[Senate Hearing 117-190]
[From the U.S. Government Publishing Office]




                                                        S. Hrg. 117-190
 
                     NOMINATIONS OF DAWN O'CONNELL
                       AND MIRIAM DELPHIN-RITTMON

=======================================================================

                                HEARING

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                                   ON

 EXAMINING THE NOMINATIONS OF DAWN MYERS O'CONNELL, OF THE DISTRICT OF 
COLUMBIA, TO BE ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE, WHO 
  WAS INTRODUCED BY SENATOR MURRAY, AND MIRIAM E. DELPHIN-RITTMON, OF 
CONNECTICUT, TO BE ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE 
 USE, WHO WAS INTRODUCED BY SENATOR BLUMENTHAL, BOTH OF THE DEPARTMENT 
                      OF HEALTH AND HUMAN SERVICES

                               __________

                              JUNE 8, 2021

                               __________

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                                Pensions
                                
                                
                                
                                
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              U.S. GOVERNMENT PUBLISHING OFFICE 
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          COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                    PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont          RICHARD BURR, North Carolina, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota                MIKE BRAUN, Indiana
JACKY ROSEN, Nevada                  ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado          MITT ROMNEY, Utah
                                     TOMMY TUBERVILLE, Alabama
                                     JERRY MORAN, Kansas

                     Evan T. Schatz, Staff Director
               David P. Cleary, Republican Staff Director
                  John Righter, Deputy Staff Director
                  
                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                         TUESDAY, JUNE 8, 2021

                                                                   Page

                           Committee Members

Murray, Hon. Patty, Chair, Committee on Health, Education, Labor, 
  and Pensions, Opening statement................................     1
Burr, Hon. Richard, Ranking Member, a U.S. Senator from the State 
  of North Carolina, Opening statement...........................     3
Bluementhal, Hon. Richard, a U.S. Senator from the State of 
  Connecticut, Introduction......................................     6

                               Witnesses

O'Connell, Dawn, Washington, DC..................................     7
    Prepared statement...........................................     9
Delphin-Rittmon, Miriam, Meriden, CT.............................    10
    Prepared statement...........................................    11

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Murray, Hon. Patty:
    Letters in support of the Miriam Delphin-Rittmon nomination..    39
    Letters in support of the Dawn O'Connell nomination..........    69


                     NOMINATIONS OF DAWN O'CONNELL

                       AND MIRIAM DELPHIN-RITTMON

                              ----------                              


                         Tuesday, June 8, 2021

                                       U.S. Senate,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 10:04 a.m., in 
room SD-430, Dirksen Senate Office Building, Hon. Patty Murray, 
Chair of the Committee, presiding.
    Present: Senators Murray [presiding], Baldwin, Murphy, 
Hassan, Smith, Rosen, Lujan, Hickenlooper, Burr, Collins, 
Cassidy, Murkowski, Braun, and Marshall.

                  OPENING STATEMENT OF SENATOR MURRAY

    The Chair. Good morning. The Senate Help, Education, Labor, 
and Pensions Committee will please come to order. Today we are 
holding a hearing on Dawn O'Connell to serve as Assistant 
Secretary for Preparedness and Response, and Dr. Miriam 
Delphin-Rittmon to serve as Assistant Secretary for Assistant 
Secretary for Mental Health and Substance Abuse. Ranking Member 
Burr and I will each have an opening statement and then I will 
introduce Ms. O'Connell. Senator Blumenthal is here today. 
Welcome. He will be introducing Dr. Delphin-Rittmon.
    After the witnesses give their testimony, Senators will 
each have 5 minutes for a round of questions. And as I told you 
all before the break, with the change in guidance from the 
office of the Attending Physician, this Committee is now 
returning to hearings that look and operate more closely to how 
they did before the pandemic. And while that means that we have 
Senators fully in the room and seated closer together, we will 
also still be providing accommodations for those who require 
additional safety measures.
    Additionally, while we remain unable to have the hearing 
fully open to the public or media for in-person attendance, 
live video is still available for--on our Committee website at 
help.senate.gov. And if anyone needs accommodations, including 
closed captioning, you can just reach out to the Committee at 
the Office of Congressional Accessibility Services. We received 
Ms. O'Connell's formal nomination on March 25th, her office of 
Government Ethics paperwork, including her public financial 
disclosures and ethics agreement on March 31st, and her 
Committee paperwork on April 4th.
    We received Dr. Delphin-Rittmon's formal nomination on 
April 27th and her Office of Government Ethics paperwork on May 
4th, her Committee paperwork on May 17th. I want to thank all 
of our witnesses for joining us, and I would like to welcome 
Ms. O'Connell's husband, Ben, and their two daughters who are 
here today, and Dr. Delphin-Rittmon's husband, Patrick. Welcome 
to all of you. The Office of Assistant Secretary for 
Preparedness and Response, ASPR, and the Substance Abuse and 
Mental Health Services Administration, SAMHSA, do critical 
lifesaving work. ASPR is charged with protecting families 
across the country from health security threats like natural 
disasters, chemical, biological, radiological, and nuclear 
agents and pandemics.
    Meanwhile, SAMHSA leads efforts to advance behavioral 
health and reduce the impact of substance use disorders and 
mental illness. These have always been critical missions, but 
the COVID-19 pandemic has put both ASPR and SAMHSA in the 
spotlight, and their work has now been more critical than ever. 
ASPR has been on the front lines of this crisis, facing 
challenges like how to manage and replenish the strategic 
national stockpile, which provides critical resources to states 
for needs like personal protective equipment and materials 
needs for testing, treatment, and vaccination. ASPR also 
oversees BARDA, the Biomedical Advance Research and Development 
Authority.
    Over the past year, Congress provided BARDA funding through 
our COVID relief bills to purchase vaccines and work with 
Federal and private industry partners to develop lifesaving 
medical countermeasures such as diagnostic tests, therapeutics, 
and of course, safe, effective vaccines. As we have seen 
throughout this pandemic, ASPR's work can directly affect the 
health and safety of American families and workers. It impacts 
whether communities are able to do adequate testing to prevent 
and respond to outbreaks, whether hospitals have equipment to 
treat people safely, and whether people across the country are 
able to get safe, effective vaccines.
    While SAMHSA was already tackling its own set of challenges 
before this pandemic struck, including an opioid epidemic that 
has ravaged communities and a suicide rate that has climbed for 
several years, COVID-19 has seen these crises become even 
worse. Half of adults in our Country say the stress and worry 
of this pandemic has impacted their mental well-being. 
Hospitals in my state, from Seattle to Spokane to Tacoma, have 
reported higher rates of mental health emergencies for youth. 
And last year we saw a record number of deaths from substance 
use disorders. Given the critical work both ASPR and SAMHSA 
have ahead, we must make sure each agency has a strong, 
experienced leader, which is why I am looking forward to 
hearing from today's nominees, both of whom are well qualified 
for their roles.
    As a member of HHS leadership during the Obama 
administration, Ms. O'Connell managed the Department's response 
to past public health emergencies like Zika and Ebola. And 
before returning to the Department under President Biden as 
Senior Counselor to the Secretary for the COVID-19 response, 
she was Director of the U.S. Office of the Coalition for 
Epidemic Preparedness Innovations, a global partnership that 
works to accelerate vaccine development, ensure equitable 
access, and jumpstart research to prevent future epidemics.
    Meanwhile, Dr. Delphin-Rittmon has served as the 
Commissioner of Connecticut's Department of Mental Health and 
Addiction Services since 2015. She also previously served as a 
Senior Adviser at SAMHSA, the agency that she is now nominated 
to lead. Before her time at SAMHSA, she spent over a decade at 
Connecticut's Department of Mental Health and Addiction 
Services, where she has served as Director of the Office of 
Multicultural Health Equity, Senior Policy Adviser, and Deputy 
Commissioner. And while today we are considering two nominees 
to help lead us forward through the end of this crisis, we 
absolutely must look back, examine our failures and successes 
in managing this pandemic, and make sure we improve our 
Nation's public health and preparedness infrastructure, so we 
are better prepared to handle the next public health crisis.
    I look forward to having hearings in the months ahead as 
Senator Burr and I work to craft bipartisan legislation related 
to that effort. We must look at how we ensure our public health 
and medical systems have sufficient capacity to provide 
services to those most at risk, improve and secure the supply 
chain for critical medical supplies, tackle the health 
disparities that impact so many of our communities, and 
strengthen the Nation's public health infrastructure and 
medical preparedness and response programs at every level.
    Now, before I turn it over to Ranking Member Burr for his 
opening remarks, I seek unanimous consent to put in the record 
10 letters in support of Ms. O'Connell's nomination and 15 
letters in support of Dr. Delphin-Rittmon's nomination. So 
ordered.

    [The following information can be found on page 39]

    The Chair. Senator Burr.

                   OPENING STATEMENT OF SENATOR BURR

    Senator Burr. Well, thank you, Madam Chair. Thank you for 
holding such an important hearing today. Dr. Rittmon, welcome, 
and Ms. O'Connell, welcome. And I welcome both of your families 
that are here today. Both of you are signing up for roles that 
will come with an unprecedented demand.
    Federal service at this level always requires a significant 
commitment of time and energy. But the pandemic has changed the 
responsibilities of these roles. You will both be in the thick 
of policy decisions to help Americans heal from a year of loss 
and lockdowns and make us better prepared for future public 
health emergencies. Strong, effective leadership is crucial for 
both of these roles, and is the attribute I value the most in 
my considerations. I plan to spend a majority of my time this 
morning speaking about the role of the Assistant Secretary for 
Preparedness and Response, which I commonly referred to as 
ASPR.
    Before I do, I want to take a few minutes to discuss the 
difficult task at hand for the Assistant Secretary for Mental 
Health and Substance Use, who will lead SAMHSA. Doctor, the 
past year has been extremely trying on the American people. 
Many have experienced loss of precedented levels, the loss of 
loved ones, the loss of being able to hug a family and friends, 
the loss of jobs and school and routine. Children are 
increasingly having stress and anxiety, and doctors and nurses 
are seeing more children showing up at the hospitals with 
serious mental health conditions. Later this week, the 
Committee will be marking up the reauthorization of the Child 
Abuse Prevention and Treatment Act to respond to the crisis of 
child abuse that has grown more acute due to the closure of 
schools during the pandemic.
    Alongside these challenges, we are in danger of losing 
ground on all of the progress that we have made in the fight 
against the opioid crisis. Should you be confirmed, you will go 
from serving 3.6 million people in Connecticut to 332 million 
in America. You have an opportunity to bring access to this 
type of care to more Americans. Don't return to the status quo. 
Let me say it again, don't return to the status quo. Embrace 
the technologies that can better serve Americans in need as we 
recover from COVID-19. Use your experience at the state level 
to empower state and local leaders to design programs and 
solutions that best fit their communities' needs. Ms. 
O'Connell, welcome.
    Candidly, I wish that this hearing had been held months 
ago. This Administration had an Acting ASPR since January 20th 
in the middle of a response to a pandemic. The statutory lead 
on public health emergencies was left open during the most 
significant public health emergency of our lifetime. ASPR 
should have been one of the first slots filled by this 
Administration. I will also point out to my colleagues that 
there is another absolutely critical public health position 
that has not yet been named, the FDA Commissioner. I have the 
greatest respect for Janet Woodcock. She is leading the FDA 
ably, and I think she has all the qualifications needed for 
this moment, but we need a fully confirmed person in that role 
in FDA.
    We need a nominee, and I look forward to vetting her in 
this Committee as soon as possible. And Ms. O'Connell, in our 
previous conversations, we talked about the reason we wrote the 
ASPR into the statute. It was to answer the simple question of 
who is in charge during a public health emergency. The statute 
is extremely clear. The ASPR is in charge and serves as the 
Principal Adviser to the Secretary on all these matters. This 
is not a political or personal choice for any administration. 
It is the law. It is a role that we envisioned with two types 
of responsibilities. First, the ASPR serves an operational 
role.
    During an emergency, the ASPR coordinates the public health 
and medical response, whether that threat is a hurricane, a 
novel virus, or chemical attack. Another part of the day job is 
the assessment of and investment in our medical countermeasure 
enterprise. As the head of the Public Health Emergency Medical 
Countermeasures Enterprise, or FEMSA, and with oversight of 
BARDA and the Strategic National Stockpile, this job covers the 
research, development, procurement, and deployment of these 
lifesaving products. Second, the ASPR is a policy job, 
assessing the threat landscape and adjusting our strategies to 
best position the United States for threats we face today and 
more importantly, in the future.
    My questions today are designed to make sure that you are a 
good candidate for the entirety of the role as developed and 
envisioned by this Committee. With each iteration of the 
Pandemic and All Hazard Preparedness Act, or PAHPA for short, 
we have adjusted our emergency preparedness and response 
framework, including the role of ASPR. During the last 
reauthorization, we more closely tied the position to the 
intelligence community, providing the ASPR with greater line of 
sight into the ever changing landscape of the threats that we 
face. We made ASPR the head of FEMSA, to coordinate and make 
decisions on medical countermeasure investments, and we updated 
the ASPR's job description to ensure a focus on both the 
operational and policy roles.
    ASPR's responsibilities also now include the stockpile, a 
move that strengthens, I think, the operational side of the 
job. With the ASPR over the stockpile, he or she can follow 
taxpayer investments from the advanced research at BARDA, all 
the way through the last mile of deployment during an 
emergency. Yet the office of ASPR has also been utilized in 
ways that are outside of its scope. This distracts the ASPR 
from its mission and ultimately makes us less prepared. When we 
wrote the first PAHPA legislation, we hoped that we would never 
have to use it, and it came into needing COVID.
    A lot of the framework that this Committee designed worked 
extremely well during the pandemic. We have three authorized 
vaccines with more on the way, dramatically changing the 
trajectory of our response to COVID for the better. But the 
response was not perfect, and the work is not done. Instead of 
looking to the ASPR, the last administration created its own 
leadership structure for the COVID response, building the plane 
and flying it at the same time.
    Congress intentionally created ASPR to avoid this confusion 
and to be the tip of the spear during a response. I know who 
was supposed to be in charge because I helped write the law 
putting ASPR in charge. So our Committee looks at what 
improvements need to be made in the law. I hope that if you are 
confirmed, you and my colleagues will work with me to see what 
mistakes were made and how to learn from them, to make it more 
clear that ASPR is, in fact, in charge and that we have the 
tool--and that you have the tools you need, and that when the 
next pandemic comes, because it likely will, the ASPR is ready 
to stand up and take the lead.
    The American people expect us to do all we can to protect 
them from a public health threat and to communicate those 
actions to them as clearly as possible. They deserve an ASPR 
that can command the response and coordinate their colleagues 
across HHS. And that brings the same urgency and vigilance to 
the role in peacetime as in the middle of a response. I look 
forward to our conversation today and hearing whether you are 
ready to risk--to rise to the challenge before you. I thank the 
Chair.
    The Chair. Thank you, Senator Burr. We will now introduce 
today's witnesses. Dawn O'Connell is an expert in public 
health, emergency preparedness and response efforts, and 
currently Senior Adviser for the COVID-19 response at the 
Department of Health and Human Services. Before she was named 
to that position earlier this year, she spent several years as 
the U.S. Office Director at the Coalition for Epidemic 
Preparedness Innovations, or CEPI, an organization focused on 
global preparedness for disease outbreaks.
    CEPI is a collaborative effort with public, private and 
civil society partners from around the world. It works to 
accelerate vaccine development, ensure equitable access, create 
stockpiles against epidemics before they start, invest in 
technology to speed up vaccine development for new diseases, 
and coordinate Governmental responses and capacity in places 
that need additional support. Ms. O'Connell's leadership to 
help CEPI quickly become a key player in developing vaccines 
against emerging infectious diseases like COVID. CEPI was a 
founding member of the Access to COVID-19 Tools Accelerator, a 
program that developed alongside the World Health Organization 
to ensure vaccines were developed and distributed equitably.
    O'Connell worked with others at CEPI to convene an 
international group of stakeholders focused on speeding up the 
purchase, production, and distribution of COVID-19 vaccines. 
But long before this pandemic and her time at CEPI, O'Connell 
was already focused on global health security.
    As a Senior HHS staffer in the Obama administration, she 
managed the Department's response to Zika, oversaw the response 
to Ebola, and coordinated efforts with state, Federal, and 
international partners, and lead HHS' work with the White 
House's National Security staff, World Health Organization, and 
partner countries to develop and launch President Obama's 
global health security agenda.
    Prior to her time in the Obama administration, she worked 
for Congressman John Spratt of South Carolina in a number of 
roles, including 4 years as his chief of staff. O'Connell 
received her B.A. from Vanderbilt University and her JD from 
Tulane University Law School. She currently lives in 
Washington, DC. with her husband and two daughters who are 
again here with her today. Ms. O'Connell, I am delighted to 
welcome you and your family.
    Thank you for joining us. And I look forward to hearing 
from you today and working with you in the future. And with 
that, I will turn it over to Senator Blumenthal to introduce 
Dr. Delphin-Rittmon.
    Senator Blumenthal.

