I know that feeling prepared to handle
such a difficult situation requires adequate training and
protocols. However, the vast majority of providers do not have
access to such resources.
To address this gap, Representatives Cohen and Kinzinger
introduced H.R. 767, the SOAR to Health and Wellness Act of
2017. This bill would build on a pilot program underway at the
Department of Health and Human Services that has enhanced the
capacity of communities to identify victims and survivors. I
look forward to hearing from our witness about how this bill
will address an unmet need for trafficking victims and health
care providers throughout the US.
Finally, we will learn about the Action for Dental Health
Act of 2017, authored by Representative Kelly. This bill would
take several steps to support and improve dental health for
some of our most vulnerable populations, including children and
the elderly. I look forward to learning more from our witness
about the importance of the initiatives in this bill to the
dental health of all Americans, but especially those known to
be underserved.
I thank all of our witnesses for being here, and I look
forward to hearing from each of you.
Mr. Collins. Thank you, Mr. Chairman, for holding this
hearing today and thank you to all our witnesses and
particularly Kevin O'Connor from the International Association
of Fire Fighters for being here today.
One bill up for discussion is legislation that I
introduced, H.R. 931, the Firefighter Cancer Registry Act of
2017. This thoroughly bipartisan effort takes the first step
towards addressing the detrimental health effects of fighting
fires.
While common sense tells us that firefighters frequently
inhale smoke and other harmful substances, we must know more
about the link between specific chemicals and diseases in order
to reduce their prevalence.
H.R. 931 requires the CDC to establish a voluntary cancer
registry so we can better understand the correlation between
serving as a firefighter and the incidence of cancer. The
registry will allow the CDC to compile a large database of
cancer incidence amongst firefighters and, through this
research, we will hopefully be able to develop new protocols
and safeguards for these brave men and women.
Thank you again, Mr. Chairman, for holding this hearing,
and I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair recognizes the subcommittee ranking member, Mr.
Green, for 5 minutes for an opening statement, please.
OPENING STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Green. Thank you, Mr. Chairman. And thank you to our
witnesses for being here this morning.
Today we are examining four pieces of legislation aimed at
improving our Nation's health, H.R. 767, the SOAR to Health and
Wellness Act would help healthcare professionals identify and
assist human trafficking victims. Far too many victims of
trafficking have a contact with a healthcare professional while
they are in captivity, yet go undetected.
According to research, a large portion of healthcare
professionals have not received specific training on human
trafficking or are poorly equipped to recognize a sign or
respond. This legislation builds on work initiated by the
Administration of Children and Families in the Office of
Women's Health in 2014 known as the Stop, Observe, Ask, and
Respond or SOAR to the health and wellness training programs
that train providers to better recognize and respond to victims
of human trafficking.
H.R. 767 would authorize a program, as well as grants to
train healthcare providers in diverse care settings.
H.R. 931, the Firefighter Cancer Registry Act, would help
advance scientific understanding and response to increased
incidence of cancer among our Nation's heroic firefighters and
I am proud to be a co-sponsor.
Several studies have identified that firefighters are at
elevated risk of certain cancers, yet little beyond that is
well-understood. H.R. 931 will direct the Centers for Disease
Control and Prevention to develop and maintain a voluntary
cancer registry for firefighters. This registration would
collect relevant information to determine the risk of develop
various cancers and inform efforts to advance interventions.
The identified data from the registry would be made
available to researchers so we can spur scientific study and,
ultimately, better protect our Nation's first responders.
The Action for Dental Health Act seeks to improve and
promote oral health care. Millions of Americans, will never see
a dentist, yet half of individuals over the age of 30 suffer
from gum disease and a quarter of young children have cavities.
The Action for Dental Health Act would reauthorize the CDC's
oral health promotion of disease prevention grants and allow
volunteer dental programs that provide free care to underserved
populations to apply directly for these grants.
Finally, we are considering H.R. 1876, the Good Samaritan
Health Professionals Act. The legislation would enable
providers to better respond to disasters. Specifically, the
legislation would limit the civil liability of healthcare
professionals who volunteer to provide healthcare services
during the response to a disaster.
I have long-supported encouraging volunteerism through
protections from civil liability for actions taken in good
faith in the professional's capacity but the solution should be
covered by the Federal Tort Claims Act in these declared
disaster areas.
Houston has tragic experience with hurricanes, floods, and
it is critical that our medical professionals who want to help
are empowered to do so. I look forward to learning more about
these worthy proposals and I want to thank the bills' sponsors,
and the chairman for this hearing, and our witnesses for their
testimony.
And I would like to yield the remainder of my time to
Congressman Butterfield.
Mr. Butterfield. I thank the gentleman for yielding and Mr.
Chairman, thank you for holding this hearing today.
This hearing is certainly an important first step in
reviewing bills that are bipartisan, can benefit all of our
constituents, and I certainly hope it will not be the last.
There are many other important public health bills, Mr.
Chairman, that we must consider, including my bills like the
RACE for Children Act and the National Prostate Cancer Plan
Act, and importantly, my colleague, Hakeem Jeffries' bill
called the Synthetic Drug Awareness Act. I hope these bills
will be taken up very soon.
The four bills that we are considering today all have
significant potential to improve public health. I am grateful
that the committee is considering the Action for Dental Health
Act introduced by my friend and colleague, Robin Kelly from
Illinois. As many of you certainly know, my father was a 50-
year dentist in a rural community in Wilson, North Carolina,
Meharry Medical College Class of 1927. So, I have always
understood the need for good oral health care and the barriers
that prevent people from accessing it. Many people do not know
that tooth decay is the most common chronic disease among U.S.
children, according to the Pew Charitable Trust. Adequate
dental care is especially lacking for individuals in low-
income, minority, and rural communities. The Pew Trust
estimates that more than 18 million low-income children went
without dental care in 2014.
This bill, Mr. Chairman, would reauthorize important CDC
oral health programs that provide grants to communities to
expand health coverage. And I am glad. I am delighted that we
are considering it today.
And I thank the gentleman for yielding. I yield back.
Mr. Burgess. The Chair thanks the gentleman. The gentleman
yields back.
The Chair now recognizes the chairman of the full
committee, Mr. Walden of Oregon, 5 minutes for an opening
statement.
OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. Thank you, Dr. Burgess. I appreciate the good
work you are putting into these bills and our colleagues on
both sides of the aisle keeping up with our bipartisanship over
the years on initiatives to advance solid public health in
America.
There are four bills before us today we have heard a bit
about. I especially want to draw attention to H.R. 931, the
Firefighter Cancer Registry Act of 2017, which requires Centers
for Disease Control and Prevent to develop a voluntary registry
of firefighter occupational information that can be linked to
State cancer registries.
Kevin, your testimony is especially pointed, given your own
personal situation, and really speaks to the importance of the
need for these types of registries, especially when it comes to
our firefighters. As you point out, we have learned a lot over
the years and what to do and not do in terms of best practices
and we have got to get ahead of this one.
Certainly in Oregon, we know the bravery our first
responders not only for traditional firefighting, but also in
the West, where the kind of fires we get in the summers in our
forests, where they face intense smoke and flames and are
frequently breathing in dangerous fumes and carcinogens on the
job.
So, this is really important legislation. And while we know
somewhat about the cancer risk, we don't know everything we
need to know. And so I thank you for your support of this bill
and Congressman Collins for introducing it, along with his
colleagues.
Legislation offered by Representative Robin Kelly, known as
the Action for Dental Health Act of 2017 would help increase
access to dental care in underserved communities, by allowing
the CDC to award grants for volunteer oral health projects and
free dental services to underserved populations.
This bill would also improve outreach, prevention, and
education in oral health. We have heard from colleagues on both
sides of the aisle about the extraordinary importance of
appropriate dental health, especially in underserved areas.
We will also consider H.R. 1876, the Good Samaritan Health
Professionals Act of 2017 authored by Chairman Marsha
Blackburn, which would provide limited liability protections
for health practitioners providing care to those in a natural
disaster, terrorist attack, or other emergency. I think we have
learned a lot over the years, as these disasters have struck
our citizens, just the importance of breaking through some of
the barriers when emergencies happen and to try and get ahead
of them with legislation like this.
Finally, we will examine H.R. 767, the SOAR to Health and
Wellness Act of 2017 authored by Representative Steve Cohen.
This bill would expand and codify the Stop, Observe, Ask, and
Respond program at HHS, which provides health professionals
training on how to identify and treat human trafficking
victims.
Human trafficking is a crime. It is a violation of human
rights. Health providers are uniquely positioned on the front
lines to interact with suspected trafficking victims and get
them the help that they need and deserve.
So I want to thank my colleagues on both sides of the aisle
for bipartisan work in these efforts and look forward to the
testimony from our witnesses.
I would say in advance I am being triple-teamed right now,
in terms of this hearing, one downstairs, and some other
meetings I have to attend to. But I appreciate your testimony,
which I have read and look forward to our committee's actions
on these important pieces of legislation.
I don't know if there is anybody else on the other side
that would like the remainder of my time but, if not, I would
yield back to the chairman and look forward to the hearing.
[The statement of Mr. Walden follows:]
Prepared statement of Hon. Greg Walden
At today's hearing, we will have the opportunity to dig
into an area where this committee has a rich history of
bipartisanship over the years--initiatives to advance public
health. There are four bills before us today, each of which
serve an important purpose in this collective effort.
H.R. 931, the Firefighter Cancer Registry Act of 2017
requires the Centers for Disease Control and Prevention (CDC)
to develop a voluntary registry of firefighter occupational
information that can be linked to State cancer registries.
Firefighters, in particular, often expose themselves to dangers
that can impact their health well beyond their years of
service.
In Oregon, we know well the bravery of the men and women
who protect our communities during fire season each year. These
firefighters are not only battling the intense smoke and
flames, but are also frequently breathing in dangerous fumes
and carcinogens on the job.
While we know there is a heightened risk of cancer among
firefighters, there is very little accurate data available to
understand the full impact. I thank my colleague, Rep. Chris
Collins for sponsoring this important legislation. This bill
will help us better understand how pervasive cancer is in this
vulnerable population, which will lead to better treatment and
prevention efforts. I believe this is an important opportunity
to make sure our Nation's firefighters know we have their backs
when they put themselves in harm's way.
Legislation offered by Rep. Robin Kelly, known as the
Action for Dental Health Act of 2017, would help increase
access to dental care in underserved communities by allowing
the CDC to award grants for volunteer oral health projects and
free dental services to underserved populations. The bill would
also improve outreach, prevention, and education in oral
health.
We'll also consider H.R. 1876, the Good Samaritan Health
Professionals Act of 2017, authored by Chairman Marsha
Blackburn, which would provide limited liability protections
for health practitioners providing care to those in a natural
disaster, terrorist attack or other emergency. Large-scale
emergencies when rescue crews are overloaded treating victims
require an all hands on deck effort. The willingness of
qualified volunteers to offer their services to those in need
should not be deterred by the fear of liability actions being
brought against them.
Finally, we will examine H.R. 767, the SOAR to Health and
Wellness Act of 2017, authored by Rep. Steve Cohen. This bill
would expand and codify the Stop, Observe, Ask, and Respond
(SOAR) program at HHS, which provides health professionals
training on how to identify and treat human trafficking
victims. Human trafficking is a crime and a violation of human
rights. Health providers are uniquely positioned on the front
lines to interact with suspected trafficking victims and get
them help.
I'd like to thank our witnesses--experts and key
stakeholders in these specific areas--for taking the time to
weigh in on these important policies. We welcome your feedback.
