[Congressional Record Volume 142, Number 104 (Tuesday, July 16, 1996)]
[House]
[Pages H7546-H7552]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
EXTENDING BENEFITS TO VETERANS EXPOSED TO AGENT ORANGE
Mr. STUMP. Mr. Speaker, I move to suspend the rules and pass the bill
(H.R. 3643) to amend title 38, United States Code, to extend through
December 31, 1998, the period during which the Secretary of Veterans
Affairs is authorized to provide priority health care to certain
veterans who were exposed to agent orange or who served in the Persian
Gulf war and to make such authority permanent in the case of certain
veterans exposed to ionizing radiation, and for other purposes, as
amended.
The Clerk read as follows:
H.R. 3643
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. AUTHORITY TO PROVIDE PRIORITY HEALTH CARE.
(a) Authorized Inpatient Care.--Section 1710(e) of title
38, United States Code, is amended--
(1) in paragraph (1), by striking out subparagraphs (A) and
(B) and inserting in lieu thereof the following:
``(e)(1)(A) A herbicide-exposed veteran is eligible for
hospital care and nursing home care under subsection
(a)(1)(G) for any disease suffered by the veteran that is--
``(i) among those diseases for which the National Academy
of Sciences, in a report issued in accordance with section 2
of the Agent Orange Act of 1991, has determined--
``(I) that there is sufficient evidence to conclude that
there is a positive association between occurrence of the
disease in humans and exposure to a herbicide agent;
``(II) that there is evidence which is suggestive of an
association between occurrence of the disease in humans and
exposure to a herbicide agent, but such evidence is limited
in nature; or
``(III) that available studies are insufficient to permit a
conclusion about the presence or absence of an association
between occurrence of the disease in humans and exposure to a
herbicide agent; or
``(ii) a disease for which the Secretary, pursuant to a
recommendation of the Under Secretary for Health on the basis
of a peer-reviewed research study or studies published within
20 months after the most recent report of the National
Academy under section 2 of the Agent Orange Act of 1991,
determines there is credible evidence suggestive of an
association between occurrence of the disease in humans and
exposure to a herbicide agent.
``(B) A radiation-exposed veteran is eligible for hospital
care and nursing home care under subsection (a)(1)(G) for any
disease suffered by the veteran that is--
``(i) a disease listed in section 1112(c)(2) of this title;
or
``(ii) any other disease for which the Secretary, based on
the advice of the Advisory Committee on Environmental
Hazards, determines that there is credible evidence of a
positive association between occurrence of the disease in
humans and exposure to ionizing radiation.'';
(2) in paragraph (2)--
(A) by striking out ``Hospital'' and inserting in lieu
thereof ``In the case of a veteran described in paragraph
(1)(C), hospital''; and
(B) by striking out ``subparagraph'' and all that follows
through ``subsection'' and inserting in lieu thereof
``paragraph (1)(C)'';
(3) in paragraph (3), by striking out ``of this section
after December 31, 1996'' and inserting in lieu thereof
``after December 31, 1998, in the case of care for a veteran
described in paragraph (1)(A) or paragraph (1)(C)''; and
(4) by adding at the end the following new paragraph:
``(4) For purposes of this subsection and section 1712 of
this title:
``(A) The term `herbicide-exposed veteran' means a veteran
(i) who served on active duty in the Republic of Vietnam
during the Vietnam era, and (ii) who the Secretary finds may
have been exposed during such service to a herbicide agent.
[[Page H7547]]
``(B) The term `herbicide agent' has the meaning given that
term in section 1116(a)(4) of this title.
``(C) The term `radiation-exposed veteran' has the meaning
given that term in section 1112(c)(4) of this title.''.
(b) Authorized Outpatient Care.--Section 1712 of such title
is amended--
(1) in subsection (a)(1)--
(A) by striking out ``and'' at the end of subparagraph (C);
(B) in subparagraph (D)--
(i) by striking out ``before December 31, 1996,'' and
inserting in lieu thereof ``before January 1, 1999,''; and
(ii) by striking out the period at the end of subparagraph
(D) and inserting in lieu thereof a semicolon;
(C) by adding at the end the following new subparagraphs:
``(E) during the period before January 1, 1999, to any
herbicide-exposed veteran (as defined in section
1710(e)(4)(A) of this title) for any disease specified in
section 1710(e)(1)(A) of this title; and
``(F) to any radiation-exposed veteran (as defined in
section 1112(c)(4) of this title) for any disease covered
under section 1710(e)(1)(B) of this title.''; and
(2) in subsection (i)(3)--
(A) by striking out ``(A)''; and
(B) by striking out ``, or (B)'' and all that follows
through ``title''.
