[Senate Hearing 118-248]
[From the U.S. Government Publishing Office]
S. Hrg. 118-248
VA'S FOURTH MISSION:
SUPPORTING OUR NATION'S
EMERGENCY PREPAREDNESS AND RESPONSE
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 15, 2023
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
_______
U.S. GOVERNMENT PUBLISHING OFFICE
55-026 PDF WASHINGTON : 2024
SENATE COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran, Kansas, Ranking
Bernard Sanders, Vermont Member
Sherrod Brown, Ohio John Boozman, Arkansas
Richard Blumenthal, Connecticut Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii Mike Rounds, South Dakota
Joe Manchin III, West Virginia Thom Tillis, North Carolina
Kyrsten Sinema, Arizona Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire Marsha Blackburn, Tennessee
Angus S. King, Jr., Maine Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Staff Director
David Shearman, Republican Staff Director
C O N T E N T S
----------
November 15, 2023
SENATORS
Page
Hon. Jon Tester, Chairman, U.S. Senator from Montana............. 1
Hon. Jerry Moran, Ranking Member, U.S. Senator from Kansas....... 2
Hon. Mazie K. Hirono, U.S. Senator from Hawaii................... 9
Hon. Tommy Tuberville, U.S. Senator from Alabama................. 10
Hon. Angus S. King, Jr., U.S. Senator from Maine................. 14
Hon. Richard Blumenthal, U.S. Senator from Connecticut........... 18
WITNESSES
Bobby Small Jr., Acting Executive Director, Office of Emergency
Management and Resilience, Department of Veterans Affairs;
accompanied by Michelle Dorsey, MD, Deputy Assistant Under
Secretary for Health Operations, Veterans Health
Administration; and Derrick Jaastad, Executive Director, Office
of Emergency Management, Veterans Health Administration........ 3
John M. Balbus, MD, MPH, Deputy Assistant Secretary for Climate
Change and Health Equity, Department of Health and Human
Services....................................................... 5
APPENDIX
Prepared Statements
Bobby Small Jr., Acting Executive Director, Office of Emergency
Management and Resilience, Department of Veterans Affairs...... 25
John M. Balbus, MD, MPH, Deputy Assistant Secretary for Climate
Change and Health Equity, Department of Health and Human
Services....................................................... 36
Questions for the Record
Department of Veterans Affairs response to questions submitted
by:
Hon. Kyrsten Sinema............................................ 43
VA'S FOURTH MISSION:
SUPPORTING OUR NATION'S
EMERGENCY PREPAREDNESS AND RESPONSE
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WEDNESDAY, NOVEMBER 15, 2023
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:29 p.m., in
Room SR-418, Russell Senate Office Building, Hon. Jon Tester,
Chairman of the Committee, presiding.
Present: Senators Tester, Brown, Blumenthal, Hirono,
Hassan, King, Moran, Tillis, and Tuberville.
OPENING STATEMENT OF HON. JON TESTER, CHAIRMAN,
U.S. SENATOR FROM MONTANA
Chairman Tester. I want to call this hearing to order. Good
afternoon. Welcome to today's hearing to examine VA's readiness
to support our Nation in times of crisis. I understand that we
have four people who have never been in front of a Senate
Committee today. We're going to work you over anyway. I'm
sorry. Now, we appreciate what you do, and we appreciate you
being here, and thank you for taking the time out of your busy
schedule to join us.
We have seen an increase in the number of and intensity of
natural and weather-related events, which have brought much
hardship and destruction. In Montana, for example, we saw
unprecedented flooding of the Yellowstone River in June 2022.
More recently, Senator Hirono's beloved Hawaii was rocked by
fast moving wildfires in Maui. That's why the VA's authority to
provide humanitarian assistance or respond to FEMA's
assignments is critically important.
Known as VA's Fourth Mission, this role is meant to improve
the Nation's preparedness for response to war, terrorism,
emergencies, and natural disasters. During the pandemic, we saw
VA's ability to help communities nationwide with its vast
emergency response capabilities. It completed nearly 200 formal
mission assignments from FEMA, which helped citizens in 47
States, District of Columbia, American Samoa, and Guam.
In carrying out these missions, VA deployed more than 6,000
staff volunteers to help minimize staff shortages nationwide
and help train others in critical infection control measures
that admitted nearly 500 non-Veteran patients to VA facilities
when the community was overrun with COVID patients or
experiencing staffing shortages.
This is critically important in my home State of Montana,
where our VA hospital at Fort Harrison stepped up to serve
folks in the community. The acute nature of COVID-19 pandemic
highlighted how fragile the Nation supply chain is. Essential
medications were in short supply and materials to make PPE
dwindled. I hope to hear from the VA about its efforts to
address those challenges ahead of future disasters.
As the largest integrated healthcare system in the United
States, VA stands in a unique position to bolster the supply
chain and address some of these challenges. VA has long relied
on an all-volunteer workforce to respond in emergency
situations. I want to know if this is a sustainable staffing
model, given the increasing frequency of which they're being
called up.
These are about a handful of areas VA will need to consider
as it seeks to make its system more robust to manage caring for
our Nation's Veterans, and acting as a backstop for our
Nation's broader healthcare system in times of crisis.
With that, I'll turn it over to Senator Moran.
OPENING STATEMENT OF HON. JERRY MORAN,
RANKING MEMBER, U.S. SENATOR FROM KANSAS
Senator Moran. Mr. Chairman, thank you. I remember when I
was the Chairman of this Committee. I was never late.
Chairman Tester. So I was here on time.
[Laughter.]
Senator Moran. But you were late, I think, then. Late was
defined by the one who had the gavel, I believe.
I thank all of our witnesses for joining us today. I
appreciate the opportunity to be with you and discuss the VA's
emergency preparedness and response, including the work the VA
does through its so-called Fourth Mission.
I didn't really know much about the Fourth Mission until
the arrival of the pandemic, and then saw the value of the
preparation that had occurred in advance, and the role that the
VA and its employees played. It was an integral role during
that pandemic, and not only in caring for Veterans, which was
an increased challenge itself, but also helping to support
State and local hospitals, and healthcare authorities. I saw it
in the State of Kansas, and I'm grateful.
I'm grateful for the hard work that the VA leaders and
frontline staff provided during the pandemic. I'm also grateful
for the hard work that the VA staff continues to do every day
in response to natural disasters and emergencies. Today, I want
to hear how the VA is leveraging the lessons learned from,
during the pandemic to improve the Department's capacity to
care for Veterans, avoid VA staff burnout, and provide needed
support to Federal, State, and local authorities during
emergency circumstances.
