[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
LESSONS FROM THE FRONTLINE: COVID-19'S
IMPACT ON AMERICAN HEALTHCARE
=======================================================================
HYBRID HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND
INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND
COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
MARCH 2, 2022
__________
Serial No. 117-71
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
59-694 PDF WASHINGTON : 2026
-----------------------------------------------------------------------------------
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California Ranking Member
DIANA DeGETTE, Colorado FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland ADAM KINZINGER, Illinois
JERRY McNERNEY, California H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
PAUL TONKO, New York BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York BILLY LONG, Missouri
KURT SCHRADER, Oregon LARRY BUCSHON, Indiana
TONY CARDENAS, California MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice NEAL P. DUNN, Florida
Chair JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California DEBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
DARREN SOTO, Florida JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
------
Professional Staff
TIFFANY GUARASCIO, Staff Director
WAVERLY GORDON, Deputy Staff Director
NATE HODSON, Minority Staff Director
Subcommittee on Oversight and Investigations
DIANA DeGETTE, Colorado
Chair
ANN M. KUSTER, New Hampshire H. MORGAN GRIFFITH, Virginia
KATHLEEN M. RICE, New York Ranking Member
JAN SCHAKOWSKY, Illinois MICHAEL C. BURGESS, Texas
PAUL TONKO, New York DAVID B. McKINLEY, West Virginia
RAUL RUIZ, California BILLY LONG, Missouri
SCOTT H. PETERS, California, Vice NEAL P. DUNN, Florida
Chair JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington GARY J. PALMER, Alabama
LORI TRAHAN, Massachusetts CATHY McMORRIS RODGERS, Washington
TOM O'HALLERAN, Arizona (ex officio)
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
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Page
Hon. Diane DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 2
Prepared statement........................................... 5
Hon. H. Morgan Griffith, a Representative in Congress from the
Commonwealth of Virginia, opening statement.................... 8
Prepared statement........................................... 10
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 14
Prepared statement........................................... 16
Hon. Cathy McMorris Rodgers, a Representative in Congress from
the State of Washington, opening statement..................... 18
Prepared statement........................................... 20
Witnesses
Megan Ranney, M.D., M.P.H., Emergency Physician, Rhode Island
Hospital \1\
Prepared statement........................................... 25
Answer to submitted questions................................ 94
Tawanda Austin, M.S.N., R.N., N.E.B.C., Chief Nursing Officer,
Emory University Hospital Midtown.............................. 27
Prepared statement........................................... 29
Answer to submitted questions................................ 101
Daniel Calac, M.D., Chief Medical Officer, Indian Health Council,
Pauma Band of Luiseno Indians, INC............................. 34
Prepared statement........................................... 36
Answer to submitted questions \2\
Laura E. Riley, M.D., Obstetrician And Gynecologist-In-Chief; New
York Presbyterian Hospital..................................... 39
Prepared statement........................................... 41
Answer to submitted questions................................ 104
Lucy McBride, M.D., Internist, Private Practice.................. 46
Prepared statement........................................... 48
Answer to submitted questions................................ 107
Submitted Material
Report ``Protecting Our Front Line, Ending the Shortage of Good
Nursing Jobs and the Industry-created Unsafe Staffing Crisis,''
National Nurses United, December 2021, submitted by Ms.
Schakowsky \3\
Article ``The C.D.C. Isn't Publishing Large Portions of the Covid
Data It Collects,'' by Apoorva Mandavilli, New York Times,
February 20, 2022, sumbitted by Mr. Dunn....................... 88
----------
\1\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF02/
20220302/114450/HHRG-117-IF02-Wstate-RanneyM-20220302.pdf.
\2\ Dr. Calac questions were not answered by the time of
publications https://docs.house.gov/meetings/IF/IF02/20220302/
114450/HHRG-117-IF02-Wstate-CalacD-20220302-SD021.pdf.
\3\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF02/
20220302/114450/HHRG-117-IF02-20220302-SD003.pdf.
LESSONS FROM THE FRONTLINE: COVID-19'S IMPACT ON AMERICAN HEALTHCARE
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WEDNESDAY, MARCH 2, 2022
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:36 a.m., in
the John D. Dingell Room 2123, Rayburn House Office Building,
and remotely via Cisco Webex online video conferencing, Hon.
Diana DeGette, (chair of the subcommittee) presiding.
Members present: Representatives DeGette, Kuster, Rice,
Schakowsky, Tonko, Ruiz, Peters, Schrier, Trahan, O'Halleran,
Pallone (ex officio); Griffith (subcommittee ranking member),
Burgess, McKinley, Palmer, Dunn, Joyce, and Rodgers (ex
officio).
Also present: Representatives Sarbanes and Carter.
Staff present: Jesseca Boyer, Professional Staff Member;
Austin Flack, Junior Professional Staff Member; Waverly Gordon,
Deputy Staff Director and General Counsel; Tiffany Guarascio,
Staff Director; Perry Hamilton, Clerk; Fabrizio Herrera, Staff
Assistant; Rebekah Jones, Oversight Counsel; Zach Kahan, Deputy
Director Outreach and Member Service; Mackenzie Kuhl, Digital
Assistant; Kaitlyn Peel, Digital Director; Caroline Rinker,
Press Assistant; Chloe Rodriguez, Clerk; Andrew Souvall,
Director of Communications, Outreach, and Member Services;
Xiaoyi Huang, GAO Detailee; Kate Arey, Minority Content Manager
and Digital Assistant; Sarah Burke, Minority Deputy Staff
Director; Theresa Gambo, Minority Financial and Office
Administrator; Marissa Gervasi, Minority Counsel, Oversight and
Investigations; Grace Graham, Minority Chief Counsel, Health;
Brittany Havens, Minority Professional Staff Member, Oversight
and Investigations; Nate Hodson, Minority Staff Director; Peter
Kielty, Minority General Counsel; Emily King, Minority Member
Services Director; Bijan Koohmaraie, Minority Chief Counsel,
Oversight and Investigations Chief Counsel; Clare Paoletta,
Minority Policy Analyst, Health; Alan Slobodin, Minority Chief
Investigative Counsel, Oversight and Investigations; Michael
Taggart, Minority Policy Director; and Everett Winnick,
Minority Director of Information Technology.
Ms. DeGette. The Subcommittee on Oversight and
Investigations hearing will now come to order.
Today the Subcommittee on Oversight and Investigations is
holding a hearing entitled, ``Lessons from the Frontline:
COVID-19's Impact on American healthcare.'' Today's hearing
will examine the COVID-19 pandemic's impacts, and how
providers, the healthcare system, and patients can better
prepare for future variants and future public health
emergencies.
Due to the COVID-19 public health emergency, members can
participate in today's hearing either in person or remotely,
via online video conferencing.
In accordance with the updated guidance issued by the
Attending Physician, members, staff, and members of the press
present in the hearing room are not required to wear a mask.
For members participating remotely, your microphones will
be set on mute for the purpose of eliminating inadvertent
background noise. Members participating remotely will need to
unmute your microphone each time you wish to speak. Please note
that, once you unmute your microphone, anything that is said in
Webex will be heard over the loudspeakers in the committee
room, and subject to be heard by the livestream and C-SPAN.
Because members are participating from different locations
at today's hearing, all recognition of members, such as for
questions, will be in order of subcommittee seniority.
If at any time during the hearing I am unable to chair the
hearing, the vice chair of the subcommittee, Mr. Peters, will
serve as chair until I am able to return.
Documents for the record can be sent to Austin Flack at the
email address we provided to staff. All documents will be
entered into the record at the conclusion of the hearing.
The Chair will now recognize herself for purposes of an
opening statement.
OPENING STATEMENT OF HON. DIANE DeGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Over the past two years, this subcommittee has held eight
hearings examining the COVID-19 response, covering everything
from vaccine development and deployment to the impacts of the
pandemic on children. Today this subcommittee continues the
examination. They--building on its long history of pandemic
preparedness oversight.
We will hear from the on-the-ground providers about how the
pandemic has impacted their own lives, the healthcare systems
they work in, and the patients that they serve. Their frontline
perspectives will provide insight into how we can better
protect the health and safety of our communities throughout the
remainder of this pandemic, and help us better prepare for
future public health emergencies.
While our witnesses today represent an array of
experiences, there are many other types of healthcare providers
serving a range of communities that have felt similar impacts
from this pandemic: emergency medical technicians, nursing home
and in-home healthcare providers, and physical and occupational
therapists, to name a few.
As we all know, the COVID-19 pandemic has impacted nearly
every aspect of American life. The healthcare system is no
exception, which has faced these impacts head on. Resource
constraints and workforce shortages existed long before the
pandemic started, but have been exacerbated to alarming degrees
over the last two years.
A recent poll found that nearly one in five healthcare
workers quit their jobs during the pandemic, and nearly one-
third of those remaining have seriously considered finding new
jobs. And we have heard the reasons for some of this from the
mental health experts who testified before this subcommittee
two weeks ago. I have heard similar experiences during a recent
visit with some of Colorado's healthcare workers, and I know
many of you can attest that the feelings of burnout,
exhaustion, and unmanageable stress are echoed in hospitals and
healthcare settings throughout the country.
We must find a way to ensure these critical workers have
the support they need. Of course, the cascading impacts of
COVID-19 do not stop with the workforce alone. The COVID-19
surges due to new variant waves have led to significant
capacity constraints within hospitals. And when hospitals are
overwhelmed, patient care can suffer. Heart attacks, car
accidents, and other emergencies don't stop for COVID-19.
Routine preventative care and so-called elective procedures,
often involving lifesaving treatment, have been delayed due to
surges in the pandemic.
But the end of a COVID-19 surge does not necessarily bring
the relief we hope for, as patients seeking backlogged services
flood facilities. Moreover, the combination of workforce
strains and capacity challenges further compound historical
inequities of health disparities, presenting further barriers
to care for people of color and other under-served communities.
There is no single solution to these challenges, but we do
have the tools to help alleviate some of these concerns today.
The most effective way to fight the pandemic and lessen the
burden on our healthcare system is for eligible Americans who
have not gotten the COVID-19 vaccine to get vaccinated. CDC
data shows that unvaccinated adults are 16 times more likely to
be hospitalized, and 14 times more likely to die from COVID-19
than fully vaccinated adults.
Further, unvaccinated adults are an astounding 41 times
more likely to die from COVID-19 than those who have been fully
vaccinated and boosted. The science is clear: vaccines are safe
and effective, and they are our best shot, literally, at
alleviating the impacts of future surges of COVID-19 on our
healthcare system.
But vaccines alone will not help us prepare for future
public health emergencies. We must identify what steps we can
take now to rebuild and strengthen thehealthcare workforce so
the burnout, trauma, and resulting impacts on patient care can
be avoided. And critically, we must ensure that future public
health emergencies do not inflame existing disparities in
access to care and health outcomes for vulnerable populations
and marginalized communities.
Congress and the Biden Administration have begun to address
some of these concerns through investments in prevention
measures and healthcare workforce and systems support, but more
must be done.
As a Nation, we have relied on healthcare workers to bear a
significant burden these last two years, working long hours and
extra shifts, often at great risk to their own health and that
of their families. We owe a debt of gratitude for their
leadership and their sacrifices. I look forward to hearing all
of their insights and recommendations for how we can work to
keep America safe and healthy for the remainder of this
pandemic and for the future.
[The prepared statement of Ms. DeGette follows:]
Prepared Statement of Hon. Diana DeGette
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. And I am now very pleased to recognize the
ranking member, Mr. Griffith, for 5 minutes for an opening
statement.
OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE
IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA
Mr. Griffith. Thank you, Madam Chair, and I appreciate you
holding this hearing. Understanding the lessons learned from
the COVID-19 pandemic is crucial for future decisionmaking.
Americans need to learn to live with COVID-19, and the
Federal Government needs to learn to better prepare for and
handle future pandemics. It is our duty on this subcommittee to
oversee the Federal Government's COVID-19 response, to examine
what worked and what did not. I have heard from frontline
workers in my district about both successes and failures
experienced over the course of the last two years.
One of the best things to come out of this pandemic for
rural areas like my district is increased use of telehealth.
Thanks to flexibilities from the Centers for Medicaid and
Medicare Services and others, residents who were shuttered into
isolation could connect to their doctors and nurses virtually.
From mental health appointments to cardiology checkups, doctors
and patients alike were appreciative for the ability to use at-
home equipment to monitor and assess.
Other emergency flexibilities implemented by Federal and
State governments also helped to increase patient access to
healthcare, such as allowing pharmacists to deliver vaccines,
and allowing hospitals to compound medications that were in
short supply. As we move forward, this committee should examine
which of these flexibilities should be available on a permanent
basis.
During COVID-19 surges, many hospitals across the country
had to think fast, often surprising even themselves with
creative solutions. Ballad Health, a healthcare system that
serves much of southwest Virginia, created a Safe at Home
program. This program helped healthcare workers monitor COVID-
19 patients at home by providing kits with a thermometer and a
pulse oximeter. Nurses called patients to help monitor them
from home, and helped schedule followup appointments for
further care when necessary, based on patient self-monitoring.
The Ballad health system cared for thousands of patients
this way. By screening patients at home, and preserving
precious resources in the hospital for the sickest of patients,
this program reduced hospital admittance rates, keeping beds
open for those who needed them most.
Despite these successes, certain policies and mandates
implemented throughout the course of the pandemic resulted in
setbacks in my district. The decision to delay elective
procedures eventually backfired for some patients and
hospitals. The delay of treatment and preventative screenings
resulted in worsened conditions for patients. People often
think of an elective surgery as--think of elective surgery as
referring to something cosmetic or optional. However, the term
is broad, covering many critical procedures, including cancer
screenings, hip replacements, hernia repairs, or the removal of
kidney stones or an appendix.
We saw a temporary fix to manage staff shortages and the
influx of COVID-19 cases ultimately leave patients frustrated,
nervous, and in weakened health. And in some cases, like that
of our friend, Congressman Andy Barr's wife, the delay in care
became fatal.
Other challenges to our Nation's healthcare systems were a
result of over-burdensome Federal mandates. Vaccine mandates
made people choose between personal choice or their livelihood,
which we know made existing problems in recruiting and
retaining healthcare workers in rural areas worse. Amid Federal
COVID-19 vaccination mandates for healthcare facilities,
healthcare workers have been fired for non-compliance, and some
have resigned or quit. In a rural hospital the loss of staff is
not only noticeable, but very damaging. Any loss of staff is
detrimental to rural hospitals.
Through this pandemic, our Nation's healthcare workforce
has learned that it is possible to be resilient in a crisis.
Even the smallest changes to care can have the biggest impact
on patient health, staffing, and hospitalization rates. This is
especially true in rural districts with smaller staffs, where
each person plays an important role in keeping the hospitals
running. The mandate didn't work.
Now that being said, I agree with Chairwoman DeGette. I
have been vaccinated. I think it is an effective tool. But
making it a mandate has forced people to choose whether they
continue to work in our local hospitals or in healthcare
systems, or give up their jobs. It is critical that we take a
closer look at the experiences of frontline workers and examine
lessons learned as we discuss solutions to face the next
pandemic.
I look forward to hearing from our witnesses, what they
experienced on the front lines, and what we can do to
incorporate their lessons that they learned as we prepare for
the next pandemic.
[The prepared statement of Mr. Griffith follows:]
Prepared Statement of Hon. H. Morgan Griffith
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Griffith. Thank you very much, Madam Chair, and I yield
back.
Ms. DeGette. The Chair now recognizes the chairman of the
full committee, Mr. Pallone, for 5 minutes.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
TMr Pallone. Thank you, Chairwoman DeGette.
Today the committee will continue our oversight of the
ongoing COVID-19 response by hearing from frontline healthcare
workers who have served their communities throughout the
pandemic. Their experiences offer valuable insights into our
current response, and ways we can better be prepared for future
public health emergencies.
And nearly four-and-a-half million Americans have been
hospitalized due to COVID-19, and more than 930,000 Americans
have lost their lives. No one has been unaffected by the
pandemic, though seniors have been particularly vulnerable to
the disease, and communities of color have faced
disproportionate impacts.
Essential workers and frontline responders, such as the
healthcare workers joining us today, have faced additional risk
and burdens. Over the last 2 months the Omicron variant ripped
through our communities, spreading quicker than prior variants.
While Omicron appears to have peaked, the experience has shown
that we must remain vigilant as new variants emerge, and we
have to continue to use the tools available to us to prevent
transmission of COVID-19, and protect the most vulnerable among
us.