                    STATEMENT OF SENATOR BLUMENTHAL

    Senator Blumenthal. Thank you, Chair Murray, Ranking Member 
Burr, Members of the Committee. I am really so proud to be here 
today. It is bittersweet because for all the reasons that 
Commissioner Delphin-Rittmon will be a great Assistant 
Secretary, we will miss her in Connecticut. And I was last here 
to introduce Dr. Miguel Cardona, the nominee for Secretary of 
Education.
    I almost want to say to President Biden, quit taking some 
of our best people because Commissioner Delphin-Rittmon is one 
of the most valued and dedicated public servants in the State 
of Connecticut. And I want to speak personally because I have 
come to know and admire her personally. She is someone who 
shows up and she wears well. She may not be the splashiest 
person when you first get to know her, but the more you know 
her, the more you admire and respect and like her as a human 
being of tremendous training and professional expertise, but 
also someone who leads by example, leads with her heart as well 
as her head.
    Talking about showing up, I have seen her at countless 
community forums and meetings with public officials, 
professional experts, but also recovering addicts and their 
families, and she is someone who knows how to communicate to 
raise awareness and support. If there is a person in treatment, 
a person seeking treatment, a person in recovery, a person who 
needs someone to help them through the insidious disease of 
addiction, Dr. Delphin-Rittmon is there. And as Assistant 
Secretary for Mental Health and Substance Abuse, she will be 
there for the Nation, as she has been for the people of 
Connecticut. She knows that solving the problem of opioid and 
mental health crises in our Country, we must meet people where 
they are at themselves.
    When she heard from the community about barriers to care, 
she deployed a mobile medication treatment program to high need 
areas. When she heard that people were struggling to access 
care, she implemented a 24/7, toll free access line to help 
people find access. And through transportation assistance, she 
literally got to care for them in the way that they needed. She 
has been the right person at the right moment for Connecticut, 
and I think she is the right person for this job for our entire 
nation. She has a background as a clinical community 
psychologist and public servant who has dedicated her life to 
helping people who suffer from the disease.
    She, more than anyone, recognizes that addiction is a 
disease, not a moral failing, and mental illness, which as I 
think everybody on this Committee recognizes, is a problem that 
we have failed to give sufficient importance to treating. And I 
know that she will be a continuing advocate for mental health 
parity, which I have fought to recognize, and I know Members of 
this Committee like Chair Murray and Senator Casey and others, 
Senator Baldwin, have as well. So I strongly recommend her to 
this Committee.
    There is no sugarcoating the problems that she has to 
address. They are Herculean, and they will require a commitment 
from the Nation and from this President, which I know will be 
forthcoming, as well as from us in the U.S. Senate. And I am 
very, very grateful for the opportunity to introduce her and 
her husband, Patrick, to this Committee. Thank you very much.
    The Chair. Thank you, Senator Blumenthal. Appreciate that 
introduction. Welcome to you, Dr. Delphin-Rittmon. And with 
that, we will begin our testimony today. And Ms. O'Connell, we 
will begin with you.

   STATEMENT OF DAWN O'CONNELL TO BE ASSISTANT SECRETARY FOR 
           PREPAREDNESS AND RESPONSE, WASHINGTON, DC

    Ms. O'Connell. Chair Murray, Ranking Member Burr, Members 
of the Committee, I am honored to appear before you today as 
you consider my nomination for the position of Assistant 
Secretary for Preparedness and Response at the U.S. Department 
of Health and Human Services. Chair Murray, thank you for the 
kind words of introduction. I must also thank President Biden 
for nominating me to this important role, and of course, thank 
my family, my husband Ben and daughters Maddie and Franny whose 
love, support, and senses of humor sustained me through late 
nights and long hours of work.
    I am honored also to be on the same panel today with Dr. 
Miriam Delphin-Rittmon, the President's SAMHSA nominee. I was 
called to public service early in life, influenced by the 
example set by my parents, an educator and social worker. This 
vocation was further strengthened as a young staffer on the 
Hill, witnessing the tragic events of September 11th. On that 
day, I was evacuated from my office in the Longworth Building 
and stood with colleagues just a few blocks from the Capitol 
watching in horror on a portable television as the Twin Towers 
fell.
    A few weeks later, our office was evacuated again, this 
time for several weeks while it was secured following the 
deadly anthrax letters sent to Congress. And then in 2005, my 
family with deep New Orleans roots was impacted by Hurricane 
Katrina. Several of my aunts and cousins were forced to leave 
their homes and a great aunt was among those evacuated from a 
nursing home that was unable to maintain power and safe 
conditions. It took our family several days to find her with 
fellow residents on a tarmac in Memphis. Grateful to the 
responders that got her there unharmed. These events ingrained 
in me the importance of a strong emergency response system.
    They also led to the formation of the Office of the 
Assistant Secretary for Preparedness and Response, the role for 
which I am being considered today. I took these lessons with me 
to HHS during the Obama administration, where I served as 
Deputy Chief of Staff to both Secretary Sebelius and Burwell. 
In that role, I helped lead the responses to several public 
health emergencies, including the Ebola and Zika outbreaks, and 
hone their skills necessary to manage complex crises.
    This experience, coupled with nearly 4 years working for 
the Coalition for Epidemic Preparedness Innovations, an 
international nonprofit whose mission is to accelerate the 
development of vaccines to prevent epidemics, uniquely 
qualified me to come back to HHS to serve as Secretary 
Becerra's Senior Counselor for COVID-19. As part of the 
Administration's current COVID response effort, I have seen how 
critically important the mission of ASPR is at this pivotal and 
unprecedented time. I have also witnessed the dedication and 
commitment of the ASPR team. If confirmed for this role and 
entrusted to lead this team, my priorities would be threefold.
    First, to deliver us quickly out of the current pandemic by 
continuing ASPR's work of accelerating the development and 
distribution of vaccines and therapeutics, and securing and 
distributing necessary PPE. Second, to restore and maintain the 
public health emergency capacity that has been severely 
strained by the pandemic, including replenishing the strategic 
national stockpile. Third, to begin preparing for the next 
public health emergency, whether natural or manmade, by keeping 
vigilant watch of the horizon, scanning for what may come next.
    If confirmed, I commit to working against each of these 
priorities in a transparent and accountable manner, and to 
always let the science lead. I also commit to working as a 
partner with this Committee. Public health preparedness and 
response is neither a Republican issue nor a Democratic issue, 
it is an American issue. If confirmed, I will work with each of 
you to ensure that the communities you represent have the tools 
needed to prepare for the next public health emergency.
    Finally, I pledge to do everything in my power to address 
the serious challenges ahead of us as we navigate threats that 
endanger Americans, our health and national security, both 
present and future. I am prepared for the task ahead and 
honored to be nominated to serve as the ASPR. Thank you for 
considering my nomination and I look forward to answering your 
questions.

    [The prepared statement of Ms. O'Connell follows:]
                  prepared statement of dawn o'connell
    Chair Murray, Ranking Member Burr, Members of the Committee--I am 
honored to appear before you today as you consider my nomination for 
the position of Assistant Secretary for Preparedness and Response at 
the U.S. Department of Health and Human Services. Chair Murray, thank 
you for the kind words of introduction.

    I must also thank President Biden for nominating me to this 
important role and of course my family: my husband Ben and daughters 
Maddie and Frannie whose love, support and senses of humor sustain me 
through late nights and long hours of work.

    I am honored to be on the same panel today with Dr. Miriam Delphin-
Rittmon, the President's SAMHSA nominee.

    I was called to public service early in life influenced by the 
example set by my parents: an educator and a social worker. This 
vocation was further strengthened as a young staffer on the Hill 
witnessing the tragic events of September 11, 2001.

    On that day, I was evacuated from my office in the Longworth 
Building and stood with colleagues just a few blocks from the United 
States Capitol--watching in horror on a portable television as the Twin 
Towers fell. A few weeks later, our office was evacuated again--this 
time for several weeks--while it was secured following the deadly 
anthrax letters sent to Congress.

    In 2005, my family with deep New Orleans roots, was impacted by 
Hurricane Katrina. Several of my aunts and cousins were forced to leave 
their homes--and a great aunt was among those evacuated from a nursing 
home unable to maintain power and safe conditions. It took our family 
several days to find her with fellow residents on a tarmac in Memphis--
grateful to the responders that got her there unharmed.

    These events ingrained in me the importance of a strong emergency 
response system. They also led to the formation of the Office of the 
Assistant Secretary for Preparedness and Response (ASPR). The role for 
which I'm being considered today.

    I took these lessons with me to HHS during the Obama administration 
where I served as Deputy Chief of Staff to both Secretaries Sebelius 
and Burwell. In that role, I helped lead the responses to several 
public health emergencies--including the Ebola and Zika outbreaks--and 
honed the skills necessary to manage complex crises.

    This experience coupled with nearly 4 years working for the 
Coalition for Epidemic Preparedness Innovations--an international non-
profit whose mission is to accelerate the development of vaccines to 
prevent epidemics--uniquely qualified me to come back to HHS to serve 
as Secretary Becerra's Senior Counselor for COVID-19.