In recent months, I have heard from a number of Kansans, VA
healthcare workers specifically, who are worried about their
ability to efficiently and effectively respond to crisis
scenarios. That is partly due to the vulnerabilities of the
VA's healthcare infrastructure, which outdates the private
sector by decades, and was built to meet a very different model
of care than the one we have today. I hope the VA witnesses
will be able to tell me how the VA's emergency preparedness
efforts are addressing that challenge.
I would be remiss, at least from my perspective, if I did
not take this opportunity to talk just a moment about the VA's
pending rulemaking regarding reimbursement rates for emergency
medical transportation services. Every day, Veterans in the
midst of medical emergencies rely on air and ground ambulances
to get them the care they need as quickly as possible.
Significantly reducing payment rates for these lifesaving
services, which the VA is currently on track to do in February,
will have a devastating impact on Veterans.
Chairman Tester, Senator Boozman, Senator Murray, and I
have been leading the charge against this reduction, and I want
to take this opportunity today to once again call on Secretary
McDonough to do what I think is the right thing and reverse
course on this rule before it jeopardizes Veteran lives.
Mr. Chairman, I thank you and yield back.
Chairman Tester. Thank you, Senator Moran for your
statement.
Today, we're going to hear from just one panel of
witnesses, but they're powerful. We have Bobby Small Jr. who's
the Acting Executive Director of the Office of Emergency
Management and Resilience at VA. He's accompanied by two VHA
colleagues, Dr. Michelle Dorsey, the Deputy Assistant Under
Secretary for Health Operations, and Derrick Jaastad, the
Executive Director of the Office of Emergency Management. I
also want to welcome Dr. John Balbus, the Deputy Assistant
Secretary for Climate Change and Health Equity at HHS.
Welcome you-all to the Committee. Mr. Small, you may begin.
STATEMENT OF BOBBY SMALL JR., ACTING EXECUTIVE DIRECTOR, OFFICE
OF EMERGENCY MANAGEMENT AND RESILIENCE, DEPARTMENT OF VETERANS
AFFAIRS; ACCOMPANIED BY MICHELLE DORSEY, MD, DEPUTY ASSISTANT
UNDER SECRETARY FOR HEALTH OPERATIONS, VETERANS HEALTH
ADMINISTRATION; AND DERRICK JAASTAD, EXECUTIVE DIRECTOR, OFFICE
OF EMERGENCY MANAGEMENT, VETERANS HEALTH ADMINISTRATION
Mr. Small. Good afternoon, Chairman Tester, Ranking Member
Moran, and Members of the Committee. I'm pleased to be here
today to discuss the Department of Veterans Affairs emergency
response to natural climate change-driven disasters, and how VA
help the communities impacted by disasters.
VA's Fourth Mission is to improve the Nation preparedness
to respond to war, terrorism, national emergencies, natural
disasters by developing plans and taking action to ensure
continued services to Veterans, as well as support to the
Nation, State, local emergency management, public health,
public safety, and homeland security efforts.
The Fourth Mission is a critical operation capability that
leverages VA personnel, equipment, and infrastructure to
support greater resource sharing across Federal departments and
agencies in accordance with Presidential Policy Directive 8 and
the National Response Framework.
Each administration supports the VA Fourth Mission by
developing and implementing policies, programs, and
capabilities to ensure access to and delivery of healthcare
services and benefits while building a culture of preparedness
and resiliency. VA has emergency managers strategically located
around the country who work with local VA facilities and
communities on a daily basis to assist with mitigation,
preparedness, and response and recovery efforts.
These emergency managers deploy to State emergency
operation centers during emergencies to support ongoing
operations and serve as the eyes and ears of the
administration. This construct allows the VA to have a
comprehensive approach to coordinating Fourth Mission
requirements, from the VA's Integrated Operations Center down
to a State, local government, or facility.
Strengthening VA's capabilities to support Fourth Mission
natural disaster operation requires planning against risk and
associated impacts that would exceed local, State, territory,
or tribal resources, including high consequence and plausible
concurrent disasters like those that unfolded across the Nation
throughout COVID-19.
It equally requires a well-trained resource and coordinated
approach between internal and external stakeholders, and a
consistent and effective means for exercising our planning,
continuity, decision support, and communication capabilities in
a complex emergency environment.
The Department's annual continuity exercise, Eagle Horizon,
tests our readiness and capabilities in event of a major
emergency. It allows us to test our continuity of operations
procedures, and emergency communications, internally, and with
our Federal partners.
VA knows firsthand the effects of climate and natural
disaster on our missions workforce and the Veteran community we
serve. For example, last year's, hurricane season saw three
landfalls along the coast of the U.S. mainland with Hurricane
Ian, tying for the fifth strongest hurricane wind speed at
landfall in the U.S. These three storms alone affected 3.2
million Veterans and 30,000 VA staff providing care and
benefits to many of them.
VA's Climate Action Plan outlines VA's response to the
projected impacts of climate change to the Department with the
goal of ensuring sustained operations to support uninterrupted
delivery of benefits and service and VA's Fourth Mission. Given
the wide distribution of VA facilities throughout the U.S. and
its territories, VA facilities are impacted by most major
national disasters. VA will continue to focus on mitigation
strategies and preparedness activities, as un-remediated
facilities or more frequently damaged or destroyed due to
increased storm activities and sea level rise.
I appreciate this opportunity to share VA's emergency
response to natural climate change-driven disasters and
demonstrate how VA helps the community impacted by disasters.
Our objectives, even in an all-hazards environment, is to give
our Nation's Veterans the top quality care they have earned and
deserve, and support our Fourth Mission capabilities when
called upon to do so.
I appreciate this Committee's continued support and
encouragement in identifying and resolving challenges as we
find new ways to care for Veterans. This concludes my opening
statement. My colleagues and I are prepared to respond to any
questions you may have, sir.
[The prepared statement of Mr. Small appears on page 25 of
the Appendix.]
Chairman Tester. We'll have questions. Thank you, Mr.
Small. Dr. Balbus, you are up next, and know that both of your
full written comments will be a part of the record.
STATEMENT OF JOHN M. BALBUS, MD, MPH, DEPUTY ASSISTANT
SECRETARY FOR CLIMATE CHANGE AND HEALTH EQUITY, DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Dr. Balbus. Good afternoon, everybody, and Chairman Tester,
and Ranking Member Moran, Members of the Committee. I'd like to
thank you for this opportunity to discuss the work of the
Office of Climate Change and Health Equity to build greater
climate resilience and sustainability in the country's
healthcare delivery systems.
The Secretary of Health and Human Services established our
office in response to Executive Order 14008, and the Office was
officially launched August 31, 2021, with the mission to help
protect the health of people in the United States, especially
those most vulnerable from the health impacts of climate
change.