Now, evidence shows that being fully vaccinated and boosted
is the most effective way to fight COVID-19 and its impacts on
our community. This remained true, even during the spread of
the Omicron variant, where unvaccinated Americans continue to
face a greater risk of severe disease and death than those
fully vaccinated. Yet today in the United States, only 69
percent of eligible Americans are fully vaccinated, and just 45
percent have gotten a booster dose.
So I look forward to hearing from our witnesses about the
efforts they found successful in encouraging people to get the
vaccine and the booster dose because, unfortunately, despite
all the available tools, the pandemic continues to
substantially strain our Nation's healthcare system.
The pandemic is exacerbating longstanding workforce
shortages, capacity issues, and barriers to access for people
of color and other under-served communities. As COVID-19 surges
caused patients to overwhelm hospitals and medical facilities,
healthcare workers have faced both mental and physical
challenges. They are experiencing work overload, burnout, and
increased anxiety or depression with women, Black, and Hispanic
healthcare workers reporting higher stress. And as different
variants have emerged, hospital capacity has at times surpassed
the number of staff beds available.
So this week, more than 75 percent of ICU beds in hospitals
across the United States remain occupied, despite the fact that
the Omicron wave has crested. And this strain not only adds to
healthcare workers' burden, but can affect patient care and,
potentially, their health.
Capacity constraints, fear of contracting COVID-19, and
other barriers to healthcare led to 4 in 10 adults delaying or
avoiding medical care in the early days of the pandemic. One in
eight adults, and an even higher rate for Black and Hispanic
adults, postponed emergency care. And delayed preventative care
and diagnosis can lead to chronic, life-threatening illnesses.
As the pandemic continues, we must contend with these broader
and longer-term impacts on Americans' health.
Fortunately, Congress and the Biden Administration have
taken action to support America's healthcare workforce, and
protect the health and safety of all Americans. The American
Rescue Plan and the CARES Act provided billions of dollars in
funding to address worker retention and wellness, and resources
for healthcare providers serving children, low-income
individuals, and seniors.
And then, last November, this committee passed legislation
that would provide support to the healthcare workforce and
expand access to important preventative services. The House-
passed Build Back Better Act also included key provisions to
invest in public health infrastructure and the healthcare
workforce.
The Biden Administration has also made hundreds of millions
of tests and masks and COVID-19 vaccines and therapies
available to Americans at no cost. The President talked even
more about what he plans to do in the future last night, and
these are critical steps to supporting the Nation's healthcare
system and the public's health. But more must be done to ease
the burden on healthcare workers, and boost--and booster--and I
say also bolster capacity.
So I just wanted to say, Madam Chair, I am grateful for the
tireless commitment our Nation's healthcare workers have shown
for the last two years, and I look forward to hearing from our
witnesses about their experiences on the front lines. Together
we can strengthen America's continued response to the COVID-19
crisis.
If I could just say, Chairwoman DeGette, I know that many
times you have approached me and talked about how we have to be
better prepared. And I know that, even before the pandemic,
when it started a couple of years ago, you were talking to me
about, you know, long-term preparedness for viruses and other
healthcare emergencies. And I appreciate the fact that you and
the members of the committee, in general, you know, want us to
think about the future.
You know, right now everybody is saying, ``Oh, everything
is great,'' right? I mean, it is not. We still have a lot of
problems. But more important--and this is what you have always
stressed, Diana--we have to think about, you know, the next
pandemic, or the next wave. And this is a very important part
of this committee's function. So thank you.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. I thank the Chair. The Chair now recognizes
the ranking member of the full committee, Mrs. Rodgers, for 5
minutes.
OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mrs. Rodgers. Thank you, Chair DeGette, Republican Leader
Griffith.
We owe it to today's witnesses and all our frontline heroes
to listen to them, to understand their perspectives, and to
provide solutions. The families who lost loved ones--about
947,000 in the United States--and those who have suffered and
sacrificed during the pandemic are owed answers to many
questions.
The first question, how did the pandemic start? Republicans
on this committee have been leading a comprehensive
investigation into the COVID-19 origins, and we continue to
urge our colleagues on the other side of the aisle to join us
in this pursuit. Understanding how this pandemic started is one
of the most important public health questions of our time, and
it is necessary to answer, hopefully, to prevent future
pandemics.
Second, why weren't we better prepared? The Federal
Government could have provided more resources to healthcare
responders. For years, the Republicans on this committee have
raised concerns about the wisdom of not funding frontline
healthcare preparedness, instead of spending more than 80
million a year on the BioWatch program that started in 2004. In
a report to the bipartisan leadership on this committee, the
GAO found this program doesn't have the science to show that it
even works.
We have also raised concerns about relying on China and
other foreign countries for critical medical supplies, which we
all know we must address.
Third question: Why is CDC mixing politics with science?
Lockdowns, distancing, and masking were almost exclusively
emphasized by the CDC, while concerns about the effects on
mental health and social and economic costs have been ignored.
Fortunately, the Trump Administration led public-private
efforts to expedite the development of effective vaccines and
therapeutics.
The vaccines vastly reduced the risk of death and
hospitalization, and now we have data on what many of us have
known from the beginning: natural immunity protects robust
protection, or provides robust protection. But even with the
effect of vaccines and better understanding of who is most at
risk, the Biden Administration has continued an unbalanced
response, uninformed by these advances. There is far too much
fear, and far too much confusion.
The CDC led from behind on the issue of school closures.
Several countries in Europe never closed their schools. Some
localities in the U.S., and even CDC Director Walensky herself,
before she came to CDC, saw no difference in safety between
three feet and the CDC-recommended six feet distancing that was
keeping schools closed. Yet when her agency put out the school
guidance, she required six feet of distance. Why? Because she
gave the teachers' union a policy pin.
As a direct result of CDC's guidelines, children have paid
a significant price in mental health harms, lagging education,
and lost time for social development. Even when schools were
mostly reopened, CDC continued to force masking requirements,
even for young children, in a departure from World Health
Organization and UNICEF recommendations.
And the CDC continues to rely on discredited studies to
force their masking agenda on kids. The CDC is supposed to--
suppressed a large study it funded that showed little benefit
to masking in schools. It cherry-picked data by highlighting a
discredited study, and suppressing another one.
But there is more. The CDC also collected data on vaccine
and booster effectiveness, breakthrough infections, and
wastewater analysis, but released very little of it. The CDC
deprived hospitals and frontline workers of data that would
have better informed mitigation and treatment efforts. All of
these moves of the CDC have undermined trust in public health
when it is needed most.
The fourth question: Why did the Biden Administration take
actions that made it harder on frontline healthcare workers?
Many hospitals struggled with staffing shortages, but
vaccine mandates may have further worsened the staffing
situation at hospitals. During the height of the Omicron surge,
the Biden Administration took nearly $7 billion from the
Provider Relief Fund, meant to help hospitals and clinics
affected by the pandemic, and used it to buy COVID-19 vaccines
and therapeutics. Congress has set aside that money to help
providers pay for pandemic-related expenses, including
staffing, personal protective equipment, care for the
uninsured, and vaccine distribution. This relief was badly
needed by rural hospitals that were competing to hire temporary
contract staff.
These are just a few of the questions that this committee
needs to pursue. We must get answers to ensure the frontline
heroes, like all of you, have trust and confidence in public
health.
[The prepared statement of Mrs. Rodgers follows:]
Prepared Statement of Hon. Cathy McMorris Rodgers
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mrs. Rodgers. Thank you, Madam Chair. I yield back.
Ms. DeGette. I thank the gentlelady.
I ask--I now ask unanimous consent that members' written
opening statements be made part of the record.
And without objection, so ordered.
I would now like to introduce our witnesses for today's
hearing: Dr. Megan Ranney, an emergency physician at Rhode
Island Hospital; Tawanda Austin, chief nursing officer at Emory
University Hospital Midtown; Dr. Daniel Calac, chief medical
officer for the Indian Health Council, Inc.; Dr. Laura E.
Riley, obstetrician and gynecologist in chief at New York
Presbyterian Hospital, all appearing on Webex. And then in
person we have Dr. Lucy McBride, a private practice internist.
I want to thank all of the witnesses for appearing before
the subcommittee today.
I know all of you are aware that the committee is holding
an investigative hearing. And when we do so, we have the
practice of taking testimony under oath. Does anyone have an
objection to testifying under oath?
Let the record reflect the witnesses have responded no.
The Chair then advises you, under the rules of the House
and the rules of the committee, you are entitled to be
accompanied by counsel. Does any of you wish to be accompanied
by counsel?
Let the record reflect the witnesses have responded no.
And so would our witness in the room please rise, and
everybody else please raise your hand, so you may be sworn in?
[Witnesses sworn.]
Ms. DeGette. And let the record reflect that the witnesses
have responded affirmatively, and you are now under oath and
subject to the penalties set forth in title 18, section 1001 of
the United States Code.
Now, at this time, the Chair will recognize each witness
for 5 minutes to provide their opening statement.
Before we begin, I would like to explain the lighting
system for the witness testifying in person.
That would be you, Dr. McBride. In front of you is a series
of lights. The light will initially be green. The light will
turn yellow when you have 1-minute remaining, and so start to
wrap up at that point. The light will turn red when the time
expires.
Now, for the witnesses who are testifying remotely, there
is a timer on the screen that counts down to the remaining
time.
And so, first of all, I would like to introduce Dr. Ranney
for 5 minutes.
Doctor?
STATEMENTS OF MEGAN RANNEY, M.D., M.P.H., EMERGENCY PHYSICIAN,
RHODE ISLAND HOSPITAL; TAWANDA AUSTIN, M.S.N., R.N., N.E.-B.C.,
CHIEF NURSING OFFICER, EMORY UNIVERSITY HOSPITAL MIDTOWN;
DANIEL CALAC, M.D., CHIEF MEDICAL OFFICER, INDIAN HEALTH
COUNCIL, INC.; LAURA E. RILEY, M.D.; OBSTETRICIAN AND
GYNECOLOGIST-IN-CHIEF; NEW YORK PRESBYTERIAN HOSPITAL; AND LUCY
MCBRIDE, M.D., INTERNIST, PRIVATE PRACTICE
STATEMENT OF MEGAN RANNEY, M.D., M.P.H.
Dr. Ranney. Thank you so much. I appreciate the invitation
to testify, Chair Pallone, Ranking Member Rodgers, Madam Chair,
and members of the committee.
Monday marks three years since our first COVID case in
Rhode Island. I was working in the emergency department that
night, and I had continued to work on the frontlines of the
COVID-19 response throughout the pandemic. I therefore testify
today as a practicing, board-certified emergency physician,
public health researcher, academic dean of the School of Public
Health at Brown University, and mother of two school-aged
children.
Let me start by recognizing that, in so many ways, we are
in a better place than we were two months ago, much less two
years ago. We have had quick development and rollout of
vaccines, therapeutics, and use of masking, testing, and
ventilation during surges. Omicron cases are plummeting. But
despite this progress, the situation in healthcare facilities
has deteriorated to new lows.
Only a few weeks ago, a nurse in charge of my emergency
department told me she was ten nurses short for the
[inaudible], and therefore forced to reduce services. She
said, ``I have been begging people to stay all day long,
offering double time and double incentives, but the nursing
staff is too burnt out.''
So today I will highlight challenges ahead, and then
propose ways to leverage this fleeting window of opportunity we
have to protect the health of America.
I also respectfully ask the members to read my written
testimony, which contains many firsthand accounts of the
challenges we face.
Let me start by discussing the profound impact of COVID on
accelerating staff shortages and hospital overcrowding,
particularly in emergency departments, the only place in our
system that provides care to all, 24/7/365.
Some have reported that as many as one in five healthcare
workers--not just docs and nurses, but home health aides, EMTs,
social workers, and more--have left bedside care during the
pandemic. These staff shortages are a problem across the
Nation, although rural communities are disproportionately hurt.
During COVID surges, due to these shortages, many hospitals
have had to resort to extreme measures, calling in the National
Guard, shutting down so-called elective procedures to try to
save space for true emergencies like strokes and traumas. But
even with these steps, we have been unable to care for patients
in a timely manner.
One nurse recently told me that every day in the ER feels
like she is going before the firing squad due to her inability
to provide adequate care. Surgeons have shared their anguish at
watching patients lose vital functions due to delays, which
highlights the most significant reason for the staffing
shortages: the mental and emotional effect of repeated COVID-19
surges on our healthcare providers. We keep showing up, but our
work keeps getting tougher, and there are no reinforcements in
sight.
In my own specialty, the proportion of emergency physicians
experiencing burnout has increased from 43 to 60 percent during
the pandemic. We also report increased
[inaudible] injury, depression, PTSD, and workplace
violence. We must fix these core issues to save healthcare.
Second, COVID has exposed weaknesses in our healthcare data
information systems. We need good data, timely, accurate,
transparent, and complete to make good decisions about what is
needed, where, when, and for whom. Thanks to the CARES Act and
the ARP, the CDC and HHS temporarily have access to many
important data streams, making earlier citizen-led data efforts
unnecessary.
But important pieces of data are still missing, things like
actual numbers of staff beds in hospitals. Lack of data related
to race and ethnicity are particularly glaring. And it is
unclear what will happen to even these preliminary data
sources, once the public health emergency is over. I and others
deeply fear the loss of hard-won data gains.
Third, we have continued problems with the healthcare
system's supply chain. Although early PPE shortages have
resolved, we face new and worsening problems with key tests,
therapeutics, and equipment for both COVID and non-COVID-
related care. The lifesaving work of folks like myself is
heavily affected by these swings in supply. We are forced to
substitute one preferred medication or treatment for another,
and sometimes there is no substitute. This directly hurts
patients.
Finally, the increasing politicization, misinformation, and
public mistrust around COVID has had a deep impact on
healthcare workers, public health, and the quality of care
provided. Three-quarters of healthcare workers say that
misinformation has negatively influenced both patients'
decisions to get vaccinated and patient care.
But all of this can be fixed. As Americans, we have a long
history of transforming public health crisis into opportunity.
In my written testimony I provide specific examples. Some were
highlighted by President Biden last night, including systemic
fixes to the healthcare delivery system; support for healthcare
workers; investing in training and retaining all types of
healthcare workers; treating the medical supply chain not as
any other part of the U.S. economy, but rather as a concern of
national security and health; and finally, rebuilding trust.
In close, every American wants to be able to show up in an
emergency department and get timely, appropriate care for their
emergency. Right now they can't. Throughout the pandemic we
have relied too heavily on stopgap solutions, instead of
addressing the underlying issues. I urge you, please think
bigger and do more.
Thank you for your time.
[The prepared statement of Dr. Ranney follows:]
[The prepared statement of appears at the conclusion of the
hearing.]
Ms. DeGette. Thank you so much, Doctor.
I am now pleased to recognize Ms. Austin for 5 minutes.
STATEMENT OF TAWANDA AUSTIN, M.S.N., R.N., N.E.B.C.
Ms. Austin. Good morning, Subcommittee Chairwoman Diana
DeGette, Subcommittee Ranking Member Morgan Griffith, members
of the committee, and my fellow witnesses. Thank you for
inviting me to participate in today's hearing. The views that I
express today are my own views, and do not necessarily reflect
the views of my employer.
My name is Tawanda Austin, and I serve as the chief nursing
officer and vice president of patient care services at Emory
University Hospital Midtown. I have been a nurse for over 20
years, and the COVID-19 pandemic presented the biggest
challenge to the healthcare workforce in decades. Today I am
going to talk about the multi-year mental and physical strain
on nurses, hospital capacity challenges, and the worsening
workforce shortage that Congress must address.
I recall rounding in our COVID ICU at the end of 2020, and
I will never forget the exhaustion and despair that I saw on
the nurses' faces. This is an ICU team that are innovators, and
they are highly engaged, a team that proudly received a third
Beacon Award during the pandemic. So it was not customary to
see them look so defeated. As I walked around getting a pulse
check on the nurses, one nurse says to me, ``Walk with me. I
want to show you something.''
She took me to four patients' rooms. We stood on the
outside of each of those rooms, peering through the glass
windows, as she explained to me how severely ill each of those
patients were, and she outlined the numerous medications and
complex therapies they each were receiving. She paused and
said, in her best clinical estimation, that not a single one of
those patients would survive.
I believe her mission was purposeful. She wanted me to
experience in just those few minutes what it was like to be on
the front line, how devastating it was to do everything
possible to save a patient's life, only to lose them in the
end. I remember feeling deflated because, as a leader, it is my
duty to support, to help find solutions to problems, to offer
comfort when it is needed. But I didn't feel that that was
enough in that moment.
As I continued to make rounds in the ICU, I stopped to
check on another nurse, who appeared to be the most exhausted
of all the nurses that I had encountered that day, and I asked
how she was doing. She explained to me that she was caring for
two patients that day, although one really required intensive
one-to-one care. She was extremely overwhelmed, and stretched
too thin. She had spent most of her day in this one patient's
room, and had not been able to check in on the other patient as
often as she wanted. On this day, like many others, the unit
was short-staffed. But fortunately, the nurse in charge was
able to support her with the care of her second patient.