    As part of the Administration's current COVID-19 response effort, I 
have seen how critically important the mission of ASPR is at this 
pivotal and unprecedented time. I have also witnessed the dedication 
and commitment of the ASPR team.

    If confirmed for this role and entrusted to lead this team, my 
priorities would be threefold:

        First, to deliver us quickly out of the current pandemic by 
        continuing ASPR's work of accelerating the development and 
        distribution of vaccines and therapeutics and securing and 
        distributing necessary personal protective equipment or PPE.

        Second, to restore and maintain the public health emergency 
        capacity that has been severely strained by the pandemic 
        including replenishing the Strategic National Stockpile.

        Third, to begin preparing for the next public health emergency 
        whether natural or man-made by keeping vigilant watch of the 
        horizon--scanning for what might come next.

    If confirmed, I commit to working against each of these priorities 
in a transparent, accountable, and collaborative manner and to always 
let the science lead.

    I also commit to working as a partner with this Committee. Public 
health preparedness and response is neither a Republican issue nor a 
Democratic issue. It is an American issue. If confirmed, I will work 
with each of you to ensure that the communities you represent have the 
tools needed to prepare for the next public health emergency.

    Finally, I pledge to do everything in my power to address the 
serious challenges ahead of us as we navigate threats that endanger 
Americans, our health and national security--both present and future.

    I am prepared for the task ahead and honored to be nominated to 
serve as the ASPR. Thank you for considering my nomination. I look 
forward to answering your questions.
                                 ______
                                 
    The Chair. Thank you, Ms. O'Connell. We will now turn to 
Dr. Delphin-Rittmon for your testimony.

 STATEMENT OF MIRIAM DELPHIN-RITTMON TO BE ASSISTANT SECRETARY 
   FOR MENTAL HEALTH AND SUBSTANCE USE, MERIDEN, CONNECTICUT

    Ms. Delphin-Rittmon. Thank you and good morning, Chair 
Murray, Ranking Member Burr, Members of the Committee. Thank 
you for considering my nomination to be Assistant Secretary for 
mental health and substance use at the U.S. Department of 
Mental Health and--at the U.S. Department of Health and Human 
Services. And thank you to Senator Blumenthal for his kind 
introduction.
    I so appreciate his leadership and fierce advocacy for 
mental health and substance use recovery needs of the people of 
Connecticut and across our Nation. It is a true honor to be 
here today. First, I want to thank President Biden for 
nominating me and placing his trust in me. Here today with me 
is my husband, Patrick Rittmon, a 22 year veteran of the U.S. 
Marine Corps. I am ever grateful for his service to our Country 
and for his support and understanding throughout my career. I 
sit before you today the daughter of Haitian immigrants who 
came to the United States filled with the hope and optimism of 
America's promise.
    My father, through perseverance, long hours, and a passion 
for learning and helping others, became a psychiatrist who 
practiced for over 50 years and achieved five board 
certifications in the mental health field. It is with the same 
passion for learning and aiding others that my parents raised 
my three brothers and two sisters and me, emphasizing 
education, hard work, empathy, compassion, perseverance with 
faith through adversity, and cherishing the blessing of our 
family. These are all values that are central to who I am today 
and core values that influence and inform my work. Throughout 
my 20 year career in the behavioral health field, I have had 
extensive experience in direct care, academic, and Government 
settings.
    Emphasizing recovery, addressing equity and culture and 
behavioral health service delivery, and system development are 
prominent themes in my work, largely influenced by my having 
received a SAMHSA minority fellowship in graduate school and my 
subsequent payback experiences with the Yale University Program 
for Recovery and Community Health in the Department of 
Psychiatry, where I conducted research, clinical care training, 
and consultation in community and State Government settings.
    I am currently an Adjunct Associate Professor at Yale, 
having been on faculty since 2002, and I am a testament to the 
value of such fellowship programs growing our diverse 
behavioral health workforce. As commissioner of the Department 
of Mental Health and Addiction Services, a role I have held 
since 2015, my focus has been on recovery--on promoting 
recovery oriented, integrated and cultural responses services 
and systems that foster dignity, respect, meaningful community 
inclusion among the individuals that we are entrusted to serve. 
The President has nominated me at an inflection point in the 
Nation's collective mental health. The COVID-19 pandemic has 
had far reaching ripple effects on aspects of our daily lives, 
many aspects of our daily lives, and it has taken a significant 
toll on mental health.
    Across the country, we are seeing increased rates of 
anxiety, depression, and tragically, tragically overdose deaths 
have substantially increased as well. As we face this 
behavioral health challenge of our lifetime, SAMHSA finds 
itself with never before seen resources to address these 
critical issues. Where we go from here will impact a generation 
of American families. If confirmed, my agenda is clear. First, 
we must increase access to mental health and substance use 
services and supports to better address the behavioral health 
challenges that children and adults alike are experiencing as a 
function of this pandemic.
    Second, we must enhance crisis and suicide prevention 
services and supports in line with the implementation of the 
988 National Suicide Prevention and Crisis Hotline. This 
nationwide change in crisis response will allow Americans to 
get services and supports where they need it and when they need 
it. Finally, the overdose epidemic continues to ravage many 
communities across the country. This is not a new problem, yet 
it has exacerbated during COVID-19, and we see daily losses in 
life nationwide. If confirmed, reaching people where they are 
via innovative prevention, treatment, harm reduction, and 
recovery solutions will be a hallmark of the work of SAMHSA.
    I realize that we may not always agree on the best 
approaches to solve these challenges, but I pledge to work 
closely with you to ensure that our decisions are transparent, 
that our team is accessible, and the SAMHSA listens to your 
views. Before I close, I must acknowledge the outpouring of 
support from across the country. I am deeply humbled and 
appreciative of all those who wrote letters or called or texted 
or helped with the letters. Thank you so much.
    I see you all as vital parts of the village that it will 
take to address this behavioral health challenge we are facing 
as a Nation. Thank you for your consideration of my nomination, 
and I look forward to answering your questions.

    [The prepared statement of Ms. Delphin-Rittmon follows:]
              prepared statement of miriam delphin-rittmon
    Chairman Murray, Ranking Member Burr, and Members of the Committee, 
thank you for considering my nomination to be the Assistant Secretary 
for Mental Health and Substance Use at the U.S. Department of Health 
and Human Services. And thank you to Senators Blumenthal and Murphy for 
your kind introductions. I so appreciate your leadership and fierce 
advocacy for mental health and substance use treatment and recovery 
needs of the people of Connecticut and across our Nation.

    It is a true honor to be here today. First, I want to thank 
President Biden for nominating me and placing his trust in me. Here 
with me today is my husband, Patrick Rittmon, a 22-year veteran of the 
United States Marine Corp. I am ever grateful for his service to our 
Country and for his support and understanding throughout out my career.

    I sit before you today the daughter of Haitian immigrants who came 
to the United States filled with hope and optimism of America's 
promise. My father, through perseverance, long hours and a passion for 
learning and helping others, became a psychiatrist and practiced for 
over 50 years achieving 5 board certifications in the mental health 
field. It is with this same passion for learning and aiding others that 
my parents raised my three brothers, two sisters and me emphasizing 
education, hard work, empathy, compassion, perseverance, with faith, 
through adversity and cherishing the blessing of our family. These are 
all values that are central to who I am today and core values that 
influence and inform my work.

    Throughout my over 20-year career in the behavioral health field, I 
have had extensive experience in direct client care, academic, and 
government settings. Emphasizing recovery and addressing equity and 
culture in behavioral health service delivery and system development 
are prominent themes in my work--largely influenced by my having 
received a Substance Abuse and Mental Health Services Administration 
(SAMHSA) Minority Fellowship in graduate school and my subsequent 
payback experiences with the Yale University Program for Recovery and 
Community Health in Department of Psychiatry, where I conducted 
research, provided clinical care, training and consultation in 
community mental health and state government settings. I am currently 
an Adjunct Associate Professor at Yale having been on faculty since 
2002 and am a testament to the value of such fellowship programs 
growing our diverse behavioral health workforce.

    As the Commissioner of the Connecticut State Department of Mental 
Health and Addiction Services, a role I have held since 2015, my focus 
has been on promoting recovery-oriented, integrated, and culturally 
responsive services and systems that foster dignity, respect, and 
meaningful community inclusion of the individuals we are entrusted to 
serve.

    The President has nominated me at an inflection point of this 
Nation's collective mental health. The COVID-19 pandemic has had far 
reaching ripple effects on many aspects of our daily lives and has 
taken a significant toll on mental health. Across the country we are 
seeing increased rates of anxiety and depression, and tragically 
overdose deaths are substantially increasing across the country.

    As we face this behavioral health challenge of our lifetime, SAMHSA 
finds itself with never before seen resources to address these critical 
issues.

    Where we go from here will define a generation of American 
families.

    If confirmed, my agenda is clear--first, we must increase access to 
mental health and substance use services and supports to better address 
the behavioral health challenges adults and children alike are 
experiencing as a result of the pandemic.

    Second, we must enhance crisis and suicide prevention services and 
supports in line with the implementation of the 988 national suicide 
prevention and crisis hotline. This nationwide change in crisis 
response will allow Americans in crisis to connect with support when 
and where they need it.

    Finally, the overdose epidemic continues to ravage too many 
communities across the country. This is not a new problem, yet it has 
been exacerbated during COVID-19 and results in daily losses for 
communities nationwide. If confirmed, reaching people where they are 
via innovative prevention, treatment, harm reduction, and recovery 
solutions will be a hallmark of the work of SAMHSA.

    I realize that we may not always agree on the best approaches to 
solve these challenges, but I pledge to work closely with you to ensure 
that our decisions are transparent, our team accessible, and that 
SAMHSA is listening to your views.

    Before I close, I must acknowledge the outpouring of support from 
across the country. I am deeply humbled and appreciative of all those 
who wrote letters or called or email and texted--thank you so much. I 
see you all as vital parts of the village it will take to address the 
behavioral health challenges we face as a Nation.

    Thank you for considering my nomination, and I look forward to 
answering your questions.
                                 ______
                                 