(c) Savings Provisions.--The provisions of sections 1710(e)
and 1712(a) of title 38, United States Code, as in effect on
the day before the date of the enactment of this Act, shall
continue to apply on and after such date with respect to the
furnishing of hospital care, nursing home care, and medical
services for any veteran who was furnished such care or
services before such date of enactment on the basis of
presumed exposure to a substance or radiation under the
authority of those provisions, but only for treatment for a
disability for which such care or services were furnished
before such date.
(d) Priority Health Care for Service in Israel or Turkey
During Persian Gulf War.--(1) Section 1710(e)(1)(C) of title
38, United States Code, is amended by inserting after
``Southwest Asia theater of operations'' the following: ``,
or who may have been exposed while serving on active duty in
Israel or Turkey during the period beginning on August 2,
1990, and ending on July 31, 1991,''.
(2) Section 1712(a)(1)(D) of such title is amended by
inserting after ``during the Persian Gulf War'' the
following: ``, or who served on active duty in Israel or
Turkey during the period beginning on August 2, 1990, and
ending on July 31, 1991,''.
SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY CHRONICALLY
MENTALLY ILL VETERANS.
(a) Establishment.--Subchapter II of chapter 73 of title
38, United States Code, is amended by adding after section
7318 the following new section:
``Sec. 7319. Committee on Care of Severely Chronically
Mentally Ill Veterans
``(a) Establishment.--The Secretary, acting through the
Under Secretary for Health, shall establish in the Veterans
Health Administration a Committee on Care of Severely
Chronically Mentally Ill Veterans. The Under Secretary shall
appoint employees of the Department with expertise in the
care of the chronically mentally ill to serve on the
committee.
``(b) Duties.--The committee shall assess, and carry out a
continuing assessment of, the capability of the Veterans
Health Administration to meet effectively the treatment and
rehabilitation needs of mentally ill veterans whose mental
illness is severe and chronic and who are eligible for health
care furnished by the Department, including the needs of such
veterans who are women. In carrying out that responsibility,
the committee shall--
``(1) evaluate the care provided to such veterans through
the Veterans Health Administration;
``(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health Administration;
``(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is needed
to improve treatment and rehabilitation of such veterans; and
``(4) identify model programs which the committee considers
to have been successful in the treatment and rehabilitation
of such veterans and which should be implemented more widely
in or through facilities of the Veterans Health
Administration.
``(c) Advice and Recommendations.--The committee shall--
``(1) advise the Under Secretary regarding the development
of policies for the care and rehabilitation of severely
chronically mentally ill veterans; and
``(2) make recommendations to the Under Secretary--
``(A) for improving programs of care of such veterans at
specific facilities and throughout the Veterans Health
Administration;
``(B) for establishing special programs of education and
training relevant to the care of such veterans for employees
of the Veterans Health Administration;
``(C) regarding research needs and priorities relevant to
the care of such veterans; and
``(D) regarding the appropriate allocation of resources for
all such activities.
``(d) Annual Report.--(1) Not later than April 1, 1997, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
implementation of this section. The report shall include the
following:
``(A) A list of the members of the committee.
``(B) The assessment of the Under Secretary for Health,
after review of the initial findings of the committee,
regarding the capability of the Veterans Health
Administration, on a systemwide and facility-by-facility
basis, to meet effectively the treatment and rehabilitation
needs of severely chronically mentally ill veterans who are
eligible for Department care.
``(C) The plans of the committee for further assessments.
``(D) The findings and recommendations made by the
committee to the Under Secretary for Health and the views of
the Under Secretary on such findings and recommendations.
``(E) A description of the steps taken, plans made (and a
timetable for their execution), and resources to be applied
toward improving the capability of the Veterans Health
Administration to meet effectively the treatment and
rehabilitation needs of severely chronically mentally ill
veterans who are eligible for Department care.
``(2) Not later than February 1, 1998, and February 1 of
each of the three following years, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report containing information
updating the reports submitted under this subsection before
the submission of such report.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 73 is amended by inserting after the
item relating to section 7318 the following new item:
``7319. Committee on Care of Severely Chronically Mentally Ill
Veterans.''.
SEC. 3. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND
CLINICAL ACTIVITIES.
(a) In General.--(1) Subchapter II of chapter 73 is amended
by adding after section 7319, as added by section 2(a), the
following new section:
``Sec. 7320. Centers for mental illness research, education,
and clinical activities
``(a) The purpose of this section is to provide for the
improvement of the provision of health-care services and
related counseling services to eligible veterans suffering
from mental illness (especially mental illness related to
service-related conditions) through--
``(1) the conduct of research (including research on
improving mental health service facilities of the Department
and on improving the delivery of mental health services by
the Department);
``(2) the education and training of health care personnel
of the Department; and
``(3) the development of improved models and systems for
the furnishing of mental health services by the Department.