These are just a few of the all-too-common stories that
have emerged from hospitals during the COVID-19 pandemic. I
share these stories with you today because they illustrate the
incredible pressure on our staff, who have been caring for
COVID patients for nearly 750 days.
In addition to the physical strain, there is the mental
stress that is plaguing our workforce. The morale of nurses has
declined over time, as they continue to care for patients who
are extremely ill and who are suffering and dying.
Additionally, nurses have shared stories of being verbally
attacked for implementing COVID-19 safety restrictions.
Patients' families have become frustrated and distressed,
taking their emotions out on nurses, and workplace violence is
at an all-time high.
The COVID-19 pandemic has tested the capacity of all
hospitals. We are facing extremely long wait times in our
emergency departments. And at the beginning of COVID, Emory
paused our elective procedures, and providers were
redistributed to our COVID units to support testing and to
support our vaccine clinics. But now that we are back at
regular operations, we again feel the immense shortage of
nurses.
Early in the pandemic we saw nurses leave. Now we are
experiencing additional staffing issues, as support staff have
also fled the industry, adding to the nurses' daily burden.
While we face challenges, Emory nurses have stepped up. The
COVID-19 pandemic forced our nurses to find new and innovative
solutions to the challenges brought on by this public health
crisis. Emory nurses placed baby monitors in the COVID rooms,
and this allowed them an additional way to communicate with
patients quickly, and make patients feel less isolated. It also
saved on PPE, by consolidating the nurse's visits into the
room. So instead of donning PPE to go in and hear the patient's
request, the nurses received the request over the baby monitor,
and entered the room once to deliver the needed care.
As we emerge from this pandemic, various lessons can be
learned from the experiences of healthcare professionals.
First, we need a far more robust workforce to combat
burnout and overall shortage of providers. I urge Congress to
fund pathways for more young people to enter the nursing field,
and programs to retain our staff.
Second, we need to address issues surrounding travel
nursing agencies. While these businesses offer the chance for
hospitals to bolster their workforce during surges, their costs
have risen to unsustainable levels. Congress should take action
so that hospitals remain financially viable, and avoid the risk
of having to reduce services or, even worse, avoid the risk of
shutting their doors.
Finally, I urge Congress to take a deeper look into the
rising trend of violence toward healthcare workers, and find
steps to mitigate this trend.
I look forward to your questions. Thank you.
[The prepared statement of Ms. Austin follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much.
Dr. Calac, now I recognize you for 5 minutes.
STATEMENT OF DANIEL CALAC, M.D.
Dr. Calac. Good day to Chairwoman DeGette, Chair
Congressman Pallone, Congressman Rodgers, and Republican Leader
Griffith. Thank you so much. My thanks to all the healthcare
workers' hard work over the last two years.
The testimony provided today is not necessarily reflective
of my corporation. I would like to provide a brief description
of the effect and response to COVID during the period of March
2020 to 2022, January.
So the context of this response is based in the Southern
California area. My primary role at the facility is chief
medical officer at this facility for the past 19 years. I serve
as the primary care provider for the panel of patients that
services nine American Indian tribes in these areas.
We currently operate out of a 30,000-square-foot facility
that is located approximately 40 miles northeast of San Diego.
There is an additional 12,000-square-foot facility about 25
additional miles from the main site, in the mountainous areas.
We provide a multi-disciplinary, ambulatory care facility that
provides care to approximately 20,000 American Indian clients
in the surrounding area. However, about 5,000 of those are
active patients.
The organization provides multiple disciplines, including
internal medicine, family practice, pediatrics, general
dentistry, behavioral health, public health outreach. We also
provide additional sub-specialties, including orthodontics,
endodontics, orthopedics, acupuncture, optometry, OB/GYN,
substance use disorder management, marriage and family therapy,
pharmacy services, and podiatry.
The organization also contracts with outside agencies that
are in neighboring cities 20 or 30 miles away.
I provide care, as a primary care physician, as I
mentioned, in internal medicine. I am also pediatrician-
trained, and also provide hospice care services to our
community.
So our COVID response in that time is spread over the
northern half of San Diego County. And so, just for references,
the area covers about 10,000 square miles. Of note, the
southern California area is home to over 30 different tribal
entities with different cultures, different dialects, and,
hence, the need to be culturally appropriate in these types of
primary care delivery. One can, obviously, see the issues
regarding delivering COVID-sensitive response care to these
communities.
In this setting a pandemic has not been seen to this
magnitude since the early 1900's. In a community where the
average lifespan is 10 to 15 years less than the average
American, the tribes in the surrounding area were required to
mount a response that was replete with challenges, including
dealing with the geographic diversity, the economic issues that
have been persistent over the past 100 years.
Considering the limited resources from which to work, the
tribes provided a boots-on-the-ground workforce by--and
spreading information by word of mouth, fliers, social media,
when appropriate.
It is important to acknowledge that, in the area that I
work, only half of the tribes have access to the--to internet
or any type of significant social media because of the
geographic diversity and the limits of providing telehealth in
these areas.
Additionally, challenges exacerbated by health literacy
makes receiving, processing, and disseminating true and
accurate information a monumental challenge, especially in our
older demographics, 60 to 70 years of age.
From a corporate standpoint, we managed to provide a
unified approach, despite the closure of our internal services.
The services that we provided, including preventive health
services, were deferred because of the limitations of providing
access in-house. We were required to provide most of our
service out in a setting that consisted of our parking lot.
So I wanted to leave the committee with recommendations on
this experience, and recommending a persistent and consistent
outlook and perspective, and continued funding in dealing with
the issues of long-term COVID, and the effects of COVID in
communities such as the rural one that I serve, looking at
providing additional perspectives in infrastructure on
telehealth for the delivery of healthcare to these outlying
communities, and especially to look at the effects the pandemic
has had on the pediatric population, in terms of delayed
delivery of healthcare services, the issues of specialty
services for the community, and also to address workplace
shortages that persist in the communities that are served by
Indian Health Services under Health and Human Services. Thank
you.
[The prepared statement of Dr. Calac follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
Dr. Riley, I am now recognizing you for 5 minutes.
STATEMENT OF LAURA E. RILEY, M.D.
Dr. Riley. Thank you, Chairs DeGette, Pallone, and Ranking
Members for inviting me to speak with you today. My name is Dr.
Laura Riley, and I am an obstetrician, gynecologist in chief at
New York Presbyterian Hospital/Weill Cornell Medicine.
As a maternal fetal medicine specialist and expert on
obstetric infectious disease, I have dedicated my career to
ensuring patients have healthy pregnancies. I am a member of
the advisory committee on immunization practices workgroup on
COVID vaccines, and I currently serve as the chair of the
American College of Obstetricians and Gynecologists'
immunization, infectious disease, and public health
preparedness expert workgroup.
While many of my colleagues in other specialties were
forced to delay non-emergency services during COVID surges, our
labor and delivery unit remained operational at full speed,
caring at great personal risk for our laboring patients.
The ongoing pandemic has placed an incredible strain on our
healthcare system and its workforce. Many labor and delivery
units, including my own, are struggling with these mounting
shortages. Obstetrics is practiced in a team. And when members
of the team are missing, that can negatively impact patient
care.
While there is no one solution to these workforce
challenges, greater investment in and training of healthcare
professionals, from physicians and nurses to technicians, as
well as efforts to diversify our healthcare workforce, are
absolutely critical.
The early days of the pandemic were a time of extreme
anxiety and confusion, especially for our pregnant patients.
Many were left wondering if they should attend their prenatal
appointments, and if it was safe to deliver at the hospital.
During that time it was essential to reiterate to my patients
that it was safe to deliver, and that their entire maternity
team is committed to making sure that they get the support they
need to birth confidently, safely, and respectfully.
One of the most important healthcare system shifts during
the pandemic was to increase the utilization and coverage of
telemedicine. Remote visits have become an expectation of
patients, and I strongly urge their continued coverage,
including extending flexibilities such as audio-only to meet
patient needs.
Additionally, an ongoing and urgent concern is our health
system's failing of historically marginalized communities, who
are disproportionately impacted by the pandemic. A key lesson
learned is that equity must be a focus of pandemic preparedness
and response.
The impact of COVID-19 on the patients I serve is
significant and ongoing. When the pandemic first began, we
worried, based on our experience with flu, that COVID-19 may be
worse in pregnant individuals. Those fears were confirmed, as
we found that they are at increased risk of severe illness and
death. Despite this evidence, and urgent calls from the medical
community, pregnant and lactating individuals were initially
excluded from COVID-19 vaccine trials, and continue to be
excluded from therapeutic trials. That meant that, when the
vaccines became available, we had very little data on their
safety in pregnancy, resulting in confusion and fueling
misinformation.
While ACOG and the CDC were finally able to make an
affirmative recommendation for vaccination during pregnancy
last summer, the long delay contributed to low vaccination
rates among pregnant individuals and the rise of adverse
outcomes.
The COVID-19 pandemic is exacerbating the maternal
mortality crisis. In September 2021, the CDC released an
advisory following the record-breaking COVID-19-related deaths
among pregnant individuals in a single month. Of note, their
primary recommendation was to increase efforts to protect
pregnant and lactating individuals through accelerated
vaccine--vaccination effort. Unfortunately, vaccine hesitancy
remains today, and I continue to counsel my unvaccinated
pregnant patients on the vaccine's protection of their health
and their newborn's health.
These routine exclusions of pregnant and lactating
individuals from research, presumably for their protection,
leaves them disproportionately vulnerable, and may have, in
this instance, contributed to avoidable loss of life. As we
reflect on the pandemic and lessons learned, it is past time to
shift the narrative on research in this population. Instead of
protecting them from research, we should be protecting them
through research.
Thank you for the opportunity to share my experiences and
expertise with you today. I look forward to your questions.
[The prepared statement of Dr. Riley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
And now, Dr. McBride, I am very pleased to recognize you
for 5 minutes.
STATEMENT OF LUCY McBRIDE, M.D.
Dr. McBride. Good morning, and thank you to Chairs DeGette
and Pallone, and to Ranking Members Rodgers and Griffin (sic)
for inviting me today.
My name is Dr. Lucy McBride. I am here as a board certified
primary care physician in Washington, DC. I have been
practicing medicine for 20 years. I have dedicated my life and
my career to helping people understand the inseparability of
mental and physical health, whether it is my teenage patients
or my octogenarian patients. I trained at the Harvard Medical
School and at Johns Hopkins Hospital.
I am not here today to be clear with any political agenda
whatsoever, but rather to share my perspective on the pandemic
as someone who has seen patients every day, patients who are on
the receiving end of complex and often confusing public health
information, and who are trying to make sense of the news.
This is a watershed moment of the pandemic. We have learned
enormous amounts about the virus over the last two years. We
have learned exactly who is most susceptible to the severe
consequences from COVID-19, and we have now incredibly safe and
effective vaccines and therapeutics. But we are not done. COVID
continues to cause widespread death and destruction. We have a
lot of work to do to increase vaccine uptake.
We have also unmasked major problems in our healthcare
system--in particular, the erosion of trust in public health
and the lack of access to needed medical care just when people
need it most. As a result, we are dealing with a parallel
pandemic of mental health and crisis and surging rates of
underlying conditions like obesity, and people just don't know
where to go for advice.
I have seen everything over the course of the pandemic. I
have had patients hospitalized from COVID. I have had patients
die from COVID. I have patients with long COVID. I have
patients with COVID right now. I have also witnessed the
social, emotional, and mental health toll of the pandemic
itself, and from all of the losses that come along with losing
friends and families--family members to the virus, but also
from lost jobs, sense of normalcy, social disruptions,
isolation, and loneliness, and just from navigating the deluge
of information coming at people every day, and the
politicization of science.
I see the emotional distress and the very real physical
manifestations of stacked stressors, from insomnia to stress
eating to substance use disorder, and the accompanying surging
levels of medical conditions like diabetes, obesity, and
depression. What I see in my patients every day is mirrored in
the medical data.
Take, for example, my patient from earlier this week, a
single mother with two children, one a middle schooler with
special needs, and the other who is a college student suffering
from depression. Stressed to the max, my patient finds herself
drinking too much, eating, not exercising. And as a result, her
blood pressure and her weight have soared during the pandemic.
Naturally, she worries about COVID-19, but that is only one of
the myriad health issues that she and I are working on
together.
So I am here to bring my firsthand appreciation for what I
am seeing, and for what I see people needing most. And that is
access to a trusted primary care provider, something that 80
million Americans do not have, particularly in rural and
poverty-stricken urban areas. Of course, I am a little biased,
because I am a primary care doctor myself. But really, COVID-19
is an outpatient disease. The ERs and ICUs have, obviously,
been critical for our most sick patients, and are certainly
where the news focus is, and where doctors like Megan Ranney
have been doing heroic and essential work.
But the fact is that the vast majority of patients with
COVID-19 are out in the world, and not in the ICUs. ERs were
flooded not only because people were severely and sometimes
critically and fatally ill, but also because they were scared
and sick, and navigating the pandemic alone without access to a
guide. So there are three unmet needs that I see in the
community that we need to face.
One is all the information--misinformation we are seeing.
More than ever, people need a trusted medical provider to
receive fact-based, nuanced medical advice. Just last month a
study in JAMA showed that the COVID vaccine uptake increases
with the number of PCPs per capita.
No. 2 is a place to manage underlying conditions. We know
that, in addition to age, one of the biggest risk factors for
severe outcomes from COVID is underlying conditions. And we
manage those, not with ER visits, but rather with longitudinal
relationships with a primary care doctor for guidance on things
like nutrition, sleep, exercise, stress management.
And three, people need a place to help apply broad public
health advice to their unique lived experience and situation. I
spent countless hours on the phone over the last two years
helping people manage everyday questions: which COVID test?
Which vaccine? Do I need a booster? And people need help
navigating these everyday decisions, and balancing risks.
There is no better role for primary care than in a global
health crisis. My hope is that our children grow up in an
America where they have unfettered access to primary care, a
hub for problem-solving, a place where mental and behavioral
health and physical health meet, where people can be fully seen
and heard, and where they don't have to worry about who to
trust. They don't land in Dr. Ranney's ER because they have
underlying health conditions that aren't managed. And when they
are short of breath, they don't have to wonder, is this COVID
or is this a panic attack? Or they can get their COVID test and
talk about their anxiety, and navigate that mental health
condition that is so common.
As we dig through the rubble of the pandemic and prepare
for the next one, we must invest proactively in medical systems
founded on relationships, rapport, and reason. Investing in
primary care is the way we invest in our health and our
collective well-being. Thank you very much.
[The prepared statement of Dr. McBride follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor, and thank you for
your work on the front lines.
Thanks to all of our witnesses for their hard work.
It is now time for members to have the opportunity to ask
you questions, and so the Chair will recognize herself for 5
minutes.
You know, when we hear the testimony today from all of our
witnesses, and when we hear from our constituents in our
districts, we know that this crisis is impacting healthcare
workers across all levels, from primary care physicians to
nursing to emergency care, and on and on. And only when we
understand where we fell short can we better understand what we
need to do for the future. As the chairman said, I am all about
recognizing the positives and the challenges, and seeing what
we need to do. And so what I want to do with our witnesses
today is drill down in what the witnesses feel are the critical
steps for Congress and the Federal Government to take to
prepare for tomorrow's challenges.
So, Dr. Ranney, I am going to start with you first. Your
testimony mentions needing a ``culture of preparedness'' to
effectively manage national disasters. What action do you think
would be key to being better prepared in the future?
Dr. Ranney. Thank you for the question. So I will note that
organizations like ASPR have previously outlined good
preparedness plans, ways to set up healthcare systems that have
adequate resiliency with staff, with supply, with real-time
data to be able to respond, identify surges when they start,
respond appropriately from stop--to stop them from getting
worse, and then to deploy healthcare workers across the
country, as needed.
Right now, though, we need to shore up our workforce. So
that is both about retaining current healthcare workers,
helping them individually manage their burnout--distress,
stopping or reducing the impact of workplace violence, and
creating those systemic fixes so that we have, particularly for
our nurses, having adequate nursing staffing ratios, and about
training up new healthcare providers, so that we can refill the
ranks from all the folks that have left.
And then the third part is working on creating new models
of access to care. I do appreciate Dr. McBride's points about
primary care providers, the minority chair's--Minority Griffith
Member's comments about telehealth. Also, new digital health
modalities, as well, can make a big difference.
And then, at the bottom of it, setting up a better data
infrastructure. So the wastewater monitoring that CDC is now
beginning to implement into its data systems are critical.