    The Chair. Thank you very much. We will now begin a round 
of 5 minute questions. And I ask all of my colleagues, as 
usual, please keep track of the clock, stay within 5 minutes. 
The COVID-19 pandemic has been devastating. And in the United 
States, the virus has killed nearly 600,000 people and sickened 
more than 30 million others. It has challenged our mental 
health and it has pushed our frontline health care workers and 
our public health systems to the brink.
    The burden of all those challenges has fallen 
disproportionately on people of color, women, people with 
disabilities, and those with the lowest incomes. You are now 
both nominated to lead offices tasked with responding to these 
challenges. And I want to hear what steps each of you will take 
to place equity at the center of that response. So if 
confirmed, how will you prioritize equity in the ongoing COVID-
19 response and ensure it is a priority in the response to 
future public health crises? And I will start with Ms. 
O'Connell.
    Ms. O'Connell. Chair Murray, thank you so much for that 
question and thank you for your leadership on these important 
issues. We have seen over this last year the disproportionate 
impact of COVID-19 on communities of color and vulnerable 
populations. And it has really brought into focus the need to 
equitably distribute vaccines, therapeutics, PPE, and other 
tools that are necessary to fight the pandemic. The Biden 
administration has made equity a cornerstone of its response. 
It is interwoven in all of the things that it has done, 
including the distribution of vaccines. It has emphasized not 
just going fast, but also going fairly.
    If I am confirmed, I will continue that work from the 
perspective of the ASPR in distributing PPE, vaccines, 
therapeutics to make sure that the tools that we have been so 
lucky to have developed so quickly in this pandemic are 
distributed equitably because in America we are not going to 
recover unless all Americans have access to these critical 
tools. And I will commit to ensuring that the tools are 
available to all communities.
    The Chair. Thank you.
    Dr. Delphin-Rittmon.
    Ms. Delphin-Rittmon. Yes. Thank you, Chair Murray, for that 
question. We know it is so important to ensure that individuals 
that are accessing our services and systems, particularly 
diverse individuals, as well as all individuals across the 
country, to include individuals within rural areas, that they 
receive optimal care and that we are able to both identify and 
address any disparities that are present. Should I be 
confirmed, I would be very interested in, for one, looking at 
the data that we have. We know that SAMHSA has a good bit of 
data. And so a part of addressing and focusing on equity is 
having a good sense of what the trends and what the disparities 
may be. So certainly that would be a part of our work.
    SAMHSA has an Office of Behavioral Health Equity and I 
would look forward to continuing to expand the work of that 
office. I also would look forward to working with the 
Secretary. I know this is a priority for the Administration and 
so I would look forward to marshaling the resources necessary 
to ensure that we address equity.
    We know this is a challenge that we have seen in our 
Country prior to the pandemic. And so, as I have throughout my 
career, would be committed to working on this important issue 
to ensure that diverse Americans, as well as Americans within 
rural areas, and all Americans accessing services and supports 
receive quality, equitable care to ensure strong health 
outcomes. Thank you for that question.
    The Chair. Thank you. Ms. O'Connell, the Office of the 
Assistant Secretary for Preparedness and Response oversees and 
coordinates the Department's response to emergencies like 
COVID-19, as well as managing the strategic national stockpile. 
We need a stockpile that can adequately address future threats 
such as infectious disease outbreaks like we have seen, as well 
as protect our frontline health care workers with the personal 
protective equipment they need. I wanted to ask you, if you are 
confirmed, how will you ensure that ASPR demonstrates both 
effective and responsible management of the stockpile before 
and during public health emergencies?
    Ms. O'Connell. Chair Murray, thank you so much for that 
question. If confirmed, I expect to spend a significant amount 
of my time working on the strategic national stockpile. We have 
certainly learned a lot in this last year and a half about what 
it was and what it wasn't and what it needs to be. I think it 
is important that we diversify what is in there to make sure 
that it is fit for purpose for whatever the most likely public 
health emergencies to come will be.
    I also think it is critical that we secure a domestic 
manufacturing base so we have a secure and resilient public 
health and medical supply chain that we can rely on both in 
peacetime and in times of need. There is going to be a lot that 
we need to learn coming out of this pandemic. And I look 
forward to working with this Committee on learning those 
lessons and applying those lessons to the strategic national 
stockpile and other places.
    The Chair. Thank you.
    Senator Burr.
    Senator Burr. Thank you, Chair. Dr. Delphin-Rittmon, I 
believe faith is a powerful tool for helping people find 
community and healing. Under current law, faith based 
organizations are eligible to compete as grantees for SAMHSA 
substance use disorder programs while maintaining their 
religious character because of a provision known as the 
charitable choice. If confirmed, will you commit to upholding 
this law at SAMHSA?
    Ms. Delphin-Rittmon. I appreciate that question, Senator, 
and again, appreciate the opportunity to appear before this 
Committee. Certainly within my work in Connecticut, I have seen 
the value of the collaborations with faith based organizations. 
And so, yes, I can confirm that I would commit to upholding the 
law related to this. I have seen significant impacts related to 
faith based organizations connecting people to services and 
supports and helping to promote long term recovery for 
individuals that connect to services.
    Senator Burr. Thank you for that commitment. Ms. O'Connell, 
as I stated in my opening statement, I think the law is very 
clear that the ASPR is in charge. Do you agree that the law 
puts the ASPR in charge?
    Ms. O'Connell. Thank you, Ranking Member Burr. I do agree.
    Senator Burr. If confirmed, what would be the first three 
things you would do differently to make it clear that you are 
in charge?
    Ms. O'Connell. Ranking Member Burr, thank you so much for 
that question and thank you for your career long commitment to 
these issues. It is an honor to be before you today, as I am 
being considered for the ASPR role that you helped create. I do 
think it is important that the ASPR is in charge. And I have to 
say I was surprised coming back into the Administration and 
into HHS in January to find the Coast Guard on behalf of FEMA, 
coordinating within the Department, doing the interagency and 
interagency coordination, a role I thought should be run by the 
ASPR. So I agree with you that is a critical, a critical role.
    Among the things I would do would be to take the work that 
I have currently been doing, which is different in scope and 
different in mission, but has helped build relationships across 
the Department, and apply those relationships in the role of 
ASPR to help coordinate on behalf of the Department both for 
the ending of the COVID pandemic and any future public health 
emergencies that might happen.
    The relationship that I currently have with the Secretary 
as his Senior Counselor will come into play. And I believe as 
ASPR, I would have the full faith of the Department behind me 
in the coordination of any public health emergencies.
    Senator Burr. Today, the scope of BARDA is larger than when 
we originally created BARDA as an entity. And there are some 
that would like to expand that even further. And I am not 
asking you to weigh in on the science behind BARDA's decisions, 
but on ways to keep the agency focused on its mission. And how 
would you ensure BARDA remains focused on the serious public 
health threats?
    Ms. O'Connell. BARDA is a unique agency within the 
Administration, and it has stepped up and risen to the 
challenge in this pandemic. Ranking Member Burr, it is the 
partner with DOD and what was called Operation Warp Speed and 
can share in the success of having these three vaccines 
developed and under authorization within 11 months.
    I believe in order for BARDA to continue to strengthen this 
mission, it must do the work that it was intended to do, which 
is to accelerate and ensure that countermeasures that will keep 
us safe from any public health emergency are developed and 
maintained. And I intend to make sure that BARDA is able to do 
that, should I be confirmed.
    Senator Burr. As you said, this is not your first rodeo in 
an administration. You were in the Obama administration under, 
I think, two Secretaries at HHS. And you said you led the 
response during--the response effort during Ebola. Now, you 
weren't ASPR then. The ASPR was actually delegated to 
concentrating on the hospital network in the country for Ebola 
patients that would come back to the U.S. What can you reflect 
to the Committee now, that the ASPR should have been doing at 
that time, and reflect what you will do?
    Ms. O'Connell. Ranking Member Burr, thank you for that 
question. I can't speak to the reasons why the Secretaries 
organize the responses the way they do. But I do intend, should 
I be confirmed as the ASPR, to lead the future of public health 
emergencies and to be the Secretary's principal adviser on 
public health emergencies and response.
    Senator Burr. Right. And Madam Chair, if I could just say 
for all Members, the question of PPE--PPE for the future, and 
the supply chain is probably the biggest issue that this 
Committee will deal with, hopefully in collaboration with the 
ASPR. There is not an easy answer to it because as we have 
learned, there is a difference between capacity and capability.
    When the Federal Government is 4 percent of the PPE 
purchases and 96 percent is outside of the Government, it makes 
it very difficult to set up a supply chain that you can control 
and assure that there is a base to sell to with the global 
competition at ridiculous prices we see today. So it is going 
to be challenging. Thank you.
    The Chair. Yes, it will. At this point, I am going to turn 
the Committee over to Senator Casey. I have to go to another 
Committee. I will be back shortly. And the next two speakers 
will be Senator Smith, Senator Cassidy, and Senator Casey will 
be holding the gavel until I return. Thank you.
    Senator Smith. Thank you so much. Thank you, Madam Chair 
and Ranking Member Burr, and it is really great to be back 
together in the Committee with everyone. And I want to also 
just welcome Ms. O'Connell and Dr. Delphin-Rittmon for your 
willingness to serve our Country at this most important time. 
So thank you so much for being with us today. Dr. Delphin-
Rittmon, I would like to direct my first question to you. And 
this is really about the pediatric mental health crisis that I 
see that we are facing in this country.
    The Star Tribune in my home State of Minnesota recently 
profiled the stories of Minnesota families who are dealing with 
this thing called emergency room boarding, caused by an 
egregious shortage of pediatric inpatient beds where families 
are so concerned about the health and well-being of their 
children that they take them to an emergency room and then 
there they stay because there is no place for them to go. And 
sometimes they are there for days. This kind of boarding, of 
course, is so traumatic and it aggravates symptoms of serious 
mental health conditions.
    It leads moms like Allison Yokum, who was quoted in this 
story, to ask herself, am I a bad mom because I took my son to 
the emergency room. But these are the choices that parents face 
when there is no better alternative, and it is only getting 
worse. Of course, we know, like so many things, this was an 
issue before the pandemic, but the pandemic has made it--has 
exacerbated it. So my question to you is, what can you tell us 
about the risks of this kind of shortage of pediatric inpatient 
beds? And what should we be doing at the Federal level to 
address this issue and to expand access to inpatient health 
care for young people who have a critical need?
    Ms. Delphin-Rittmon. Yes. Senator, I want to thank you for 
that question, and I also appreciate the time that we had a 
couple of weeks ago to speak about these and other issues. You 
know, this is a challenge that we are seeing across the 
country. We know that there is a shortage of child 
psychiatrists, for example, across the country. So certainly 
workforce is an important area to address here. We know that it 
is critical for children to be treated at the appropriate level 
of care.
    Children in emergency Departments for long periods of time, 
that can create experience of trauma onto itself for the 
children, and in some instances for the families as well. So it 
is an area that we really need to come together on and do some 
real creative thinking and innovative thinking around how to 
address this, particularly in terms of workforce, but also in 
terms of how to better meet the needs of children prior to 
their being in crisis and needing an emergency Department. 
HERSA has done a lot of work in this area.
    In fact, they have recently put out a guide related to 
children's mental health that includes information related to 
assessments and triage and working with community providers and 
partners. And so I think that is a real valuable resource that 
is there. Dissemination of resources like that to hospitals I 
think would be extremely helpful. If I am confirmed, I would be 
very interested in meeting with you and working with others 
across Government to further explore this critical issue.
    We know it is important to get children connected to care 
so that they can receive optimal health outcomes as well. But 
thank you for the question and for your work and advocacy in 
this area as well.
    Senator Smith. Thank you so much. I appreciate it. I am 
working with colleagues on a package of policy solutions to 
expand access to mental health care, especially for young 
people. One piece of this is a loan forgiveness. It would 
provide loan forgiveness for providers who are able to practice 
in shortage areas. This is a piece of legislation I am working 
on with Senator Murkowski. Also looking at increasing Federal 
Medicaid reimbursement for behavioral health. The reimbursement 
is often so important. And then third, increasing access to 
school based mental health care. You and I spoke about this. 
This is something I and many of my colleagues have an interest 
in and is a great way of reaching young people before they are 
in a real crisis situation.
    Before I--I am going to run out of time and a minute here, 
I want to just briefly talk with Ms. O'Connell. The pandemic 
exposed our Nation's dependance on countries for the supply of 
our essential prescription drugs. Over 70 percent of 
manufacturers that supply the United States with active 
pharmaceutical ingredients are based overseas. We have a 
serious issue here.
    Senator Cassidy and I are working on bipartisan legislation 
that would incentivize domestic manufacturing of essential 
antibiotic drugs to secure our medical supply chain. In the 
minus 3 seconds I have left, maybe if you could just comment 
very briefly on that need.
    Ms. O'Connell. Senator Smith, thank you so much for your 
question, and I will try to be real quick just to say that I 
commit to working with you and Senator Cassidy on this bill. I 
do think this past year and a half has exposed some cracks in 
our medical and public health supply chains. And I look forward 
to trying to solve for that and incentivize more domestic 
manufacturing.
    Senator Smith. Thank you so much.
    Senator Casey. Thank you, Senator Smith.
    Senator Cassidy.
    Senator Cassidy. Hey. Hello. Thank you both. I appreciate 
the call that both of you gave. And Dr. Delphin-Rittmon, thank 
you for your husband's service. So, thank you both. Ms. 
O'Connell, let me start with you, please. And this will be 
something we spoke about on the phone but I still think it is 
worthwhile to publicly speak about. The--speaking of ASPR, and 
how they kind of show got shoved to the back seat in this last 
response to the pandemic, my appropriations guys, just kind 
of--just kind of pointing things out.
    They don't know how to dispense billions of dollars, HHS in 
general and ASPR in particular. Inevitably, this is going to 
fall to FEMA because FEMA knows how to dispense billions of 
dollars. Unfortunately, FEMA doesn't have medical staff and so 
it is going to be not as efficient as if they did. And that was 
just as amusing when it started. And it turns out it was 
absolutely true. So it is kind of a structural problem, if you 
will.
    How would you address that structural problem without 
creating a gazillion other people who are working from home 
during a pandemic?
    Ms. O'Connell. Senator Cassidy, thank you so much for that 
question and thank you so much for the good conversation we 
had. And I enjoyed speaking about this particular issue. And if 
I am confirmed, it is one I have been reflecting on because we 
currently have, as I mentioned to Ranking Member Burr, BARDA is 
the partner with DOD right now in what was the operation--