``(b)(1) The Secretary shall establish and operate centers
for mental illness research, education, and clinical
activities. Such centers shall be established and operated by
collaborating Department facilities as provided in subsection
(c)(1). Each such center shall function as a center for--
``(A) research on mental health services;
``(B) the use by the Department of specific models for
furnishing services to treat serious mental illness;
``(C) education and training of health-care professionals
of the Department; and
``(D) the development and implementation of innovative
clinical activities and systems of care with respect to the
delivery of such services by the Department.
``(2) The Secretary shall, upon the recommendation of the
Under Secretary for Health, designate the centers under this
section. In making such designations, the Secretary shall
ensure that the centers designated are located in various
geographic regions of the United States. The Secretary may
designate a center under this section only if--
``(A) the proposal submitted for the designation of the
center meets the requirements of subsection (c);
``(B) the Secretary makes the finding described in
subsection (d); and
``(C) the peer review panel established under subsection
(e) makes the determination specified in subsection (e)(3)
with respect to that proposal.
``(3) Not more than five centers may be designated under
this section.
``(4) The authority of the Secretary to establish and
operate centers under this section is subject to the
appropriation of funds for that purpose.
``(c) A proposal submitted for the designation of a center
under this section shall--
``(1) provide for close collaboration in the establishment
and operation of the center, and for the provision of care
and the conduct of research and education at the center, by a
Department facility or facilities in the same geographic area
which have a mission centered on care of the mentally ill and
a Department facility in that area which has a mission of
providing tertiary medical care;
``(2) provide that no less than 50 percent of the funds
appropriated for the center for support of clinical care,
research, and education will be provided to the collaborating
facility or facilities that have a mission centered on care
of the mentally ill; and
``(3) provide for a governance arrangement between the
collaborating Department facilities which ensures that the
center will be established and operated in a manner aimed at
[[Page H7548]]
improving the quality of mental health care at the
collaborating facility or facilities which have a mission
centered on care of the mentally ill.
``(d) The finding referred to in subsection (b)(2)(B) with
respect to a proposal for designation of a site as a location
of a center under this section is a finding by the Secretary,
upon the recommendation of the Under Secretary for Health,
that the facilities submitting the proposal have developed
(or may reasonably be anticipated to develop) each of the
following:
``(1) An arrangement with an accredited medical school that
provides education and training in psychiatry and with which
one or more of the participating Department facilities is
affiliated under which medical residents receive education
and training in psychiatry through regular rotation through
the participating Department facilities so as to provide such
residents with training in the diagnosis and treatment of
mental illness.
``(2) An arrangement with an accredited graduate school of
psychology under which students receive education and
training in clinical, counseling, or professional psychology
through regular rotation through the participating Department
facilities so as to provide such students with training in
the diagnosis and treatment of mental illness.
``(3) An arrangement under which nursing, social work, or
allied health personnel receive training and education in
mental health care through regular rotation through the
participating Department facilities.
``(4) The ability to attract scientists who have
demonstrated achievement in research--
``(A) into the evaluation of innovative approaches to the
design of mental health services; or
``(B) into the causes, prevention, and treatment of mental
illness.
``(5) The capability to evaluate effectively the activities
of the center, including activities relating to the
evaluation of specific efforts to improve the quality and
effectiveness of mental health services provided by the
Department at or through individual facilities.
``(e)(1) In order to provide advice to assist the Secretary
and the Under Secretary for Health to carry out their
responsibilities under this section, the official within the
central office of the Veterans Health Administration
responsible for mental health and behavioral sciences matters
shall establish a peer review panel to assess the scientific
and clinical merit of proposals that are submitted to the
Secretary for the designation of centers under this section.
``(2) The panel shall consist of experts in the fields of
mental health research, education and training, and clinical
care. Members of the panel shall serve as consultants to the
Department.
``(3) The panel shall review each proposal submitted to the
panel by the official referred to in paragraph (1) and shall
submit to that official its views on the relative scientific
and clinical merit of each such proposal. The panel shall
specifically determine with respect to each such proposal
whether that proposal is among those proposals which have met
the highest competitive standards of scientific and clinical
merit.
``(4) The panel shall not be subject to the Federal
Advisory Committee Act (5 U.S.C. App.).
``(f) Clinical and scientific investigation activities at
each center established under this section--
``(1) may compete for the award of funding from amounts
appropriated for the Department of Veterans Affairs medical
and prosthetics research account; and
``(2) shall receive priority in the award of funding from
such account insofar as funds are awarded to projects and
activities relating to mental illness.
``(g) The Under Secretary for Health shall ensure that at
least three centers designated under this section emphasize
research into means of improving the quality of care for
veterans suffering from mental illness through the
development of community-based alternatives to institutional
treatment for such illness.