Mr. Burgess. The Chair notes the chairman's attendance and
is very appreciative because I know it is a busy morning for
you, and I thank you for being here.
The Chair now recognizes the gentleman from New Jersey, the
ranking member of the full committee, Mr. Pallone, 5 minutes
for an opening statement, please.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you Mr. Chairman. I believe that we can
all agree on the importance of supporting our country's public
health system. A strong public health response is one of the
first lines of defense when our Nation is faced with a health
crisis. It is also an important tool when addressing
longstanding healthcare issues, including the prevention of
harmful and closely chronic conditions. And today we will hear
from our witnesses on the four public health bills.
Mr. Chairman, I am not going to repeat what is in the
bills, but I do want to comment on them.
With regard to H.R. 767, the SOAR to Health and Wellness
Act, I wanted to say that a doctor's visit or emergency
department trip is a critical point of intervention for
victims, as it may be a rare moment in which they can detach
from traffickers. Teaching providers to recognize the signs of
trafficking and providing them with the resources to assist
victims can truly be the difference between life and death. So
I want to thank Congressman Cardenas for his work on this bill.
With regard to H.R. 931, the Firefighter's Cancer Registry
Act is another bill which we will discuss that creates a
voluntary cancer registry of firefighters to collect data
related to their cancer risk and outcomes. And firefighters may
be exposed to carcinogens and other hazardous chemicals that
impact their health while they are on the job. The registry
would help CDC collect and monitor information from
firefighters over time to inform the best prevention and
intervention practices.
H.R. 1876, the Good Samaritan Health Professionals Act,
again, our volunteer health professionals are a crucial
resource in major disasters. I remember 9/11 and the bravery of
medical volunteers from all over the Nation, especially from my
home State of New Jersey, as they headed across the water to
help the victims in New York City. I also think of the response
to Hurricane Sandy and how many people survived the storm, due
to the action of medical volunteers.
While I am always concerned about preempting strong State
laws, I look forward to learning more about this bill and
understand what we can do as lawmakers to support medical
volunteers at the Federal level.
And finally, I want to thank Congresswoman Robin Kelly, who
I see is here, for her work on H.R. 767, the Action for Dental
Health Act of 2017. Oral health is often thought of as separate
from a person's medical care but the truth is that oral health
is vital to overall health, ensuring access to affordable
dental care would lower the number of emergency department
visits for preventable oral conditions and reduce the risk of
chronic disease. In short, it would lead to an improved quality
of life.
And again, I thank our witnesses. I look forward to the
discussion.
[The prepared statement of Mr. Pallone follows:]
Prepared statement of Hon. Frank Pallone, Jr.
Thank you Mr. Chairman. I believe that we can all agree on
the importance of supporting our country's public health
system. A strong public health response is one of the first
lines of defense when our Nation is faced with a health crisis.
It is also an important tool when addressing longstanding
healthcare issues, including the prevention of harmful and
costly chronic conditions. Today we will hear from our
witnesses on four public health bills:
H.R. 767, the SOAR to Health and Wellness Act, establishes
a pilot program to train health care providers to identify and
care for potential human trafficking victims. A doctor's visit
or emergency department trip is a critical point of
intervention for victims, as it may be a rare moment in which
they can detach from traffickers. Teaching providers to
recognize the signs of trafficking and providing them with the
resources to assist victims can truly be the difference between
life and death. Thank you to Congressman Cardenas for his work
on this bill.
H.R. 931, the Firefighter Cancer Registry Act of 2017,
introduced by Congressmen Collins and Pascrell, is another bill
we will discuss that creates a voluntary cancer registry of
firefighters to collect data related to their cancer risks and
outcomes. Firefighters may be exposed to carcinogens and other
hazardous chemicals that impact their health while they are on
the job. The registry would help CDC collect and monitor
information from firefighters over time to inform the best
prevention and intervention practices.
H.R. 1876, the Good Samaritan Health Professionals Act,
would limit the civil liability of the volunteer health
professionals that provide their services during disaster
response. Our volunteer health professionals are a crucial
resource in major disasters. I remember 9/11 and the bravery of
medical volunteers from all over the Nation, especially from my
home State of New Jersey, as they headed across the water to
help the victims in New York City. I also think of the response
to Hurricane Sandy and how many people survived the storm due
to the action of medical volunteers. While I am always
concerned about preempting strong State laws, I look forward to
learning more about this bill and understanding what we can do
as lawmakers to support medical volunteers at the Federal
level.
And finally, I would like to thank Congresswoman Robin
Kelly, who is here today, for her work on H.R. 767, the Action
for Dental Health Act of 2017. This bill would reauthorize the
CDC oral health promotion and disease prevention grants, and
would allow volunteer dental programs and other eligible
entities to apply for these CDC grants.
Oral health is often thought of as separate from a person's
medical care, but the truth is that oral health is vital to
overall health. Ensuring access to affordable dental care would
lower the number of emergency department visits for preventable
oral conditions, and reduce the risk of chronic disease. In
short, it would lead to an improved quality of life.
I want to thank our witnesses for being here today to talk
about these bills and their impact on our healthcare system. I
look forward to our discussion.
Mr. Pallone. I would like to yield the remainder of my time
to Mr. Cardenas.
Mr. Cardenas. Thank you very much. I want to thank the
chairman and also the ranking member for holding this hearing
today.
Human trafficking is an issue that really hits home for us
in Los Angeles. Unfortunately, we are one of the largest
trafficking cities in the world. I have been involved in
combatting human trafficking efforts since my days on the city
council.
For example, while I was on the city council, the case
occurred where 12 women were forced to work as prostitutes in
South Los Angeles in a brothel to pay off debts to their
smugglers. It was a wake-up call for me and the entire city. We
can and should be doing more to prevent human trafficking and
we can.
That is why I am proud to join Congressmen Cohen,
Kinzinger, and Wagner in introducing H.R. 767, the SOAR to
Health and Wellness Act--Stop, Observe, Ask, and Respond. This
bipartisan bill creates a pilot program at the Department of
Health and Human Services to ensure that more healthcare
professionals are trained to identify and assist victims of
human trafficking.
Victims of forced sex and labor trafficking are often
incredibly difficult to identify. Over 20 million human beings
are victimized by traffickers worldwide every single year. And
more than 85 percent of trafficking victims end up in a
healthcare setting at some point. Despite this, fewer than 60
hospitals around the country have been identified as having a
plan for treating patients who are victims of trafficking. Only
five percent of emergency room personnel are trained to treat
trafficking victims.
This bill is part of the solution to the bigger issue of
human trafficking. I urge my colleagues to join me in the fight
against human trafficking by supporting this common sense
legislation.
And when we did identify that in Los Angeles, we actually
did something at very, very little cost. All of the law
enforcement agencies throughout L.A. city and county from the
Federal level to the State level came together with the not-
for-profit service providers and we created a human trafficking
task force. And the identification of human traffic victims
went up incredibly high and the identification rate didn't have
misses. They were all positive hits. So many lives were saved.
And I thank you very much. I yield back.
Mr. Burgess. The Chair thanks the gentleman. The gentleman
yields back.
That concludes Member opening statements. The Chair would
like to remind Members that, pursuant to committee rules, all
Members' opening statements will be part of the record.
And we do want to thank all of our witnesses for being here
this morning and taking time, their time to testify before the
subcommittee. Each of our witnesses will have the opportunity
to give a summary of their opening statement, which will be
followed by a round of questions for Members.
So today we have with us Mr. Kevin O'Connor, assistant to
the general president of the International Association of Fire
Fighters; Dr. Cheryl Watson-Lowry, the American Dental
Association; Dr. Martin Levine, interim clinical dean, Touro
College of Osteopathic Medicine; and Dr. Jordan Greenbaum, the
director of the Global Child Health and Well Being Initiative
from the International Center for Missing and Exploited
Children. We appreciate all of you being here today.
And Mr. O'Connor, you are now recognized for 5 minutes to
summarize your opening statement. Thank you.
STATEMENTS OF KEVIN B. O'CONNOR, ASSISTANT TO THE GENERAL
PRESIDENT, INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS; CHERYL
WATSON-LOWRY, D.D.S., MEMBER, AMERICAN DENTAL ASSOCIATION;
MARTIN S. LEVINE, D.O., INTERIM CLINICAL DEAN, TOURO COLLEGE OF
OSTEOPATHIC MEDICINE; AND JORDAN GREENBAUM, M.D., MEDICAL
DIRECTOR, INSITUTE FOR HEALTHCARE AND HUMAN TRAFFICKING,
CHILDREN'S HEALTHCARE OF ATLANTA, AND MEDICAL DIRECTOR, GLOBAL
INITIATIVE FOR CHILD HEALTH AND WELL BEING, INTERNATIONAL
CENTRE FOR MISSING AND EXPLOITED CHILDREN
STATEMENT OF KEVIN B. O'CONNOR
Mr. O'Connor. Thank you, Chairman Burgess, Ranking Member
Green, full committee Chair Walden and Ranking Member Pallone,
distinguished members.
I am Kevin O'Connor, and I head the Governmental Affairs
and Public Policy Division for the International Association of
Fire Fighters. I am here today on behalf of over 305,000
members who provide fire, rescue, and emergency medical
services to every congressional area in the country.
Cancer is a scourge that plagues the fire service of people
of all ages and in every region of the country. It is a disease
that impacts both men and women, young and old. It is a sad
truth that when people join the fire service, they knowingly
recognize that they will incur a higher chance than the general
public of contracting and dying from cancer.
Firefighters respond to every conceivable disaster,
emergency, or hazardous incident. The environments to which our
members are exposed are laden with carcinogens, biohazards, and
other chemical formulations and compounds. Under any
circumstances, these products are hazardous but, under
combustion, they emit byproducts that can be fatal, both at the
emergency scene and years later through the accumulation of
occupational diseases.
Every year, the IAFF honors our fallen heroes at a memorial
service in Colorado Springs. For the past generation, more
firefighters have died of occupational cancers than those who
are killed on the fire scene, at building collapses, and
vehicular accidents, and all other incidents combined. In fact,
over 60 percent of our deaths are cancer-related.
There are three principle studies that track elevated
incidence of cancer among firefighters. The first is a
University of Cincinnati analysis which combine data from over
two dozen other studies and classify the heighten risk of
firefighters into several categories.
Secondly, NIOSH tracked cancer data in over 30,000
firefighters over a 59-year period from large metropolitan
regions and compiled data demonstrating increased risk of
firefighters of dying from seven specific cancers.
Lastly, a 40-year 16,000 firefighter cohort study in the
Nordic countries largely mirror the results found by NIOSH.
Here are some of those collective findings: Firefighters
contract testicular cancer at a 102 percent greater rate than
the general public; mesothelioma, 101 percent more; non-
Hodgkin's lymphoma, 51 percent; multiple melanomas 53 percent;
rectum cancer, 45 percent; and sadly, the list continues.
Cancer is an epidemic in our industry. To eliminate or
reduce cancer risk, we need data. It is problematic but there
is only three major studies that track these statistics. The
IAFF and our members applaud Representative Chris Collins for
introducing H.R. 931 and those who have co-sponsored the
legislation. The measure already has over 165 bipartisan co-
sponsors and, as stated, would establish a voluntary cancer
registry through the Center of Disease Control exclusively for
firefighters, career, volunteer, part-time, wildland, all
measures of firefighters. This information could be accessed by
researchers, epidemiologists, and physicians to track cancer in
our profession and use the findings for more advanced or
targeted research. Simply put, it will be a centralized data
collection point.