As a focal point for action to address the climate crisis
within the entire Department of Health and Human Services,
we've also taken on ensuring that health systems in the United
States are resilient to increasingly severe climate-related
threats, and also reducing their own significant contributions
to greenhouse gas pollution.
I'm pleased to appear today together with colleagues from
the Veterans Health Administration and plan to emphasize the
following points. First, the health impacts of climate change
are being felt now throughout the United States, but the
suffering induced falls most heavily on low income,
disadvantaged populations, and other vulnerable groups. In
addition to the health impacts, the health system impacts of
climate change are also being felt now with attendant health
impacts from that and economic damages. Climate change
compounds all the other financial stresses on health systems.
Fortunately, initial steps that address both health system
resilience and greenhouse gas pollution reduction, like health
system microgrids, also reduce energy costs for the systems
that install them. The Office of Climate Change and Health
Equity is helping coordinate an all-of-government approach to
the health aspects of the climate crisis, including helping
ensure the healthcare safety net of the country is able to take
full advantage of technical assistance and financial resources
provided for sustainability and resilience. For example, those
that are available through the Inflation Reduction Act.
This past summer brought unprecedented human suffering and
damage from extreme weather events across the country. From the
wildfire smoke degrading air quality in New York City, to the
devastation of Maui, many parts of the country directly
experienced more frequent and more severe climate change
impacts than ever before. And these climate-related impacts
directly impacted the health and well-being of those living in
the United States.
But the impacts were not equitably distributed. We know
certain populations such as children, older adults, those with
chronic health conditions and living with disabilities, racial
and ethnic minorities, and people experiencing homelessness are
more at risk of negative health outcomes from climate-related
hazards. This is true for both the general population and
specifically for Veterans.
For example, a recent publication from the Department of
Veterans Affairs, Stanford University, the University of Iowa,
and the Centers for Disease Control and Prevention, found that
Black and American Indian, Alaska Native Veterans were more
likely to be diagnosed with heat-related illnesses, and
Veterans with coexisting medical conditions also saw a greater
increase in heat-related illness over time. And importantly,
that report found that the rate of heat-related illness in
Veterans had increased between 2002 and 2019.
After a summer of record breaking temperatures, Maricopa
County, Arizona recently announced there were 425 heat-related
deaths in 2023, tying the record from 2022, but with nearly 200
deaths still under investigation. In 2022, 42 percent of the
heat-related deaths in Maricopa County were among individuals
experiencing homelessness, and 67 percent involved substance
use. And of those deaths involving substance use, over half
were among individuals experiencing homelessness.
These sobering statistics from Arizona are relevant to the
care of Veterans as well. In 2022, over 33,000 Veterans were
experiencing homelessness on any given night comprising
approximately 7 percent of all adults experiencing homelessness
in the U.S. And additionally, more than 20 percent of Veterans
with post-traumatic stress disorder also have concomitant
substance use disorder.
In addition to these health impacts, climate change also
poses risks of stress and disruption to healthcare delivery.
Climate-related extreme weather events and disasters can
disrupt healthcare systems at multiple points, creating a surge
in demand, resulting in staffing shortages, affecting critical
supply chains, and damaging infrastructure. And we've seen how
health system failures have resulted in loss of life after
Hurricane Ida, Superstorm Sandy, and especially Hurricane Maria
in Puerto Rico, where roughly 3,000 excess deaths occurred over
the four months following the storm.
And we know that climate change will continue to have an
impact. A 2022 study found approximately one-third of
metropolitan statistical areas on the Atlantic and Gulf Coasts
have half or more of their hospitals at risk of flooding from
even relatively weak hurricanes. Sea level rise, increased
frequency and severity of hurricanes will further increase this
risk. And unfortunately, there's been very little investment in
studies like this that highlight future risks, and especially
studies that analyze the specific tipping points that have
caused health systems to fail in extreme events. We hope this
evidence base can be built to make facilities and systems more
resilient and to save lives.
Our office aims to have the entire health sector working
together to meet the challenges of climate change. That means
becoming more prepared for climate events and also more
sustainable, decreasing the health sector's 8.5 percent
contribution to our country's greenhouse gas emissions.
Reducing greenhouse gas emissions through interventions
like increased energy efficiency and renewable energy sources
can reduce operating costs, freeing resources for investment in
essential patient services, and this has been documented in
several instances.
Moreover, emissions reduction and resilience are closely
related. As an example, the VA makes renewable power part of
its facility infrastructure and equipment upgrades where
feasible.
Chairman Tester. I would ask you to wrap it up.
Dr. Balbus. Okay. VA hospitals use 38 percent less energy
per square foot in the national average, and by installing
onsite renewable power, VA facilities become more resilient to
grid failures.
I have much more to talk about. I want to highlight that
our office is convening the Federal Health Systems, the Indian
Health Service, the Veterans Health Administration, the Defense
Health Agency, and the Bureau of Prisons to work on climate
resilience and sustainability of the systems, and especially as
required by Executive Order 14057 to reduce the greenhouse gas
emissions. We've also created----
Chairman Tester. That's good enough. Senator Moran has
another hearing he needs to get to, and so we're going to go to
questions. Thank you. Your entire statement will be part of the
record.
Dr. Balbus. It's all in writing, and so I appreciate the
opportunity.
[The prepared statement of Dr. Balbus appears on page 36 of
the Appendix.]
Chairman Tester. Senator Moran.
Senator Moran. Thank you for your testimony. I apologize
for the intrusion by the Chairman, but he's trying to be
helpful to me. And I'm grateful for that.
Mr. Small, I'm going to ask my--I think my questions to
you. There's a whistleblower from the U.S. Customs and Border
Protection that recently reached out to my staff indicating
that the VA is paying for healthcare services provided to non-
citizens in detention.
A VA portal established for community providers to submit
claims to the VA for healthcare for non-citizens, includes
documentation that this has been going on since at least 2020.
ICE reporting to Congress references, ``a service level
agreement between the VA and DHS for the provision of those
services.''
Under what authority is the VA providing claims processing
services to non-citizens at the border?
Mr. Small. Yes, Senator. Thank you for that question. I'm
not aware of these allegations. I will defer to my colleagues
in Veterans Health Administration to see if they're aware of
such allegations.
Chairman Tester. Are either of you aware of the situation
Senator Moran talked about?
Mr. Jaastad. I am not aware of enrollment and beneficiaries
or delivery of healthcare services being provided. I am aware
of the support that VHA is providing to our Veteran service
members within Customs and Border Patrol, and specifically
counseling and making sure that they are able to continue to
receive the services that they're entitled to.