``(h) The Under Secretary for Health shall ensure that
information produced by the research, education and training,
and clinical activities of centers established under this
section that may be useful for other activities of the
Veterans Health Administration is disseminated throughout the
Veterans Health Administration. Such dissemination shall be
made through publications, through programs of continuing
medical and related education provided through regional
medical education centers under subchapter VI of chapter
74 of this title, and through other means. Such programs
of continuing medical education shall receive priority in
the award of funding.
``(i) The official within the central office of the
Veterans Health Administration responsible for mental health
and behavioral sciences matters shall be responsible for
supervising the operation of the centers established pursuant
to this section and shall provide for ongoing evaluation of
the centers and their compliance with the requirements of
this section.
``(j)(1) There are authorized to be appropriated to the
Department of Veterans Affairs for the basic support of the
research and education and training activities of centers
established pursuant to this section amounts as follows:
``(A) $3,125,000 for fiscal year 1998.
``(B) $6,250,000 for each of fiscal years 1999 through
2001.
``(2) In addition to funds appropriated for a fiscal year
pursuant to the authorization of appropriations in paragraph
(1), the Under Secretary for Health shall allocate to such
centers from other funds appropriated for that fiscal year
generally for the Department of Veterans Affairs medical care
account and the Department of Veterans Affairs medical and
prosthetics research account such amounts as the Under
Secretary for Health determines appropriate to carry out the
purposes of this section.''.
(2) The table of sections at the beginning of chapter 73 is
amended by inserting after the item relating to section 7319,
as added by section 2(b), the following new item:
``7320. Centers for mental illness research, education, and clinical
activities.''.
(b) Annual Reports.--Not later than February 1 of each of
1998, 1999, and 2000, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives a report on the status and
activities during the previous fiscal year of the centers for
mental illness, research, education, and clinical activities
established pursuant to section 7320 of title 38, United
States Code (as added by subsection (a)). Each such report
shall include the following:
(1) A description of the activities carried out at each
center and the funding provided for such activities.
(2) A description of the advances made at each of the
participating facilities of the center in research, education
and training, and clinical activities relating to mental
illness in veterans.
(3) A description of the actions taken by the Under
Secretary for Health pursuant to subsection (h) of that
section (as so added) to disseminate information derived from
such activities throughout the Veterans Health
Administration.
(4) The Secretary's evaluations of the effectiveness of the
centers in fulfilling the purposes of the centers.
(c) Implementation.--The Secretary of Veterans Affairs
shall designate at least one center under section 7320 of
title 38, United States Code, not later than January 1, 1998.
SEC. 4. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL RESIDENTS
AND INTERNS.
Section 7406(c) of title 38, United States Code, is
amended--
(1) by striking out ``Department hospital'' each place it
appears and inserting in lieu thereof ``Department facility
furnishing hospital care or medical services'';
(2) by striking out ``participating hospital'' in paragraph
(4)(C) and inserting in lieu thereof ``participating
facility''; and
(3) by striking out ``hospital'' both places it appears in
paragraph (5) and inserting in lieu thereof ``facility''.
SEC. 5. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR
PHYSICIANS AND DENTISTS WHO ENTER RESIDENCY
TRAINING PROGRAMS.
Section 7432(b)(2) of title 38, United States Code, is
amended--
(1) by inserting ``(A)'' after ``(2)''; and
(2) by adding at the end the following:
``(B) The Secretary may suspend a special pay agreement
entered into under this section in the case of a physician or
dentist who, having entered into the special pay agreement,
enters a residency training program. Any such suspension
shall terminate when the physician or dentist completes,
withdraws from, or is no longer a participant in the program.
During the period of such a suspension, the physician or
dentist is not subject to the provisions of paragraph (1).''.
SEC. 6. REPORTING REQUIREMENTS.
(a) Extension of Annual Report Requirement.--Section 107(a)
of the Veterans Health Care Act of 1992 (Public Law 102-585;
38 U.S.C. 1710 note) is amended by striking out ``Not later
than January 1, 1993, January 1, 1994, and January 1, 1995''
and inserting in lieu thereof ``Not later than January 1 of
1993 and each year thereafter through 1998''.
(b) Report on Health Care and Research.--Section 107(b) of
such Act is amended--
(1) in paragraph (2)(A), by inserting ``(including
information on the number of inpatient stays and the number
of outpatient visits through which such services were
provided)'' after ``facility''; and
(2) by adding at the end the following new paragraph:
``(5) A description of the actions taken by the Secretary
to foster and encourage the expansion of such research.''.
SEC. 7. ASSESSMENT OF USE BY WOMEN VETERANS OF DEPARTMENT
HEALTH SERVICES.