The registry would be structured in a fashion that will
track various demographic and employment information, including
years of service, call volume, risk factors, and more but
protect the confidentiality and privacy of the responders. The
national registry would provide a trove of useful data and
information.
I have a personal interest in H.R. 931. I am a cancer
survivor. Before assuming my current post, I served as a
firefighter in Baltimore County for 16 years, a career much
shorter than many other firefighters. I won't embellish my
service. I responded. I did my job just like everyone else.
Last year, I developed prostate cancer. The statistics say
that firefighters between 30 and 49 years of age have a 159
percent greater chance at contracting prostate cancer than
other men. Was my cancer job-related? I don't know the answer
to that. But I do know that both my grandfathers lived past 80
and my father is still a very vibrant 85-year-old. I had the
prostate removed last year and, as of today, I am cancer-free.
Knowledge and information are very powerful tools. We need
those tools to track, treat, and prevent cancer. The
firefighter cancer registry does just that.
I encourage this committee and the entire body to act
favorably and expeditiously on this legislation.
I thank you for the opportunity to testify today and am
willing to answer any questions. Thank you very much.
[The statement of Mr. O'Connor follows:]
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Mr. Burgess. The Chair thanks the gentleman for his
testimony.
Dr. Watson-Lowry, you are recognized for 5 minutes, please.
STATEMENT OF CHERYL D. WATSON-LOWRY
Dr. Watson-Lowry. Good morning. Mr. Chairman and members of
the subcommittee, thank you for the opportunity to testify this
morning in support of the Action for Dental Health Care Act
2017 introduced by Representative Robin Kelly. Thank you very
much.
My name is Dr. Cheryl Watson-Lowry. I am a practicing
dentist from Chicago, Illinois and a member of the American
Dental Association.
As you may have seen from my bio, I am a second generation
dentist. My dad went to Meharry. I started working with my dad
when I was 11 years old and I started working chair-side when I
was 15 years old.
My practice is in the inner city and my patients range in
age from 6 months to 107 years old. My patients include
professionals, politicians, teachers, police officers,
students, fast food workers, and even one patient that sells
incense on the train to pay his bills, including for his dental
services.
The Action for Dental Health Bill you are considering could
positively affect every patient in my practice, which is why I
am so passionate about it.
This bill is important because healthy teeth and gums
aren't a luxury. They are an essential for good oral health and
good overall health. As a practicing dentist, I know the causes
of dental disease can be varied and complex. So the solutions
for the dental health crisis facing America today needs to be
wide-ranging. The American Dental Association is very proud to
support H.R. 2422 because the legislation helps to address the
numerous barriers to accessing care and oral healthcare
services. The ADH bill does this by providing funding for
organizations engaged in volunteer dental projects that provide
free dental care directly to those in need but it also
establishes a second grant program to promote oral health
initiatives design to facilitate private-public partnerships
collectively called Action for Dental Health Initiatives.
A good example of a successful volunteer project, the ADA's
Give Kids A Smile program, which has provided free oral
healthcare services for over 5.5 million children since 2003.
While pro bono programs serve as an important safety net for
individuals who cannot afford coverage, we all know that
offering free oral health services is not a long-term solution.
That is why in 2013, the ADA launched the Action for Dental
Health Initiative.
The ADA initiative is a nationwide community-based movement
aimed at ending the dental crisis. It is composed of eight
initiatives designed to address specific barriers to care. This
morning, I would like to focus on just two of the ADH
Initiatives: emergency room referrals and community dental
health coordinators.
A key initiative in the ADH program is reducing the number
of people who visit the emergency room for dental conditions by
referring them to dental practices. These emergency room visits
for dental problems cost more than providing regular care by
oral health professionals. It is estimated that the U.S. spent
nearly $3 billion on E.R. dental visits between 2008 and 2010.
Also, most E.R. visits only provide patients with pain
medication and antibiotics. They do not treat the underlying
problem.
While recent research indicates that hundreds of E.R.
referral programs in virtually every State are working and the
use of emergency room for dental conditions have been
decreasing, we cannot let up now. More still needs to be done
to expand E.R. referral programs and H.R. 2422 will help.
The ADA also believes that the use of community dental
health coordinators, also called CDHCs can continue this
positive trend by connecting patients to dental homes and
ensuring that the care is delivered in the most appropriate and
cost-effective venue possible. The ADA's commitment to
improving America's oral health has led us to invest more than
$7 million in the CDHC program. This program trains individuals
to provide patient navigation, oral health information, and
preventative self-care for patients who typically do not
receive dental services.
The CDHCs work in inner cities, remote rural areas, and
Native American lands. They help people who might otherwise
through the cracks of what can be a complicated delivery
system. Most CDHCs grew up in these communities, so they better
understand the problems that affect the access to dental care.
The CDHC model has been adapted to numerous community
settings, including clinics, schools, Head Start programs,
institutional settings, churches, and other venues. It is
important to note that an evaluation based on 88 case studies
of CDHC programs demonstrated the real-world value of the CDHC
in making the dental team more efficient and effective. Before
the end of this summer, the CDH program will have over 100
graduates working in 21 States. With the help of H.R. 2422, we
hope that the number will continue to grow and help our
Nation's vulnerable find dental homes.
Mr. Chairman and subcommittee, thank you for the
opportunity to share with you why the ADA believes the Action
for Dental Health Act of 2017 will enhance ongoing efforts to
reduce the barriers to oral health care facing Americans today.
Thank you.
[The statement of Dr. Watson-Lowry follows:]
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Mr. Burgess. Thank you and thank you for your testimony.
Dr. Levine, you are recognized for 5 minutes for a
summarization of your opening statement, please.
STATEMENT OF MARTIN S. LEVINE
Dr. Levine. Thank you, Chairman Burgess, Ranking Member
Green, and--Chairman Burgess, thank you. Ranking Member Green
and members of the subcommittee, on behalf of the American
Osteopathic Association and the nearly 130,000 osteopathic
physicians and osteopathic medical students we represent, than
you for the opportunity to testify this morning on the Good
Samaritan Health Professionals Act of 2017.
My name is Martin Levine, D.O. I am a board-certified
osteopathic family physician from New Jersey and I also have
the distinct privilege of having served as the 115th President
of the AOA in the 2011-2012 term.
I have practiced osteopathic family medicine and
osteopathic manipulation as well as sports medicine for 34
years. Throughout my career, I have always worked with students
and I am now the Interim Clinical Dean at the Touro College of
Osteopathic Medicine in Harlem.
I have also served as a team physician at every level of
sports, including local college, Olympic, and professional
sports teams. In addition, I have been proud to serve as a
volunteer physician at the New York City Marathon for over 20
years and also as the Elite Athlete Recovery Area physician at
the Boston Marathon for the past 18 years.
On April 15, 2013, after finishing my duties with the Elite
Athletes, I was triaging runners in front of the main medical
tent just after the finish line of the Boston Marathon when the
first of two bombs exploded on Boylston Street. We heard the
explosion and I saw the plume of smoke begin to rise. And the
first thing I noticed with it, there were no people standing in
that area anymore.
I immediately told the staff inside the tent to make room
and to clear out anyone that was able to leave, as it was clear
we were going to have casualties. And then I turned and ran to
the site of the explosion.
As I arrived at the scene, the second bomb went off further
up Boylston Street. As one of the first responders at the site
of the first blast, I saw blood everywhere and dozens of
victims on the ground with severe wounds, mostly below the
waist. Many of the victims were missing lower limbs and
bleeding profusely. So I and other responders improvised
tourniquets with our belts and identification badge lanyards to
staunch the bleeding. We transported victims to ambulances
using stretchers, backboards, wheelchairs, whatever was
possible.
Thanks to the quick work of the EMS, other first
responders, and the ambulances, the first casualty to arrive at
the hospital was there in 14 minutes and they were in the
operating room within 22 minutes of the blast. In seconds, we
had gone from helping runners recover from the race to treating
spectators with severe trauma--horrific injuriesinflicted by a
bomb.
The medical team at the Boston Marathon is always prepared
to treat mass casualties, just not the type of wounds we saw on
that day. As part of the medical responders, I didn't feel the
chaos of the moment; we were simply doing what we had to do in
that situation and most important was that we were able to save
lives.
I am grateful that the committee is holding the hearing
today to examine the Good Samaritan Health Professionals Act,
legislation that will help provide professional healthcare
volunteers with much needed certainty when serving as
volunteers during federally declared disasters. The desire to
help save lives drives many physicians and healthcare
professionals from all over the country to volunteer when
disaster strikes.
While the scale of the disaster and the scope of needs will
always vary, providing uniform Federal standards for
professional liability will help ensure that a sufficient
healthcare workforce can be mobilized without unnecessary
delays or confusion. In our case of the marathon, the race's
liability coverage would have protected as volunteers for
treating the runners. But we had to shift to treating
spectators in a much different capacity which would not be
covered under that policy.
This legislation will help fill in the existing gaps in our
liability protection laws. While many States have such
protection in place, the current patchwork of laws does not
provide healthcare professionals with the certainty they need
and the inconsistency in understanding the application of these
laws has resulted from physicians being turned away from
disaster areas, when they attempt to volunteer their services.
A uniform Federal standard narrowly focused to apply to
federally declared disaster areas will ensure that qualified
medical professionals can contribute their services to provide
communities with the medical assistance they need.
As an osteopathic physician, I am trained to treat the
whole person, addressing not just the body but the mind and
spirit. Disaster victims require the need for emotional
support, comfort, and empathy, as they receive the care needed
to address their physical wounds. In this case, it was an act
of terrorism. In other instances, it might be a natural
disaster or public health outbreak. Regardless, this
legislation would provide healthcare professionals with the
comfort and emotional well-being of knowing that they are not
at financial risk when voluntarily treating victims of
federally recognized disasters.
Thank you once again for the opportunity to provide my
testimony before the subcommittee today. On behalf of the
nearly 130,000 osteopathic physicians and students across the
country, we appreciate your attention to the important issue
and thank the committee members for taking steps to advance
public health.
Thank you.
[The statement of Dr. Levine follows:]
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Mr. Burgess. The Chair thanks the gentleman for his
testimony.
Dr. Greenbaum, you are recognized for 5 minutes for an
opening statement, please.
STATEMENT OF JORDAN GREENBAUM
Dr. Greenbaum. Thank you. Good morning Chairman Burgess,
Ranking Member Green, and subcommittee members. I appreciate
the opportunity to testify in front of you today.
I am a child abuse physician and the Medical Director of
the Institute for Human Trafficking at Children's Healthcare of
Atlanta. The purpose of the Institute is to improve the lives
of children and families affected by human trafficking by
enhancing mental health and medical care through research,
training, and education.
I am also the Medical Director of the Global Initiative for
Child Health and Well Being at the International Center for
Missing and Exploited Children and a HEAL Trafficking member, a
national organization dedicated to ending human trafficking
using a public health approach.
A 15-year-old girl was admitted to Children's Healthcare of
Atlanta a few years ago for a suicide attempt. She had ingested
alcohol and a narcotic. It was only after she woke up in the
intensive care unit and was interviewed by one of our social
workers that we learned her depression existed in the context
of human trafficking.
What if we had never asked her about her depression or the
circumstances of her life? She probably would have been
admitted briefly to a psychiatric institution and then, in all
likelihood, discharged back to her life of exploitation.
For the next 4 minutes, I would like to make three
essential points: human trafficking is a healthcare issue;
healthcare professionals need training in order to be able to
recognize and respond to human trafficking; and the SOAR to
Health and Wellness Act is a very effective strategy for
addressing this widespread need for education and training.