Senator Moran. That makes sense, Mr. Jaastad, to me, but I
would be interested if you could follow up with a response. I'd
like to make sure we're prioritizing the healthcare for
Veterans that--we regularly hear about the shortage of
providers, and I want to make sure that we're focused as our
priority at the VA is on Veterans.
And then if there, I'm told is a copy, there is a service
level agreement that I mentioned, and it would be useful--
that's between the VA and DHS--it would be useful if me and my
staff could see a copy of that agreement.
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VA Response: VA is currently gathering the requested Service Level
Agreements (SLAs) with DHS in response to the Committee's request. We
are working to have copies to the Committee early January.
------------------------------------------------------------------------
And then Mr. Small, I would think you would defer answering
this question as well. And I say that with a smile, I'm not
cringing at that, but you heard me mention the emergency
transportation issue. It is an important one. It's an important
one now, it's an important one when we have a significant
emergency or national disaster in our country.
In February, the VA's reimbursement rates for air and
ground ambulance services are going to be significantly reduced
in accordance with a pending VA rule change. Ambulance
providers across the country have told me that this will
substantially reduce the availability of ambulance services for
Veterans and for other Americans. This is particularly an
important issue for me as a Kansan in the rural nature of our
State, and air ambulance service is hugely important in the
delivery of a patient to a regional hospital.
I understand that the VA is considering delaying
implementation of that rule, and I indicated in my testimony
that the Chairman, Chairman Tester, and Senator Boozman,
Senator Murray, we've all been calling on the VA to do so. I've
been asking the VA for the last month for clarity on their path
forward and yet to receive a response.
My question is, is the VA intending to delay implementation
of the rule to reset reimbursement rates for emergency
transportation services beyond the current February 2024,
effective date?
Mr. Small. Yes, Senator, thank you for that question. Yes,
my colleagues in VHA do manage a patient movement program for
the Department. So I will defer to my colleague Derrick Jaastad
for a response.
Mr. Jaastad. Ranking Member Moran, while I cannot speak to
the day-to-day transportation, I can speak to what we are doing
within the realm of Federal patient movement as the Executive
Director of the Office of Emergency Management.
The efficient, timely, and consistent ability to move
survivors of disaster or uniformed service members to
definitive care is my number one priority. We maintain 48
Federal Coordinating Centers as well as hundreds upon hundreds
of NDMS partner facilities. Over the last 18 months, I am very,
very proud of the number of full-scale exercises that we have
had the opportunity to conduct, reestablishing relationships
within healthcare coalitions within our emergency medical
service providers, as well as with other community partners.
And so when we speak of the need to move patients,
especially those impacted by disasters or other events, I am
very confident in our ability to ensure that those survivors
are reaching definitive care.
Happy to take the transportation question on the day-to-day
back for record.
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VA Response: VA is changing the rates that we pay for special mode
transportation services--including air ambulance transportation--to
better align with the rest of the health care industry while continuing
to provide world-class, affordable care to those we serve. According to
a report from the Inspector General in 2018, VA had been paying about
60% more than the industry standard (CMS rates) for ambulance services.
To address this discrepancy and be good stewards of taxpayer money, VA
undertook rulemaking to change the rates VA pays for air ambulance
services. Under the new regulation, VA will pay the lesser of actual
charge associated with an ambulance service, or the standard CMS rate
for that service, unless a separate rate has been established based on
local contracts between air ambulance providers and local VA medical
centers. VA intends to include terms in these contracts to ensure that
Veteran care will not be adversely impacted, and that Veterans will not
receive bills for these services. More information about these changes
can be found here: https://www.federalregister.gov/documents/2023/02/16/
2023-03013/change-in-rates-va-pays-for-special-modes-of-transportation.
These changes were originally slated to become effective on February 16,
2024, but VA is currently developing a rule that will delay the
effective date by approximately one year, until February 2025. VA
expects the rule delaying the effective date to be published prior to
February 16, 2024.
------------------------------------------------------------------------
Senator Moran. Mr. Jaastad, would you, or Mr. Small, or Dr.
Dorsey, would you visit with my staff at the conclusion of this
hearing and see if we can find a path forward to get
information from the VA with your assistance?
Mr. Small. Yes, Senator.
Senator Moran. Thank you all very much.
Thank you, Mr. Chairman.
Chairman Tester. Senator Hirono.
HON. MAZIE K. HIRONO,
U.S. SENATOR FROM HAWAII
Senator Hirono. I just wanted to submit for the record a
statement, especially after the Maui fires. So thank you.
Senator Hirono. In August, Hawaii experienced our worst
natural disaster since becoming a State in 1959 and the
deadliest wildfire in our country since 1918 when wildfires
ripped through communities in West upcountry Maui. And in mere
moments, an entire town, Lahaina was destroyed and thousands of
people lost their homes and all their belongings, including
many Veterans.
There is some 7,000 people still living in hotels and
Airbnbs, and providing long-term homes, including, of course,
for the Veterans in those communities remain a huge priority.
But thankfully, VA of the Pacific Islands Healthcare System was
able to operationalize quickly, contacting the most vulnerable
Veterans by phone or text, and assessing whether there would be
issues accessing critical services like dialysis or treatments
like oxygen.
In the days following the wildfire, leaders at the VA
central office were communicative about steps that they had
already taken and planned to take to support Veterans impacted
by the wildfire. In addition, VA was present at hotels, housing
those who were displaced, and the Disaster Resource Center to
let Veterans and family members know what services were
available to them.
In this extremely challenging time, VA stepped up to ensure
our Veterans and others in the community had the essentials
they needed. Unfortunately, we know that natural disasters,
like the fires of Maui, are only becoming more commonplace,
underscoring the importance of VA's own preparedness and its
Fourth Mission.
I hope we can use this hearing to capture any lessons
learned from VA's response to the wildfires, and ensure we're
equipping local VA facilities and staff with the tools they
need to respond to other disasters in the future.
Thank you, Mr. Chairman, for holding this hearing so that
we can begin to work with our agency partners to bolster
preparedness and response to extreme weather events that are
becoming far too commonplace. And I'm glad that we have a
witness who is very much focused on climate change as being one
of the reasons that we are seeing so many of these natural
disasters.
Chairman Tester. Thank you, Senator Tuberville.
HON. TOMMY TUBERVILLE,
U.S. SENATOR FROM ALABAMA
Senator Tuberville. Thank you, Mr. Chairman. Thanks for
appearing today. Your first time up, huh? Interesting.