Operation Warp Speed. And what DOD has brought into the 
Department is extraordinary capacity when it comes to 
logistics, acquisitions, and contracting. And one of the first 
things I will be faced with, if confirmed, is figuring out how 
much of that capacity should be brought into the Department. 
And I don't----
    Senator Cassidy. Now, it does seem to be a duplication of 
effort because it isn't often that this is required, let's hope 
never again, so we don't want people just kind of twiddling 
thumbs, waiting for the next pandemic. Do you see where I am 
going with that?
    Ms. O'Connell. Absolutely. Any capacity that we add to the 
Department would have to be right sized and fit for purpose. 
Also have a peacetime use as well as a pandemic or emergency 
use. So I agree with you on that. But it is something that I 
think the Department is having to face and think about. And I, 
appreciated your question about that.
    Senator Cassidy. Dr. Delphin-Rittmon, thank you again for 
calling, and for speaking. And obviously, one of the criticisms 
is what happened at the Whiting facility, if I am pronouncing 
that correctly, or Whiting facility in Connecticut when you 
were the Director overall. And so I just thought I would give 
you a chance publicly to speak to that, because if I am asked, 
I can refer to your public statement.
    Ms. Delphin-Rittmon. Yes. Thank you again, Senator, for our 
conversation and for that question. The patient abuse that 
happened at Whiting was a tragedy and should never have 
happened. I take patient abuse very seriously. And so 
immediately working with my team called in the state police 
because I wanted an outside investigation in addition to our 
H.R. investigation. Ultimately, 37 staff were separated from 
state service and 10 staff----
    Senator Cassidy. Can I interrupt you for a second, because 
what seems critical here is, at what level were you relative to 
the facility? Do you follow what I am saying? Because if you 
are the head of a whole Department, but there is four layers 
between, that is one thing. But if you are like in the office 
at the Whiting facility, that is the other thing. So could you 
elaborate on that, please?
    Ms. Delphin-Rittmon. Yes, I appreciate that question. So as 
Commissioner, I have a number of state hospitals, the two state 
hospitals that I oversee. Whiting Forensic Hospital is one of 
those hospitals. At the time, it was combined with Connecticut 
Valley Hospital, but now it is a hospital unto itself. That was 
part of the system change we put in place. So there is myself 
as Commissioner. There was a CEO of the hospital. There was 
medical Director, a full leadership team of the hospital. And 
that was one hospital that I oversaw as part of the whole 
Connecticut system of care.
    Senator Cassidy. I am sorry I interrupted your answer. So 
continue, please.
    Ms. Delphin-Rittmon. Yes. So, of course, the first step was 
ensure the safety and security of the patients there at the 
hospital. Then also called in the state police, wanted an 
immediate outside investigation. Ultimately, again, 37 staff 
were separated from state service, 10 were tried and convicted 
related to the abuse. Worked with the state legislature around 
having a law said that if people fail to report abuse or 
neglect, that is a crime.
    Really worked on a specific system changes related to that. 
Also worked on enhancing our security and camera systems 
throughout the hospital. Brought in a consultant and reviewed 
policies, procedures, and implemented other significant system 
changes within the hospital. This work is ongoing. Ongoing in 
terms of ensuring the staff have the appropriate training, that 
they are aware of the policies related to reporting, and so it 
has been an ongoing area of work. But ultimately, my aim is to 
provide quality care to ensure the safety and security of the 
individuals that we serve and to help people move into 
recovery.
    Senator Cassidy. If I may summarize, you are not directly 
responsible, but you ultimately were, but still you were above 
and you got a leadership team between you and these incidences, 
and that subsequent to this, the corrective measures have been 
taken as well as the punitive for those who were concerned, 
correct?
    Ms. Delphin-Rittmon. That is correct, Senator. Yes.
    Senator Cassidy. There is many other things to speak about, 
but I will defer to my colleagues on the--I know Chris Murphy 
and I have worked so closely on many of these issues, too. So I 
will defer to them on those other issues. But thank you both 
for your answers.
    Ms. Delphin-Rittmon. Thank you, Senator.
    Senator Casey. Thank you, Senator Cassidy.
    Senator Lujan.
    Senator Lujan. Thank you so much. Dr. Delphin-Rittmon, 
given the spike in opioid deaths last year, I very much 
appreciate that the Biden administration is devoting 
significant resources into addressing the substance use 
disorder crisis. In New Mexico, drug overdoses increased by 25 
percent in 2020, fueled largely by the increase of the deadly 
synthetic opioid fentanyl. The recently released budget calls 
for a 63 percent increase in funding for SAMHSA, $3.7 billion 
increase over last year. Should you be confirmed, how do you 
plan on utilizing those resources to ensure that Americans have 
access to the treatments that can help curb those tragic 
overdoses?
    Ms. Delphin-Rittmon. Thank you for that question, Senator. 
And for your advocacy on this issue. I also appreciated the 
conversation that we had a couple of weeks ago. I appreciated 
learning about your priorities in areas that we can collaborate 
on, should I be confirmed. These resources are critical.
    I can say as a state commissioner, have so appreciated the 
Federal resources and commend Congress there. Should I be 
confirmed, it will be critical that SAMHSA continue to support 
states in funding prevention, and treatment, recovery, harm 
reduction, that we work across also Federal agencies and 
partners to ensure that our opioid response strategies are 
strong, that they are meeting people where they are, that they 
are helping people move into long term recovery.
    You mentioned fentanyl. We know fentanyl is frequently 
present in many of the overdoses. We see that in Connecticut 
quite a bit. Thankfully, now SAMHSA states can use Federal 
funds to purchase fentanyl test strips. That is a significant 
change and will be of real value to states in terms of harm 
reduction.
    Certainly all of those areas, should I be confirmed, would 
look forward to continuing to advance and would look forward to 
meeting with you, Senator, as well, to learn more about your 
needs and interests in this area as well.
    Senator Lujan. Well, I look forward to more conversations, 
especially learning about the kinds of initiatives that you 
launched in Connecticut that you believe can be launched across 
America to help people. Now, during COVID, we also have seen an 
increase in not just opioid use, but rightfully so that has 
been well documented. However, we have also seen an increase in 
alcohol use disorder as well.
    Although not generated nearly the headlines, alcohol use 
disorder is far more prevalent than other forms of SUDs. We are 
going to need to do a better job of screening and identifying 
those with alcohol use disorders so we can get them the 
treatments that they greatly need. Between the President's 
proposed budget, COVID relief, and the recently passed American 
Rescue Plan, how would you utilize the investment in SAMHSA to 
help the estimated 15 million Americans suffering from alcohol 
dependance?
    Ms. Delphin-Rittmon. Yes, I appreciate that question, 
Senator. We know that Americans across the country are 
struggling with alcohol use disorder. Certainly see that in 
Connecticut as well. When we met, I spoke about the recovery 
coach in our emergency Department initiative. Our recovery 
coaches connect with individuals who are brought to the 
emergency Departments as a function of acute alcohol 
intoxication, in many instances more than individuals who are 
brought there as a function of opioids. So we know that this is 
an area that is critical that we focus on.
    If confirmed, I would be interested in working certainly 
within SAMHSA around continuing to scale up and put in place 
strategies to address opioid use disorder, and also be 
interested in working with you to learn more about what you are 
seeing and what the challenges and needs are within your state. 
But definitely this is an area that we need to address. We know 
Americans across the country are struggling with alcohol use 
disorder as well as opioids and other substances. So appreciate 
that question, Senator.
    Senator Lujan. Thank you. Ms. O'Connell, Project Echo, 
which we had a chance to visit about, is an innovative 
telementary model headquartered at the University of New Mexico 
and was once championed by my late father when he was a member 
of the state legislature led by Dr. Sanjiv Aurora. On the 116th 
Congress, I was proud to work with my colleagues in the House 
and in the Senate to pass the Echo Act of 2019. How will ASPR 
continue to utilize telehealth and programs like Project Echo 
to create peer to peer learning networks to enhance 
preparedness in the future?
    Ms. O'Connell. Senator Lujan, thank you so much for that 
question. And I enjoyed the opportunity to have this 
conversation about Project Echo when we spoke a few weeks ago. 
I think telehealth has been one of the successes that's come 
out of the pandemic. The pandemic, of course, has stressed the 
American society in so many ways.
    But our ability to use telehealth and reach people to train 
doctors and nurses, to be able to treat people and harder to 
reach places, I think is going to be one of the legacies, 
excuse me, of the pandemic that we take with us, and we will be 
able to use in ASPR moving forward when we are working with 
rural and hard to reach communities. So thank you and thank you 
to your father for his support of that initiative.
    Senator Lujan. Thank you. And I yield back.
    The Chair. Thank you.
    Senator Braun.
    Senator Braun. Thank you, Madam Chair. My questions are for 
Dr. Delphin-Rittmon. Last Congress, Senator Markey and I 
introduced two pieces of legislation. One called the label 
Opioids Act, requires prescription opioids to contain a warning 
label specifying that opioids may cause dependance, addiction, 
and overdose. The Safer Prescribing of Controlled Substances 
Act would enforce new training regimens upon practitioners that 
would incorporate best practices on how to prescribe the pain 
medications.
    HHS would prescribe these requirements in both of these 
acts. I think my question would be in taking legislation like 
that, and how do you view getting coordination between agencies 
so that even if ideas like this don't get incorporated in the 
law, that we do a better job of using the tools that we can 
administratively to do common sense things like proper labeling 
and practices that you would want practitioners to use in a 
kind of an elusive area that we have had marginal results with.
    Ms. Delphin-Rittmon. Yes, thank you for that question, 
Senator, and for your work and advocacy in this really critical 
area. We know that looking at prescribing practices is one 
really key strategy for helping to address the overdose and 
addiction rates that we are seeing, substance use rates that we 
were seeing. And so I appreciate your work there. Should I be 
confirmed, you mentioned the piece around collaboration. As a 
clinical community psychologist, I love working from that 
space, bringing groups together that are connected to or that 
touch an issue to think creatively around how we can come up 
with strategies that make a difference.
    I would welcome that opportunity within HHS. There is an 
internal HHS Behavioral Health Coordinating Council. That is 
certainly one space where some of this work could be done, but 
also would look forward to bringing together states. As a 
Commissioner, I so appreciated the times when SAMHSA brought 
the Commissioners together to have conversations. And we often 
say that we love sort of bootlegging from each other, and we 
love sort of taking the best practices that we hear working in 
different states. And so I think there are opportunities, 
should I be confirmed, to bring states together on a regular 
basis for that state to state learning in conversation.
    But I appreciate, again, your work in this area, should I 
be confirmed. Would look forward to having follow-up 
conversations, and do believe that the collaboration across 
Federal agencies, states, as well as community partners is 
critical here for addressing this challenge.
    Senator Braun. I think in addition to alerting 
practitioners and patients of all the pitfalls of using 
opioids, that there needs to be some emphasis on other 
methodology, other ways of trying to address chronic pain. Now, 
where you at on trying to be a voice for alternatives in 
addition to trying to do a better job with what we do with 
opioids, in other words, new ideas?
    Ms. Delphin-Rittmon. Yes, thank you for that, Senator. So I 
am a full believer in the value of using really all that will 
work. This is such a challenge in terms of the overdose rates 
we are seeing across the country. I think it is critical that 
we marshal all tools or resources we know that can make a 
difference. There is a vast amount of literature on alternative 
strategies for managing pain. It doesn't always have to be a 
pill. For some individuals, meditation or reiki or acupuncture 
can make a difference in terms of pain management.
    I think it is critical to look at some of those evidence 
based practices as well and offer them to individuals to the 
extent that it fits with their treatment spectrum. But I 
appreciate that question. It is something in Connecticut that 
we have put in place. Auricular acupuncture has been shown to 
help with cravings.
    It is an emerging evidence based practice, and so should I 
be confirmed, would look forward to exploring other strategies, 
really, for addressing pain management. So, thank you for that 
question.
    Senator Braun. I think that is important in terms of 
alternative methods and then maybe also for pharma to be 
looking at ways that they need to invest in pain management 
that doesn't rely on so much emphasis on opioids. So thank you 
so much.
    Ms. Delphin-Rittmon. You are welcome.
    The Chair. Thank you.
    Senator Baldwin.
    Senator Baldwin. Thank you, Madam Chair. For Ms. O'Connell, 
I appreciated the chance to speak with you a few weeks back. 
And one of the things we talked about was our domestic 
manufacturing capabilities here. I have long been a champion of 
buy America policies and domestic manufacturing. And part of 
the reason I became first interested in that was during my time 
in the House of Representatives, we would have hearings on the 
seasonal influenza vaccine, etcetera, and I became very 
concerned that we didn't have any, in some cases, or enough 
companies producing these vaccines here at home.
    I think that presently we have seen very clearly that we 
don't have enough companies making medical countermeasure and 
devices, etcetera, here in America. It has been an erosion over 
time, but it has left us really unprepared to respond to 
pandemics, including the one that we are emerging from. Now, 
the Pentagon is in charge of monitoring the defense industrial 
base. But I think we need somebody charged with monitoring the 
public health industrial base to monitor the domestic sources 
of drugs, of raw materials, medical devices, personal 
protective equipment, and other critical products that we have 
seen in short supply during this pandemic and monitoring the 
capacity available to make these products in a crisis.
    Do you think that Health and Human Services, including 
ASPR, should take a more active role in both monitoring the 
public health industrial base and actively addressing current 
domestic manufacturing constraints through improvements to long 
term contracting and purchasing commitments and additional 
transparency?
    Ms. O'Connell. Senator Baldwin, thank you so much for that 
question and thank you for the good conversation we had a few 
weeks ago. I think you are right on, HHS should be charged with 
monitoring and maintaining a resilient and secure medical and 
public health supply chain. And the ASPR, the Acting ASPR right 
now has been leading an interagency effort with the supply 
chain coordinator at the White House, part of the COVID 
response, to oversee this work. What we saw last year was 
unprecedented.
    We saw the global community all needing the same components 
at the same time, and it was unprecedented, but it was also a 
warning that we have been too reliant on international sources 
for some of these components. I think if I am confirmed, a lot 
of the work that I will do ahead will be to take on what the 
Acting ASPR has been doing, and to make sure that we have a 
secure and resilient public health emergency and medical supply 
chain. The ASPR currently has something called the watchtower, 
where they are watching and monitoring all of the medical 
supplies to understand what the push and pulls are.
    That is something that came up, I believe, under Dr. 
Kadlec's leadership in the last year, and it is something, 
should I be confirmed, as ASPR would expect will be a critical 
part of the work that I undertake to secure the medical supply 
chain.
    Senator Baldwin. Thank you. In the previous administration, 
there was very little transparency when it came to 