As you know, reliable estimates of the incidence and
prevalence of human trafficking are lacking but the best
estimates suggest that millions of adults and children around
the world are impacted by human trafficking and the United
States is a major destination country. Victims of trafficking
may experience a plethora of physical and mental health adverse
consequences ranging from physical assault injuries, sexual
assault injuries, sexually transmitted diseases, HIV/AIDS,
tuberculosis, major depression, and post-traumatic stress
disorder. In a recent study of youth sex trafficking victims,
47 percent reported attempting suicide within the past year.
Despite the criminal nature of human trafficking and the
desire of traffickers to elude detection, research consistently
shows that victims do have contact with medical professionals.
In a study of female survivors, nearly 88 percent had been seen
by a medical professional during their period of exploitation
but we also know that victims rarely self-identify when they
seek medical care. I believe that every day hundreds of victims
across the United States are coming to our clinics and our
emergency departments and presenting for symptoms, being
treated for conditions, and discharged with no one ever asking
about the possibility of exploitation.
Consider a 14-year-old trafficked boy who comes to a clinic
with symptoms of a sexually transmitted infection. He might
easily be treated for his symptoms and sent on his way, without
anyone ever asking about the possibility of exploitation or the
circumstances of his life. Subsequently, that same unidentified
victim may become HIV-positive or experience major traumatic
injuries from a physical assault.
This medical visit represents a critical missed
opportunity. Health and services are within arm's reach but go
untouched. To prevent lost opportunities such as these, to
offer exploited persons help in leaving their situation, it is
imperative that healthcare professionals recognize signs of
high-risk youth and adults, ask questions appropriately and
provide trauma-sensitive care.
The SOAR to Health and Wellness Act would address the
critical need for training of healthcare providers. This
training would be specific to the needs of varied
professionals, ranging from medical and mental health
practitioners, social workers, and public health professionals.
And importantly, the training would be based on research, not
emotion; on facts, not speculation. It would use well-
established adult learning strategies to facilitate changes in
practitioner attitude, knowledge, and behavior. And the
training would be formally evaluated to make sure it is
effective.
Essential to facilitating lasting change in any medical
practice is to support the newly trained practitioners and this
can be facilitated through good protocols for providers to use
whenever they suspect a patient has been trafficked. H.R. 767
addresses this need by including protocols in the program
development--protocols for offices, clinics, and hospitals, and
provision of technical assistance to those who want to
implement the protocols.
Training and technical support of healthcare professionals
are critical components of the U.S. effort to curb the tide of
human trafficking. Healthcare professionals have a unique role
in preventing exploitation and identifying victims, as well as
assisting them in escaping their plight. But without evidence-
based, high-quality, easily accessible training, and technical
assistance, the very large, complex, and unwieldly healthcare
sector may well lose track of the human trafficking issue and
give up its role in fighting the battle against exploitation.
We cannot allow that to happen.
Thank you very much for allowing me to testify in front of
you today.
[The statement of Dr. Greenbaum follows:]
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Mr. Burgess. And thank you. We appreciate your testimony.
And I thank all the witnesses for their testimony.
We are now going to move into the question portion of the
hearing.
Just before we do that, I do want to recognize Dr. David
Scott, who was a lead co-sponsor on the Good Samaritan Health
Professionals Act. So, I certainly want to acknowledge his good
work on that.
I will get in trouble for doing this but I want to
recognize the presence of Dr. Laura Sirott in the audience. She
is a McCain Fellow from the American College of OB/GYN. She
practices I think in Los Angeles, California and we are very
grateful to have her attention this morning as the good folks
at ACOG sponsor the McCain Fellowship to foster a greater
understanding of public policy as it relates to health care.
Dr. Levine, thank you so much for being here this morning.
Thank you for your work.
You know it was shortly after Hurricane Katrina struck on
Labor Day weekend and I am sitting in my office a little bit
north of Dallas, Texas, as a Member of Congress, but clearly
there was a need. And I was somewhat startled to find out that
if I made myself available down at Reunion Arena in Dallas,
Texas, where I had a State license but I no longer carried
liability insurance, I could be at risk. But if I traveled to
Louisiana, where I didn't have a medical license, I could
volunteer all day long.
Now, it turns out I was probably more useful as a triage
individual, helping people get placement in nursing homes in
the Metroplex who were in trouble in Louisiana but it struck me
that day that there is kind of a patchwork that governs this.
Is that correct?
Dr. Levine. Yes, sir and it is hard for the physicians who
may want to travel, for whatever reason, out of State but also
within their own State. It is difficult when you are telling
your insurer, liability insurer for your own practice, that if
you are working outside of your practice spots, you may not be
covered. So even if I am in the same State, some of the
liability will not cover you within your own State.
Mr. Burgess. So just as a matter of course, a physician who
wishes to volunteer in one of those types of situations, do
they need to call their liability carrier first before they
volunteer?
Dr. Levine. Obviously, that would be very difficult and
with the chaos of disasters, it is almost impossible to find
out immediately what you would be covered by.
Mr. Burgess. Yes, in your situation in Boston, obviously,
that would have been impossible in that chaotic moment.
And I want to thank you for being there and responding. I
will tell you, having watched that drama unfold on the
television here on Capitol Hill, it was very, very difficult.
And it really wasn't until the medical professionals came out
that night and gave the press conference that I had a sense
that things were back under control. So, clearly, the people
who respond in events like that provide, in addition to taking
care of the people that are injured at the scene, it also
provides care to those of us who are not on the scene, that
somebody competent is in charge and taking care of those who
were injured.
Mr. O'Connor, I want to thank you for your presence today.
You have provided us information on something which I was
unaware, was the dramatic increase, and if I understand your
testimony correctly, that started around calendar year 2002, or
is that just when we started keeping statistics?
Mr. O'Connor. Well, the statistics have been kept longer
than that. My testimony was germane to the IAFF's fallen
firefighter, when we started tracking statistics internally.
That is just for those who actually have perished in our
organization. That is not comprehensive of the entire fire
service.
Mr. Burgess. I see.
Mr. O'Connor. Statistics started being collected in 1950.
The one study that I referenced began then and ended in 2009.
The problem, unfortunately, has been the gathering of
information has not been complete. There has been certain
aspects in terms of risk factors, how long people served as
firefighters, a lot of that other type of demographic data has
not been collected. It has just basically been review of death
certificates.
Mr. Burgess. Well, you certainly added good evidence to why
the collection of data is important.
Dr. Greenbaum, let me ask you. In your testimony you talked
about a 14-year-old who came to an emergency room. When I
practiced in Texas, if there was even any evidence of child
abuse, I was required to call Child Protective Services. It
wasn't optional. It was an obligation in which case, I could
perhaps incur legal liability if I didn't do that. Would that
not have been the case for this child that you referenced in
your testimony?
Dr. Greenbaum. In many States, commercial sexual
exploitation falls under the child abuse mandated reporting
laws. It is not uniformly so. And I think all too often, people
don't ask the questions about the background and what led to
that sexually transmitted infection. So, they don't get the
information that would tell them the child has been exploited,
requiring a report.
Mr. Burgess. Well, I thank you for your testimony and for
your work on this.
It wasn't in this committee, but, on the Helsinki
Commission a year and a half ago, we had a very compelling
hearing on this issue of human trafficking and both of the
women who testified--it was very courageous for them to come
forward--it was their interactions with the healthcare system,
where the evidence and clues were missed. One of the things
that just struck me during that hearing was each of those
witnesses stated that their trafficking was done by a family
member. So merely the fact that it is a family member who
brought someone in for care does not mean you don't have to
worry about that. In these two cases, it was a direct result of
their family member doing the trafficking that caused them to
be in the emergency room or the clinical setting where they
were that day.
And the other thing that struck me is the length of time
that it went on before there was actually recognition. So I
suspect that is what you have brought to us today is extremely
important and something the committee clearly needs to look at.
I am going to yield back my time and recognize the ranking
member of the subcommittee, Mr. Green from Texas for 5 minutes
for questions, please.
Mr. Green. Thank you, Mr. Chairman.
Mr. O'Connor, welcome to our committee and I want to thank
you and your fellow firefighters across the country. If I
hadn't gotten into politics, I would probably have been a
firefighter since my grandfather and my two uncles were.
But cancer continues to be a devastating effect on
individuals throughout our country. The American Cancer Society
estimates that 692,000 Americans will die from this horrible
disease. And these efforts--last Congress we passed the Beau
Biden Cancer Moonshot, which was part of our 21st Century Cures
in support in improving the lives of all Americans.
The Firefighter Cancer Registry, though, is really
important because there is an incidence of firefighters, even
though nowadays they have a lot better equipment, when they go
into a fire, they don't know what they are breathing. It could
be chemicals, particularly in an area like I come from because
we have a chemical industry.
What is currently known about the link between firefighter
occupation and cancer?
Mr. O'Connor. Well I mean that is a very good question and
there is multiple answers for it.
First, their industry has changed so much in the 31 years I
became a firefighter. You are absolutely right. If this room
itself caught on fire, there is carcinogens in just about
everything, toxic flame retardants. For wildland firefighting,
people just think that it is the trees and it is nature
burning. In many cases, it becomes a conflagration, like what
occurred in Colorado Springs, where 200 houses went up. The
World Trade Center, the collapse, the particulates.
Firefighters are exposed to it from almost the minute they
walk into a fire station. One of the problems we encounter is
diesel exhaust just in the station from the equipment starting
and shutting off. Obviously, when they get on the scene, they
have exposure through inhalation, through breathing. Certainly,
the technology of self-contained breathing apparatus has
improved and lung cancer has actually diminished a little bit
over the last generation because it was a known risk.
But what we are finding now is that people are getting
exposed through, essentially, their sweat, basically through
their clothing absorbing into the skin, through so many
different sources. It isn't just the inhalation risk. It is
almost every aspect of it.
The other aspect is the type of fires have changed so much
and the responsibilities of firefighters. Many years ago, it
was simple construction. People understood the risk. But today
it is hazardous materials response, it is EMS. There are so
many different things, every measure of disaster. It was
referenced the situations down on the Gulf Coast, the same
thing with Super Storm Sandy.
We are exposed and what this registry does differently than
any other study is it takes almost every factor into account,
not just people contracting and dying, but it will actually
take how long somebody is a firefighter, what type of
firefighter. Are they large city firefighters, where they may
have more responses and more varied responses? Are they
volunteer, paid on call, wildland? All those demographics are
going to be taken into account. So, hopefully, over a period of
time, we will actually be able to assimilate the information
and digest it and make it useable to prevent cancers in the
future.
Mr. Green. Thank you. Thank you all for bringing the bill
before us.
Dr. Levine, because our chair coming from Houston, I
remember very well Hurricane Katrina. And at the Astrodome in
Houston we received a quarter of a million folks from
Louisiana. They brought us good gumbo, too, and we sent them
back with good barbecue.
My concern about the bill that would just give protection
from lawsuits and we have a patchwork of laws with States.
Louisiana is different from Texas, for example, maybe. But on
the Federal level, if we could give these tort claims
protections under a Federal act, would that solve the same
problem?
Dr. Levine. I believe it might and I am saying might. I
mean there are still State laws that are fairly strong in this
area so, they would still be there for protection. But I would
think that having one overarching one is what we are after
here, one overarching Federal law that would tell the first
responders it is OK to be there and do what you need to do.
If you are relying on State law, you may or may not know
what is going on at the moment and that time is really the key
to any act and any treatment of an individual.
I mentioned that 14 minutes, and 22 minutes, and minutes to
get somebody to the OR, when we are talking about a large loss
of blood, either you do it or you don't. There is no questions.