(a) Reports to Under Secretary for Health.--The Center for
Women Veterans of the Department of Veterans Affairs
(established under section 509 of Public Law 103-446), in
consultation with the Advisory Committee on Women Veterans,
shall assess the use by women veterans of health services
through the Department of Veterans Affairs, including
counseling for sexual trauma and mental health services. The
Center shall submit to the Under Secretary for Health of the
Department of Veterans Affairs a report not later than April
1, 1997, and April 1 of each of the two following years, on--
(1) the extent to which women veterans described in section
1710(a)(1) of title 38, United States Code, fail to seek, or
face barriers in seeking, health services through the
Department, and the reasons therefor; and
[[Page H7549]]
(2) recommendations, if indicated, for encouraging greater
use of such services, including (if appropriate) public
service announcements and other outreach efforts.
(b) Reports to Congressional Committees.--Not later than
July 1, 1997, and July 1 of each of the two following years,
the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report containing--
(1) the most recent report of the Center for Women Veterans
under subsection (a);
(2) the views of the Under Secretary for Health on such
report's findings and recommendations; and
(3) a description of the steps being taken by the Secretary
to remedy any problems described in the report.
SEC. 8. MAMMOGRAPHY QUALITY STANDARDS.
(a) In General.--(1) Subchapter II of chapter 73 of title
38, United States Code, is amended by adding after section
7320, as added by section 3(a), the following new section:
``Sec. 7321. Mammography quality standards
``(a) A mammogram may not be performed at a Department
facility unless that facility is accredited for that purpose
by a private nonprofit organization designated by the
Secretary. An organization designated by the Secretary under
this subsection shall meet the standards for accrediting
bodies established under section 354(e) of the Public Health
Service Act (42 U.S.C. 263b(e)).
``(b) The Secretary, in consultation with the Secretary of
Health and Human Services, shall prescribe quality assurance
and quality control standards relating to the performance and
interpretation of mammograms and use of mammogram equipment
and facilities of the Department of Veterans Affairs
consistent with the requirements of section 354(f)(1) of the
Public Health Service Act. Such standards shall be no less
stringent than the standards prescribed by the Secretary of
Health and Human Services under section 354(f) of the Public
Health Service Act.
``(c)(1) The Secretary, to ensure compliance with the
standards prescribed under subsection (b), shall provide for
an annual inspection of the equipment and facilities used by
and in Department health care facilities for the performance
of mammograms. Such inspections shall be carried out in a
manner consistent with the inspection of certified facilities
by the Secretary of Health and Human Services under section
354(g) of the Public Health Service Act.
``(2) The Secretary may not provide for an inspection under
paragraph (1) to be performed by a State agency.
``(d) The Secretary shall ensure that mammograms performed
for the Department under contract with any non-Department
facility or provider conform to the quality standards
prescribed by the Secretary of Health and Human Services
under section 354 of the Public Health Service Act.
``(e) For the purposes of this section, the term
`mammogram' has the meaning given such term in paragraph (5)
of section 354(a) of the Public Health Service Act (42 U.S.C.
263b(a)).''.
(2) The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section
7320, as added by section 3(b), the following new item:
``7321. Mammography quality standards.''.
(b) Deadline for Prescribing Standards.--The Secretary of
Veterans Affairs shall prescribe standards under subsection
(b) of section 7321 of title 38, United States Code, as added
by subsection (a), not later than the end of the 120-day
period beginning on the date of the enactment of this Act.
(c) Implementation Report.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
Secretary's implementation of section 7321 of title 38,
United States Code, as added by subsection (a). The report
shall be submitted not later than 120 days after the later of
(1) the date on which the Secretary prescribes the quality
standards required under subsection (b) of that section, or
(2) the date of the enactment of this Act.
SEC. 9. PATIENT PRIVACY FOR WOMEN PATIENTS.
(a) Identification of Deficiencies.--The Secretary of
Veterans Affairs shall conduct a survey of each medical
center under the jurisdiction of the Secretary to identify
deficiencies relating to patient privacy afforded to women
patients in the clinical areas at each such center which may
interfere with appropriate treatment of such patients.
(b) Correction of Deficiencies.--The Secretary shall ensure
that plans and, where appropriate, interim steps, to correct
the deficiencies identified in the survey conducted under
subsection (a) are developed and are incorporated into the
Department's construction planning processes and given a high
priority.
(c) Reports to Congress.--The Secretary shall compile an
annual inventory, by medical center, of deficiencies
identified under subsection (a) and of plans and, where
appropriate, interim steps, to correct such deficiencies. The
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives, not later than
October 1, 1997, and not later than October 1 each year
thereafter through 1999 a report on such deficiencies. The
Secretary shall include in such report the inventory compiled
by the Secretary, the proposed corrective plans, and the
status of such plans.
SEC. 10. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY,
MILWAUKEE COUNTY, WISCONSIN.