Dr. Balbus, you're talking about medical centers
implementing microgrid and solar power systems on top of
parking lots. Given in my State of Alabama, but I'm going to a
couple of them next week before Thanksgiving, we have some good
ones and we have some not so good. How do we use our priorities
in terms of whether we put something on top of a building for
solar panels or whatever, how do we make a decision on what's
more important, the building or the microgrid? I mean, how do
you do that? Because we've got a lot of bad buildings in the
country.
Dr. Balbus. I think that's an excellent question, and it
really has to be decided on an institution-by-institution
basis, and an assessment of the risks. Your point as well taken
that for some facilities, the flooding could be such a risk
that that's where the first dollar should go.
All of this is about risk management and ensuring, you
know, reducing the financial risk to an already stressed health
system. Loss of revenue from being shut down by a flood or shut
down by another event is as devastating as a decrease in
reimbursement. But the fact that there is this financial
incentive for the renewable energy and microgrids, and that the
operation costs decline after that, make that a financially
viable investment. But again, I wouldn't say--it'd have to be
decided on a case-by-case basis whether you----
Senator Tuberville. You don't do that then? You don't make
those decisions.
Dr. Balbus. I do not make those decisions. No.
Senator Tuberville. All right. Let's go back to Senator
Moran's question. Mr. Small, since 2021, 6.5 million people
have been apprehended at our southern border. It's no secret
that a lot of our States are beyond capacity. Does the VA
consider the border surge a national emergency?
Mr. Small. Senator, thank you for that question. The VA
considers anything that impacts the Department's ability to
provide service to our Veterans as something we should be
concerned about.
As far as the VA's position on the southern border, sir,
I'm an emergency manager, sir, so I'm not equipped to answer
that question, but I can take it back for clarification.
------------------------------------------------------------------------
-------------------------------------------------------------------------
VA Response: VA does not provide or fund any health care services to
individuals detained in U.S. Immigration and Customs Enforcement (ICE)
custody. At no time are any VA health care professionals or VA funds
used for this purpose. Congress has authorized VA to provide health
care to non-Veterans under limited circumstances. The vast majority of
this authorized non-Veteran care is provided to Veteran families--
including the spouses and children of Veterans with severe
disabilities, the spouses and children of Veterans who died from
conditions associated with their military service, and the spouses and
children of Veterans who died in the line of duty. VA is also
authorized to provide or cover some health care for Veteran caregivers,
family members of Veterans who served at Camp Lejeune, and allied
Veterans in rare cases (at the expense of their home nations). VA also
occasionally provides authorized care through its ``Fourth Mission,''
in which VA employees support our nation's preparedness for response to
war, terrorism, national emergencies, and natural disasters. Our top
priority at VA is making sure that Veterans have timely access to the
high-quality, world-class health care they deserve. In fiscal year
2023, VA provided the most health care appointments to Veterans in VA
history, and Veteran outpatient trust scores reached 91%.
------------------------------------------------------------------------
Senator Tuberville. So what would be the VA's role if we
considered it a national emergency? I mean, are we taking
people in? I'm just asking.
Mr. Small. I think the VA's role would be, Senator, to
respond to any Fourth Mission requirement we may receive to
support a national emergency.
Senator Tuberville. Do you know if we're providing illegals
with healthcare in VAs?
Mr. Small. No, Senator, I'm not aware of that.
Senator Tuberville. How could we find that out?
Mr. Small. Senator, I would have to take that back to the
Department and find an answer for you.
------------------------------------------------------------------------
-------------------------------------------------------------------------
VA Response: VA does not provide or fund any health care services to
individuals detained in U.S. Immigration and Customs Enforcement (ICE)
custody. At no time have any VA health care professionals provided
health care to individuals in ICE custody. Nor are any VA funds used
for this purpose. The ICE Health Service Corps (IHSC) provides and pays
for all health care services for individuals detained in its custody.
The Financial Services Center (FSC), which is part of VA's Office of
Management, is a franchise fund organization that offers the
administrative function of medical claims processing services to VA and
other government agencies. Since 2002, FSC has had an Interagency
Agreement with the Department of Homeland Security's IHSC to provide
these administrative medical claims processing services. Under this
agreement, IHSC pays fees to FSC for the claims processing services
rendered and covers all disbursements made to pay for medical claims
payments to providers. IHSC is solely responsible for the authorization
of health care services and obtaining the providers to deliver the
health care.
------------------------------------------------------------------------
Senator Tuberville. What about doing abortions on illegals
in VAs? Do you know of any of that happening?
Mr. Small. No, Senator, I'm not aware of that happening.
Senator Tuberville. Would anybody else like, like to chime
in on this about the southern border? Anybody else?
Mr. Jaastad. Senator Tuberville, Derrick Jaastad. One of
the things that we have done and under our Fourth Mission is
really taking care of our Federal interagency partners. We did
so with COVID vaccines and administered thousands. We again, as
I mentioned, are taking care of our colleagues in uniform in
the Customs and Border Patrol with counseling services through
readjustment counseling through ensuring that the Veterans that
are entitled to care are being--that we're able to deliver care
in those outpost areas.
And so, whether that's the CBP, hopping in a van and going
to one of our medical centers, or whether that's RCS and
traveling out to their outposts. We're ensuring that those that
are entitled to care are receiving care.
Senator Tuberville. Well, I'll be going to a couple of them
next week and close to the southern border. So we'll find out.
I just hope we're taking care of our Veterans. As Senator
Tester said, we need to take care of our Veterans. And I can
understand that we need to give everybody healthcare, but it's
real important to me we take care of our Veterans. Thank you-
all. Thanks, Mr. Chairman.
Chairman Tester. Senator Hirono.
Senator Hirono. Thank you. This is for Dr. Balbus--am I
pronouncing correctly? So in your testimony, you stated that
the climate-related extreme weather events and disasters can
disrupt healthcare systems at multiple points, creating a surge
in healthcare demand, resulting in staffing shortages.
So can you speak to how these kinds of events could further
exacerbate our existing staffing shortages, and what are you
doing to prepare for these kinds of eventualities?
Dr. Balbus. So I think to just unpack that testimony a
little bit. Events like heatwaves, like wildfire smoke events,
or hurricanes, create injured patients, exacerbate underlying
diseases, and that creates a patient demand. But in terms of
staffing shortages in the setting of a disaster, that's more in
the setting of flooding, or wind damage, or things like that in
a very specific short-term sense.
But of course as you're pointing out, that acute staffing
shortage, because people can't get to work and--you know, but I
take this from things like the analysis of Superstorm Sandy and
what shut down the health systems. And in many cases, it was
because the people who work there couldn't get there because of
the flooding or because of having to care for their families.