There is no--you know you don't have time anything except to
respond.
Mr. Green. An example is we worked for years for the
Federally Qualified Health Clinics to have volunteer doctors so
they could provide for the underserved in giving them Federal
tort claims protection by volunteering in those clinics. So
that was just an example.
Mr. Chairman, I would like to yield my last 2 seconds to my
colleague, Congressman Sarbanes from Maryland.
Mr. Sarbanes. I thank the gentleman for yielding. I don't
know that I am going to be here when it comes time.
I just wanted to thank you, Kevin. You mentioned your 16
years of service to the residents of Baltimore County. I
represent those folks and, on their behalf, I want to thank you
and for your extraordinary advocacy on all of these issues.
And I yield back.
Mr. Burgess. The Chair notes the gentleman's time had
expired when he yielded time that didn't exist.
Mr. Green. Well, I had 5 seconds.
Mr. Burgess. So, it comes off future time.
I do now want to recognize the gentleman from Virginia, Mr.
Griffith, for 5 minutes for your questions, please.
Mr. Griffith. Thank you very much. I do appreciate it. I
appreciate all of you all being here. These are all important
topics. I was talking earlier, I had carried legislation
related that also dealt with hypertension but also cancer, when
I was in the State legislature.
The dental program, let me start there, although I have got
lots of questions and I tend to be somebody that reads, looks
at things, and tries to sort things out. One of the things that
it said is that among the groups that can get some assistance
from this bill would be ones that are affiliated with an
academic institution and that are exempt under the taxes and
offer free dental service programs to underserved populations.
We have, in my district, a group that sets up weekend
medical clinics at a large field and they have a dental
component with a number of dentists who come in and give their
entire weekend, and they bring all the equipment, and they have
a mobile unit, and so forth but they are not affiliated, as far
as I know, with any academic institution. Is that something
that is critical, you think, to the bill or can we maybe carve
out an exemption if they are long-standing providers of free
medical, or in this case, dental care to an underserved area?
Dr. Watson-Lowry. This bill does not say that you have to
be associated with an institution. It is basically providing
local solutions to local problems.
So if that particular group wanted to be able to apply for
funding, they could apply for funding also.
Mr. Griffith. All right, I do appreciate that.
I have got an issue on the Good Samaritan Section 2, if I
might ask a couple of questions on that. And I guess the first
one is that--I don't think there would be any problem with it--
I think the language might need to be tightened up just a
little bit because it appears that it might actually say that,
if they are on their way to the scene and they are driving 85,
90 miles an hour and they run over a pedestrian, they might be
covered. You wouldn't have any problem--you are trying to get
to the folks who are providing medical care, once they get
there, as I understand it. It think that is the intent of the
bill. Would you not agree that is the intent of the bill? Just
to make sure we are not getting folks in trouble who are trying
to be good guys.
Dr. Levine. Yes, I would agree. Thank you.
Mr. Griffith. All right and I do want to work on that.
Likewise, and it may need to be tweaked a little bit, it
might be in there, would you have any problem if we made it
clear that the medical care they were providing was at least
within the scope of their license, so that--I mean I know,
obviously, the health--you mentioned mental health, which I
think is important and a lot of folks can do that, but I am not
sure I want my chiropractor trying to reattach my fingers.
Dr. Levine. I would agree always with the scope of practice
within their license, yes.
Mr. Griffith. All right and I do appreciate that.
And one thing that I think because of your background, Dr.
Greenbaum, that might have been misunderstood but my reading of
the bill does not say it is just for minors who are sexually
trafficked, it is looking for adults who you know they might be
18 or 19 who are being sexually trafficked, too. Is that your
understanding as well?
Dr. Greenbaum. Absolutely, the bill includes both adults
and minor sex and labor trafficking, yes.
Mr. Griffith. And obviously, theoretically, minors are
probably more vulnerable but if you had somebody that has been
in the system as a person who has been trafficked or enslaved
in that industry, they could be an adult but have been in for a
while or it could be somebody with diminished--some forms of
diminished capacity.
Dr. Greenbaum. Absolutely. You make a very good point. A
lot of the children that we see age out and so they are 19, 20,
21 but they started when they were 15. So a lot of adults were
kids when they started. And then a lot of adults are very
vulnerable because of disabilities, mental health issues, other
reasons. And so yes, but this bill will cover everything.
Mr. Griffith. This bill will cover everything.
Well, I appreciate it and these are all, I think, bills
that are trying to do good things for the American people and I
appreciate you all's testimony here today.
And Mr. Chairman, I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair recognizes the gentlelady from Florida, Ms.
Castor, 5 minutes for questions, please.
Ms. Castor. Well, thank you, Mr. Chairman for organizing
this hearing and thanks to all of our witnesses who are here
today. These are all very positive ideas and bills.
And Mr. O'Connor, thank you for your long-term service.
And Dr. Levine, thank you. I am so grateful that you were
in the right place at the Boston Marathon and that is quite a
story. So, thank you for being there.
I wanted to focus on Congresswoman Kelly's bill. I think it
is such an important reauthorization. And I want to thank her
and Congressman Simpson and ask Dr. Watson-Lowry a few
questions because I have seen dentists in Florida, the Florida
Dental Association, they really do a wonderful job of providing
free care. In fact, I have a few statistics here that kind of
blew me away.
The Florida Dental Association's Mission of Mercy Event,
just over the past couple of years in Pensacola, that is a
pretty small town in the Panhandle, their events saw more than
1,800 patients and provided more than $1.4 million in donated
care just in March. Similar, in Jacksonville, saw 2,800
patients, where they provided $2.75 million in donated care and
there were almost 2,500 volunteers.
In my hometown of Tampa, there are some outstanding
dentists with the public service interest, along more with more
health. Their event saw more than 1,600 patients; 8,000
treatment procedures worth over $1 million; more than 350
dentists, registered dental hygienists who volunteered; and
there were 1,000 support volunteers.
So there are very serious gaps in dental care in America.
And I wanted to ask you to talk about that, this troubling lack
of access to dental services and how we have to rely on these
volunteer initiatives and describe your experience with
providing free dental care in your community.
And as we talk to our colleagues about the importance of
making this investment through the CDC to local communities,
what are the long-term benefits? Isn't there a return on
investment here?
Dr. Watson-Lowry. Well, thank you for your question. I just
want to say last year I went to the Florida Dental Association
meeting, and it was wonderful, in Orlando. I met some new
friends down there.
But yes, it is a wonderful question. In Illinois we have a
MOM's Event approximately every 2 years because it takes so
much to set it up and it costs so much. We have to get sponsors
and that type of thing. Our last event we had about 2,000
patients visits and did more than $1 million worth of service.
So, that is something that is going on across the country.
What this bill does is bring the CDHCs online a little bit
more and increasing their numbers. What we have is it kind of
bridges that gap. There are a lot of patients that don't know
where to get care. There has been an increase in Medicaid
funding but if a patient has a problem but they don't know
where to go, then the first place they go is to the emergency
room.
And so we are trying to--this bill helps to cut down on
those emergency room visits so that patients can receive care
at a dental office, or in a practices, an FQHC. That care may
cost $70 versus an emergency room visit that is $700 or more.
And when they go to the emergency room, as I mentioned in my
testimony, they just get a prescription for an antibiotic and a
pain medication and then they are back in the emergency room in
a couple of months or a month or so and they haven't gotten
that care.
So, this addresses that situation. It puts the CDHC in
place so that they can help those patients find the proper
place to receive care, make sure they have transportation for
that, and also talk to them about maybe if they have some
anxieties about going to the dentist and help them through
those issues, and teach them about prevention.
That is one of the key things that I see in my practice.
One of the first visits I talk to them about well, you have
this cavity; it is not just about treating that cavity. How did
that cavity get there? And a lot of my patients are one
peppermint on Sunday in church every Sunday and that is causing
them to lose all of their back teeth. And it is costing them,
especially seniors, it is costing them a lot of money.
So, everything that we have in here is going to help bridge
that gap.
Ms. Castor. And there is an important education element
that comes with all of this----
Dr. Watson-Lowry. Huge. Huge.
Ms. Castor [continuing]. So that they are not returning
patients.
Dr. Watson-Lowry. Exactly. Exactly. I don't know if I have
the time but I have a friend that was in Alaska and saw the
Native Americans. And he went to the grocery store and three of
the four rooms were stacked from floor to ceiling with pop. The
children were drinking pop all day. They weren't drinking milk
because that was $7 for a half a gallon of milk. And so all of
their cavities--they were losing their front teeth because they
had cavities in their front teeth from drinking the pop.
And so just the education, letting them know this is what
is causing the problem and helping them find a solution to that
and teaching the parents, teaching the kids what to do and what
not to do. That is a huge component.
Ms. Castor. Thank you very much. I yield back my time.
Dr. Watson-Lowry. Thank you.
Mr. Burgess. The Chair thanks the gentlelady. The
gentlelady yields back.
The Chair recognizes the gentleman from Kentucky, Mr.
Guthrie, the vice chairman of the subcommittee, 5 minutes for
questions.
Mr. Guthrie. Thank you, Mr. Chairman. I appreciate the
recognition.
And first to Mr. O'Connor. Should this legislation be
enacted, the CDC will be tasked with collecting data from all
over the United States. Can you please share how the publicity
for firefighter's data solicitation will take place and how do
you foresee the data collection taking place?
Mr. O'Connor. Well, the bill addresses that. The CDC, along
with NIOSH, will get with stakeholders from the fire service. I
would imagine that would include organizations representing
professional firefighters, a managerial component of the fire
service, the International Association of Fire Chiefs, the
National Volunteer Fire Council. Collectively, we have about
1.1 million firefighters across the country. I imagine that
they will be sitting down with the CDC, based on the direction
articulated in the bill and try and come up with a process
whereby the data can be aggregated, probably department by
department, in terms of if a department chooses to participate,
they would be able to essentially provide the data from their
employees, their retirees, because that is a huge component of
it as well, to make sure that you have got length of service of
all the people involved and do it in a fashion that essentially
people are de-identified; that you are able to basically get
the data, the information on people but protecting their
confidentiality.
I could envision that you know if there needs to be a
deeper dive in terms of direct information, that there may be a
process in place whereby the researchers at CDC or the people
keeping the database would be able to contact these people but
it would be on a voluntary basis.
Mr. Guthrie. OK, thanks.
Let me go to Dr. Watson-Lowry. You mentioned in your
testimony that most Medicaid dental programs fall short of
providing the amount and extent of care needed by low-income
patients. According to Kaiser Family Foundation, even States
with extensive adult dental benefits, patients have a difficult
time finding a dentist.
I know a lot of dentists don't accept private insurance and
some accept private but not Medicaid. And could you kind of
walk through why it is hard to find a dentist that does
Medicaid?
In Kentucky, I have visited some. We do pediatrics and,
although they are not celebrating their reimbursements, don't
get me wrong, but the biggest issue that they talk about is
booking chair time and having no-shows. That is one of their
biggest issues.
Dr. Watson-Lowry. Thank you for that question.
Yes, this bill addresses that with the community health
coordinators. They help them navigate those situations so they
help them find someplace that takes--in Illinois we have like
three different kinds of coverage for Medicaid, which makes it
very complicated in the paperwork with the doctors. So but when
they can find one, they have to be able to find transportation.
So the CDHC helps so that that chair time doesn't go empty and
so that improves the utilization of the participators that are
functioning there. It helps that whole situation and improves
care and it also cuts the cost because you can see more
patients in less time.