understanding how decisions were being made with regard to 
combating COVID-19. And I think the lack of critical 
information impacted our ability to respond. And going forward, 
I think we must work to ensure that members of the public and 
certainly Members of Congress have accurate and necessary 
information when it comes to both our preparedness needs and 
our response to future crises.
    We must ensure that we make responsible investments and 
that those are informed by science and public health and not 
special interests. And so how will you work to improve 
transparency when it comes to ASPR's work and spending? And 
will you commit to combating the power of special interests at 
the agency?
    Ms. O'Connell. Senator, thank you for this question. I 
think one of the major lessons learned over the last year and a 
half is how critical open and transparent communication is. And 
when the information changes, how important it is to let the 
American public know what we are now learning has changed.
    If I am confirmed as the ASPR, I commit to open and 
transparent dialog with this Committee, with other Members of 
Congress that are interested in the work that ASPR is doing, 
with the constituencies and stakeholders that are invested to 
make sure that I am held accountable for the work that I am 
doing and that it is fitting in to the priorities that Congress 
has set out for ASPR, and that the American public expects from 
ASPR.
    Senator Baldwin. Thank you.
    The Chair. Thank you.
    Senator Collins.
    Senator Collins. Thank you. Dr. Delphin-Rittmon, yesterday 
we had a good conversation about our shared concern that the 
country is going in the wrong direction with respect to overall 
drug use and overdose fatalities. It is said very plainly in a 
newspaper headline from Maine, Maine's overdose deaths set a 
new record in 2020, and 2021 started out even worse. Maine saw 
a 32 percent increase in overdose deaths in 2020 and actually 
more people died from overdose deaths than died from COVID.
    This trend, unfortunately, is true nationally as well. 
COVID certainly played a role and was a setback. It caused the 
increased isolation, new stresses, challenges in accessing 
prevention and treatment services. It impeded recovery 
supports, like peer support programs, which I know both you and 
I believe can be highly effective. But the fact remains, we had 
502 people die in 2020 of drug overdoses and that far surpassed 
the previous high in 2017, which we thought at the time was the 
height of the epidemic.
    The subsequent years started edging down and then we had 
this large increase. What specifically do you think we should 
be doing to counter drug overdoses?
    Ms. Delphin-Rittmon. Thank you for that question, Senator, 
and for the conversation that we had yesterday. And my 
condolences to the people of your state. It is--the overdose 
deaths are hard. They have ripple effects across communities 
and families and individuals. And so this is a challenge that 
as a country, we have been grappling with it and we really need 
to continue to grapple with it. I think we can take what we 
have learned and what we have seen up to this point that makes 
a difference. When we look at data across the country, we see 
that fentanyl is one thing that is driving many of the overdose 
deaths.
    We know now that Federal resources can be used to test 
substances for fentanyl. That could make a significant 
difference. If individuals are aware that there is fentanyl in 
the substances, that could help to bring overdose deaths down. 
It is a harm reduction strategy. And so in addition to, giving 
people a fentanyl test strip, there is an opportunity to let 
them know about services and supports. And often when people in 
recovery are running the harm reduction centers are a part of 
that work, there is also an opportunity for people in recovery 
to give individuals hope and to let them know that they can 
make it to the other side of their addiction. And so we have 
seen that make a difference in Connecticut.
    I think fentanyl test strips can make a difference. As we 
have talked, I think recovery coaches and emergency Departments 
can make a difference. We just finished an analysis in 
Connecticut that shows that--so we looked at data. It shows 
that individuals who have a recovery coach within this 3 year 
period that we are looking at where 2.6 times less likely to 
die by the end of the study. So recovery coaches can help 
connect people to services and supports. And that is what we 
found in this study. It was an invited evaluation that SAMHSA 
asked us to do based on this initiative.
    We now currently have recovery coaches in 25 emergency 
Departments across the state. We also know medication assisted 
treatment makes a difference. It is one strategy that is an 
evidence based practice that can help people move into long 
term recovery. One thing that we have implemented in 
Connecticut is mobile medication as a treatment. People aren't 
always going to come in to services and supports, but we can 
bring services and support to community members, particularly 
if we use data and take a data approach to have the mobile 
medication assisted treatment vans go to where hotspots are and 
go to where we know vulnerable populations are.
    I think there are things we can do looking at what we have 
done up to this point that makes a difference. And should I be 
confirmed, will be happy to have conversations with you about 
this and about what you are seeing in Maine. So thank you.
    Senator Collins. Thank you. Ms. O'Connell, last month, HHS 
devoted more than $2 billion meant for other health initiatives 
toward covering the cost of caring for unaccompanied immigrant 
children, migrant children on the Southern border. The 
redirected funds that included $850 million that Congress 
originally allocated to rebuilding the Nation's strategic 
national stockpile. Well, another $850 million is being taken 
from money that was set aside to expand COVID testing. Out of 
all the programs that could possibly be chosen to reprogram 
funds, why was the SNS chosen, and what is the plan to make 
sure it is not shortchanged?
    Ms. O'Connell. Senator Collins, thank you so much for that 
question. When the American Rescue Plan was being negotiated, 
the Department became aware of how expensive it was going to be 
to care for the increasing number of minors at the border in 
times of COVID. COVID required that these minors be separated 
so the shelters had to be larger, less full, the minors had to 
be tested. There were just significant costs that came along 
with caring for the unaccompanied minors in a pandemic.
    At that time, the Department worked with Congress to have 
$850 million appropriated to support that work. And it was in 
that bucket that you are referring to that money was added. And 
so my understanding after talking to our budget team is that it 
was a zero sum, that money, the $850 million was put in for 
that purpose and has been used for that purpose and that the 
stockpile has not been impacted.
    Senator Collins. I will say that is not my understanding. 
Thank you.
    The Chair. Thank you.
    Senator Casey.
    Senator Casey. Thanks, Chair Murray. I want to thank our 
witnesses for your commitment to public service and your 
commitment to excellence, as well as you do that service and 
obviously the commitment of your families to that service that 
you have engaged in. I want to start with Ms. O'Connell. Both 
in reference to the pandemic all hazards legislation over time, 
as well as a bill that I have introduced, the so-called Ready 
Act, it is a Real Emergency Access for Aging and Disability 
Inclusion for Disasters Act, a long name that needs an acronym, 
the Ready Act. I have prioritized, including both people with 
disabilities and older adults in all phases of the disaster 
process, both preparation and response, as well as recovery and 
mitigation.
    When I outlined that, I don't mean simply having older 
adults and people with disabilities give public comments or be 
advisory board members. I mean, be on the panels and on the 
Committees that decide how best to prepare for disasters and 
be--really be part of the process of responding and deciding on 
what mitigation should look like. So I am looking for true 
engaged participation in all of these processes of protecting 
Americans and responding to their needs. So I ask for your 
commitment regarding these Americans.
    Again, I am talking about people with disabilities and 
older adults. Ensuring that these Americans are represented and 
have a strong voice in all phases of emergency and disaster 
processes, and I ask you to commit to report back to the 
Committee how you are including these Americans in the work 
that the ASPR does.
    Ms. O'Connell. Senator Casey, thank you so much for that 
question. I appreciated the conversation we had a few weeks ago 
where we were able to touch on some of these important issues. 
And I want to thank you for your long time leadership 
representing and supporting these vulnerable populations. These 
vulnerable populations are often overlooked in planning and 
preparedness exercises. And should I be confirmed as ASPR, you 
have my commitment that I will not overlook these populations 
and will work to ensure that they have the tools they need in 
any public health emergency.
    Senator Casey. Look forward to having some feedback after 
your confirmation. Dr. Delphin-Rittmon, I wanted to ask you 
about children's mental health, in particular as we consider 
where we are after, or we hope, coming out of the pandemic. 
Even before the pandemic, we were facing both a behavioral and 
mental health crisis, particularly for children and for 
teenagers. The pandemic obviously has amplified this need with 
both rising numbers of patients and increased severity of 
symptoms that require more substantial treatment resources.
    At the same time, we have urgent workforce shortages. In 
Pennsylvania, pediatric health care providers report that 
children are waiting sometimes not just weeks, but even months 
to get the mental health care services they need, which, of 
course, puts them at risk for worsening illness and suicide. If 
confirmed, how would you use SAMHSA's authorities to work with 
Federal and state, as well as local partners to strengthen the 
pediatric, mental, and behavioral health workforce, to meet the 
needs of children and teens experiencing mental health issues?
    Ms. Delphin-Rittmon. Thank you for that--thank you for that 
question, Senator. We know that this is such a critical area 
right now in terms of the workforce shortages we are seeing 
across the country within children's mental health, but really 
across the board. In terms of children's mental health, we are 
seeing a shortage of psychiatrists and other behavioral health 
workers who are trained to be able to work with children. I 
think SAMHSA can play a real role here, collaborating with 
other Federal partners that are working on this area.
    HERSA does quite a bit related to workforce development, 
and I think there are opportunities to collaborate with HERSA 
and other Federal partners. We know that loan repayment 
programs or fellowship programs do make a difference in terms 
of bringing providers into a field. They are real valuable 
incentives. And, I am a testament to that being a fellow of the 
minority fellowship program. So certainly that is one area that 
we could look at to begin to grow and expand the workforce. 
Other things like telehealth though. I think to address the 
immediate needs that we are seeing in terms of shortages, 
particularly in rural areas, telehealth can play a real value 
in terms of connecting kids and families to services and 
supports where providers may not physically be.
    I think there are opportunities there. But should I be 
confirmed, would look forward to working across the range of 
diverse partners that touch this issue. Community providers 
touch it, states touch it. There is quite a bit of innovation 
happening at the state level. And so as a Commissioner, again, 
I think one thing SAMHSA can do is bring together states from 
state to state learning around best practices.
    I think that is certainly a key strategy. But appreciate 
the question, Senator. And should I be confirmed, I would look 
forward to following up with you on this as well to hear about 
some of your ideas.
    Senator Cassidy. Thank you, doctor. Thanks, Chair Murray.
    The Chair. Thank you.
    Senator Hassan.
    Senator Hassan. Well, thank you, Chair Murray and Ranking 
Member Burr. Thank you to our nominees for being here today, 
both of you, and for your families, for your willingness to 
serve. I want to start with a couple of questions to you, Dr. 
Delphin-Rittmon, and I appreciated our conversation just 
yesterday. As the opioid epidemic has devastated communities 
and families across the country. You just spoke to that 
eloquently a few minutes ago. Since 2017, I have worked with my 
colleagues to secure funding for state opioid response grants, 
including more than $86 million for New Hampshire. This funding 
has enabled states to expand access to lifesaving treatment and 
services for those struggling with substance use disorder. But 
I am concerned that hard won progress may be in jeopardy.
    As we discussed yesterday, some of the hardest hit states, 
including New Hampshire, are at risk of a dramatic cut in state 
opioid response grant levels under the program's current 
funding formula. So, doctor, from your experience as 
Commissioner of the Connecticut Department of Mental Health and 
Addiction Services, can you speak to the importance of 
reliable, robust funding for mental health and substance use 
disorders services for states?
    Ms. Delphin-Rittmon. Yes, thank you for that question, 
Senator, and for our conversation yesterday. I appreciated 
hearing about your priorities and what you are seeing within 
New Hampshire. We are neighbors, so what happens in New 
Hampshire impacts the region. What happens in Connecticut 
impacts, New Hampshire? So, the reliable funding is critical. 
It is important to be able to keep programs going in a stable 
way to ensure that the programs are available for individuals 
that are relying on them. We routinely have internal 
discussions around sustainability and how to think about 
continuing programs. So the reliable continuity of funding is a 
critical issue related to maintaining robust service systems.
    Senator Hassan. Well, thank you. If confirmed, will you 
commit to ensuring that the funding formula for state opioid 
response grants does not cause States like New Hampshire to 
experience dramatic funding cliff?
    Ms. Delphin-Rittmon. Yes. No, I appreciate that question, 
Senator, and your advocacy, your fierce advocacy for the people 
of New Hampshire and across the country. If I am confirmed--
again because we, we are seeing the rates continue to rise, and 
if I am confirmed, I commit to doing all that we can to address 
the overdose rates that we are seeing across the country, to 
include ensuring that, states receive resources that they need 
to be able to address the crisis.
    Senator Hassan. Right. And I understand that you are a 
nominee, and it is a little bit difficult when you are not yet 
part of an administration to make a commitment. But I am asking 
for a specific commitment here for a reason. I have asked the 
same question of the HHS Secretary, the Deputy Secretary, and 
others during their confirmation processes. They tell me that 
they are not--at that point, they told me they weren't yet part 
of the Administration, but now they have been confirmed and the 
Department is still not committing to fixing this problem.
    Is it your understanding that SAMHSA has the authority to 
make adjustments to the state opioid response grant program, 
for example, increasing the number of hardest hit states beyond 
10? Do you understand that you have--that SAMHSA has the 
authority to do that?
    Ms. Delphin-Rittmon. Senator, I am not at SAMHSA yet. And 
certainly one of my priorities is expanding access to mental 
health and substance use services. The funding component of 
addressing the crisis is quite critical. Should I be confirmed, 
this certainly is one of the areas that I would be interested 
in looking at. And it would be critical to look at to get a 
better understanding of the funding processes.
    Senator Hassan. Well, we will follow-up with you on this, 
because this is an issue about the Department and your 
understanding of SAMHSA's authority. Will you work to ensure 
transparency and collaboration between congressional offices 
and SAMHSA on this and other issues related to funding 
formulas?
    Ms. Delphin-Rittmon. Absolutely, Senator. I love working 
from that space and would ensure transparency, collaboration, 
ongoing discussions as necessary to further unpack and address 
this issue.
    Senator Hassan. Okay, I am going to follow-up with 
questions on the record on this topic before your markup to get 
more precision and clarity about the path forward. Because what 
I want to stress here today is that simply shifting grant 
funding from state to state as data shifts and as a substance 
use disorder crisis worsens just isn't a viable long term 
solution. We are going to play whack a mole. One state is going 
to bump into the top 10 so we are going to shift funding there. 
Other states, the crisis will worsen, we will shift funding 
back. That doesn't help us get to where we need to be, which is 
to combat the substance use disorder as the epidemic and health 
care crisis that it is.