My office is not the office that manages healthcare
workforce. That's part of HRSA, and so I can't answer,
personally, how we are trying to address the workforce shortage
overall. But, importantly, by doing the proper kind of an
assessment, which is what our office is doing to create the
guidance and the tools so that a healthcare facility can assess
its accessibility in the setting of an unprecedented flood
using forward-looking data, we can start to anticipate that
kind of a problem and they can do workarounds on a facility-by-
facility basis.
Senator Hirono. So of the panelists, how does the VA
prepare? You have a lot of buildings, for example, facilities.
And to prepare these facilities to withstand these natural
disaster events, how do you do that in terms of making sure
that your staff can get there and patients can get to your
facilities, et cetera?
Because in Hawaii, we have a number of VA facilities,
CBOCs, we have the hospitals, et cetera. So can somebody
respond to me, do you have something in writing that says here
are all the different things that we're going to need to do to
mitigate what happens in a disaster so that you can continue to
provide services to the Veterans?
Mr. Small. Yes, Senator. VA Office of Acquisition Logistics
and Construction, is the lead for coordinating with various VA
administrations and staff offices to evaluate available
information to determine climate change-related risk affecting
VA facilities.
The results are used to develop a climate change risk list
that is used to evaluate VA design standards and identify gaps,
and help identify mitigation and preparedness measures the
Department should take.
Senator Hirono. And that includes instances where your
infrastructure and facilities are destroyed during a natural
disaster. There's a plan B?
Mr. Small. Yes. The VA climate plan addresses new design
standards as we bring on new facilities to make sure those new
facilities are equipped for occurring climate change and sea
level rises.
Senator Hirono. So something specific as the wildfires in
Lahaina. 7,000 people living in hotels. Do you know how many of
those people are Veterans?
Mr. Small. I do not, ma'am. I will refer to my colleagues
in VHA. Maybe they can provide----
Senator Hirono. They should know, right? The VA Pacific
Healthcare System should know who the Veterans are or who have
lost their homes. This is just an example of what can happen
during a disaster, and how do you keep track of the Veterans,
and how you provide them continuity of services?
Mr. Jaastad. Yes. Senator, thank you for the question.
While absolutely tragic, the loss of life, the loss of
infrastructure, the loss of property. We were able to identify
many promising practices coming out of the response,
specifically of the VA, in Maui. The fact that we were able to
deliver needed medicines, and medical supplies, prescriptions
to our Veterans where they were. Our ability to track who was
picking up prescriptions in order to understand who is still
alive and receiving the necessary medicines that they require.
Our ability to do outreach pre-event, or during the event,
and post-event through our vulnerable patient care program and
our VEText program is unprecedented. The ability for VA
providers that we're moving from O'ahu to Maui, bringing
supplies is a best practice. While there were many lessons
learned, do we have the names of those that are still in
hotels, no, but our providers know who they are.
Senator Hirono. Thank you very much for your commitment and
your ongoing presence to help us. Recovery will be long and
take a lot of resources. Thank you, Mr. Chairman.
Chairman Tester. Senator King.
HON. ANGUS S. KING, JR.,
U.S. SENATOR FROM MAINE
Senator King. Thank you, Mr. Chairman.
I'll bet when you prepare for these hearings, you don't sit
around saying, how will we handle a compliment? I want to
deliver a serious compliment. We had a horrendous mass shooting
in Maine just about a month ago today. And VA Maine stepped up
immediately. They cleared beds in their hospital facility. They
set up an incident command center. They made their chaplain
available on a 24-hour basis. They provided outreach to the
reserve squadron that this shooter was a member of.
They did everything that they could have possibly done.
They postponed a non-emergency surgery in order to be available
as a backup to the local hospital. So I just want to get that
on the record. This was a prime example of the Fourth Mission
carried out in a stunningly effective and important way. And I
want to thank you, and hope you'll pass my thanks on to the
folks at Maine because they did a great job.
Second question, dealing with emergencies, and this was a
good example, almost all emergencies end up being handled
primarily by the State and local authorities. FEMA has an
important role, of course, but often the first responders are
the State police or the State emergency management people.
And I guess my question is, Mr. Small, to what extent do
you have an institutional--develop an institutional Fourth
Mission relationship with State and local emergency personnel?
Mr. Small. Yes, Senator. Thank you for that question. VA
emergency manager are embedded in the communities, but I would
refer to my colleague here, Jaastad, to provide details how
they work with the local communities on a daily basis, Senator.
Senator King. Thank you.
Mr. Jaastad. Thank you, first and foremost, for the
compliment. It's very unfortunate that we have become
proficient in having these services ready. We have a storied
history in supporting mass shootings. The Pulse nightclub
shooting. We deployed a number of Mobile Vet Centers as well as
mobile medical units, and actually had to save at that event.
In 2017, we also supported the Las Vegas mass shooting with,
again, readjustment counseling service Mobile Vet Centers, as
well as mobile medical units.
The Northeast is unique. It is a tight-knit community. VA
is a member of that community, whether it's the CBOC in
Lewiston----
Senator King. Maine is a big small town with very long
streets.
[Laughter.]
Mr. Jaastad. But whether it's Lewiston or the Medical
Center in Togus, there was no daylight between the State,
between FEMA, between our area emergency managers, and those
providers on the ground. When we look at how do we maintain
those relationships with the State and with the communities, we
do so deliberately and with intentionality----
Senator King. That's what I'm looking for. There's a pre-
existing structure. It's not ad hoc when an emergency strikes.
Mr. Jaastad. No, it is not. And when we look at--when
emergency strikes, that's 25 percent of emergency management is
response. 50 percent of emergency management is proactive. It's
preparedness, and it is mitigation. It's developing those
relationships locally and being that force multiplier to bring
the full force and weight of multi agencies, many agencies in
order to minimize the time we spend in response and the time we
spend in recovery.
The more we prepare, the more we mitigate, the more
resources we can bring to bear for our Fourth Mission.
Senator King. And it's important to me, it seems to me that
the local and State emergency preparedness folks know of your
capacity and as part of their toolkit.
Mr. Jaastad. It absolutely is. And really, when we look at
the investment that has been made in preparedness and in our
ability to respond, we maintain a tremendous amount of national
assets. Whether that's our mobile ICUs, our high water
vehicles, our deployable resources, mobile medical units,
Mobile Vet Centers, we have the reach because we are embedded
in the communities and we've invested in our communities.
Senator King. And I think you've answered this, but to be
clear, this is a preexisting, conscious relationship that's
built up prior to crisis. In other words, are there meetings,
are there regular communications just to integrate the
resources that you bring with local and State resources?
Mr. Jaastad. There absolutely are.
Senator King. This isn't a case where an emergency occurs
and you call up and say, can we help? I presume there's already
a relationship established.