Mr. Guthrie. Good. Thank you. Because the issue is that we
have to overbook, therefore, it is not good for our patients
who come in and have to wait----
Dr. Watson-Lowry. Exactly.
Mr. Guthrie [continuing]. Because they don't distribute
themselves, the no-shows, and sometimes there is just no one
there and they are not using their chair. So, it is a thing
they are trying to thread the needle on.
Dr. Watson-Lowry. There are some studies that have shown
that they have reduced the no-show rate by 18 percent, the
CDHCs.
Mr. Guthrie. Perfect. Perfect.
I am going to get a couple more questions in. So, Dr.
Levine, why is it not sufficient to require medical volunteers
to present their medical license on site?
Dr. Levine. Well, I assume this is a combination of two
things. One is your medical license----
Mr. Guthrie. I mean, if it is a large disaster, not just
general. Go ahead, I am sorry. Go ahead, please.
Dr. Levine. Your license is one thing but liability
coverage is a separate issue. Here, we are just dealing with
the liability issue as to whether or not the physician is there
to respond only if he or she is covered potentially. It has
nothing to do with presenting their license only. What does
that mean and who is going to verify that license, at the time
of the disaster? That is very difficult and it is so chaotic
that it is hard to do. And sometimes that will even take a few
days in a normal situation.
Mr. Guthrie. Right.
Dr. Levine. That is the difficulty.
Mr. Guthrie. OK, thanks for that.
And then Dr. Greenbaum, in your testimony you say that
research consistently shows that victims of trafficking do have
contact with medical professionals. Are there certain health
providers and certain health settings who are more commonly in
contact with suspected trafficking victims?
Dr. Greenbaum. There has been a limited amount of research
but probably the most relevant research shows that about two-
thirds show up to emergency departments in hospitals but a
quarter of them also go to public health clinics, Planned
Parenthood, sexually transmitted infection clinics, and some to
their own doctors like their gynecologists or their
pediatricians. So it really runs the gamut, but I would say
that probably emergency departments and public health clinics
are the biggest.
Mr. Guthrie. OK, thank you. I appreciate that.
My time has expired, and I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
And the Chair recognizes the gentleman from Maryland, Mr.
Sarbanes, for 5 minutes for questions, please.
Mr. Sarbanes. Thank you, Mr. Chairman. I want to thank the
panel for being here today on these very important proposals
that I think you see broad agreement of support for.
I wanted to ask you, Kevin, and again, thank you for not
just your service in Baltimore County but your advocacy on
these issues and being a terrific resource for so many of here
on the Hill when it comes to issues that affect firefighters of
all categories across the country.
I think I have a pretty decent understanding of what the
registry offers and, obviously, we support it. I was wondering
if you could speak a little bit to what kinds of advances, in
terms of technology, and equipment, and other things are
available to firefighters when they are going into these
situations that can help to reduce some of the risks for cancer
and other diseases. Because I imagine, as you become more and
more aware of the heightened risk for these things, that you
are thinking about that as you come on to the scene and that
there has probably been some advances with respect to that.
Mr. O'Connor. The best way to answer that question is
through example. When I came to the fire service in 1985, I was
issued a helmet, a turnout clip coat, and three-quarter rubber
boots. So what that meant is every time I went into a fire,
large portions of my body were exposed. If something happened
below the waist, essentially, any type of water, wash off
contamination, could go down into those boots.
Over the years, we made a determination that because of
some of the diseases, cancer and other diseases, were being
caused by those type of exposures, that it made sense to more
fully encapsulate a firefighter.
So, we came up with hoods that protect the neck and the
ears. But unfortunately, technology hasn't advanced to the
point that it is a complete coverage, a complete shield. You
still, as I said in my testimony, you can absorb materials,
toxic soups, if you will, in your sweat, things of that nature
going into your pores. That serves as a single example.
A successful story is with respect to lung cancer. Many
years before I came to fire service, people went into buildings
without self-contained breathing apparatus. They were inhaling
everything. Over the years, the advancement in that technology
has been marked in terms of the duration with which people can
stay in that type of an environment. But even that has--it is
not drawbacks but its limitations. For years, people thought
that once the fire was done, you took your breathing mask off
and you walked around. But the residual smoke and toxicity that
was there continued to cause diseases.
Within the fire station itself, the diesel exhaust, which I
referenced, now we have what is called a Nederman exhaust
system that actually attached to the exhaust.
So as things manifest and we are able to make
determinations, the technology ultimately catches up to it. The
problem is, the way that people are being exposed to these
toxins now is very different than it was even 15 years go. So,
essentially what we need, we need the information and data on
these different types of cancers. It is not just a simple
cancer. It is like a prostate cancer or a colon cancer. We are
having clusters of cancer of firefighters that are exposed to
benzene, for example, and they develop a very specific type of
liver cancer which occurred, actually, in Baltimore many years
ago.
So this information really allows us to take a deep dive
and look at it and essentially work with our partners that
manufacture clothing, the researchers to come up with things to
better protect firefighters and, essentially, try to de-risk it
as much as possible.
Mr. Sarbanes. Well, thank you for that answer, and I think
what it shows is the attention, through this registry, to the
issue can heighten the awareness so that we can have more
technologies developed but also points to the need for
investing the resources that can allow for better protection
and better protective equipment and so forth. And actually even
potentially extends to--I know there is issues around sort of
flame retardant and other kinds of things that are put onto
furniture. And in theory, that is supposed to help the
situation when a fire breaks out. But to extend its generating
smoke and other things that can be inhaled that are even more
toxic than if you didn't have those retardants in place.
So it gets a conversation going. I don't know if you want
to respond to that.
Mr. O'Connor. Yes, very quickly. Our organization has been
in the forefront of trying to expose some of the problems with
flame retardants and the potential health hazards they pose not
just to firefighters but to ordinary citizens, as well. I
think, at the last count, 26 States have enacted some type of
law, either regulating, forcing disclosure on flame retardants.
Legislation was just passed in Maryland with respect to its
impact on children. So, it is something that we are very
involved in.
But you are absolutely right. That is a hazard not just to
firefighters but to the general public.
Mr. Sarbanes. Thank you. I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair recognizes the gentleman from New York, Mr.
Collins, 5 minutes for questions, please.
Mr. Collins. Thank you, Mr. Chairman. I ask unanimous
consent to enter into the record letters of support for H.R.
931 from the International Association of Fire Chiefs, the
Congressional Fire Services Institute, the National Volunteer
Fire Council, International Association of Fire Fighters, and
the National Fallen Firefighters Foundation.
Mr. Burgess. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Collins. Thank you.
So, Mr. O'Connor, I mean, we touched on this briefly, but I
know we have, just in my one county alone, 99 volunteer fire
companies. And when we look back at what was the standard
procedures 20, 30 years ago versus today, I always think back
when firefighters would tell me they would keep their turnout
gear in their car, in the trunk. So they would be fighting a
fire today and God knows what chemicals they could be
associated with. And we certainly had a lot of chemical fires
in the Niagara Falls area. You know they would finish the fire
and just throw the turnout gear into the trunk of the car and
drive their kids to baseball games and the like, having no clue
that there could be an association of what was on that turnout
gear then exposing their families to where we are today with a
lot of protocols. Some stations follow these protocols better
than others.
But if you could comment just a little bit. And I have got
a sign in my office that says in God we trust; all others,
bring data. And where this data will be taking us, especially
with the manufacturers of some of this gear, as we are learning
and, certainly, with the data, we will continue to learn more
to produce safer equipment and better apparatus.
If you could maybe just where we have gone just in the last
10 years and where this might take us.
Mr. O'Connor. Well, first, I again really want to thank you
for your stalwartship on this issue. It is very important. And
as you have indicated, data is what really matters with respect
to being able to do this tracking and making these
determinations.
And you are absolutely right. I mean part of it you can't
get around of it, is resources as well. You know I mentioned my
ensemble when I first went to the fire department. You are 100
percent right. We did not adequately clean our turnout
clothing. We were afforded one set of turnout clothing. If you
were busy, you went from one fire immediately to the next fire
and the aggregation occurred.
You were consistently wearing it, whether it was a fire
call--if you were going out on a cold evening for an EMS call,
what did you put on? You put on your turnout coat. Your
previous calls might have been at a chemical plant. It might
have been at a fire where you were exposed to different things.
So people were consistently re-exposed to the carcinogens and
the toxins that they encounter on their calls.
Beyond that, you are also correct in the volunteer fire
service but also in a career fire service. If you were detailed
from one station to another, you took your turnout clothing,
you threw them in the car, and you were continuing re-breathing
in all of that. It is a real hazard.
The sad aspect, though, unfortunately, is we have not been
able to quantify that. We have not been able to really make any
direct determination. We know it is hazardous but, in the
absence of good data, we haven't been able to do that.
All the studies that I have mentioned are very
comprehensive studies in terms of just one simple analysis.
They looked at the death certificates and they made their
determinations. What your bill, hopefully, will be able to do
is provide enough data, enough demographics in terms of work
and risk, what people actually do that we can factor that into
the equation and try to make these determinations.
I do believe that a lot of the companies that do
manufacture this type of equipment are partners with the fire
service. Certainly, we do have some issues at times but, at the
end of the day, they can only design equipment that is safe and
healthy if they have the data to recognize how we can better
avoid these hazards.
Mr. Collins. So another question is we have seen the
cancer, the prevalence of cancer. Are we seeing it while a
firefighter is currently serving or after they have left the
service?
Mr. O'Connor. Both. Some of it manifests early. The one
statistic that I put out was a 159 percent increase of men
firefighters between 30 and 49 years of age. Most of those
people are still in the service but a lot of these diseases are
manifesting afterwards.
A good example is in your home State, the aftermath of 9/
11. We lost 343 people that day. Unfortunately, in the days
since 9/11, 1,590 firefighters have contracted some form of
cancer. Many of those people have retired from the service and
the symptoms are just coming now. And that is one example. It
is a very graphic example but the same thing is applicable
throughout the country in departments large and small, where
you will see the aggregation and accumulation of people, the
hazards that they have encountered over the years, manifest in
terms of developing some type of cancer years after retirement.
Mr. Collins. Thank you for your testimony. My time has run
out, and I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair recognizes the gentlelady from California, Ms.
Eshoo, 5 minutes for questions, please.
Ms. Eshoo. Thank you, Mr. Chairman, and thank you to the
witnesses, not only for being here today but the work that you
have done over your entire adult life in key areas; great
contributions to the country.
I also want to compliment my colleagues that are sponsoring
the four bills today for their work because I think that they
are offering a good legislation.
I want to start with Dr. Watson-Lowry first. You are aware
that the House recently passed legislation that would allow
States to pick and choose which essential benefits, health
benefits they require insurance plans to cover. Pediatric oral
care is currently one of the ten essential health benefits
covered in the Affordable Care Act. The House-passed bill also
makes cuts to Medicaid, which currently requires coverage of
early and periodic screening, diagnostic treatment, the EPSDT--
we have abbreviations for everything here--including dental
screening.
So what I would like to ask you to at least touch on is the
continuing need for programs like these to be funded by the
CDC's oral health promotion and disease prevention grants for
people who are currently served by these programs.
And, also, touch on the benefits that people will be--you
know on what people are going to be forced to make changes to
Medicaid that could result in the elimination of these
benefits. I think that we have Members here that may not even
realize that that is in the bill that passed the House. But
nonetheless, it is one of the essential health benefits.
So, would you comment on that please?
Dr. Watson-Lowry. Thank you for your question.
Just one point is the children being covered in the
essential health benefits that almost slipped out. And the ADA
noticed that and it was like the 11th hour and we were able to
get that back in.