(a) Modification of Reversionary Interest.--The Secretary
of Veterans Affairs is authorized to execute such instruments
as may be necessary to modify the conditions under which the
land described in subsection (b) will revert to the United
States so as--
(1) to permit Milwaukee County, Wisconsin, to grant all or
part of such land to another party with a condition on such
grant that the grantee use such land only for civic and
recreational purposes; and
(2) to provide that the conditions under which title to all
or any part of such land reverts to the United States are
stated so that any such reversion would occur at the option
of the United States.
(b) Description of Land.--The land covered by this section
is the tract of 28 acres of land, more or less, conveyed to
Milwaukee County, Wisconsin, pursuant to the Act entitled
``An Act authorizing the Administrator of Veterans' Affairs
to convey certain property to Milwaukee County, Wisconsin'',
approved August 27, 1954 (68 Stat. 866).
(c) General Authorities.--The Secretary may carry out this
section subject to such terms and conditions (including
reservations of rights for the United States) as the
Secretary considers necessary to protect the interests of the
United States. In carrying out this section, the Secretary
may eliminate any existing covenant or restriction with
respect to the tract of land described in subsection (b)
which the Secretary determines to be no longer necessary to
protect the interests of the United States.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Arizona [Mr. Stump] and the gentleman from Mississippi [Mr. Montgomery]
will each control 20 minutes.
The Chair recognizes the gentleman from Arizona, [Mr. Stump].
(Mr. STUMP asked and was given permission to revise and extend his
remarks.)
General Leave
Mr. STUMP. Mr. Speaker, I ask unanimous consent all Members have 5
legislative days to revise and extend their remarks and include
extraneous material on H.R. 3643, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Arizona?
There was no objection.
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, H.R. 3643 extends for 2 years expiring authorities for
the VA to provide priority health care to Persian Gulf veterans and
veterans exposed to agent orange.
This bill makes VA's authority to provide priority care to veterans
exposed to ionizing radiation permanent.
It also contains additional provisions which will be explained by the
subcommittee chairman momentarily, and I urge my colleagues to support
this bill.
I want to thank my good friend, Sonny Montgomery, the ranking
minority members of the full committee for his work on this measure.
Before yielding to him, I also want to thank Tim Hutchinson, chairman
of the SubCommittee on Hospitals and Health Care, and Chet Edwards, the
ranking minority member on the subcommittee.
Additionally, Mr. Speaker, Corrine Brown and Jack Quinn, both members
of the VA Committee, should be commended for their contributions to the
bill.
I also want to recognize Lane Evans for bringing provisions to the VA
Committee's attention which are needed to modify the title restrictions
in a 1954 VA land conveyance to the county of Milwaukee.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Arkansas [Mr. Hutchinson].
Mr. HUTCHINSON. Mr. Speaker, I rise in strong support of H.R. 3643,
legislation to extend through December 31, 1998, the period which the
Secretary of Veterans Affairs is authorized to provide priority health
care to certain veterans who were exposed to agent orange or who served
in the Persian Gulf war and to make such authority permanent in the
case of certain veterans exposed to ionizing radiation.
The Committee on Veterans' Affairs has demonstrated a long history of
bipartisan support for those veterans who may have been exposed to
chemical or environmental hazards during their service in the Southeast
and Southwest Asian theaters of war. specifically, the bill extends
priority health care to agent orange and Persian Gulf veterans to
December 31, 1998.
With regard to agent orange, this bill incorporates those provisions
accepted by the full committee in the last session and were dropped out
during conference with the Senate. As you may
[[Page H7550]]
remember, the provisions recognize the categorical list of diseases and
their respective association with agent orange exposure to provide
priority health care for veterans suffering from diseases in the first
three of the five categories. The provisions neither alter nor have any
bearing on the recent decision of the Secretary to presumptively
service-connected veterans with prostate cancer and peripheral
neuropathy.
The bill also makes permanent priority health care for radiation-
exposed veterans and creates a VA committee on the care of severely
chronically mentally ill veterans and centers for mental illness
research, education, and clinical activities. This provision,
originally introduced by subcommittee Ranking Member Chet Edwards,
would require that committee members be VA employees with expertise in
the care of the chronically mentally ill and that it submit annual
reports to the House and Senate Veterans' Affairs Committees on ways of
improving care to this priority treatment group. Over 40 percent of
VA's patients are treated for mental health problems.
The bill would also require the VA to establish centers of excellence
in mental illness research and clinical activities with the acronym
MIRECC. The purpose of the MIRECC's would be to facilitate the
improvement of health care services for veterans suffering from mental
illness, especially from conditions which are service-related, and to
develop improved models for the furnishing of clinical services.
MIRECC's would be modeled after the successful Geriatric Research,
Education, and Clinical Centers [GRECC's].
Under the provisions of this bill, the VA is authorized to
appropriate the amount of $3,125 million for fiscal year 1998 and $6.25
million for the fiscal years 1999-2001.