Setting up other data systems that we have accurate information
not just on race, ethnicity, and age of cases, but also
hospitalizations, so that we have real-time data on staffed
hospital beds, so that we have real-time data on supply
shortages. Again, personal protective equipment was----
Ms. DeGette. Doctor, I am going to--I am sorry, I am going
to need to interrupt you, so I can----
Dr. Ranney. No problem.
Ms. DeGette [continuing]. Get to the rest of my questions.
Dr. Ranney. Go ahead.
Ms. DeGette. I want to ask you, Ms. Austin, the same
question. What do you think we need to do to support nurses and
address the challenges in the future?
[No response.]
Ms. DeGette. OK, I will come back to you, Ms. Austin, I
think we are having a technical issue.
I want to ask you, Dr. Riley. You have noted the
availability of vaccines and treatments that were instrumental
in supporting the health and well-being of your patients, but
there was a delay in the evidence necessary to assure safety
and efficacy among pregnant and lactating women. Briefly, what
can we do to recommend--to address this in the future?
Dr. Riley. I think--thank you for the question. I think it
is really important that we figure out how we are going to
involve pregnant and lactating women in research earlier in the
process.
Research could have been done on the vaccine, giving us
information about safety that would have allowed us to
vaccinate even more women. The long delay allowed us to then
fill that in with the mistrust and, you know, all sorts of
things on the social
[inaudible], which have led to fewer pregnant women being
vaccinated than we would hope.
I think the other
[inaudible] that we need to really focus on is the
surveillance systems which, in the past, did not include
information on pregnancy and lactating women. And those
surveillance systems, which have now been stood up for COVID-
19, need to remain in place. So not only do we need
surveillance of disease, we also need surveillance of vaccine
use and vaccine safety, which are absolutely critical. Thank
you.
Ms. DeGette. Ms. Austin, do we have you back?
Ms. Austin. Yes, I apologize. I lost audio for just a few
minutes there. Thank you so much----
Ms. DeGette. Technology is our friend.
Ms. Austin [continuing]. The question.
Ms. DeGette. Go ahead. Go ahead. The question was what
steps do you think that we can take to support nurses and
address the challenges we found with COVID?
Ms. Austin. Yes, I think the biggest opportunity for our
nurses, I hear all the time, is our staffing shortages. I
think, if there is anything at all that could be done, it is
just investing in our accredited nursing residency programs.
Emory has one of only two nursing residency programs in the
State of Georgia, and it is truly a pipeline for us. Over the
last couple of years we have brought in about 500 new nurses,
new graduate nurses, and our goal this year is to bring in over
700. So I think that anything that could be done to help
partner with the Federal Government to grow our program would
be really helpful.
Ms. DeGette. Thank you so much.
Dr. McBride, I am out of time, but I--you know, my daughter
is a primary care doctor in San Francisco, and I know the work
that all of you do. I would be interested if you could just
very briefly tell us what Congress can do to help support
primary care doctors going forward, because there is a severe
shortage, as you say.
Dr. McBride. So right. Before the pandemic we had an
enormous shortage of primary care physicians, particularly as
patients age, and if you have Baby Boomers, and people are
living longer. So here's my advice.
First, we have a supply problem. We need to incentivize
people coming out of medical school to come into primary care
professions. Right now the incentives are to go into
specialties that are more procedural-based, and we need to--in
my opinion, I am biased, obviously--make primary care the kind
of crown jewel of medicine, because it is the place--it is the
ground game, it is where trust is born, it is where
relationships and rapport are born, to be able to dispense
trust and nuanced information. And if we have better primary
care, particularly with behavioral health and mental health
services woven in with PAs, NPs, doctors, and extensions of us,
then we can do better to prevent mental health despair,
physical health problems.
And so it is about getting more people in medical school to
go into primary care. It is also about----
Ms. DeGette. I am sorry to interrupt you, but my time is
way expired, and I appreciate the ranking member. I know--I am
sure we can get more from you. Thank you.
And I am going to recognize Mr. Griffith for 5 minutes.
Mr. Griffith. Thank you very much. I am going to ask for a
little indulgence, too, because I want us to go back to Dr.
Riley for just a second on one of your questions, because part
of our duty is not only to get information for ourselves, but
to make sure people back home that might be watching on C-SPAN
have an opportunity, too.
And Dr. Riley, you mentioned surveillance systems. Define
that for us. You were talking about nursing and so forth.
Dr. Riley. So I was talking about having information on
COVID infection specifically for pregnant women and lactating
women. So that surveillance system that the CDC, you know,
ultimately stood up allowed us to then figure out that, in
fact, COVID infection was worse for pregnant women.
Mr. Griffith. I got that. But the problem is, I am not sure
folks back home understand what you mean by ``surveillance
system'' that the CDC stood up. That is what I am trying to get
at----
Dr. Riley. Oh, I am sorry.
Mr. Griffith [continuing]. Just a definition.
Dr. Riley. OK.
Mr. Griffith. That is all right.
Dr. Riley. So a way of counting cases of--you know, being
able to recognize that the patients coming into the hospital
are pregnant or not pregnant, lactating/not lactating, race
ethnicity, so getting more information on patients as they come
into the hospital or as they leave the intensive care unit, so
that you can figure out exactly who is getting sickest.
Mr. Griffith. Thank you very much. That is very helpful.
Dr. McBride, at the beginning of the pandemic the Centers
for Medicare and Medicaid Services announced that all elective,
non-essential procedures should be delayed during COVID-19
outbreak. CMS also stated that the decision to proceed with
these procedures would be made by the clinician, patient
hospitals, State and local health departments, et cetera. But
as a result of that, patients and doctors across the U.S.
postponed procedures. More recently, during the Omicron
outbreak, some states and hospital systems continue to grapple
with the decision to delay elective, or so-called elective,
procedures to manage care for COVID-19 patients.
Looking back on the decisions to postpone procedures, were
there any options besides across-the-board postponements that
we could have made?
Dr. McBride. So, as we all know, hindsight is 20/20.
Mr. Griffith. Yes, ma'am.
Dr. McBride. But I do think it is important to realize,
moving forward--because we will have another wave of COVID-19,
we will have another pandemic, whether it is in six years, six
months, or six decades--to recognize that COVID is only one
threat to our health and well-being. It is enormous, right? We
have lost almost 950,000 American lives. People are suffering
from long COVID and other sequela from the virus. But I think
it is also important to realize that elective surgeries, for
example, are essential for people to keep people healthy, to
prevent the underlying conditions that then put them at higher
risk for poor outcomes.
So I don't claim to have the solution, but I think we need
to make sure that we gather as much information now on the
virus, who exactly it affects, so that we tailor our mitigation
measures more appropriately to the actual risk, and that we
don't do more harm than good with mitigations.
Mr. Griffith. And I appreciate that, because there are
situations where harm was done because, as I said in my
opening, most people, when they hear elective, they think you
are talking about something that doesn't need to be done, or
cosmetic surgery, or something like that, when in often cases
it is the diagnosis phase, where you are trying to figure out
what is wrong. And it may not appear to be an emergency today,
but, as we know, unfortunately, sometimes it is actually an
emergency, or the test would have turned up something that
needed to be dealt with right away.
All right. Also Dr. McBride, and then also Dr. Riley,
during the COVID-19 pandemic healthcare providers had to adopt
remote methods to care for their patients by using
telemedicine. This is especially important in under-served and
isolated communities, where it is more difficult to access
care. We know that telemedicine can save lives, and I am glad
that the healthcare facilities in my district have taken
advantage of the Federal grant funds to enhance their
capabilities.
Did you use telehealth during the pandemic? And if so, what
type of equipment did you need to use to monitor patients from
home?
We will start with you, Dr. McBride, then we will go to
you, Dr. Riley.
Dr. McBride. Thank you for that question. So telehealth was
a lifeline during the pandemic. I actually wrote an opinion
piece in The Washington Post in the spring of 2020 with the
former FCC Chairman Reed Hundt about the urgent need to get
universal broadband access to all Americans, particularly, as
you said, for those in rural communities and marginalized
communities, who don't have access to internet service, which
right now is a beautiful adjunct to, for example, primary care.
Particularly with mental healthcare, which, as you know, is
a surging and crisis in this country, you know, in-person
therapy, in-person Alcoholics Anonymous is probably better than
virtual, but virtual therapy and virtual AA is better than no
therapy and no AA. So if we can get people the access to the
internet services they need, then we can reach the far corners
of----
Mr. Griffith. And I agree with that. What did you use in
your practice, or what did you need to update or improve in
your practice to make that happen?
Dr. McBride. We had to do a control/alt/delete on how we
practice medicine, if you will.
[Laughter.]
Dr. McBride. We--so basically, Zoom and Microsoft Teams, we
had to--you know, I remember the days of getting my 92-year-old
patient, for example, to log in to Zoom, and do the passwords.
I became a tech support, in addition to a doctor, trying to
help her manage her sore throat. Is it COVID? Is it something
else? On Zoom.
So, you know, we need better tech capabilities. We need
better tech support, not just doctors----
Mr. Griffith. All right.
Dr. McBride [continuing]. And we need
[inaudible]----
Mr. Griffith. And I have----
Dr. McBride [continuing]. Access.
Mr. Griffith. I have to cut you off, because my time is up.
And Dr. Riley, I will probably ask that as a written
question. If you could give me your answer in writing to those
questions, I would greatly appreciate it.
[The information appears at the conclusion of the hearing.]
Mr. Griffith. But I must yield back.
Ms. DeGette. I thank the gentleman.
All the Members of Congress also became tech support
experts, as well, Doctor.
The Chair now recognizes the chairman of the full
committee, Mr. Pallone, for 5 minutes.
Mr. Pallone. Thank you, Chairwoman DeGette. I wanted to ask
Ms. Austin, initially.
You state in your testimony--and I quote--``The COVID-19
pandemic forced our nursing workforce to find new and
innovative solutions to the challenges brought on by this
public health crisis.'' So if I could ask you, do you think the
availability of new tools, such as the COVID-19 vaccines and
treatments, has helped your team and other nurses in the
country keep these challenges from being worse in the United
States? And, if so, how?
Ms. Austin. I would say yes to that. You know, our nurses
really appreciated the opportunity--when our vaccines came out,
they appreciated the opportunity to take the vaccine. They
appreciated the opportunity that there were patients, family
members that were taking the vaccine. Because again, you know,
what nurses are fearful of, most of them, is being exposed and
having to take, you know, the virus home to their family
members. So I think that vaccination is, for most nurses, is
appreciated.
And I do think it helps with
[inaudible], and all the other things that they are doing.
It is one less thing to worry about while they are trying to
take great care of patients.
Mr. Pallone. Thank you.
Dr. Riley, your patients have had specific needs in
thinking about their own safety and health, and that of their
families for the past two years. What is the availability well
what has the availability of COVID-19 vaccines meant to your
patients, Dr. Riley?
Dr. Riley. It has been tremendously helpful to patients. I
think, for those who have availed themselves of the vaccine, I
think that there is good data to suggest that it certainly has
helped them, personally. So women are less likely to become ill
and land in the ICU if, in fact, they are vaccinated, pregnant
and vaccinated.
I think also we now have good data that suggests that the
antibodies that those women make after vaccination are
transmitted to the newborn, and can be protective through
newborns, who can sometimes get sick.
So I think that, you know, patients who are unvaccinated
are the ones that we are really trying to target now, so that
they can protect their own health, as well as the health of
their babies.
Mr. Pallone. The committee has supported a range of
legislation intended to support healthcare workers and the
broader health infrastructure, including 48 million in funding
recently made available by the American Rescue Plan for
community-based organizations in rural and tribal communities
to expand public health capacity. So, Dr. Calac, I wanted to
ask you, how critical are the investments such as those in the
communities you serve with the Indian Health Council?
Dr. Calac. Thank you for your question. Those needs are
critical.
I would like to segue off of Ms. Austin's question, in
terms of nursing, the importance of nursing not only in
facilities and in hospitals, but also in public health
settings, where you send out nurses to these rural communities
to support the needs of patients that cannot come in, or cannot
have access to a telehealth platform and receive the care that
they need.
So in terms of the continued funding supports for
healthcare workers, it is critical that we not only look at
nursing, but also other forms of healthcare providers,
including physicians. I might just support and recommend
programs like Indians Into Medicine, which is a 5-year program
looking at providing funding for Indians going into medicine.
And quoting the 2017 Association of American Medical Colleges
data, where we had, between 2012 and 2017, 93,000 medical
graduates, and only 131 of those were identified as American
Indian and Alaska Native. So 93,000, and only 131 physicians
that would potentially go back to the communities to serve
those rural areas that we just spoke of.
Mr. Pallone. Let me just--one more question of Dr. Ranney
about--you know, we have a number of--we had passed legislation
to address behavioral health, and how that impacts health
providers.
Dr. Ranney, how do these targeted investments in behavioral
health, or the behavioral health needs of healthcare
professionals, you know, how important are they? If you just
would comment on that.
Dr. Ranney. So briefly, they are just tremendously
important.
The Lorna Breen Act, which, obviously, was named for one of
my fellow emergency physicians who killed herself after taking
care of COVID patients and then catching COVID herself in the
early days of the pandemic, is just a tremendous step forwards.
In the face of burnout, PTSD, depression, so many
healthcare providers are leaving. And as the other witnesses
testified, a teammate's departure isn't just about losing that
staff member. It is also about the overall culture of the team.
So providing individual-level support, reducing stigma to
getting that support, encouraging State medical licensure
boards and hospitals to not ask about behavioral health
treatment when licensing, those are all critical steps to
helping us be healthy, so that we can better take care of our
patients.
Mr. Pallone. Thank you.
And thank you, Chairwoman DeGette.
Ms. DeGette. The Chair would like to remind all of the
members who are appearing on Webex that they need to mute
themselves, both the witnesses and the members. We are getting
feedback because people aren't muting themselves. Thank you.
The Chair now recognizes Mrs. Rodgers for 5 minutes.
Mrs. Rodgers. Thank you, Madam Chair. This will not be the
last pandemic we face, and I believe that it is critical that
we learn from our response to not only prepare us for future
pandemics, but to ensure we do not repeat the costly and
harmful policies that we have seen over the last couple of
years.
To that end, John Hopkins recently published a report that
lockdowns had little to no effect on COVID-19 mortality, but
certainly brought significant social and economic cost. Dr.
McBride, in your--your written testimony you speak to this, and
you note that we failed to tailor our mitigation efforts to
those highest at risk. Can you please explain how this
happened, and why it was especially harmful?
Dr. McBride. So I think, in the panicked spring of 2020,
when we didn't know much, if anything at all, about the novel
coronavirus, it arguably made sense to do everything we could,
right, to prevent all of the widespread death and destruction.
I think the two biggest failures in my mind in the public
health response were the closures of schools and the prolonged
closures of schools.
We know now that, in a public health emergency, schools
should be the last to close and the first to open. And we
imposed very strict interventions on children, who we now know
face the lowest risk of any age cohort for severe consequences
from COVID-19. That is not to dismiss the ongoing suffering of
families who have lost children to COVID-19. The death of a
child is tragic, regardless of the cause. And we--it is not to
dismiss kids with long COVID, with MIS-C. It is not to dismiss
any of the devastation. It is simply to say that closing
schools has done harm to our youngest generation.
And second, the other major health--public health failure
in my mind was that we did not protect our most frail elderly
patients as well as we could during the early days of the
pandemic. We know that there is an increase in risk of severe
consequences and death from COVID that goes with age. And we
could have done things like paying home health or nursing home
aides to work at one nursing home facility, instead of many,
because they were unwittingly spreading the disease, even
though they were trying to help protect their patients.
And so I think, you know, as I said earlier, hindsight is
2020. I do not ascribe mal intent to anyone. I simply think
that it is really important moving forward--because, again, we
will face another pandemic, we will face another COVID wave--
that we tailor our mitigations, and we appropriately calibrate
the risk mitigation measures to the population at risk, and
then arm people with tools and information to use to protect
themselves.
Again, I will go back to my main argument in my testimony.
This is another reason why we need primary care hubs. We need
patients to be able to pair the broad public health advice with
their unique lived experience, age, underlying health
conditions. We can do a lot better the next time around.
Mrs. Rodgers. As a mom, I really appreciate your voice,
your fighting on the front lines to get our kids, our children,
back in school.
Just as a followup, do you believe it was foreseeable? You
talked about the impact of the prolonged closures of schools.
Do you believe it was foreseeable?
Dr. McBride. I think we know that school is essential, not
only for learning. It is also essential for kids who aren't
safe at home. Kids don't always come from a happy, healthy
home. Kids use school for their food. They use it--they need it
for their emotional health. They need it for social bonds. That
is where kids get their athletic activities.