That is critical for children to receive care. When
children lose their teeth at an early age, that can affect
their self-esteem in school. Another thing is that that is the
highest reason that children missed school and a lot of people
don't realize that. That is the most common chronic disease is
dental cavities. And so when children are missing school, the
other problem is now, at least in Illinois, the schools don't
get the funding for that child for that day. So, it has
repercussions that----
Ms. Eshoo. There are repercussions.
Dr. Watson-Lowry. Exactly--that follow behind those things.
As far as funding for adults, patients that have diabetes,
there is a clear connection between diabetes and periodontal
diseases.
Ms. Eshoo. There is.
Dr. Watson-Lowry. So even some of the insurance companies
have started covering the adults that have diabetes for them to
come in three times a year instead of twice a year because they
found the savings in that. You can save thousands of dollars a
year with patients that have chronic conditions like diabetes.
And when we reduce their chronic dental conditions, it helps to
improve their overall health.
So, it is critical that patients receive care and also
these preventative care issues that we have. And we are hoping
that those things will help the whole population of the United
States, along with, as I mentioned before, the educational
piece, helping prevent----
Ms. Eshoo. Thank you very, very much.
To Dr. Martin Levine, first, I want to thank you for your
service as a first responder during the Boston Marathon bombing
in 2013.
What I want to ask you is: Does current liability law, in
your view, actually discourage health professionals from
volunteering during times of emergency? I mean, is that even on
their mind or do they know and not go, or know and be hesitant,
or just go?
Dr. Levine. Thank you for the question.
Unfortunately, I think it is on their mind. I think they do
react to it. There were several articles in the New England
Journal of Medicine following the Boston event. One of them was
from an individual who texted his mother. He was working in the
medical tent as a volunteer for the first time as a physician.
And his mother texted him back: Get out of there as quickly as
possible. And as he was leaving, it was only because the
individual who was on the microphone in the tent, who is not a
physician, said please don't leave your patients at a time of
crisis that he turned around and said maybe I shouldn't leave.
But one of the things that was on their minds was my
responsibility is in the medical tent, where the runners are,
not anywhere else. So, I am not leaving the tent to see what
happened outside. So there were physicians in the tent who did
not go elsewhere.
By the time I got back into the medical tent, most of the
triage was finished on the site but a lot of the physicians
were no longer there. So, yes, it is absolutely on their minds.
Ms. Eshoo. There is the answer. I am going to submit
further questions to the witnesses, as Members are allowed.
And with that, I want to thank you again for what you do.
I yield back.
Mr. Burgess. The Chair thanks the gentlelady. The
gentlelady yields back.
The Chair recognizes the gentleman from New Jersey, Mr.
Lance, 5 minutes for questions, please.
Mr. Lance. Thank you, Mr. Chairman, and good morning to the
distinguished panel. And I will ask several questions and if
they have already been answered, I apologize. We are between
two subcommittee hearings this morning.
To Mr. O'Connor, I understand that there has already been
an in-depth study of cancer in over 30,000 participants in
three major U.S. cities. Mr. O'Connor, can you tell me which
cities have been studies and are additional studies necessary?
Mr. O'Connor. Let me answer your second question first.
Mr. Lance. Yes.
Mr. O'Connor. Yes, additional study is definitely needed.
Mr. Lance. That is Mr. Collins' bill.
Mr. O'Connor. Absolutely.
Mr. Lance. Yes.
Mr. O'Connor. The three cities that were utilized were San
Francisco, California; Chicago, Illinois; and Philadelphia,
Pennsylvania.
Mr. Lance. I see.
Mr. O'Connor. They were chosen, I imagine, by the
researchers at that point in time because they represented
different parts of the country----
Mr. Lance. I see.
Mr. O'Connor [continuing]. And the call volumes there were
substantial.
But what I would note and one of the reasons why additional
study is needed, they are three relatively similar type fire
departments, large metropolitan areas. Certainly, there is
different hazards between cities but very, very extensive call
volume during the time of the study.
Park of what we are trying to--what Mr. Collins' bill is
trying to accomplish is looking at the broad fire service,
where people work in smaller communities; where people have a
higher number of call volumes, where perhaps they have a
greater incidence of hazardous materials response; whether they
are responding to wildland fire; the whole aspect of it. Those
three cities, essentially are relatively homogenous in terms of
their call load.
The other aspect that I had mentioned a little bit earlier
is that a lot of the employment demographics weren't taken into
account in terms of how long people remained a firefighter,
where they were assigned, what their specific duties were, ages
when they were employed, et cetera, and that is what we are
hoping to accomplish in the cancer registry.
Mr. Lance. In the part of New Jersey I represent, not
exclusively but predominately, firefighters are volunteers.
Mr. O'Connor. Correct.
Mr. Lance. I represent 75 municipalities. If we each
represent three-quarters of a million people, that is roughly
10,000 in each of the municipalities. And so it is different
from large metropolitan areas.
Should any study include the effect on volunteer
firefighters?
Mr. O'Connor. That is included in this, volunteer as well
as paid on-call.
Mr. Lance. Yes.
Mr. O'Connor. So, absolutely. And in fact, your colleague
read into the record a letter from the National Volunteer Fire
Council, which represents volunteer firefighters supporting
legislation for that reason.
Mr. Lance. Thank you.
To Dr. Levine, I understand your practice is in Bayonne in
Jersey City. Is that right?
Dr. Levine. That is correct, sir.
Mr. Lance. You ought to move to Westfield or Somerville in
the district I serve.
Dr. Levine. I live in your district.
Mr. Lance. Where do you live?
Dr. Levine. Short Hills.
Mr. Lance. Short Hills. Do you want me to wash your car or
mow your lawn?
Dr. Levine. That won't be necessary, sir.
Mr. Lance. That won't be necessary. I am pleased to hear
that since the last time I mowed a lawn was sometime in the
middle of the last century.
Many States have reciprocity agreements with their
neighboring States, Dr. Levine. Perhaps wouldn't it be easier
for States experiencing a large-scale disaster to ask their
neighboring States to send medical volunteers? And I am
interested in your expertise, based upon what you have done,
including at the Boston Marathon.
Dr. Levine. The bill explicitly recognizes the State laws
that provide a stronger protection to the volunteer health
professionals but, as you know, some of those States are not as
strong.
And as an example, we spoke about 9/11 in another context
but having, unfortunately, been involved, I guess in some ways
in that disaster as well----
Mr. Lance. Yes, of course.
Dr. Levine [continuing]. I was at Liberty State Park after
being at Bayonne Hospital that had some of the first wounded.
Mr. Lance. Yes.
Dr. Levine. But there was a group of surgeons who were
taking a course, a CME course to pass their recertification
boards at the Meadowlands. They took a bus over to Liberty
State Park and set up a triage unit that would have been very
valuable, had there been more injured personnel because they
were coming over by boat to Liberty State Park to evacuate
lower Manhattan. They were from all over the country.
And the problem, potentially, with neighboring States is
that the reciprocity is usually one neighboring State to
another like New York and New Jersey.
Mr. Lance. Yes.
Dr. Levine. They were from Oklahoma, et cetera.
Mr. Lance. Yes, of course. Very good. Thank you.
I won't have time to ask questions of Dr. Watson-Lowry or
of Dr. Greenbaum but I admire your fine work in your areas of
expertise, the dental health of this country and also, of
course, identifying missing and exploited children. Thank you
for your public service in what you do, as well as the rest of
the panel.
Thank you, Mr. Chairman.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair recognized the gentleman from Georgia, Mr.
Carter, 5 minutes for questions, please.
Mr. Carter. Thank you Mr. Chairman and thank all of you for
being here. These are very important pieces of legislation and
I appreciate your interest in them.
I want to start with Dr. Greenbaum. Dr. Greenbaum, I am
from Georgia as well and served in Georgia State Legislature
and certainly, human trafficking a problem in a lot of urban
areas but particularly in Atlanta.
When I served in the Georgia State Senate, we addressed
this and it is something that we passed legislation on. In
fact, a great champion of this has been State Senator Renee
Unterman, who has passed Rachel's Law and the Safe Harbor Law
and those are very important.
And you know human trafficking is horrific and it is
widespread and it is in our urban areas. We think it is not
there but it is there. And oftentimes, the only people that
these victims will see will be healthcare professionals, while
the victims are in captivity. And I say captivity and I mean
they are in captivity. I think you all understand that. But how
can nurses and doctors; how can they identify? Are we doing any
training to help them to identify victims?
I know it is very difficult but are we doing anything? Are
there any telltale signs that we can point toward?
Dr. Greenbaum. We are doing a lot of training for
healthcare providers in looking for possible indicators and red
flags and there are some well-known ones. We are also doing
some research to actually come up with a screening tool that
can be used in a very busy healthcare setting to identify
children who are at risk and we are validating that in a multi-
site study out of Children's Healthcare of Atlanta.
But we do try very hard to make healthcare providers,
nurses, and doctors, and physician assistants aware of the red
flag indicators that might suggest that person is high-risk.
Mr. Carter. Do you concentrate on emergency rooms or just--
--
Dr. Greenbaum. We do a lot of work with emergency rooms but
also with general internists, and pediatricians, and just about
any specialist, especially gynecologists also will see a fair
number of victims as well. So really, we try to educate
everybody in the healthcare system.
Mr. Carter. What about the Children's Hospital of Atlanta;
have they done anything that you are aware of? Have they got
any programs like this?
Dr. Greenbaum. Yes, I think the Institute for Human
Trafficking was just funded this year and we are doing the
research I talked about earlier, as well as doing a lot of
training of healthcare providers and people who work in the
healthcare sector. We do a lot of webinars and on-site
trainings, as well as the research into a screening tool for
children.
Mr. Carter. And results, have you seen positive results as
a result of this education and efforts?
Dr. Greenbaum. Yes, we have tracked the results of our
webinars and there were large improvements in knowledge and
skills, as well as the use of the materials that we trained
people on in their practice. So people began screening. People
began talking to other healthcare providers about human
trafficking, which is exactly what we wanted.
Mr. Carter. Well, I want to thank you for your work
because--and I want to make sure my colleagues all understand
what a big problem this is. It is a serious problem,
particularly in international cities, if you will, like
Atlanta, where you have so many people coming in like that. It
is something we have really struggled with and I think we have
made progress and I am very proud of that.
Dr. Greenbaum. Yes, I think that Georgia has done a whole
lot with the issue of human trafficking, partly because Atlanta
is such a major hub.
Mr. Carter. Exactly. Exactly.
Dr. Watson-Lowry, I wanted to ask you about the dental
bill. I know that CDC works with a lot of the local
communities, and they have State partners in local communities,
and they do a lot to help with water fluoridation and making
sure that they have monitoring systems to help the communities
monitor their water systems and all. And they also send funds
to health departments for oral education and for different
things.
So if they are doing this, explain to me the purpose of the
partnerships or the contracts that are outlined in this
legislation. I mean are we duplicating things here? Is this
necessary or how is this going to complement that?
Dr. Watson-Lowry. Thank you for your question.
It is necessary because this is more grassroots. It is
local solutions to local problems. Sometimes the CDC is flying
up here. We need things on the ground. We need to be able to
address the issues that are local in those particular areas and
be able to take care of those problems efficiently.
The CDHCs are able to--a lot of those CDHCs are from those
particular areas so they know exactly what the situations are,
what the problems are. They can get the patients to those
locations, make sure they receive the services, make sure they
receive the care that they need. Sometimes it is just difficult
finding the exact location to get the particular service that
you need.