The bill also makes technical changes to title 38 to facilitate the
training of physicians and dentists in any VA facility and suspends
special pay agreements for physicians and dentists who enter residency
training programs.
Two amendments which encompass the committee's bipartisan concern for
veterans were added to the bill during the Subcommittee on Hospitals
and Health care markup.
The first amendment, offered by my friend and colleague Jack Quinn,
provides that those veterans who served in Turkey and Israel during the
time period of August 2, 1990, to July 31, 1991, be included in the
definition of Persian Gulf veterans for the purpose of priority health
care. The Department of Defense has estimated that approximately 8,145
veterans served in Israel and Turkey during the 11-month period. Under
the current definition of the gulf war theater, these veterans are
excluded and therefore not eligible for priority health care as
provided under this bill.
Jack has also been a leader in the fight for mammography sceening at
VA facilities, and has introduced legislation which has been
incorporated into the second amendment, offered by Congresswoman
Corrine Brown, which would reinstate reporting requirements through
1998 on the number of women who receive VA health care services;
requires VA to assess barriers that may prevent women veterans from
receiving proper health care; and identifies patient privacy
deficiencies and makes recommendations on the correction of existing
deficiencies. It also requires VA to adopt the same mammography
standards used by the private sector and HHS. Finally, it directs that
the mental health needs of women veterans who are chronically mentally
ill be addressed by the Committee on the Care of Severely Chronically
Mentally Ill Veterans.
The hard work of Mr. Quinn and Ms. Brown is invaluable and I
appreciate all they did to strengthen this bill.
I would also like to recognize the bipartisan efforts of Lane Evans
and Gerald Kleczka, who have worked hard to ensure that language which
would transfer VA land to the State of Wisconsin to facilitate the
building of a new Milwaukee Brewers stadium is included in the bill.
Finally, I would like to extend my heartfelt thanks to Committee
Chairman Bob Stump, Ranking Member Sonny Montgomery, and subcommittee
Ranking Member Chet Edwards for all the hard work they have done in
ensuring that this bill is brought to the floor today.
Mr. MONTGOMERY. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I would like to point out that the gentleman from New
York [Mr. Gilman] is not a member of our committee but he always comes
over when we have bills on the floor about veterans and makes some
comments. The gentleman from Arizona [Mr. Stump] and I are very
appreciative that he takes that time and interest.
This bill is the result of the excellent work done by our
Subcommittee on Hospitals and Health Care. At one time, the Honorable
John Paul Hammerschmidt and I served as ranking member and chairman of
this subcommittee. Today, Representative Tim Hutchinson, who serves in
the seat which Mr. Hammerschmidt used to hold, is the chairman of the
subcommittee, and Chet Edwards of Texas whose district includes the
Olin E. Teague VA hospital, is the ranking member.
The subcommittee oversees 173 medical centers, all of which provide
outpatient care and inpatient care. At 131 of these medical centers,
the Veterans Health Administration also operates a nursing home care
unit. In addition to these facilities, there are 391 independent,
satellite, community based, rural outreach or mobile clinics operated
by VHA, and this number should grow in future years as VHA tries to
make VA care more convenient for veterans.
For my colleagues who may not know how important the VA health care
system is to veterans, let me recite a few numbers from the most recent
national survey of veterans.
The VA treated 64 percent of the most seriously disabled service-
connected veterans who needed hospital care.
Almost half of the veterans with no health insurance, and 44 percent
of veterans with incomes below $10,000, were treated by VA if they
needed hospital care.
There are very significant changes taking place inside the veterans
medical system. The Under Secretary for Health, Dr. Kenneth Kizer, is
really shaking up the way things are done. He's trying to make sure the
veterans are satisfied with the health care that VA provides them. Even
at a time when the VA medical budget is under some pressure, Dr. Kizer
assures us that he can serve the same number of veterans with fewer
employees
The chairman of the committee, my good friend Bob Stump, has been
very supportive of the needs of veterans, and I wash to commend him for
his leadership of the committee. He has continued to work with me and
other members on both sides of the aisle to report legislation which
will improve the services provided to veterans.
This bill, H.R. 3643, as amended, is an example of the bipartisan
work of our committee. It includes provisions to extend the authority
to provide health care to Vietnam veterans and Persian Gulf veterans,
and includes an expansion of that authority suggested by Mr. Quinn for
service members who served in Israel or Turkey during the Persian Gulf
war. The bill also includes several provisions authored by my colleague
from Florida, Ms. Corinne Brown, dealing with the special health care
needs of women veterans.
Mr. Speaker, this bill also includes a provision which would resolve
a technical problem clouding the future use of a 28-acre parcel of land
conveyed by the VA to Milwaukee County, WI, as authorized by statute in
1954, for recreational and other purposes. The terms of that conveyance
provided that if the county were to attempt to transfer title to a
third party, title would automatically revert back to the VA. Unlike
two other adjacent parcels of land previously transferred from VA to
the county, the deed of conveyance made no provision for reversion ``at
the option of the United States''.