We have seen surging rates of obesity and children in
part--not fully, but in part--because kids have been relatively
inactive and on screens much more than they were pre-pandemic.
Although that was--I am a mother, I know the screens are not an
easy problem to solve.
But I think it was foreseeable that school closures would
cause harm. I think we thought that this was going to be a
short-term, 2-week flatten-the-curve proposition.
Mrs. Rodgers. Yes.
Dr. McBride. But here we are, two years----
Mrs. Rodgers. Yes.
Dr. McBride [continuing]. Into the pandemic.
Mrs. Rodgers. Yes.
Dr. McBride. We have so much accumulated data on who is at
highest risk.
Mrs. Rodgers. Yes.
Dr. McBride. And I think we need to really, really----
Mrs. Rodgers. Before I run out of time, would you just
speak briefly if you have reviewed the data at CDC around the
mask mandate on our kids, and its impact?
Dr. McBride. Sure. No, I have looked very, very closely at
the mask mandate data. And what I would say is that there is no
real-world compelling evidence at this moment, in March, 2022,
that mask mandates in schools have meaningful effects on the
transmission of the virus in the schools.
That is not to say that masks don't work, or can't work. I
am not anti-mask. I was wearing a mask all day yesterday in my
office, seeing a sick patient. It is simply to say that the
burden of proof is on the intervention.
The norm is to see faces in schools, to see the broad range
of expression on teachers and coaches and mentors' faces and on
peers' faces. It is to say that there are unintended harms of a
mandate, for example, on children who are autistic, children
who have speech and language delays, children who have English
as a second language. And even for neurotypical children,
seeing people's faces is the norm.
Mrs. Rodgers. Thank you, thank you.
Dr. McBride. So any intervention that we impose----
Mrs. Rodgers. Yes.
Dr. McBride [continuing]. Particularly if it is mandated,
needs to have more benefit than harm.
Mrs. Rodgers. Thank you. My time has expired.
I appreciate a little extra time there. I yield back.
Ms. DeGette. You bet. The Chair now recognizes Ms. Kuster
for 5 minutes.
Ms. Kuster. Thank you, and I just can't resist going back
to the last witness.
We all would like to have the children in schools, and
certainly now, and we would all--delighted to get rid of our
masks. Do you think, if the previous President had taken the
vaccine publicly a year ago, when he chose to take it privately
and not tell anyone, that that would have made a difference in
vaccine uptake, and would have ended this pandemic earlier?
Dr. McBride. I think----
Ms. Kuster. That is to the previous witness.
Dr. McBride. Is that for me?
Ms. Kuster. Yes.
Dr. McBride. Absolutely. I think if the previous President
had modeled vaccine confidence, it would have made an--
absolutely, a big difference. And one of my jobs in medicine
is----
Ms. Kuster. It would have saved hundreds of thousands of
lives, possibly, and certainly would have saved many, many
children from harm.
So I will dive back into my remarks, but I can't leave that
unsaid.
Like many places throughout the country, my home State of
New Hampshire [inaudible] surge caused by Omicron over the last
few months. And at one point in December there was not a single
available bed in the five-State area in our region.
I spoke with hospital leaders across my district in
December, who detailed the serious impact of COVID-19 on
workforce bed availability and delays in healthcare. And in my
own family, we have had delays in healthcare directly related
to the COVID surge.
Like all Americans, I am glad to see that the Omicron surge
is largely behind us, but it must be underscored that this
surge and the tragic deaths that followed were driven
overwhelmingly by unvaccinated Americans.
Throughout the pandemic, hospitals and healthcare providers
have had to delay elective procedures to be able to respond to
surges in COVID-19 cases and hospitalizations. My own brother's
surgery has recently been delayed. Hopefully, it will happen
today. But all of us are scrambling in our families to
rearrange travel schedules and to try to be there for those who
we love.
Dr. Ranney, your testimony mentioned colonoscopies, heart
surgeries, and even brain surgeries as the type of surgeries
postponed or disrupted. Can you give us a better understanding
of the types of services that are considered elective?
And what are some potential implications of delaying these
procedures?
Dr. Ranney. Thank you, Representative. So to be clear,
again, these elective surgeries are not cosmetic; they are
things that are utterly necessary. It is about removing a
pituitary mass, something--a mass in the brain that is
threatening your sight. It is about removing cancer. It is
about repairing an aorta before it bursts.
And what happens when these surgeries get delayed is that
they triage according to what is the most likely to be most
life-threatening. Those are the ones that get moved up. So I
know of many patients who had their surgeries delayed, ended up
with emergent conditions, ended up in my ER, and then we had to
make space for them.
The trouble was, though, is that so many of our nurses were
redeployed to take care of COVID patients that we couldn't
adequately staff post-surgical ICU beds. And this was true, of
course, not just in my own hospital system, but in others
across the country, which then created a knock-on effect of
having to keep patients in the emergency department longer
before they could get the surgeries.
One of my colleagues, actually, in Wisconsin recently told
me that he is diagnosing more advanced cancer now and
recurrences of cancer than he ever has, because of folks having
to put off these procedures, imaging studies and so on, due to
COVID, and due to the staffing limitations they are in.
Ms. Kuster. And in our situation, I am having to fly across
the country tomorrow evening because they won't keep my brother
in the hospital post-surgery because of COVID. So this is
really impacting people's lives.
Studies confirm patients also made the decision to delay
medical care, and you have mentioned that. A CDC study earlier
in the pandemic found 4 in 10 adults delayed or avoided care,
including urgent and emergency care, a trend that is
continuing. What is--you have mentioned delaying care and the
consequences. But I am wondering, delaying screenings and
preventative care, if you could, review the consequences on
both patients and the healthcare delivery system.
Dr. Ranney. Absolutely. So early in the pandemic, when our
COVID visits were high, overall number of visits dropped. That
has also happened during the Delta surge and during the Omicron
surge. And what we found was actually in parallel: the number
of at-home cardiac arrests increased, the number of strokes
that we couldn't treat increased, because people stayed out
when they really should be coming in to get evaluated.
We are also seeing delays in things like dental care that
result in people coming in with major cavities or tooth
abscesses. We are seeing delays in diagnoses of cancer, and, of
course, we are seeing increases in untreated behavioral health
problems, opioid overdoses, and the like, problems that pre-
existed before the pandemic, but have worsened over the last
two years.
Ms. Kuster. And we do intend to----
Ms. DeGette. Thank you so much.
Ms. Kuster [continuing]. To that. Thank you, my time----
Ms. DeGette. The gentlelady's time has expired.
Ms. Kuster. I yield back.
Ms. DeGette. Mr. Burgess?
Mr. Burgess. Thank you, and thanks to our witnesses for
being here today. This is exactly the type of hearing that we
should have been having over these last two years, so I am
grateful that we are having it. I hope this is not the last.
I hope we will continue to do this type of work because, as
you will recall, the congressional approach to the pandemic
were massive supplemental emergency appropriations, but we are
an authorizing committee. We are supposed to do the work. We
are supposed to take the testimony from the experts and come up
with how the money is most correctly to be spent, and then the
appropriators write the check. But these last two years, we
have written a lot of checks without doing the groundwork ahead
of time, so we can do some of it after the fact.
But the Congressional Budget Office was in my personal
office earlier this week, and they said there is, I think,
around $350 billion of unspent, unobligated funds in all of the
appropriations packages we did as emergency measures over the
past two years. So when I hear discussion about we need more
money for this, for that, I don't disagree. But that is because
this committee has not done the authorization work that it
should have done over these last two years.
Now, having said that, let me--Dr. Riley, I will not get
through every question that I have got to get through, so I
will be submitting some of these questions in writing, and look
forward to your responses.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. But Dr. Riley, if I could ask you, we actually
have a doctor's caucus here in Congress. The surgeon general
came and talked to us a couple of weeks ago. He said, doing his
rounds around the country, he was very concerned about
physician burnout, as am I, as all of you.
But one of the things that was sort of left unmentioned is
every year we turn around and we start cutting Dr. McBride's
pay, and Dr. Riley's pay because of the physician fee schedule
in Medicare. So I will just ask you, Dr. Riley. Do you think,
if we as a committee, would spend the time addressing issues
like provider pay, that that would help some of the workforce
issues and the burnout issues?
Dr. Riley. Thank you for the question. I suspect yes. I
mean, I think that, you know, people want and deserve to be
compensated for the work that they do.
I do think that there is also the opportunity to
incentivize certain aspects of medicine. I think that we are--
you know, we are facing a really important challenge right now,
where every aspect of healthcare, whether you are a physician,
a nurse, a technician, a genetic counselor, et cetera, all of
those people are absolutely critical to what we do, but all
need to be compensated. And there is quite a bit of, you know,
technical education that needs to go into that.
So yes, I do think that----
Mr. Burgess. Yes. And I will have to move on because,
again, time is so short.
So Dr. Ranney, I had a question for you. I have got a
hospital. It is not in my district, it is just outside of my
district. As everyone knows, with coronavirus, we do have some
things that can be administered as an outpatient. That is a
wonderful benefit. Once someone gets sick enough to be in the
ICU, once they have had the course of steroids, after they have
failed Remdesivir, there is not much on the shelf to be able to
administer to those patients to try to save them.
There is work going on. In fact, one of the hospitals just
outside of my district is working with a compound called
Zyesami that is a vasoactive intestinal peptide, which seems to
show a lot of promise, just in general. And this is what has
been so frustrating with the FDA through this pandemic. You get
something into a phase three trial, so it is more likely than
not to be beneficial. You have got nothing else, and a sick
patient in the ICU on the ventilator.
So what about the access to late-stage therapeutics in
coronavirus patients who are in critical care?
Dr. Ranney. So I think the emergency use authorization--
thank you for the question. I think emergency use
authorizations are a critical tool for us to use during a
pandemic to improve the speed at which we have access to
therapeutics that have good safety data and decent efficacy
data.
I don't want to spend any time or money on things that----
Mr. Burgess. Yes, I have got to interrupt you there,
because----
Dr. Ranney. Yes.
Mr. Burgess [continuing]. I agree with you. The problem is
this particular compound, that application is gummed up in the
FDA. They might get to it in September. We have situations
where it is not the regulation, but we have personalities that
we can't get past, and that is one of the things that needs to
change as we go forward in this pandemic.
I thank all of our witnesses for being here. I know how
valuable your time is.
I will yield back to the chair.
Ms. DeGette. I thank the gentleman. Ms. Schakowsky, you are
now recognized for 5 minutes.
Ms. Schakowsky. Thank you, Chairwoman DeGette, and I
appreciate your holding this hearing. We owe our nurses and
doctors and all of the frontline healthcare workers an enormous
debt, and the title of this hearing, lessons from the front,
really drives home what I believe is the point that we have to
listen to our healthcare workers, and give them the supplies
and the support and the resources that they are asking for.
And though they are not here at this hearing today. I want
to recognize that labor unions that represent frontline
healthcare workers have provided a path for critical health and
safety protections for workers and for patients. And for this
reason I would ask to put into the record a December 2021
report from National Nurses United, the largest national union
representing registered nurses from around the country.
Ms. DeGette. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Ms. Schakowsky. Thank you. The nurses and healthcare
workforce is in crisis, and it has been for, actually, a long
time. And we know that there is a shortage of good-paying,
permanent nursing jobs, where nurses and--are fully valued, and
their work at--for their work at the bedside. And this is
exactly why we need to invest in permanent jobs, with good
wages, and benefits, and safe staffing standards.
I am very proud that I have introduced legislation, and
leading the legislation called Nurse Staffing Standards for
Hospital Patient Safety and Quality Care, and I would like to
talk to--ask Dr. Ranney.
In reviewing your written testimony, I noted that--I noted
and appreciate, actually, that you referenced the dire need to
implement minimum nursing standards. And I wondered if you
could talk more about the science and the evidence that backs
up the need to have minimum nursing staffing ratios.
Dr. Ranney. Absolutely, and I can share specific studies
after the hearing. I don't have all of the exact numbers at my
fingertips, but the short version is that there is ample
evidence that having low nurse-to-patient ratios improves
patient outcomes, decreases patient mortality, decreases staff
burnout, not just for nurses, but also for the rest of the
team. Asking nurses to take care of more than a certain
standard number of patients, with a lower number of patients
acceptable in the intensive care unit compared to on hospital
floors, but going past that limit increases, again, both
patient harm and nurse and others' burnout.
Ms. Schakowsky. Is that the lack of the--any kind of
staffing ratios, and is there a reason for burnout of nurses,
that they just feel overwhelmed?
And we do see a flight of nurses. That was mentioned by one
of our other witnesses, and that that would help to keep people
on the job.
[Pause.]
Ms. Schakowsky. Dr. Ranney?
Dr. Ranney. Absolutely. Thank you. That would absolutely
help to keep people on the job.
Speaking to nurses that are in states that have nursing
staffing ratios versus those without, there is a really big
difference in terms of their quality of care provided, their
levels of burnout, and their willingness to stay there.
Ms. Schakowsky. So I really appreciate that, because we are
talking not only about the nurses themselves and their ability
to stay on the job, but I think the data that you referred to
that shows that the outcomes for patients really improves, and
I have talked to nurses who are so worried that they have not
been able to make sure that the medication is correct, and we
know that there are--is a good deal of harm that happens in
hospitals that--some of which can be attributed to the fact
that the nurses can't spend enough time. So I just thank you
for that.
And you know, we want to do everything we can to make sure
that both the workers and the patients have what they need, as
we go forward.
And so I yield back. Thank you.
Ms. DeGette. I thank the gentlelady. Mr. McKinley, you are
now recognized for 5 minutes.
Mr. McKinley. Thank you, Madam Chairwoman. Lessons learned
from the pandemic. There are several things that I am going to
try to get through in a short time.
Several of the hospitals in West Virginia have indicated
that they seem to have increased efforts to hack into their
hospital records. I don't know whether that is unique to West
Virginia. Has it been--for all--anyone of the panel, have they
seen that across the country during this pandemic, that people
are trying to get access to health records? Can anyone comment
about that, just quickly?
Hearing none, let me go to Ms. Austin----
Dr. Ranney. This is Dr. Ranney----
Mr. McKinley [continuing]. If I could.
Dr. Ranney [continuing]. Just to say that there--the issue
of cyber attacks on healthcare records is an issue that has
been going on for a very long time, and I can provide data from
Dr.----
Mr. McKinley. Increase. Has there been an increase in this?
That is what I am trying to get to.
Dr. Ranney. That I am not sure. I will find out.
Mr. McKinley. OK. To Austin down in Emory, we have had--my
wife was a critical care nurse for 45 years, and we have known
about this shortage of nursing care for some time, and--but
during the pandemic there was a call or demand for increased
nursing care. And so the traveling nurses really took off on
this.
And so hospitals like Emory, or the larger hospitals all
across America, are paying--I know, we have records of it--as
much as $200 an hour for the first 1,000 hours that they
worked. That is exacerbating the shortage that Schakowsky just
talked about. Larger hospitals can afford to pay that. But
rural hospitals, like we have in West Virginia, and in eastern
Ohio or elsewhere, rural areas, can't compete with that. We
are--they are being robbed of their nurses.
So I am curious. What is the solution? They can't afford to
pay more, or they would have been doing that. How are small
hospitals supposed to exist during a pandemic when their nurses
are being robbed to go someplace else? Can one of the panelists
comment about that?
Ms. Austin. Thank you for that question. I am happy to. I
would like to acknowledge and thank your wife for her many
years of nursing service.
I think that is--the question that you asked is a question
that all hospitals are asking themselves, whether it is a rural
hospital, or a larger hospital in a metro city.
One thing I talked about earlier is the ability to bolster
any types of training programs to actually increase the nursing
pipeline, I think, could be really helpful. That way we can
decrease, I think, the dependency on contract labor. Contract
labor is not sustainable. In my healthcare organization we are
having a lot of conversations about how to mitigate the labor
cost for travelers. I mean, it is--in the beginning it is meant
to be a very temporary way to supplement, say, nurses that are
on leaves of absences. It is not a way that we want to staff
our hospitals, because, again, I say it is just not
sustainable, financially.
Mr. McKinley. Thank you very much. I may reclaim my time. I
am trying to get two quick questions.
During the pandemic also there was this shortage of PPE,
and we were seeing companies like Premier that were trying to
level out to make sure that it was distributed. But yet this
committee, or the Energy and Commerce, has before it a bill
that is going to restrict. We know we need more plastics, but
yet we have, in this committee, an effort to try to restrict
increased plastic production in America. It just doesn't make
sense to me.
So what they are talking about under--you know, it was the
Clean Future Act. Under section 902 it says, for the next three
years, there will be no new plastic manufacturing in America. I
think--it just befuddles me as to why we would do this, when we
need the plastic.