Mr. Jaastad. Within three minutes of the shooting being
reported, the medical center director in Togus received a call.
We're part of the community. We're part of the response.
Senator King. Thank you.
Thank you, Mr. Chairman. It was very impressive the way
that came together.
Chairman Tester. Indeed. Mr. Small, senior leaders from VHA
participated in the daily coordination meetings hosted by FEMA
during the pandemic. And what they found was there was
considerable inter-agency fragmentation, at least early on. In
some instances, the bureaucratic process for getting FEMA
assignments delayed VA from providing care that was much
needed.
Now with the pandemic behind us, can you speak to any
changes being made to the national framework that will benefit
VA's ability to help in local communities even faster?
Mr. Small. Thank you, Senator. VA headquarters maintain
consistent coordination and participation in governing bodies,
which allows continuous awareness of potential support at the
local levels. During emergencies, we provide VA liaison to the
National Response Coordination Center, and we are members in
good standing of FEMA-led recovery support function leadership
group, and emergency support leadership groups.
This governing body coupled with continuous partnership
with other Federal departments and agency, as well as the
National Security Council, provide us an ability to translate
local needs into improved policies and practices.
Chairman Tester. So in your testimony, you know, the VA is
partnering with DoD to conduct a DoD, Military-Civilian
National Defense Medical System Interoperability Study--it is a
mouthful. I trust a lot of lessons from the pandemic and other
formal missions will inform this review. Are you able to
provide this Committee with an update on the timeline for this
work's completion?
Mr. Small. Yes, Senator. My esteemed colleague, Mr.
Jaastad, will provide the details, sir.
Mr. Jaastad. Thank you, Chairman Tester, the MCNIS, if I
can, the Military-Civilian National Disaster Medical System
Interoperability Study is conducted by DoD through the National
Disaster Medical System of which VA--there are five pilot
sites.
VA maintains two of those pilots, and these are our Federal
Coordinating Centers, or FCCs. The two VA FCCs are in Denver
and in Omaha. Year 1 of the pilot study was really the study
part of it. Years 2 through 5, are implementation, years 5 and
beyond, are expansion.
Chairman Tester. So are you done?
Mr. Jaastad. And just a little bit more.
Chairman Tester. Keep going.
Mr. Jaastad. We have partnered with DoD on this, and yes,
we are looking at lessons learned. As a matter of fact, both
the current director and the former director have been out to
Martinsburg, West Virginia to walk through our assets.
Chairman Tester. So can you talk about year 1? You're
talking about year 2 through 5? You talked years 5 through 10.
When was year 1?
Mr. Jaastad. It predated me. I want to say it was 2020.
Chairman Tester. 2020. So by 2025, you'll have the first
assessments all done and ready for us to review?
Mr. Jaastad. DoD is the primary.
Chairman Tester. Right? But the assessments DoD is doing
with you will be done so that we can review them?
Mr. Jaastad. I cannot speak to DoD, sir.
Chairman Tester. Neither can I. Well, Okay. We'll, we'll
keep our eye out for that.
Dr. Balbus, do you oversee pharmaceuticals within HHS?
Dr. Balbus. My small office does not oversee
pharmaceuticals that----
Chairman Tester. So could you take this for the record?
Dr. Balbus. Sure.
Chairman Tester. There are more than a 100 high-use
pharmaceutical products that are not produced domestically, but
they're essential for common diseases like diabetes. These
drugs are susceptible to global supply chain disruptions, and
those supply chain disruptions occurred during the COVID-19
pandemic. I believe they constitute a national security risk.
So can you go back to your people and ask them what is
being done in this realm to ensure that those supply chain
challenges and disruptions don't occur in the next pandemic, or
don't occur in the next natural disaster, or how about just
don't occur?
Dr. Balbus. Absolutely. Post-COVID, there is a lot of work
on supply chain resilience as per the Administration for
Strategic Preparedness and Response in the Food and Drug
Administration, and we can come back with a summary of that.
Chairman Tester. That'd be great.
That same question for the VA. Not only pharmaceuticals,
but beyond pharmaceuticals, critical supplies and equipment to
help keep VA facilities running and serving Veterans. Some of
it now is manufactured right here in America because of the
pandemic. Is there anything the VA is doing to ensure that we
have access to those supplies when we need them?
Mr. Small. Yes, Senator. VA follows, complies with the Buy
American Act, Trade Agreements, and Infrastructure Investment
and Job Acts. Additionally, procurement officers interact with
industry frequently to educate and inform them that the Federal
Government, VA, must comply with the BAA, TAA, and we are very
interested in products that are made in America.
Chairman Tester. So the last question that I have is that
you have volunteer teams called DEMPS. They play a critical
role in the VA's Fourth Mission. Between the COVID-19 pandemic
and near continuous use for responding to national and weather
disasters across this country, the all-volunteer force is
experiencing a high level of burnout.
So, Mr. Small, can you update the Committee on recent
efforts to establish a collection of dedicated deployment-ready
teams?
Mr. Small. Yes, sir.
Chairman Tester. Or maybe you have a different view on the
burnout issue.
Mr. Small. No, I do not, Senator. But before I hand this
question over to my esteemed colleague, Derrick Jaastad, I just
would like to reiterate our commitment to conducting realistic
national level exercise permitting us to test our strategic
level-readiness of the Department through engagements of our
senior leadership on the complexity associated with emergency
environment.
Additionally, this continued engagement and exercise of our
continuity of operations, emergency relocation groups, our
devolution emergency relocation group provides a mechanism for
testing and training our communications to the administration
and the staff officers. But I will defer to----
Chairman Tester. I've got that. And that's good work. The
question becomes, Senator King brought up an issue with the
shooting in Lewiston, Maine, and how you guys were able to
respond really quick. You were able to do that, I assume,
because you've had a volunteer force ready to go in that
region. Is that correct?
Mr. Small. Yes, Senator. We do. I would defer to Mr.
Jaastad. He can provide details on the DEMPS program.
Chairman Tester. So the real question is, is that these
folks are getting used more, and more, and more. We heard the
testimony from Dr. Balbus. We see what's happened in the
country from a disaster standpoint, whether it's man-made or
nature made. And if you see burnout as a problem, we heard from
Mr. Small, what else is being done so we make sure we got the
people on the ground?
Mr. Jaastad. Chairman Tester, indeed we did stress our
DEMPS system. But, I think, it's also very important to note
that our DEMPS volunteers have a warrior spirit and a servant's
heart. Over the last year, we've added an additional 1,200
volunteers to those ranks.
When we look at applying lessons learned from COVID, we
have to address our ability to respond to multiple events,
whether it's hotspots, whether it's hurricanes, whether it's
mass shootings, or wildfires. The CDT program, the Clinical
Deployment Team program, was funded in January of last year.