Mr. Carter. Great. Well, thank you for your work. Thank all
of you for being here today. This is most important legislation
that we are talking about.
And Mr. Chairman, I yield back.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
The Chair would like to recognize the ranking member of the
subcommittee, Mr. Green, 5 minutes for redirect questioning.
Mr. Green. Well, thank you, Mr. Chairman for letting me go
first.
Dr. Watson-Lowry, in your testimony you talk about the
elderly face the greatest barriers in accessing dental care for
any group population. I know in our district our seniors, we
have a lot of dual eligibles, so Medicaid does cover it but
Medicare doesn't.
How are the Action for Dental Health Programs currently
increasing access to dental care for the vulnerable elderly?
Dr. Watson-Lowry. Thank you for that question.
One of the tenets of the plan trains dentists to treat
patients in the nursing homes. It is very difficult for
patients in the nursing home to get out and get access to
dental care and get to dental offices. Some of them don't have
mobility. I have a patient, in particular. She is able to get
transportation to our practice but now she has had surgery, she
can't get back to get her services.
I have done some care in nursing homes and gone out but
there are certain procedures I have to have equipment to go to
those areas. So we are trying to train dentists to do
procedures in those nursing homes and maybe have the
availability to have equipment so that they can take it with
them and go take care of those patients.
But they are a very vulnerable population and they have
served us very well. We don't want to see them be neglected.
Mr. Green. I am also interested in the Medicare. Do you
know of any Medicare Advantage programs that offer dental?
Because so many of them, we have a lot of competition between
plans.
Dr. Watson-Lowry. There are. It depends. Some situations
depend on the State. We can get more information to you from
the ADA. But some of those plans get to be complicated so it
makes it very difficult for the dentists to be able to navigate
what they can do, what they can't do, what is covered, and what
is not covered. And some of those crossovers cause paperwork
barriers.
So some of this helps with some of that paperwork but we
can get more information to you in writing from the ADA.
Mr. Green. OK. And today we are hearing more and more
evidence that chronic conditions, such as diabetes and heart
disease have impact from bad oral health. Would you discuss the
evidence and educate us on how the oral health and general
health are linked?
Dr. Watson-Lowry. Well, I am going to give you a situation.
I had a particular patient that was coming in and he was doing
fine for a while and then all of sudden he was losing a tooth
every year. I looked in his mouth and I told him you know I am
looking at some things and it looks like you have diabetes. And
he went to his physician and he said well, no, you don't have
diabetes.
And I kept telling him something is not right and his
doctor looked again. But he was borderline. He was just flying
under the radar. Over a 10-year period, he lost 12 teeth.
He retired from the police force. He went to another
physician and then they told him, yes, you do have diabetes. He
came in to me and he said you were right, Doc, all along. But
by this time, he was having problems with his eyes. He was
having a lot of other problems, threatening losing a foot, a
lot of other things that were going on.
So, it is really important that we address these issues
with patients. Periodontal disease is a silent killer. A lot of
patients don't even realize they have it and they just notice
their teeth loosening. So it is really important that we talk
to the patients, educate them, and get these things under
control so that they can, their overall health can be improved.
Mr. Green. Do you have any information regarding cost
savings of dental case management for patients who have chronic
medical diseases such as diabetes or special conditions that we
can say show the before and after that you actually have?
Dr. Watson-Lowry. Well, one study shows that there was a
reduction of $1,300 per patient that had diabetes. Also, these
patients, we can reduce them going to the emergency rooms when
they are having other medical problems when we keep their
dental conditions under control. So, there are cost savings
there, as far as emergency room situations are concerned and
all their other healthcare issues, keeping that blood sugar
under control when their periodontal disease is under control.
Mr. Green. OK, thank you.
Dr. Greenbaum, I want to thank you for your work. Coming
from the Houston area international airports like L.A. and
Miami, and New York, we have terrible situations.
You discussed in your testimony the need to focus on
trauma, and form, and culture in appropriate care. Can you
explain some of the evidence-based techniques that should be
used when caring for human trafficking victims that are trauma-
sensitive and culturally appropriate?
Dr. Greenbaum. Yes, thank you. We all know that human
trafficking victims have experienced complex trauma before they
were trafficked and, certainly, during their period of
trafficking. And so that likely impacts the way they see the
world, the way they see us, as healthcare providers, and the
things they say and do, and the way they interpret what do.
So we have to, as healthcare providers, be able to stand
back and say OK, that person may be acting belligerent, or may
be acting aggressive, or may be very socially withdrawn. That
is not reflecting on me. That is their trauma talking, and it
is really important that I don't rise to that and that I sit
and be very nonjudgmental because that is going to build the
rapport that allows them to find out more information and
provide services.
So until you can really get beyond that, that trauma
exterior, it is very hard to get to the real issues and provide
care.
Mr. Green. To get through that ice.
Thank you, Mr. Chairman.
Mr. Burgess. The gentleman yields back. The Chair thanks
the gentleman.
I will now recognize myself for 5 minutes for redirect. I
won't use all of the time.
But Dr. Greenbaum, I think Ranking Member Pallone, in his
opening statement, talked about the interaction with the
healthcare system, giving an opportunity for the victim to
detach from their trafficker. And in that other hearing that I
referenced in the Helsinki Commission, the chairman, Chairman
Smith from New Jersey ran, one of the things that impressed me
was how not only was the trafficker a family member but they
would never leave the patient. And he even detailed multiple
E.R. physician visits. At least one time through labor and
delivery, the naming of the child was done by the trafficker. I
mean these were clearly clues that fall outside the norm. So, I
recognize that what you are talking about doing can be very
important, and very impactful, and clearly, it is an area where
we need to make a difference.
And understanding that people coming in in that situation
are not always going to be truthful about their situation but
there can be other clues that lead to the correct assignment of
what is actually happening.
So I am grateful that you are here today. And again,
although that hearing was in a different committee in the
Helsinki Commission, that has bothered me since that hearing
occurred. So I am grateful to see that we are taking some
tangible, measurable steps towards solving that problem and I
believe next week is the week that we focus on human
trafficking. So it is appropriate that we are doing the hearing
this week to do that.
And to every other member of our witness panel today, I
can't thank you enough. Dr. Levine, again, you provided,
whether you knew it or not, reassurance to the country that
night and I was grateful for the participation of all of the
medical professionals in Boston that day. I think it was an
important part of the healing of our country.
Dr. Watson-Lowry, thank you for what you do in helping
provide services to people who need them so desperately.
And Mr. O'Connor, my patron saint back home in Louisville,
Texas was Chief Latzky of my fire department. He has now gone
on to a different department, a trophy club. But certainly
before I ever ran for public office, it was his example of
giving back in public service that has always--it has been a
North Star for me, something to help guide me through my time
in public service. So, I thank you for being here today and
what you brought to the committee.
I see that we have been joined by Mr. Bilirakis, who I
would be happy to recognize 5 minutes for questions.
Mr. Bilirakis. Thank you very much. I appreciate it. I had
the V.A. full committee meeting and TELCOM. So, I apologize for
being late.
Dr. Levine, Florida is bracing for the next big one each
hurricane season and its implications, especially for a State
with a significant population growth over the last few years, a
sizeable portion age 55 and older. A huge concern, and God
forbid we get it, but we have got to be prepared.
Can you walk us through the Volunteer Protection Act and
why it is so--I mean what is your opinion and why is it not
sufficient? Yes, please.
Dr. Levine. I believe it goes to a certain point but,
unfortunately, a healthcare professional providing medical care
specifically. There is a difference between just doing first
aid, doing triage, but actually providing medical care goes to
another level that I don't believe would be covered for that
physician from a liability perspective.
At the Boston Marathon, we deal with mass casualties every
year. It could be hyponatremia. Approximately 20 to 30 people
have that. It is life threatening.
We deal with cardiac disease. Again, it could be two to
five a year. With 38,000 runners, typically we are going to get
one cardiac event per 100,000, also life threatening.
We also deal with hyperthermia, in which people have body
temperatures, core temperatures of 104 to 109 every year. This
past year was not as bad as 2012, in which we had 24 people who
had to be in the dunk tank for almost 30 minutes. Those are
life-threatening conditions that you must have medical care and
get their temperatures down within 30 minutes.
In a disaster situation, you don't have time to understand
whether, at the moment, you are going to have the capability of
evacuating someone to a hospital immediately. You may have to
actually render the care immediately.
One of the things at the Boston Marathon was, when I got to
the site, there were a lot of people with their shirts off, who
were trying to staunch the bleeding by putting a cotton shirt
up against, unfortunately, a limb stump. What that did was, it
actually increased the amount of flow into the shirt. Now,
these were people that were volunteers but they were not
medically trained. So they didn't know that they probably
should have torn the shirt, tied it around and used
tourniquets.
So, if a medical personnel is not going to be on the site
because they are not covered by the Volunteer Act, this is why
this act I think is necessary.
Mr. Bilirakis. Thank you very much.
Dr. Watson-Lowry, in preparation for this hearing, I
reached out to the dental community to get a sense of the cost
impact of dental issues in my district. I know it is
significant.
In 2014, there were at least 163,906 E.R. visits in Florida
for dental problems, almost none of which were cured in the
E.R., obviously, and the hospital bills exceeded $243 million.
In Pasco County, and I represent all of Pasco County, but
in Pasco County alone, it accounted for approximately $10.9
million in E.R. expenses--$10.9 million in E.R. expenses.
Can you explain how the E.R. referral works and how does it
provide cost savings?
Dr. Watson-Lowry. Thank you for your question.
Mr. Bilirakis. Sure.
Dr. Watson-Lowry. There are approximately 200 E.R.
diversion programs that we have going right now. There are
approximately six different models, so they work differently in
different situations. So, we can get information to you
specifically on that.
But suffice it to say, when you have someone going to the
emergency room, that can cost over $700 for that one emergency
visit and, as we mentioned before, it doesn't cure the problem.
We can take care of that issue in a dental practice or a dental
clinic for one-tenth of that cost.
So there is one particular program that the patients go in,
they receive the service, and to pay for that service, they
actually volunteer in different areas. So there have been
situations where they have decreased the E.R. visits by 50
percent and increased the volunteer hours in other settings by
like 9,000 different volunteer setting visits.
So there are a lot of different programs that are there and
we can get more information to you about those different ones.
Mr. Bilirakis. Yes, please do. Please do. I am very
interested.
One more question, Mr. Chairman or--can I go to one more?
What do you think?
Mr. Burgess. The gentleman is testing the patience of the
Chair.
Mr. Bilirakis. OK. All right, I will yield back and submit.
Thank you very much, Mr. Chairman.
Mr. Burgess. The Chair thanks the gentleman for yielding.
Mr. Bilirakis. I want my bills passed.
Mr. Burgess. The Chair thanks the gentleman for yielding
back his time.
Seeing that there are no further Members wishing to ask
questions, I do want to thank all of our witnesses for being
here today.
We have received outside feedback from a number of
organizations on these bills and I would like to submit
statements from the following for the record: Representative
Simpson of Idaho, a co-sponsor of H.R. 2442, the American
Association of Neurological Surgeons and the Congress of
Neurological Surgeons, the American College of Surgeons, and
the American Hospital Association, PIAA, and the International
Association of Fire Chiefs.
Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. Those will be added to the record.
Pursuant to committee rules, I remind Members they have 10
business days to submit additional questions for the record. I
ask that the witnesses submit their response within 10 business
days upon receipt of the questions.
Without objection, the subcommittee stands adjourned.
[Whereupon, at 12:07 p.m., the subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
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