But Dr. McBride, I want to turn to you at the last of it
and say, because of the children with mental health, I am
curious to see what we are saying in--for schools. Are we going
to continue to depend on our teachers to try to take on the
mental health issue?
Can you talk to me a little bit? Because this is very
frustrating, when I see, as we come through the pandemic, how
we deal with this.
Dr. McBride. Absolutely. I mean, teachers are some of the
unsung heroes of the pandemic.
Mr. McKinley. Yes.
Dr. McBride. We owe a debt of gratitude for our frontline
health workers, our essential workers, our teachers.
We cannot ask teachers to be mental health providers. I
mean, I think one of the reasons--at least the teachers I know
and care for as patients--go into teaching is to be not only
someone who educates children, but also a mentor, and a guide,
and provide emotional support.
But in order to help children, you know, recover from the
stacked stresses of the pandemic, regardless of their lived
experience, and in order to bolster their mental health moving
forward, we need to make sure that educators are aware of
mental health issues.
And here is an idea that I--one of my friends works in D.C.
here. She is a pediatrician, and her clinic is annexed to
Anacostia High School. If we can build in primary care, and
annex it to schools, particularly schools in marginalized,
under-served, often urban communities, where people can get
vaccines, or they can get basic primary care, and they can get
access to truthful information right in the school setting,
that would do a lot to bolster the mental and, therefore,
physical health of children and adolescents. Make it easy to
get access to mental healthcare, even at school or annexed to
school, because teachers cannot do--they are wonderful, but
they can't do everything.
Mr. McKinley. Thank you.
Ms. DeGette. Thank you.
Mr. McKinley. I have run out of time----
Ms. DeGette. The Chair now recognizes Mr.----
Mr. McKinley. I yield back.
Ms. DeGette. Mr. Tonko.
Mr. Tonko. Thank you, Madam Chair. The pandemic has
adversely impacted our Nation's healthcare workers, and leading
many to experience work overload, burnout, and feelings of
anxiety or depression. In addition to what we have heard this
morning, a survey of pandemic frontline healthcare workers
found a majority experienced worry and stress negatively
affecting their mental health, with 3 in 10 needing mental
health services as a result of the pandemic.
This is one of the reasons that I have introduced H.R.
1716, the COVID-19 Mental Health Research Act, along with my
colleague and friend, Congressman Katko. This bipartisan
legislation would fund research to study the effects of COVID-
19 as a pandemic, and what effect it has had on the mental
health of Americans, including its impact on healthcare
providers.
So, Dr. Ranney, as an ER doctor, I imagine that workplace
stress is commonplace. Can you describe how the pandemic has
impacted the mental health of emergency physicians, and what
you mean by--and I quote--``moral injury'' that you make
mention of in your testimony?
Dr. Ranney. Thank you for the question, Representative. I
have stories in my written testimony around the effects of both
treating COVID-positive patients for two years on end, and the
effect of the continued staffing shortages on the emotional
health of frontline providers. It is things like not being able
to care for your patients because you are too busy with others.
It is about having patients wait out in the waiting room, who
you know are desperately ill, but who you simply can't get to
because there aren't staffed beds back in the emergency
department.
Moral injury is really a concept that derives from wartime.
It is the idea of being exposed to or having to make choices
that go against the moral fiber of your being, that go against
how you were trained, your faith, your sense of integrity,
simply because you have no other options. And that is what
healthcare providers have faced over and over during the
pandemic. We have been forced to make decisions that we would
not normally make, that we know are hurting patients or their
families, simply because there is no other choice, because
there is no space, because there are no staff, because there
are no optimal medications, or sometimes because the equipment
that we depend on is not available.
It is, at this point in the pandemic, a totally preventable
occurrence if we had adequate staff and adequate supply chains.
Mr. Tonko. So with that being said, Doctor, what can we do
to, beyond that, better support healthcare workers during this
pandemic and beyond?
Dr. Ranney. Thank you, Congressman. So there is a
combination of individual level support. Again, things like
your bill, the Lorna Breen Act, some innovative projects that
are being done at hospitals around the country. I highlight in
my testimony Project Cobalt, that is being developed by
colleagues at Penn to provide digital therapeutic support to
healthcare providers. It is about destigmatizing reaching out
for mental healthcare and behavioral healthcare.
But most of all, it is about supporting us in our daily
jobs. Those individual-level solutions are important for
helping those of us that have been there, but what we really
need is things like loan repayment programs, increased
staffing, improved ability to, honestly, just support our
patients, do our jobs, and support their families.
Mr. Tonko. Thank you.
A study by the Occupational Safety and Health
Administration found that, prior to the pandemic, healthcare
workers were already four times as likely to face workplace
violence, such as physical assaults or threats, than workers in
private industry. Since the pandemic we have seen disturbing
reports about verbal and physical abuse directed toward
healthcare workers. Some hospitals have even had to issue panic
buttons to their staff.
Ms. Austin, the nurses often bear the brunt of this abuse.
In fact, as you mentioned in your testimony, nurses have been
verbally attacked for implementing COVID-19 safety
restrictions, and patients and families take their emotions out
on nurses. Did your nursing team witness an increase in verbal
and physical attacks over the last two years? And, if so, how
have you and your colleagues coped?
Ms. Austin. Yes, we have. One thing that we have done here
at our hospital is we have instituted a workplace violence
prevention team. We have encouraged our nurses to report every
instance of either verbal or physical abuse. Often times, what
we have found is that nurses believe that, you know, this is
just what is supposed to happen, and they take on the verbal--
usually not the physical, but the verbal abuse they will let
go. And so we have done a lot of work to encourage nurses to
report every single instance.
Our workplace violence prevention team will respond to
every single instance to ensure that our nurses are supported,
to make sure that we have had conversations with patients. We
have involved our public safety department, if that was
necessary. We make sure that our leaders are rallying around
our staff, so that they know that they have full support from
our hospital around these types of instances.
Mr. Tonko. Thank you very much, and Madam Chair, I yield
back.
Ms. DeGette. I thank the gentleman. The Chair now
recognizes Mr. Palmer for 5 minutes.
Mr. Palmer. I thank the witnesses for being here, and for
the chairwoman holding this hearing.
One of the things that I think has been touched on a little
bit is the impact of the lockdowns on school children. But I
haven't heard anyone talk about this, Dr. McBride, the surge in
teen suicides. I mean, we have seen a record number of teen
suicides. It got so bad in Las Vegas that it forced the Las
Vegas schools to reopen.
I know that the medical community has been overwhelmed with
the--treating COVID patients, but added to that are the
complications of being locked out of jobs, being locked out of
schools, being cutoff socially from peers and friends. Hasn't
that added to your workload?
To Dr. McBride, yes, thank you.
Dr. McBride. Absolutely. I mean, I think it is important to
recognize that ER visits for mental health concerns, suicide
rates cannot possibly measure the breadth and depth of people's
despair, as defined by having depression, anxiety, OCD, PTSD,
substance use disorder.
I would also say, to make it clear, that there are many,
many routes of people's underlying health conditions in the
mental health sphere. In other words, people have lost loved
ones to COVID-19. That is a trauma. People have also lost a
sense of normalcy in their fourth-grade classroom. That is also
a loss.
So I think that the roots of the mental health crisis are
broad and varied, but I think it is not a coincidence that the
surgeon general----
Mr. Palmer. Let me ask for a little clarification here,
because when you start talking about how broad it is, that
implies that there are underlying conditions that may have been
made worse by the lockdowns. But that is true of physical
health, as well.
Dr. McBride. Sure.
Mr. Palmer. So the bottom line is here--and I am looking at
this Johns Hopkins--it is not a report, it is an assessment of
existing research, and I just want to read what it said, that
``The lockdowns during the initial phase of the COVID-19
pandemic have had devastating effects. They have contributed to
reducing economic activity, rising unemployment, reducing
schooling, causing political unrest, contributing to domestic
violence, undermining liberal democracy. These costs to society
must be compared to the benefits of lockdowns, which our meta
analysis has shown are marginal, at best.'' And then it
concludes with this, ``such a standard benefit cost calculation
leads to a strong conclusion: lockdowns should be rejected out
of hand as a pandemic policy instrument.''
And the thing that bothers me about this is that we knew
this before this report came out. And as a consequence, I mean,
there is all kinds of research out there and studies that show
that we had this surge in teen suicide, particularly among
women. We had teachers quitting. We now--you talk about a
shortage of healthcare workers, we now have a shortage of
teachers. And a lot of it has to do with the lockdowns.
Dr. McBride?
Dr. McBride. So I think you are absolutely right, that
lockdowns have done enormous harm on our social fabric, on our
economy, on our physical health. And I think it is not a
coincidence that the surgeon general has issued a concerning
report about pediatric and teen mental health. And we know that
the AARP, the American Association of Pediatrics, the American
Association of Child and Adolescent Psychiatrists, and the
Children's Hospital Association issued a very concerning report
in October, saying that kids are at high risk, and are
experiencing unprecedented levels of anxiety and depression. So
it is not a coincidence.
And I think that, moving forward, we need to be better at
recognizing that health is about more than the absence of
COVID-19, and that people face myriad threats to their health
and well-being from depression, diabetes, obesity, substance
use disorder, and highly contagious respiratory viruses. That
is our job in healthcare, is to think broadly about health.
Mr. Palmer. My--one of my biggest concerns about this,
aside from all of the other things that we have just discussed,
is this massive loss of public confidence in medicine and
science, and in the political leadership of this country. We
have to get back to science, we have to get back to medicine,
and we have got to figure out a way to restore the public's
confidence in those who make these type decisions, that they
cannot be political.
With that, Madam Chairman, I yield back.
Ms. DeGette. I thank the gentleman, and I agree. The Chair
now recognizes Mr. Ruiz for 5 minutes, virtually.
Mr. Ruiz. Thank you, Chairwoman. This is a very special day
and hearing for me, not only because of the topic, but because
a good old friend is part of the hearing witnesses.
I texted Dr. Dan Calac earlier today, and I said who would
have ever imagined, during those long hours of studying at
Harvard Medical School for our exams, that one day he would be
a witness in a hearing before Congress, and I would be a member
of that committee. And we worked tirelessly fighting to reduce
disparities and fighting for health equity as medical students,
as residents. And now here we are, doing the same work, and I
am so proud of the work and his leadership throughout all of
this.
So thank you, Doctor, my good friend, Dan Calac, for being
here.
The nation's health system relies on a range of professions
and people to support the health of all people in all
communities. From the public health infrastructure within
Federal, State, local, tribal, and territorial health agencies
to the networks of non-profits and private healthcare
facilities, it takes every entity working together to prepare
for and respond to public health emergencies, in addition to
preventing disease and promoting Americans' health every day.
Unfortunately, the COVID-19 pandemic has been a stark
example of the consequences of failing to support a robust
public health infrastructure. According to a Kaiser Health News
and Associated Press analysis from August 2020, in the decade
prior to the pandemic at least 38,000 State and local public
health agency jobs had been eliminated, 38 jobs had been--
thousand jobs--had been eliminated in public health. And now,
two years into this pandemic, we are continuing to grapple with
the consequences of our weakened public health infrastructure.
Dr. Calac, has the weakened public health infrastructure
impacted your patients and communities across to public health
information and education about COVID-19 and would
strengthening this infrastructure, especially within the IHS
system, help address access and health disparities and
inequities Native Americans face? And if so, how?
Dr. Calac. Thank you, Congressman Ruiz. There is, as we all
have seen in the past couple of years, a tremendous disparity
that has been uncovered by the pandemic in the delivery of
healthcare services. And it is no more evident than what we see
in health and human services, and especially in providing
healthcare to those rural communities, and also those
communities with under-represented individuals who are at
increased risk for health disparity, whether they exist in
rural communities, or they are in urban communities, in
impoverished areas.
The placement, as we had spoke about with many of the
interviewees and the people on the panel today, is the
workforce needs. So it is an interesting predicament we are
right now, and I really recognize the fact that we have two
American Indian individuals on this subcommittee, which is not
typical for Congress.
But the issue of dealing with what we are going to do with
the problem moving forward, and so I think we have multiple
lessons to garner information from. But what are we going to
do, in terms of workforce?
Mr. Ruiz. I am glad you said what do we do moving forward,
because in some of the more under-served parts of my district,
community health workers, or the promotoras, played a vital
role in keeping my constituents safe and healthy. They were the
ones educating those communities on how to obtain and use PPE,
how to access testing, and the importance of getting
vaccinated, and build trust between the community and the
healthcare professionals. They became critical liaisons between
my constituents and health and community support systems like
the county health department, churches, and our healthcare
district.
This certainly is not the last pandemic that we will face,
and there are lessons that we learned through this one that we
can carry into our planning for the future. Dr. Calac, as a
provider who cares for a widely under-served population, I know
you have seen the unique challenges that those communities
face. Do you see an increased role in our use of community
health workers, both in future pandemics and in our public
health education systems in general?
Dr. Calac. Community health workers and public health
nurses and primary care providers, together, can provide that
role for those areas at most risk.
Mr. Ruiz. Thank you.
Dr. Calac. And looking at options for loan repayment, as
one of our panelists had mentioned, I know that the loan
repayment through the Indian Health Service is not a tax-
deferred loan payment. There is a current bill in Congress
looking at providing a tax-deferred option for the loan
repayment. I am currently an--I was an Indian Health Service
recipient of that scholarship, and I am looking forward to more
progress----
Mr. Ruiz. Thank you, Dan. I have about----
Dr. Calac [continuing]. In the future.
Mr. Ruiz. --10 seconds left. I want to ask Dr. Ranney.
You talked about how healthcare delays caused worsening
health outcomes. We have a lack of access in under-served
communities. How has those health delays affected the
disparities that we see in under-served populations' health?
Dr. Ranney. Thank you, Representative, and it is a joy to
see you, and thank you for representing our specialty in
Congress.
Very briefly, we already had wide disparities according to
race and ethnicity in health outcomes. Those have only worsened
during COVID, both in terms of COVID outcomes and in terms of
access to other preventative care and timely treatment. Our
safety net hospitals have been the worst affected by the
pandemic, by PPE shortages, and, of course, by COVID itself.
Mr. Ruiz. Thank you very much----
Ms. DeGette. Thank you so much.
Mr. Ruiz. I yield back.
Ms. DeGette. The gentleman's time has expired. The Chair
now recognizes Mr. Dunn for 5 minutes.
Mr. Dunn. Thank you very much, Madam Chair and Ranking
Member Griffith, for hosting us here today to discuss the
impacts of COVID-19 on American healthcare. The impacts across
all medical specialties are so wide-ranging that it would be
literally impossible to adequately address them in a single
hearing. It is my hope, however, that this committee will
continue this important work.
Dr. McBride, I greatly appreciate your remarks and ongoing
work to raise awareness of the detrimental effects of masking
policies and school closures on our Nation's children with no
proven benefit. President Biden's COVID response team and
public health officials have actually failed our children in
this regard. America is behind the curve on in-person schooling
and school masking policies, and the most concerning impact
that I am hearing about is a sharp uptick in suicidal ideation
among children, as well as record numbers of children
presenting to emergency rooms having attempted suicide. This is
a government-manufactured tragedy.
I am also learning of developmental and learning delays
among children, which is concerning in its own right. This
Administration's public health policies have been an outright
failure, and destroyed the credibility of our public health
officials, as my colleague, Mr. Palmer, noted.
The--I would like at this point, if I may, to enter into
the record an article published last week in the New York
Times: ``The CDC Isn't Publishing Large Portions of the COVID
Data it Collects.'' I will submit that for the record, if I
may.
Do I have consent, Madam Chair?
[No response.]
Mr. Dunn. Do I have your consent for the--to put that in
the record?
Ms. DeGette. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Dunn. Thank you so very much.
To make matters worse, the New York Times has just revealed
what many of us had been suspecting, that is that the CDC had
been cherry-picking its data and its studies to suit their
message as a means to a political end. Not--they were
controlling people, not disease, controlling people. Americans
can't make good decisions for themselves and their families
when they have no trust in the public health institutions. CDC
has violated that trust, and this subcommittee needs to hear
directly from them on that subject.
While the mental health impacts of the pandemic are already
apparent, the long-term physical health impacts are only
beginning to become apparent. In my specialty, urology, a
record number of newly diagnosed proState cancer cases are
presenting as metastatic disease--that is to say too late to
cure. We know early screening saves lives, and I can't stress
enough how important it will be for people to get back to their
doctor's office and make up for the missed opportunities of the
last two years.