$85 million to hire 360 clinicians, 20 per VISN, 5 doctors, 11
nurses, 2 social workers, and 2 LPNs.
As a function of this cohort of FTE, they are eligible, or
they are scheduled for possible deployment of 30 days twice a
year. That's under the auspices of OEM. And so every month, I
will have 60 providers ready to deploy in under 72 hours. This
is a complementary program to the 12,000 DEMPS volunteers that
are still active within our rosters.
Chairman Tester. Okay. You're talking nationwide figures,
right?
Mr. Jaastad. Yes.
Chairman Tester. Yes. So the question becomes in a more
sparsely populated State like Maine or Montana. It worked in
Maine. Do you feel that confident throughout the rest of the
United States as far as availability of volunteer manpower?
Mr. Jaastad. Volunteer manpower, yes.
Chairman Tester. Okay. I lied. I got one more question. You
got a cache program that was established after 9/11 because of
what transpired on 9/11. We're two decades since 9/11, things
have changed significantly. Can you speak to what you're doing
to revisit the contents of those caches to make sure that they
reflect our environment today?
Mr. Jaastad. Chairman Tester, the cache program is managed
by three separate program offices. The Office of Public Health,
Emergency Pharmacy Services, and the Office of Emergency
Management.
Chairman Tester. And how often are you revisiting them, and
are they being changed to reflect the challenges of today?
Mr. Jaastad. We meet as co-chairs quarterly to review
inspections. We are also a standing member on the Public Health
Emergency Medical Countermeasures Enterprise, hosted by HHS.
Chairman Tester. And are the contents of those caches being
changed? Have they changed significantly? Have they changed at
all since 9/11?
Mr. Jaastad. Actually, the PHEMCE, or Public Health
Emergency Medical Countermeasures Enterprise, works in
conjunction with the CDC to do an annual report in terms of
what we see as threats, what the SNS or Strategic National
Stockpile has, and how the all-hazards emergency cache should
complement that. And so, yes, we do make adjustments within the
inventory.
Chairman Tester. Within the inventory to reflect. Okay.
Good enough. Senator Blumenthal.
HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thanks, Mr. Chairman. Thanks for
holding this very important hearing and apologies for being
detained. I just want to say about this issue, it is so
important in Connecticut where COVID caused many of our staff,
the docs, the nurses, maintenance, to be burned out. But also
what we've seen lately in terms of resiliency challenges,
climate change and extreme weather causing flooding at our
facilities--the West Haven facility--emphasizing, again, the
importance of replacing that facility as is ongoing, new
parking, new surgical unit around the way.
But we need the investment in capital. And, I think, with
all due respect, the President's been great to the VA, but I
think the investment in capital still falls short of where it
has to be to meet many of these emergencies that you've been
discussing today.
And I guess my question to you is what do you see as the
priority in terms of the facilities, the structural
sustainability? Where do you see as the main challenges that
can be met by investment in the actual structures, the
infrastructure, the facilities that the VA does?
Mr. Small. Yes. Thank you, Senator. I will defer to my
colleague in VHA to speak to the VHA medical facilities.
Dr. Dorsey. Thank you for that question. I will say that
the VA has just completed their climate vulnerability
assessment. That was in 2023, and we're using this as a tool to
really assess and evaluate the overall vulnerability of our VA
assets.
So we've looked at two different components. Our physical
vulnerability, which is combines actually three different
climate metrics. So exposure so the probability that a site may
be susceptible to climate phenomenon, for example, sea level
rise and flooding, sensitivity of that site to a climate-
related hazard, and then the adaptive capacity to be able to
adapt to those situations.
We've also taken a look at the social vulnerability of the
population in that area. For example, socioeconomic status,
housing characteristics, race, age, educational level,
disability status. So we are using the results of this climate
vulnerability assessment to really help inform deeper dives,
and look at specific facilities and areas of concern, but also
to make plans for our future infrastructure investments.
Senator Blumenthal. Thank you.
Thanks, Mr. Chairman.
Chairman Tester. I want to thank our witnesses for being
here today. I appreciate the--yes. Senator King, you may have
the floor.
Senator King. Mr. Balbus, first a story about your title.
Deputy Assistant Secretary. I worked in this institution some
years ago as a staff member, and I once called the Office of
Management and Budget to seek a witness at a hearing. And the
fellow said we'll send you, I think it was a deputy assistant
secretary or a deputy undersecretary.
And I said, well, I don't really know the titles. Can you
tell me who this is? And the fellow gave me an answer--if I
ever write a book about Washington, this will be the title--he
said, ``He's at the highest level where they still know
anything.'' That's you, Mr. Balbus.
[Laughter.]
Dr. Balbus. I'll take that one.
[Laughter.]
Senator King. I've come to realize that I'm now above that.
The question I have is, in your title, Climate Change and
Health Equity, do you see trends in terms of climate change
affecting the frequency and severity of disasters? I mean, I
realize you're not a climate scientist, but tell me about the
relationship between climate change and things like the Maui
wildfires, or flooding in the West, or severe hurricanes.
Dr. Balbus. Well, absolutely. I mean, there's no doubt that
we've seen substantial warming, for example, of the oceans, and
the warmth of the ocean fuels the hurricanes. So we see much
more rapid strengthening and intensity of the hurricanes that
are hitting the Gulf Coast as one example. We're seeing more
extremes of drought, which is partly why Maui experienced its
devastating wildfire.
So the trend line is very clear. In NOAA's billion-dollar
disasters graph, many people have seen this, they keep having
to actually change the y-axis because the number of billion-
dollar disasters keep setting records year after year in the
last few years.
Senator King. Could you get hold a copy of that and supply
it to the Committee, please?
Dr. Balbus. Absolutely.
Senator King. Thank you.
Thank you, Mr. Chairman.
Chairman Tester. There is no doubt from a fiscal
standpoint, we cannot continue to forward what's been going on
from a disaster standpoint. We need to figure out common sense
ways to get arms around this.
Senator King. One suggestion that Senator Rubio and I are
working on is funding preventive measures so that we're
preventing the disaster, which is much more expensive to remedy
than it is to prevent.
Chairman Tester. That's 100 percent correct.
Senator King. Thank you.
Chairman Tester. I want to thank the witnesses today. I
appreciate you being here. Now, you're seasoned Veterans. I
appreciate the robust conversation around this topic. There
were several questions that were asked for the record. I'd ask
you to get them back in a timely manner. We will keep the
record open for a week, and this hearing is adjourned.
[Whereupon, at 4:29 p.m., the hearing was adjourned.]
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