    [The following information was not submitted for the Record.]
I am really looking forward to working with the Administration 
on this, but I am also looking for commitments from the 
Administration. I also just wanted to briefly touch on the X-
Waiver. One of the limits that we have in accessing substance 
use disorders treatment is the existence of this so-called X-
Waiver. Doctors can prescribe an opioid without getting special 
permission, but they can't prescribe medication, assisted 
treatment without getting this waiver.
    Senator Murkowski and I have a bill to eliminate that 
waiver. Will you commit to working to expand access to 
medication assisted treatment by supporting efforts that 
Senator Murkowski and I are undertaking to eliminate the X-
Waiver?
    Ms. Delphin-Rittmon. Yes, I appreciate that question, 
Senator. And so we know medications as a treatment, as I 
mentioned, it absolutely helps people move into long term 
recovery. As one of my priorities around expanding access to 
substance abuse and mental health services, that includes 
expanding access to medication assisted treatment. So I can 
commit to certainly meeting with you and to working to expand 
access across the country.
    Senator Hassan. Okay, thank you. It is going to be critical 
to getting existing doctors able to provide this treatment. 
Thank you. Thank you, Madam Chair.
    The Chair. Thank you.
    Senator Marshall.
    Senator Marshall [continuing]. Figure out which mic is 
better for me to use. Thank you so much. My first question is 
for Ms. O'Connell. Ms. O'Connell, dealing with antibiotic 
resistant bacteria continues to be a challenge. And here is the 
challenge. You don't need to use these antibiotics very often, 
but when you need to, you really need them. If a patient is 
sitting there dying in the ICU because of a bacteria that is 
resistant to antibiotics, we need a special laser to go in 
there and treat the problem.
    Anyway, most of the pharmaceutical companies are not 
developing them because it is not profitable. They don't get 
used very often, but yet we need them, right. So I hope you are 
little bit familiar with the challenge there. There is just not 
a good return on investment. There is 43 antibiotics in 
development right now.
    My question for you is, how can we work together to ensure 
that BARDA provides the private sector and the necessary 
resources to strengthen antibiotic research and development?
    Ms. O'Connell. Senator, thank you so much for your 
question. And I really appreciated the opportunity to speak 
with you a few weeks ago. Antibiotic resistance is a 
significant issue. When I was Deputy Chief of Staff in the 
Obama administration, one of the jobs that I was responsible 
for was implementing President Obama's antimicrobial resistance 
agenda across the interagency, it was called CARB, Combating 
Antibiotic Resistant Bacteria.
    As part of that initiative, BARDA took on something called 
Carb-X, which was a private, public partnership to accelerate 
the development of antibiotics and to try to get pharmaceutical 
companies willing to begin looking at new antibiotics. Since I 
have been back and working solely on COVID, I am not sure where 
we are with the Carb-X initiative. But Senator, I commit to 
you, if I am confirmed as ASPR, that is one of the first things 
I will do and look forward to working with you and reporting 
back on where that progress is.
    Senator Marshall. That is great. If there is anything we 
can do to put wind beneath your sails, if you are confirmed, 
please reach out to us. It is an issue near and dear to my 
heart. My next question for Dr. Delphin-Rittmon, if you don't 
mind, I want to talk about certified community behavioral 
health clinics for a second. And one of the biggest challenges 
I see in our hospitals is dealing with mentally ill, having a 
mental crisis in an emergency room. And this has been a problem 
going back to when I was in medical school.
    This typical situation is, we admit a patient in the 
emergency room that is a danger to themselves and others. And 
really, there is just no good discharge plan so that patients 
sits there for 24, 48 hours at a time. We have a special room 
for that person. We have to put a nurse one on one. Our 
sheriff's officers or police officers have to provide an 
officer, one on one to take care of that situation. And they 
are just, certainly at the state level, we need more 
opportunities.
    But we did a consolidated appropriations grant in December. 
We authorized millions of dollars to certify community 
behavioral health clinics. Our sheriff's officers feel like 
they are being left out of the loop on how to use those moneys 
and what the solution looks like. And I am not sure if you are 
familiar with that grant, but I sure hope that we include law 
enforcement, that these community behavioral health clinics 
reach out to the law enforcement and to the nurses and the 
hospitals. It needs to be a team effort.
    I can tell you story after story of, a person that the 
sheriff's office thought was headed to the mental health 
center. They were discharged later without notifying the 
sheriff's officers and a murder resulted. And unfortunately, 
this happens too often and any light you can shed and 
commitment to this issue.
    Ms. Delphin-Rittmon. Yes. Thank you for that question, 
Senator. And I appreciate our discussion several weeks ago as 
well. This is a critical issue. And I do have to say that 
CCBHCs, so the certified community behavioral health centers, 
we so appreciate those resources in Connecticut. We have 
several that have been stood up across the state. It is a real 
opportunity to provide integrated care, to get people connected 
to both primary care, but also behavioral health services and 
supports.
    Certainly, it is an opportunity also to connect with other 
community providers, as you mentioned, to include police 
officers. And so I think that is a valuable component of that 
framework. I think a role SAMHSA can play there with the 
CCBHCs, but also with the enhanced crisis services and supports 
through the 988 implementation--I think there is a real 
opportunity to bring in police Departments and officers there 
as well as part of the crisis continuum response.
    Certainly, if I am confirmed, would be--look forward to 
working with you and others there. But this is a real critical 
area in terms of getting people connected to the needed 
services. And the role that community, policing your community 
officers can play as it relates to connecting people with 
mental health services and supports.
    Senator Marshall. Well, great. If we have the opportunity 
to get some of the pieces of the puzzle together, our office or 
someone from your staff, we would love to talk too. And thank 
you so much, Madam Chair. I yield back.
    The Chair. Thank you.
    Senator Murphy.
    Senator Murphy. Thank you very much, Madam Chair. Thank you 
both for your service and your continued willingness to serve. 
Commissioner, I am very sorry that I was not here at the outset 
of the meeting to introduce you, but I know that Senator 
Blumenthal did a more than adequate job. I just wanted to spend 
1 minute at the beginning of my few moments of remarks to just 
commend Commissioner Delphin-Rittmon to the Committee. She and 
I have known each other. We have worked very closely together.
    I got the chance to chair the Health Committee when I was 
in the state legislature, and the Mental Health Reform Act that 
Senator Cassidy referenced passed in late 2016, was a product 
of the work of this Committee, the collaboration of Senator 
Cassidy and myself, but also the result of I don't know how 
many meetings that the Commissioner and I did together in 
Connecticut, developing ideas for the legislation and seeking 
input from a cross-section of consumers, patients, and 
providers, and advocates in Connecticut.
    I am deeply grateful to her for how much work she put in to 
trying to help us develop sound Federal policy. And some of the 
work she has pioneered in Connecticut, we have lifted and 
brought to the whole country. For instance, Connecticut modeled 
a program whereby we put recovery coaches inside emergency 
rooms. These are, folks who have had lived experience often 
with recovering from substance abuse.
    We have them anchored in our emergency rooms. And so when 
someone presents often with an overdose, the minute that they 
interact with a provider, they are also interacting with 
someone who has gone through the same experience they have. And 
that recovery coach funded by the Department of Mental Health 
and Education Services in Connecticut stays with them after 
they leave. And that early interaction, we have found, has made 
a very big difference.
    We now have a Federal grant program that will allow for 
other states to copy Connecticut's model. So I am deeply 
appreciative of the work that she has done to pioneer some 
pretty innovative programing that we now are being able to 
disperse nationwide. So I am very, very, very glad to have you 
on the precipice of this incredibly important role. Have 
enjoyed our time working together in Connecticut. I just have 
sort of one question for you, Commissioner. In the Mental 
Health Reform Act of 2016, we elevated the role of SAMHSA 
Director to an Assistant Secretary position. We thought that 
was really important because there are so many conversations 
that happen at the leadership level in HHS that SAMHSA needs to 
be at the table on.
    I will give you two examples and maybe ask you to just 
comment on how you might be able to sort of move forward the 
conversation in two regards. First is on the issue of physical 
and behavioral health integration, something you have spent a 
lot of time working on in Connecticut. For instance, we have 
tried to get more mental health services into our community, 
federally qualified community health care clinics.
    I would love to see there be a more aggressive conversation 
Department wide on making sure that we are providing grants to 
states that incentivize mental health and physical health 
services coming together. Second is the issue of parity. Again, 
a conversation that happens at HHS but also has intersections 
at DOL because they regulate a lot of these insurance plans. 
Senator Cassidy and I introduced legislation, I think, just 
yesterday that continues to build upon our efforts to enforce 
existing Federal parity laws, meaning you cover mental health 
just like you cover physical health.
    But we can't make progress on that unless we are 
cooperating across Departments. And that is, again, an 
opportunity for an Assistant Secretary as opposed to the prior 
sort of more compartmented role, just overseeing SAMHSA, to be 
able to make a difference. So in the minute that I have left 
you remaining to just comment on the priority you may place on 
integration and parity.
    Ms. Delphin-Rittmon. Yes. Thank you for that question, 
Senator. And I just so have appreciated your advocacy and work 
in Connecticut. The recovery coaches were just thrilled to be 
able to have that work elevated at a national level. And we 
know that work can make a difference. So both parity and health 
care integration would be in our priorities for me. I see those 
as connected to expanding access to mental health services and 
supports which one of my primary priorities. You are right, 
though. The parity piece requires quite a bit of collaboration 
across HHS and community partners and state partners as well. 
And as a clinical community psychology, I love working from 
that space. I think that is where the work often happens. 
Bringing people together and figuring it out. Staying at the 
table and really figuring it out.
    Should I be confirmed, I would look forward to that. I do 
think there is a real opportunity now that the SAMHSA role has 
been elevated as part of HHS. And I thank you for your 
leadership and advocacy there as well. And so, again, there is 
just an opportunity to work across HHS agencies that touch the 
two issues that you mentioned, both health care integration as 
well as health care parity or mental health parity.
    Should I be confirmed, I would look forward to working 
across Departments, but also with you and others in Congress to 
address those important areas. So thank you for that question.
    Senator Marshall. Great. I look forward to working with 
both of you. Thank you, Madam Chair.
    Senator Burr. Senator Rosen.
    Senator Rosen. Well, thank you, Senator Burr. And, of 
course, Madam Chair, for holding this hearing. And to our 
nominees, thank you for your prior service, your willingness to 
serve again. I would like to speak a little bit about our 
supply chain safety net. As the pandemic spread and critical 
medical equipment such as masks, gowns, even ventilators, 
became scarce and in high demand, so many of our small and 
medium sized manufacturers, they just stepped up, including 
several companies in Nevada. They retooled their facilities.
    They did their part to meet the needs brought on by this 
public health crisis. And they no doubt saved many lives by 
doing that. And we are very grateful. So, Ms. O'Connell, as 
Congress and the Administration, you are going to consider 
changes to the strategic national stockpile. What 
considerations are being made to develop a domestic backup 
supply chain? This could be a network of smaller manufacturers 
who may do something else during normal production times and 
then they ramp up.
    Well, how do we support them to maintain their readiness? 
How do we use them to improve our future readiness? And would 
you commit with me to work on this.
    Ms. O'Connell. Senator, thank you so much for that 
question. What we saw in this last year and a half was a real 
warning sign that we did not have a secure and resilient public 
health and medical supply chain. And one of the reasons is we 
had such reliance on international components. So if confirmed, 
one of the places I expect to spend a lot of my time is 
figuring out how to increase domestic manufacturing, what 
incentives we should offer. It has been extraordinary what some 
of the small manufacturers, including those in your state, did.
    We heard the stories early in the pandemic of the vodka 
company that started making hand sanitizer, or I think in 
Colorado there was a mattress manufacturer that started making 
masks. We should reward that kind of innovation. That is 
exactly what built America and what we are going to need in 
order to move out of this pandemic. And so I just look forward 
to working with you and Members of this Committee on figuring 
out how we can incentivize and encourage that sort of domestic 
manufacturing so it is not just a once in a pandemic 
experience, but it is something that we can maintain and rely 
on and create a secure supply chain.
    Senator Rosen. Yes, I couldn't agree more. I think we have 
to incentivize them to kind of do this maybe in the background 
from their regular business, so they are ready to surge up if 
unfortunately we need them, because there are so many lessons 