Dr. McBride, to that end, as you know well, hospitals
facing a surge of COVID-19 cases postponed many semi-elective
surgeries and medical services. Do you think that the
postponements and now rescheduling of those elective and semi-
elective procedures could be contributing to the current high
case volumes, even as Omicron is subsiding?
Dr. McBride. Thank you very much for that question. Yes, I
think that delaying care for underlying health conditions has
caused major problems.
Pre-pandemic we had surging rates of obesity, substance use
disorder, and under----
Mr. Dunn. Lots of things.
Dr. McBride. And--excuse me?
Mr. Dunn. Lots of things. Let me ask you. In your hospital,
would you say it is bed capacity or staffing shortages that are
most critical to the hospital's capacity to take new patients?
Dr. McBride. I am sorry, can you repeat the question?
Mr. Dunn. Bedding? Bed--shortage of beds, or shortage of
staff? Which is more critical in your hospital?
Dr. McBride. So I am not sure I am the right person to
answer that question, because I work mostly in the outpatient
setting.
Mr. Dunn. OK, that is fair enough. I have been surveying a
lot of hospitals in my district, and they all say it is the
staffing.
I would also like to ask you this. We know that the public
health agencies failed a lot on the messaging, specifically on
natural immunity. Can--they have only recently recognized that.
Can you tell us how--what that meant to our COVID response?
And tell me also if there is any disease that we vaccinate
for after somebody recovers from that disease. So smallpox,
yellow fever, diphtheria. Do we come in behind the disease and
vaccinate? I can't think of one.
Dr. McBride. Well, I mean, I can think of one off the top
of my head, which is the chickenpox virus that lives latent in
our system. If we had chickenpox as a child, we boost people
later in life to prevent shingles, which is the reactivation of
chicken pox.
Mr. Dunn. That is a different, very different virus----
Dr. McBride. Well, sure.
Mr. Dunn [continuing]. Vaccine.
Dr. McBride. Excuse me?
Mr. Dunn. It is a different vaccine.
Dr. McBride. Yes.
Mr. Dunn. Yes. So, I mean, but you don't reintroduce
chickenpox to the----
Dr. McBride. So let's talk about natural immunity. So I
don't love the word ``natural immunity,'' because it----
Mr. Dunn. From infection.
Dr. McBride. But what I would call--you know, there is
vaccine-induced immunity and there is infection-acquired
immunity. We all, ultimately, will be----
Mr. Dunn. I see my time is running out. I am just going to
say that, when I was in med school, they taught us that
mandates undermine public confidence in public health. And----
Ms. DeGette. Would the----
Mr. Dunn [continuing]. We didn't do that.
But I yield back, Madam Chair.
Ms. DeGette. Dr. McBride, do you want to finish your answer
on that?
Dr. McBride. About the----
Ms. DeGette. Natural immunity versus----
Dr. McBride. Sure. So there is infection-acquired immunity
and there is vaccine immunity. We all, ultimately, will be
tragically exposed to coronavirus, whether we want to or not.
It doesn't mean we will all get infected or get sick.
We would rather be prepared by getting vaccinated when we
are ultimately faced with the virus, because the vaccines, as
we know, take the claws and the fangs away from the virus, and
turn it into a more manageable disease.
At the same time----
Ms. DeGette. Thank you.
Dr. McBride [continuing]. It is important to recognize
infection-acquired immunity is real. And in some people and
populations it is more durable and superior to vaccine-induced
immunity. It is important we recognize that the human immune
system is not a political body, that it has basically--that it
is the human immune system, and that we need to recognize
people's lived experiences, people who have been exposed and
infected, and to weave that into decisionmaking in the doctor's
office as to whether or not to get a third shot, or a fourth
shot, or whatever we may end up doing in our public health
guidance.
And also, we need to recognize that that should drive
public policy when we are thinking about mandates.
Ms. DeGette. Thank you. Thank you so much. It goes back to,
as Mr. Palmer said, science.
Let's now recognize Miss Rice for 5 minutes.
Miss Rice. Thank you, Madam Chair.
The public health and healthcare workforce shortages in the
United States, obviously, pre-dated the pandemic. But as we all
know, it has made an already bad situation rise to the level of
a crisis situation over the past two years. Even before COVID-
19, public health departments faced a workforce shortage
created by limited resources and an exodus of retiring workers.
These existing challenges were further amplified under the
strains of the pandemic.
But the shortage in health professionals isn't just limited
to the public health sector. Estimates by the Health Resources
and Services Administration predict that, by 2030, the demand
for all types of primary care providers, including physicians,
nurse practitioners, physician assistants will exceed supply of
these workers by more than 15 percent. Demand for nursing
occupations in long-term care settings is likewise expected to
grow 46 percent by 2030. So it is clear that we need strategies
and solutions to address this provider gap.
Ms. Austin, can you share more about your experience in
managing Emory Midtown's nursing team through staff shortages
during the pandemic?
And let us know what your biggest challenge in keeping your
shifts actually staffed----
Ms. Austin. Yes, thank you for the question.
You know, we talked earlier about the cost of travel
contracts. What we have done here at Emory is that we have
invested in contract labor, one, because we know that, when
nurses have the support that they need, when nursing ratios are
adequate and are safe, our patients receive better care. That
is a big thing that we stand on here at Emory, is quality
patient outcomes. We couldn't have done it without contract
labor. We want to make sure that, again, our nurses have safe
staffing ratios.
And even prior to the pandemic, we had what I would
consider probably one of the best nursing staffing ratios in
the city, and we get that information from nurses who come to
us from other hospitals. So I would say that we have typically
done a really good job with that. We are ahead of most health
systems in that respect.
But we are not immune to what has happened during this
pandemic, where we have seen nurses leave. So we have had to
again bolster our staff using contract labor to ensure our
patients receive the care and have the outcomes that we would
want them to.
Miss Rice. Thank you.
Dr. Riley, you reference in your testimony the Association
of American Medical Colleges, the fact that they found that the
strains that COVID-19 placed on the health--workforce has been
felt most acutely by women, physicians, and physicians of
color. And as you stated, the field of obstetrics and
gynecology has been particularly impacted.
How have these shortages affected maternity care teams and
patients in your practice?
Dr. Riley. So I think that the concern is that, because we
work in a team, when we are missing even one or two people, you
know, and their expertise, it is really difficult to give
patients the experience that they deserve.
So we, you know, break our necks to be sure it is safe, but
being able to take the time to teach breastfeeding, and take
the time to, you know, get people ready to go home with this
newborn that they don't know what to do with, those are the
things that tend to get lost. And so I think that the--you
know, unfortunately, I suspect that there are patients who will
say, ``My experience was not as great as it could have been.''
And I think that that is really pretty tragic.
I do think also, as we think going forward, it is not going
to be a quick fix to--we can't just plug people into the
workforce. And so I really think that we need to think way
back, and start at STEM. We need people who are going to be
able to, you know, really work on the science, as people have
said multiple times during this conversation. And we need to
start that as early as, you know, third grade, fourth grade,
whatever it is, and get people excited about science, because
we just need so much help.
Miss Rice. You know, you make a good point, Doctor,
because, you know, if there is one thing that we have seen
also, maybe one of the upsides, was that there has been this
increased interest in people getting involved in the medical
field, whether it is from, you know, EMTs to nursing to
doctors. And we should do everything we can to enable people to
enter those fields
[inaudible]. Obviously, as we have all been talking about,
we need to increase the pool of this workforce.
So thank you all so much for coming and testifying today,
and I yield back the balance of my time.
Thank you, Madam Chair.
Ms. DeGette. I thank the gentlelady. Mr. Joyce, you are now
recognized for 5 minutes.
Mr. Joyce. Thank you, Chair DeGette, for yielding, and to
Ranking Member Griffith for holding this hearing today. I would
also like to thank our distinguished panel of physicians and
health providers for not only appearing here today, but for all
the work that you have done during this pandemic.
Dr. McBride, recently entered into this hearing, a New York
Times article reported that the CDC over the last year
collected extensive data on vaccine and booster effectiveness,
breakthrough infections, and wastewater collection for the
presence of virus, but subsequently released very little
information of this data.
Even what was released included the CDC Morbidity and
Mortality Weekly Report, which was published in late January of
this year--showed that during the Delta surge case rates for
those with previous infection, what we consider acquired
immunity, and no vaccination were substantially lower, almost
four to five times lower, than those who were previously
vaccinated, four to five times lower with acquired or natural
immunity, and hospitalization rates followed a similar pattern.
What is the impact of the CDC withholding data or delaying
the release of that data for you, as a healthcare professional
on the front line treating those with COVID-19?
Does this withholding data fracture your relationship to
utilize CDC information when you are one on one with the
patient?
Dr. McBride. Thank you for that question. Trust is the glue
in patient care and in public health. And I do worry that we
have seen an erosion of trust in doctors and in public health
institutions.
We need our institutions to succeed. I want the CDC to
succeed. We need to have broad public health advice. We also
need clear communication of truthful, real-time data and
information. We need to have--as Dr. Ranney touched on, we need
to understand who is in the hospital. Is it an incidental COVID
infection, or is it someone who has--is in the hospital for
COVID-19? Is that person--you know, we need to know in terms of
racial and ethnicity data. We need to know, do they have
underlying conditions? We have so much work to do to have the
public understand and trust what the CDC is telling us.
One of the parts of my job that has been very, very
challenging during the pandemic is helping people make sense of
the news and the changing guidance. You know, people don't have
the luxury of paying attention to COVID like I have every
single day for the last two years. And so they are calling me
with just everyday decisions. And I think one of the challenges
is that, even people who are paying attention have a hard time
making sense of the guidance, and there has been an erosion of
trust, because they see the New York Times article, for
example, last weekend talking about withholding of information.
Again, I do not ascribe mal intent or ill intent. I simply
think we need much more transparency and trust and
communication of facts to the general public.
I think another thing is, for people to trust the CDC, the
CDC needs to trust people. It needs to trust people with--it
needs to trust people that they can handle murky and muddy
information. When I have a patient who has a diagnosis, but I
am not yet sure what the trajectory is, it doesn't help my
patient for me to withhold information or to not tell them the
full truth. I want to give them hope when it is rooted in the
facts and the science, but I also want to be honest and real
with them about what is going on. Same goes for the public.
People are smarter than we give them credit for. The public
is paying attention to a lot of the data that is coming out.
And I think, if the CDC could more transparently communicate
facts and data in real time, then we, as primary care doctors,
can act more as the lieutenants for the CDC, and transmit that
information to our patients for their everyday lives. Should I
go to school? Should I go to work? Which vaccine? How many
booster shots do I need?
Mr. Joyce. Does that--my time is limited, but does that
lack of transparency and transfer of information, which you
just discussed, does that make your job more difficult----
Dr. McBride. Absolutely.
Mr. Joyce [continuing]. As a Johns Hopkins-trained
physician, someone who is used to dealing with data, used to
dealing with this every day of how you practice, does that lack
of transparency from the CDC make your job as a physician more
difficult?
Dr. McBride. It absolutely does. And one of the reasons why
I have cut my practice in half in the pandemic, and am donating
50 percent of my time doing advocacy work and pro bono work, is
that I am trying to help people--stripped of politics, stripped
of ideology, no financial incentive, I am reaching now almost
20,000 people with a weekly newsletter to dispense nuanced,
contextualized information to a wide audience. I am reaching
people in rural America. I am reaching people in urban areas
who don't have access to primary care doctors.
It is hard when the CDC is putting the burden on the
general public, and when we don't have access--80 million
Americans, as I said earlier, don't have access to a primary
care doctor to translate the information--sometimes confusing,
and sometimes not the full picture--into everyday
decisionmaking.
And so again, we need trust, transparency, first and
foremost. We need primary care doctors out there for people to
have access to information that--and we need primary care
doctors to be able to trust the CDC.
Again, I believe in the CDC.
Ms. DeGette. The gentleman's time has expired----
Dr. McBride. I trust the CDC in many ways, but we need to
do better.
Ms. DeGette. The gentleman's time has expired. Thank you.
Mr. Joyce. Thank you, and I yield.
Ms. DeGette. The Chair now recognizes Ms. Schrier for 5
minutes.
Ms. Schrier. Thank you very much, Madam Chair. This has
been quite a 2-years, and we have learned a ton, and a lot of
those topics have been discussed already today. I think that
there are questions that are still going to come at us, and
that may hit us very hard. My question is going to be directed
at Dr. Riley, so I will just give that heads up.
I am a pediatrician, 20 years in practice. I have
experienced vaccine hesitancy, which is about one percent of
my--of the parents that I would see who would flat-out say, no,
not immunizing, no way, no how. Probably around ten percent, 15
percent. Just--questions, they just--very legitimate questions.
I just had to meet them where they are, answer some questions,
make them feel reassured. And then we moved on, and got
everybody vaccinated. I have just been blown away by how
politicized this has become, by the extreme misinformation out
there, and vaccine--it is not just hesitancy, it is like a
rabid sense that is anti-vaccine.
The question I think we may be headed for now is what will
this now do to routine childhood vaccinations that--it is not
just going to be a question of whether children in school
should be required to have a COVID vaccine, it is--I am
wondering--perhaps going to be a question of re-examining every
routine childhood vaccine, measles, mumps, chickenpox, you name
it, and questioning that.
And so, Dr. Riley, I was just wondering if you could
comment on any concerns you might have there, or what you
thought might be coming our way.
Dr. Riley. I certainly agree with your thought that vaccine
hesitancy is, you know, truly a problem. I think the WHO just
recently named vaccine hesitancy as a global health issue to
really be grappled with. And I think that we have to recognize
that, as people lose confidence in science, which is
unfortunate, and as our inability to communicate in all the
different ways that we need to, that just fuels the vaccine
hesitancy.
I think that we have to get back to the basics, understand,
you know, the diseases that we are trying to prevent, let the
public understand the diseases and how devastating they can be,
and then, you know, re-educate on the benefits of vaccines,
not--in addition to the safety, but also the benefits to
prevent disease. And I think that that is, you know, sort of
where we are going to need to go.
But I share your concern as I try and, you know, explain to
pregnant women every day that this is--you know, the COVID
vaccine is something that we feel will decrease the likelihood
that they themselves will be ill, and that there is evidence
now that there is protection for their babies.
Ms. Schrier. Thank you, and I share those concerns. In
fact, I am even a little bit more concerned now, because even
seeing how many people have died in this country, how many
people are in the hospital, you know, the vast difference
between vaccinated people who are safe from being in the
hospital or dying, and those not--even with that data, there is
still extreme hesitancy. And so I wonder if conversations about
measles and how devastating that can be will even carry.
Speaking of lack of trust, just a quick question for Dr.
Ranney: public health. There is tremendous need across the
board. We don't have a public health infrastructure, and then
distrust grew in our public health system. Do you think that,
if we had a baseline public health infrastructure, where in
routine cases they would be doing well baby visits at homes,
and helping with mental health and substance abuse disorders,
if we had that infrastructure already in place, do you think we
would have more success rolling out a big public health
campaign, come any future pandemic?
Dr. Ranney. Thank you, Representative. Absolutely. Our
investing today adequately in our public health infrastructure
is critical for us dealing with future surges of COVID, and
whatever comes next.
Community health workers and peer specialists are
important. Disciplining physicians who are active purveyors of
disinformation is critically important, and our correctly
interpreting and sharing those interpretations of data with our
patients is important.
And I actually want to take a moment to correct some of the
prior information that has been shared. There actually was not
a dramatic increase in pediatric suicides during lockdowns. In
fact, pediatric suicides dropped dramatically during lockdowns,
and we have seen a small increase in adolescent girls'
emergency department visits, most significantly over the last
couple of months. So I just want to correct the record on that
part.
But overall, investing in public health infrastructure,
ensuring that they have adequate workforce, adequate tools,
adequate ability to get data and then share it nationally,
which will speed up the sharing of data by the CDC if they get
good data from local departments, is absolutely critical to our
meeting the challenges of the future head on.
Ms. Schrier. Thank you very much. Thank you for setting the
record straight. I yield back.
Ms. DeGette. Thank you so much. The Chair now recognizes
Mrs. Trahan for 5 minutes.
Mrs. Trahan. Thank you, Chairwoman DeGette and Ranking
Member Upton, for holding this important hearing.
As many of my colleagues have mentioned today, the COVID-19
pandemic brought healthcare workforce issues to the forefront
as it exposed gaps and weaknesses in our Nation's preparedness
for public health emergencies. And these workforce issues are
present across healthcare workforces, and have highlighted the
need for public health, behavioral health, EMS, primary care,
and long-term care professionals.