that we learn from emergency response, because the pandemic has 
just literally changed almost every aspect of our life, how we 
work, how we socialize, and now we take steps to move back to 
normal.
    Look, here we are in this hearing. So, Ms. O'Connell, what 
do you think, and I know we only have 2 minutes, so it is 
bigger than 2 minutes, but what does HHS's role and what are 
the most important lessons that we learn from this so we can 
start thinking about how we support our communities and our 
Country doing all of this going forward?
    Ms. O'Connell. That is such a critical question at this 
time, where we hope we are at an inflection point in the 
pandemic as we are working to get 70 percent of adults with at 
least their first dose of vaccine by July 4th. We are starting 
to see America return to normal, and we do need to start 
capturing the lessons learned. And one of the commitments I 
will make, if confirmed as ASPR, is not just to go through a 
lessons learned process, but to actually apply those lessons 
moving forward.
    Often in response efforts, we review what happened and we 
write up a report and we put it on the shelf until the next one 
comes. What I would like to do is actually apply those lessons 
and make sure that we have the advantage of everything that we 
learned this time to be ready for the next public health 
emergency.
    Senator Rosen. I think that is a great idea, apply the 
lessons. And something that I would like to move on quickly in 
my last few seconds, Dr. Delphin-Rittmon, grief counseling. So 
many people have just lost their loved ones. I know we have 
over 40,000 children who have lost a parent, that the grief is 
enormous, enormous burden for so many across not just our 
Country, but in the world too. What should we be doing to 
provide grief counseling in the wake of COVID even more 
robustly than we might already do in hospice situations or some 
of those things? And this is trauma. It may be in a different 
way than when we have disasters or public health emergency. 
What do you think about grief counseling and the role there?
    Ms. Delphin-Rittmon. Thank you for that question, Senator. 
So grief counseling, as we know right now, is so critical. The 
last year, in addition to losing friends and loved ones and 
family members, there has been losses related to just the daily 
rhythms of our lives, children not being able to participate in 
sports events or not being able to participate in the rhythms 
of family events.
    I would say that the grief and loss related to the pandemic 
related experiences is some of what is contributing to the 
higher rates of anxiety and depression and substance use that 
we are seeing across the country right now. So grief counseling 
is, I think, a critical part of the mental health work that 
needs to be done across the country. So states right now, I 
mean, I certainly from a state perspective, and SAMHSA can 
support this, so states have increased resources related to the 
block grant, the American rescue dollars, and, all of those 
resources at a local and state level are being used to expand 
services, whether it is mental health or substance abuse 
services.
    I think the grief counseling on the mental health side 
could certainly be part of--it needs to be part of that mental 
health work. SAMHSA can play a role there from the treatment 
and technical assistance area we provide--or SAMHSA provides 
quite a bit of technical assistance to states. I know we 
certainly appreciate it in Connecticut and welcome those 
dollars.
    I think this is an area where some of those TA dollars can 
be used to strengthen the counseling skills of individuals 
within states to the extent that it needs--may need to be 
expanded. So appreciate that question. I think this is 
certainly an area that is important to look at, an area that 
SAMHSA can play a real role in. Should I be confirmed, would 
look forward to working with you further on this. Thank you.
    Senator Rosen. I think we really need to work on this in 
our schools in particular, as these kids go back. They are so 
vulnerable. Thank you so much.
    Ms. Delphin-Rittmon. Yes. Thank you.
    Senator Burr. Governor.
    Senator Hickenlooper. Thank you, Senator. First, before I 
say anything, just thank you both for your service, especially 
at this time when there is, as you are clearly aware, such 
great need. Let me start out with Dr. Delphin-Rittmon. I 
appreciate tremendously your commitment. And as someone who 
lived in Connecticut for 10 years, a long, long time ago, I 
appreciate your service there and your comments about the 
issues around child mental health. We have seen a 90 percent 
increase in behavioral visits at our children's hospital in 
Colorado--a 90 percent increase in just these past years.
    There really is a pediatric mental health pandemic and it 
certainly is also tied--the question I want to get to is, we 
have a just a terrible, terrible challenge with the opioids, as 
you well know, and the Colorado Health Foundation recently came 
out with a survey that more than half of Coloradoans suffer 
from increased mental health strain from the pandemic. This has 
led to just out of control increases in drug overdoses and drug 
use.
    In May 2020, we had 130 people die of a drug overdose. That 
is nearly double the average rate of all of 2019. And we have 
seen just a dramatic uptick this year as well. I know that 
addressing opioid use has been a major priority for you. And 
how can we make sure that states like Colorado and so many 
other states are able to access all the resources available to 
them through SAMHSA and ensure that they are--that we are using 
those resources in the most efficient way?
    Ms. Delphin-Rittmon. Yes, thank you for that question, 
Senator. And I appreciate the meeting that we had a couple of 
weeks ago. I appreciate hearing about your priorities and your 
advocacy for the people of your state and the country. So, yes, 
SAMHSA can play a real role in assisting states around the 
resources that are being provided. We know that work in the 
area of prevention and treatment and recovery, harm reduction, 
even working with criminal justice systems and supports can 
help to make a difference as it relates to opioid patterns and 
trends, as well as the mental health trends that we are seeing 
in the country.
    SAMHSA can certainly play a role there in terms of 
supporting states. Would be happy, if I am confirmed, to meet 
with you, to learn more about what you are seeing and 
experiencing within Colorado. As I mentioned previously, that 
bringing states together for the state to state learning and 
sharing around best practices, around what we see that is 
making a difference, SAMHSA can play a real role there as well. 
Through the Behavioral Coordinating Council.
    Again, that would be an internal group. Many different 
agencies touch this important work. And so there are 
opportunities to do important work there as well. But should I 
be confirmed, would look forward to having follow-up 
conversations with you and working across HHS, as well as with 
states and community providers on this critical issue as well. 
Thank you.
    Senator Hickenlooper. No, thank you. And thank you for your 
time and your commitment. Ms. O'Connell, thank you as well 
for--this is a unique time to step up and I really appreciate 
that. The Biden administration has made significant efforts to 
really begin making inroads into reaching out to the minority 
communities when it comes to COVID-19 response and the 
vaccination effort.
    I think the key here is we can't stop with what we have 
seen from the COVID-19 response, and we need to invest in the 
public health infrastructure necessary to make sure that we not 
only maintain but expand the contact within these communities 
so that in the next pandemic, the next disaster, we don't find 
ourselves triaging at the last minute, but we are able to be 
out ahead of this and have relationships and networks in place. 
So question, how will you continue the Administration's 
outreach efforts to these sometimes hard to reach communities?
    Ms. O'Connell. Senator, thank you so much for that 
important question. The Biden administration has made equity a 
cornerstone of its response, and that has been important to me. 
It is interwoven in everything that it is considered and done, 
including, as you mentioned, the vaccine distribution efforts. 
It focused on not just going fast, but fairly. And I think 
that's an important lesson that I will carry with me, should I 
be confirmed as ASPR, that it is critically important that the 
PPE, the vaccines, the therapeutics, all of the tools needed to 
fight the pandemic are equitably distributed to all the 
communities.
    One of the tools that we are currently using are trusted 
messengers. Making sure that trusted community leaders are 
sharing the message and helping communities access these 
critical tools. Should I be confirmed, I would continue to use 
that approach. The ASPR has a role with regional and local 
communities in helping prepare them for the next public health 
emergency, and it would be critical to me that equity is a part 
of that effort.
    Senator Burr. Senator Murkowski.
    Senator Murkowski. Thank you, Mr. Chairman, and thank you 
for your commitment, your good work. Front page, front page of 
the Anchorage Daily newspaper this morning is kind of 
discouraging. An Alaska public health alert sent out on the 
increase in heroin overdose emergency Department visits in 
2021. Since March of 1921, Alaska has experienced an increase 
in heroin overdose emergency visits compared to 2020. The 
average number has more than doubled. So we have seen a 
doubling from March 1 to May 29. And these are overdose deaths 
that are occurring in all regions of the state, but most 
increases in the South Central, Southeast area. There is still 
further review that is going on with regards to this, in terms 
of why this increase.
    Is it supply, is purity of potency? It is, of course, 
always a concern, but when you see that dramatic increase, it 
causes lots of questions to be asked. One of the things that I 
would like to raise here as we are in the--we feel like it is 
the aftermath of COVID-19, but I have heard from so many around 
the State of Alaska on the need for recovery, housing for those 
that are experiencing homelessness, and substance abuse 
connected with that. So many of our rural communities lack 
detox centers or any recovery services whatsoever.
    This is--this continues to be a struggle for us. But as we 
are looking to particularly our rural areas and the capacity 
issues and the funding to offer recovery services, how do we 
expand access to comprehensive recovery programs in addition to 
the tools that I am sure you have discussed as medically 
assisted treatment? And these are big questions that are not 
possible to really resolve in a few minutes. But just Dr. 
Delphin-Rittmon, if you would respond to that.
    Then also, are we seeing in other parts of the country 
equally dramatic increases in instances of overdoses in our 
emergency rooms around the country?
    Ms. Delphin-Rittmon. Thank you for that question, Senator, 
and for the meeting that we had a couple of weeks ago. It is 
tragic, to hear some of the stats related to the overdose 
deaths and the increases that we are seeing. I think it is 
critical to look at those things we know that can make a 
difference, and to the extent possible, to look at the data, to 
see what is driving some of the trends. Should I be confirmed, 
I would be interested in following up and having some follow-up 
conversations and discussions with you.
    One thing that we saw in Connecticut was that fentanyl was 
driving some of our overdose deaths and so increasing the 
availability of fentanyl test strips. I think that can be of 
real value in terms of, helping to potentially reduce 
overdoses, but also potentially connect people to services and 
supports. So I think that could be a valuable strategy. In 
addition, recovery coaches, as we know. You mentioned the 
recovery housing.
    Recovery housing can also make a real difference. Often 
within recovery housing, recovery coaches are available. Other 
wraparound services and supports are available. It does provide 
an opportunity for people to be connected to other needed 
services. And so that is a real valuable resource as well. 
Should I be confirmed, would be very interested in, and again, 
having follow-up conversations with you. I think the resources 
that are currently available to states in terms of the block 
grant as well as some of the American rescue plan dollars, 
appreciate the Congress's work there, can help to fund some of 
these innovations that you have mentioned, whether it be 
recovery housing or enhancing even telehealth.
    Telehealth, we know, can make a difference in rural areas 
where there are challenges with connectivity and connecting 
with providers. So those are just a few strategies that can 
make a difference. Certainly, this is one of my priorities, 
should I be confirmed. Would be interested in working with you 
and of course other states and across HHS on this critical 
issue. So thank you.
    Senator Murkowski. I appreciate that recognition. Also in 
our conversation that we had, and I appreciated that, the 
discussion about suicide and the very unfortunate, again, 
statistics that we face in Alaska with the rates of suicide and 
particularly with our younger populations. We had--since March 
2020, Juneau, Alaska has experienced 15 suicide attempts by 
children under the age of 15. And, you just--your heart just 
goes out. Most of those are the common--most common method that 
we saw there was pharmaceutical overdose.
    Again, how we can deal with these issues that truly just 
eat away at the hearts of our communities is something that I 
want to be focused on. SAMHSA does have an important role in 
these services. But everything that we can do to promote 
suicide prevention, suicide prevention resources, reduce the 
stigma that is associated with seeking out mental health care, 
these are all problems that we should share in common and seek 
to address. Madam Chair, thank you.
    The Chair. Thank you very much. That will end our hearing. 
And I want to thank all of our colleagues for their thoughtful 
questions. Ms. O'Connell, Dr. Delphin-Rittmon, thank you for 
your time. Thank you for your very insightful answers. For any 
Senator who wishes to ask additional questions, questions for 
the record will be due tomorrow, June 9th at 5 p.m.
    The hearing record will remain open for 10 business days 
for Members who wish to submit additional materials for the 
record. And this Committee will next meet on Thursday, June 
10th at 10 a.m. in Dirksen 106 for an executive session to mark 
up the Child Abuse Prevention and Treatment Act Reauthorization 
of 2021.

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    [Whereupon, at 12:04 p.m., the hearing was adjourned.]

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