The effects of these shortages are especially felt in
under-served communities, which have historically experienced
diminished access to healthcare services. Indeed, nearly half
of the counties in Massachusetts have shortages of infectious
disease physicians, and our westernmost county has zero. That
is why I introduced the Bolstering Infectious Outbreaks
Preparedness Workforce Act with Congressman McKinley, which
will offer student loan repayment as a major new incentive to
recruit more physicians, nurses, and other healthcare
professionals to work in infectious diseases
[inaudible] preparedness in communities with the greatest
need.
So, Dr. Ranney, why is access to loan forgiveness,
especially for medical specialties with lower average annual
salaries like ID physicians, important in building up and
retaining a robust and diverse healthcare workforce?
Dr. Ranney. Thank you very much for that question. So the
average physician graduates with more than $200,000 of debt.
They go through residency, where their debt continues to grow,
and then that can dissuade folks from taking on some of the
lower-paid professions. Many folks that do go into primary care
actually choose to not take insurance, and to take direct
concierge care payments instead, in order to increase their
income.
I myself was the benefit of the loan repayment program in
order to pay off my medical school loans. I know that Dr. Calac
was, as well. It is critical, in terms of getting physicians
and other healthcare professionals to be able to work on the
front lines in under-served communities, to be able to spend
time doing research, and to do other critically important
public health functions, and to not take those higher
remunerating jobs, to not have to go to areas that pay better.
I will also say that loan repayment would make a big
difference for those that have been on the front line for the
last couple of years as a small token of gratitude to help
retain frontline providers who have been there throughout the
pandemic. Having a loan repayment program such as Congresswoman
Maloney's would be helpful for those who have served throughout
the pandemic.
Mrs. Trahan. Absolutely, and I thank you for flagging
Chairwoman Maloney's bill, because I couldn't agree more.
I am going to switch gears because the President mentioned
last night in his State of the Union address the importance of
Congress conquering other public health crises, such as rising
substance use disorder rates that require specialized
healthcare professionals.
And I would like to just ask you one more question, Dr.
Ranney. As you noted, the importance of American Rescue Plan
workforce investments, including for substance use disorder
treatment and recovery programs, you know, I was encouraged to
see that Brown University's Warren Alpert Medical School class
of 2020 graduates were the first in the Nation to graduate with
training that allows them to prescribe medications to treat
opioid use disorder in any U.S. State.
So as a trained emergency physician, you interact with
patients seeking treatment for a range of physical and mental
health issues, and often have opportunities to provide
effective interventions for individuals with an opioid or other
substance use disorder. In your experience, do you agree that
more patients with OUD could be helped if comprehensive
training on how to identify, treat, and manage patients with a
substance use disorder was the standard?
Dr. Ranney. One hundred percent I agree. In my emergency
department, thanks to the leadership of our former director of
health, Dr. Alexander Scott, as well as our former Governor,
now Secretary of Commerce Raimondo, we actually have standard
screening--we have standard protocols for every patient that
comes in with opioid use disorder.
We prescribe Suboxone at the bedside during an emergency
department visit for folks who have overdosed on opioids. That
has been shown over and over again by my fellow emergency
physicians, as well as addiction medicine specialists, to be
the best way to help prevent overdose deaths.
Surrounding that with a suite of pre-recovery supports is
also critical, whether in-person or remote. This is one of the
most important things that we can do to help folks who are
subject to opioid use disorder.
And I will strongly urge that we actually get rid of the X
waiver requirement, which is a huge barrier to prescribing a
medication that is no more dangerous--and perhaps more
helpful--than many of the medications that we prescribe every
day for many other disorders.
Mrs. Trahan. Well, thank you. I appreciate both of those
answers.
And to all the other witnesses, thank you for your
testimony today.
I yield back. Thank you, Madam Chair.
Ms. DeGette. I thank the gentlelady. The Chair now
recognizes Mr. O'Halleran for 5 minutes.
Mr. O'Halleran. Thank you, Madam Chair and Ranking Member,
for holding this meeting. Thank you to the panelists for their
presentations today.
The issues that we have heard from today's witnesses are
not new. The pandemic has strained our health systems and
exposed our doctors, nurses, and frontline workers to
overwhelming conditions and a constant struggle to treat
patients and save lives.
I was happy to spend the last two weeks touring my district
and talking to healthcare providers and administrators. These
are rural and tribal providers, and they are struggling. Some
of these struggles are not new. Payment models continue to
discriminate against rural providers, and healthcare systems
continue to incentivize doctors and providers to settle in
urban and suburban areas and practice medicine in well-
resourced settings.
But what is new are incredible staffing challenges.
Hospitals, community health centers, our doctors' offices,
paramedics, EMTs, and ambulatory services, among others, are
all suffering from the same staffing issues, and it is harming
access to care in rural and tribal areas. This is an area that
is--this committee needs to be focused on, and I look forward
to working with anyone who is interested in actually addressing
the issues that rural and tribal communities are facing.
Just as a side issue, you know, a lot of people will say,
``Well, why don't they just move into urban areas?'' Well, we
need them out in rural areas for producing the food, bringing
water in, making sure our transportation systems work, on and
on and on. This is a combination that is needed critically in
our future.
So, Dr. Calac, thank you for joining us today. Your
testimony highlights this longstanding lack of investment in
Indian Health Services facilities. Can you elaborate on some of
the challenges the Indian Health Council faced in providing
quality medical services within your community before the
pandemic?
Dr. Calac. Thank you for the question. Just a couple of
comments regarding the workforce that currently exists now.
So I am one of only two pediatricians in the area
surrounding a 50-square--or 50-mile radius from our site. So
that poses a challenge to provide that pediatric care.
But also, with the same concern for the demographic, the
need to have kids enter STEM programs such as the Native
American Research Centers for Health, which is a NIH-funded
program to retain and recruit Native Americans to go into
medical school and/or research, is an important program that
actually highlights your concerns and the needs for promoting
recruitment and retention for this workforce.
And I would also like to comment on the fact that my son is
actually one of--actually, the only M.D./Ph.D. who will be at
University of California San Diego, providing--or finishing up
his studies there over the last four years. But he will be the
only Native American from this area to accomplish that feat.
So I think just examples of those wide disparities show a
need to have a continued workforce, and some of the challenges
that tribes and rural areas as a whole across the country are
facing.
Mr. O'Halleran. Well, thank you, Doctor. And this is
another question for you.
Since my time in Congress I have focused on addressing
longstanding failures of the Federal Government to provide
support to tribal communities and, for that matter, rural
communities throughout our country.
However, since the pandemic, Congress has taken several
actions to support tribal communities, including increasing
funding through the CARES Act, the American Rescue Plan, and
the bipartisan Infrastructure Investment Jobs Act. Which
programs have been most effective throughout the pandemic?
And, should we rework--and should be reworked to provide
additional support to tribal healthcare?
And if you can, comment also to rural healthcare.
Dr. Calac. Yes, thank you. The funds that have been
provided through the CARES Act and through several different
funding mechanisms to support the tribal missions in the area
have been phenomenal. And without those funds we would not have
been providing the care that we have done so with testing,
tracing, treatment for those individuals afflicted with COVID,
and providing the supportive care for the preventive healthcare
measures that we have had to catch up on.
It is said that pediatrics are almost a year and a half
back, in terms of preventive health exams. So I think looking
at Indian Health Service funding and other public health
service programs, since the budgets have been relatively flat
over the last ten years, is an important first step.
Mr. O'Halleran. Well--and thank you, Doctor. Thank you,
Madam Chair, and I yield.
Ms. DeGette. I thank the gentleman.
We have several members of the full committee who have
asked to waive on, and we are always pleased to accommodate
them. So first I will recognize Mr. Carter for 5 minutes.
Mr. Carter. Thank you, Madam Chair, and thank all of you
for participating in this. It is extremely important.
I want to ask kind of a general question, and I will start
with you, Dr. Ranney. What data do you think the CDC should be
collecting at this time that it hasn't collected?
Dr. Ranney. Thank you for that question. You know, the big
challenge that the CDC faces is that there is very little
mandated data from local or State health departments that is
required to be reported to the CDC.
There is also a lack of standardization of data, which
means that, when the CDC gets it, they have to spend a lot of
time cleaning and verifying it, which then delays release of
the data to the public.
And there is simply an absence of much data, such as others
have outlined: age, race and ethnicity, income level, et
cetera, of cases and hospitalizations. There is a lack of data
around adequate staffed beds. HHS reports hospital beds and
hospital capacity, ,period but doesn't take account for
staffing shortages.
The wastewater data is a great thing that is going to be
really important for us for predicting future surges. I could
go on.
The best analogy that I can make is I think back to when we
fought the epidemic of car crash deaths back in the 1970's. We
developed NHTSA, and we developed multiple, well-funded data
initiatives within NHTSA, such as the fatality accident
reporting system, the EMS information systems. Those are
critical ways that we can monitor in real time new reasons for
increasing car crashes and car crash deaths, and then change
things accordingly. We need the same type of system in place
for COVID data to allow us to have early warnings, and to
respond in kind.
Mr. Carter. Well, thank you. Thank you for that.
Dr. Riley, I will ask you the same thing. What data should
the CDC be collecting at this time that you don't think that
they are collecting?
Dr. Riley. So I really think I would just add on to that,
that one of the major issues that doesn't ever come up is
whether or not someone is pregnant or lactating. And so that
field alone would allow us to understand, you know, what is
happening to that particular patient population.
And as I said in my testimony earlier, I think that we need
to understand two things: one is what is the impact of COVID
infection on pregnancy and lactating women; and then what is
the effect of or the effects of vaccination on that same
population. But without asking those questions, we are sort of
left not knowing.
Mr. Carter. Hey, great responses, thank both of you.
Dr. McBride, I will go to you. Do you think there should be
a wider variety, if you will, of voices that--at the COVID-19
response itself? Are we including enough different people, and
enough different--and a variety of people, of professionals?
Dr. McBride. Thank you for that question. I think the more
voices, the more diverse array of experiences and areas of
expertise, the better.
Personally, I wish that there were more mental health
experts----
Mr. Carter. Exactly.
Dr. McBride [continuing]. In the COVID-19--because this is
a collective trauma, this is like no other experience in at
least my lifetime, but it is a collective trauma that really
warrants careful attention to individual and population mental
health.
But yes, absolutely. We need all sorts of races,
ethnicities, income levels, areas of expertise----
Mr. Carter. Absolutely, good.
Dr. McBride. All of it.
Mr. Carter. Thank you. Thank you.
Ms. Austin, I wanted to ask you very quickly, in--do you
feel like--that the clarity that you got from CDC for your
nursing staff on when to wear PPE, and what kind of PPE, do you
think that that was sufficient?
Ms. Austin. I think early on we had a great deal of trust
in the information that we were receiving from the CDC. I think
the thing that caused a little bit of concern was when some of
those things changed. I have heard from many of the nurses at
the--on the front lines, is their concerns about the changing
mandates, the changing information.
So I would just say that, yes, there was concern about the
information that changed. But overall, I would say that I
respect the CDC's position, and have followed their guidance
throughout this pandemic.
Mr. Carter. Good.
And Dr. Calac, I guess you are the only one I haven't asked
a question. The same question there. Any--the consistency of
the CDC and the information you were getting.
Dr. Calac. I would just echo Ms. Austin's comment. Yes, the
PPE that--we have been trained for many years in its use in
multiple different situations, other than just COVID, I think
was a usable practice that we had instituted.
However, the effectiveness of different masks, whether they
be two layers, cloth, N95s, was somewhat disparate as we moved
forward in the pandemic. But still looking forward to
additional support and improved guidance as we round out the
pandemic and looking forward to the next.
Mr. Carter. My time has expired. Thank you, Madam Chair.
Ms. DeGette. I thank the gentleman. The Chair now
recognizes Mr. Sarbanes for 5 minutes.
Mr. Sarbanes. Thank you very much, Madam Chair, and thank
you for allowing me to waive on to this hearing today. I
appreciate it very much.
Obviously, the focus here has largely been on workforce
shortages, particularly aggravated or exacerbated by the
pandemic, when we look at the healthcare workforce. But we know
these shortages have been accumulating. It is a, I guess, a
strange turn of phrase, ``shortages accumulating,'' but that is
what has been happening for years now. And we are just looking
at new and extra dimensions of that challenge.
I have been focused on this for a long time, was able to
work to get a provision into the Affordable Care Act that would
create a National healthcare Workforce Commission to kind of
systematically look at and assess what the shortages are, and
put forward recommendations, policy recommendations, on how to
address, and we are going to continue to try to bring that
focus to bear. But we also have to get creative, I think, and
innovative about how to meet those shortages, whether it is
nurses or physicians, other caregivers in the continuum of
care.
And Dr. Ranney, I apologize if I am not pronouncing your
name correctly, but I would be interested in getting your
perspective. I have a bill that I am re-introducing called the
Primary Care Physician Reentry Act. It would direct the
Department of Health and Human Services to establish a
demonstration program that could facilitate physician reentry
into primary care clinical practice after an absence from their
practice for one reason or another after retirement to try to
create an incentive, an expedited process of bringing these
physicians back.
Do you think that that is a good idea, could that help us?
Do you think that it would be appealing to retired
physicians?
Do you think it could help us address this workforce
shortage?
If you could speak to that, I would appreciate it.
Dr. Ranney. Thank you. I am not familiar with your bill,
but look forward to learning about it.
I will also say that Dr. McBride is the primary care doc,
not me, so I will let her talk about what will get folks into
primary care.
But I do think that providing avenues, on-ramps to get
physicians who have left bedside care back comfortable with the
current clinical care environment, with current data around
medical care, and getting them back into the clinical sphere is
certainly something that would be helpful.
Whether it is about retired physicians or others who have
left bedside care for a variety of other reasons, having a way
to re-acclimate, to buildup our clinical skills, and get back
into bedside care is a terrific idea.
Mr. Sarbanes. Thank you.
Dr. McBride, if you could, give me a quick thumbs up or
thumbs down on that as a possible benefit, in terms of getting
more physicians into the----
Dr. McBride. Yes, absolutely----
Mr. Sarbanes [continuing]. To address the shortage, I would
appreciate it.
Dr. McBride. Whatever we can do to get more people into
primary care. And not just to get more people in primary care,
but to incentivize them to go into primary care, instead of
subspecialty medicine, for example.
You know, those of us in primary care went into this field
to be able to have time with patients, to establish a
relationship so they can talk to you about their depression,
their anxiety, and their dementia, and their diabetes, and
their myriad health issues.
My patient who is 82 I saw earlier this week. He is on 15
medications. He has a new heart valve. He has atrial
fibrillation. He has hypertension. He has diabetes. And he has
newly lost his wife. If I have 5 minutes to talk to the
patient, I really cannot do my job. I cannot do what needs to
be done.
So we need to make sure that we are not only incentivizing
doctors out of medical school to go into primary care, we need
to change the system so that time with a trusted guide is the
commodity, instead of, you know, treating primary care as just
sort of a referral mill, where--and where the rapport and the
relationship is, and the--isn't the commodity.
The commodity needs to be the trust, the rapport, and the
relationship. There is a lot we can do when we sit down with
our patients and talk to them, look them in the eye, and help
them kind of meet their broad human needs by understanding who
they are as a person, and what their specific vulnerabilities
are, and how to protect them from the myriad threats that
people face, whether it is COVID-19, or loss, or, you know,
other health harms.
Mr. Sarbanes. I appreciate that, and I like that idea of
the commodity of trust, and how we can invest in it and make
sure that we reimburse for it in a way that creates the right
incentives.
Dr. Ranney, I have just got a couple of seconds left here.
Why shouldn't there be a school-based health center in every
school in America to address not just physical health needs on
the part of our students, but the increasing mental health
needs that they need, fully staffed with counselors, with
mental health professionals, with social workers, et cetera? If
you could speak to that briefly, I would appreciate it.
Dr. Ranney. I will say that, heck, right now I would just
take a school nurse in every school in America. That, in and of
itself, would be tremendous. School-based health centers are
great, both for getting kids and families care, and they can be
augmented with telehealth or with digital care.
I will also add that, in addition to getting physicians in
the workforce, we also need all the staff around us. We are a
team. It is not just a physician, it is also nurses, medical
assistant, home health aides, and more.
Mr. Sarbanes. Thank you very much.
Madam Chair, thank you.
Ms. DeGette. I thank the gentleman.
I gotta to tell you, Mr. Griffith and I both want to thank
all of the witnesses for coming today. You were a wonderful
panel, and a wonderful team. You gave us a lot of great
information, and we will use it going forward.
I want to remind embers that, pursuant to committee rules,
that they have ten business days to submit additional questions
for the record to be answered by witnesses that appear in front
of the subcommittee.
And I want to ask the witnesses, if you do get these
questions, if you can, respond promptly to any of them.
And with that, the subcommittee is adjourned.
[Whereupon, at 1:16 p.m., the subcommittee was adjourned.]
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