A major league baseball stadium was constructed on the site made up
of these three parcels of land. In October 1995, the State legislature
of Wisconsin authorized financing and construction of a new stadium to
replace the existing stadium on the site. That legislation requires
Milwaukee County to convey all three tracts of land to the State.
That proposed conveyance raised a question of law as to whether,
under such a transfer, the three tracts would
[[Page H7551]]
revert back to the United States under the terms of the earlier
conveyances. As described by the Department of Veterans Affairs'
General Counsel, a ``reversionary interest is a property right that
runs with the land* * *'' and the Secretary lacks the authority to
waive or otherwise extinguish the right of reversion. With respect to
the parcels VA conveyed in 1949, however, the deed of conveyance
provides for reversion, in the event of alienation of any part of the
tract, at the option of the United States. The General Counsel
concluded, in a February 2, 1996, memorandum opinion, that ``the
Secretary of the VA has authority to exercise the option of the right
of reversion on behalf of the United States, and the concomitant
discretion to decline the option.'' The General Counsel further
concluded, however, with respect to the property conveyed in 1954, that
the law gives VA no discretion and a reversion would be automatic.
The Department of Veterans Affairs has advised, with respect to its
authority to weigh the option of reversion regarding the two parcels,
that it will not exercise the option in favor of reversion back to the
United States so long as the existing statutory restrictions on use are
followed. The Department has further advised that in the event that
legislation is introduced to modify the deed restrictions, the VA would
not object to releasing the properties from the restriction against
alienation.
While recent press reports indicate success in developing other
elements of a financing plan for the proposed new stadium, legislation
is clearly needed to enable the county to transfer the 28-acre tract,
which would otherwise revert to the United States, to the State of
Wisconsin.
Section 10 of the amended bill would authorize the Secretary of
Veterans Affairs to execute such instruments as may be needed to modify
the conditions under which VA conveyed the 28-acre tract to Milwaukee
County in 1954. Such authorization would permit the county to grant all
or part of the land to another party, subject to the condition that the
land be used only for civic and recreational purposes, and to provide
that any reversion to the United States would occur at the option of
the United States. The measure would also provide that the Secretary
may carry out this provision subject to such terms and conditions as
the Secretary considers necessary to protect the interests of the
United States.
Also included, are provisions suggested by the ranking member, Mr.
Edwards, which would improve the VA's treatment of mentally ill
veterans.
Mr. Speaker, veterans with mental illness are five times more likely
to use VA for health care services than the rest of the veteran
population. This bill calls for VA to establish a committee of experts
to assess its mental health programs and make recommendations for
improvement. It also authorizes the establishment of up to five centers
of excellence that would provide mental health research, education and
clinical care.
{time} 1330
Mr. Speaker, I yield 2 minutes to the gentleman from Illinois [Mr.
Evans].
Mr. EVANS. Mr. Speaker, the extension of priority care for veterans
who were exposed to agent orange reflects the compromise reached in the
Veterans' Affairs Committee last year on this issue. I must admit that
I was not completely satisfied with the legislation and I still have
reservations. Specifically, I still believe that we should be covering
all of the categories in the Agent Orange Act of 1991.
However, I still believe, as I did last year, that this is a solid
compromise which will ensure that the health care needs of deserving
Vietnam veterans will be met. The recent release of the Institute of
Medicine's report on agent orange only reaffirms that we must continue
to honor the health care needs of our Vietnam veterans.
I would again like to thank Chairman Stump, Mr. Edwards, Mr.
Hutchinson, and Mr. Montgomery for their efforts last year to work out
legislation which I feel protects the rights of veterans. The rest of
legislation, which also provides for our Persian Gulf war and atomic
veterans, is right on target and should be supported by all of my
colleagues.
Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentleman from New
York [Mr. Gilman], the chairman of the Committee on International
Relations.
(Mr. GILMAN asked and was given permission to revise and extend his
remarks.)
Mr. GILMAN. Mr. Speaker, I am pleased today to rise in support of
H.R. 3643, extending benefits to veterans who have been exposed to
agent orange, and I commend the gentleman from Arizona, the
distinguished chairman of our Committee on Veterans' Affairs, and the
gentleman from Mississippi, the distinguished ranking minority member,
Mr. Montgomery, for bringing this measure to the floor at this time,
and I thank the gentleman from Mississippi for his kind remarks.
This legislation provides for the extension of much needed assistance
to those veterans who have contracted health problems due to their
exposure to radiation in World War II, to exposure to agent orange in
Vietnam or to their service in the Persian Gulf.
Mr. Speaker, specifically, this measure extends through December 31,
1998, health care benefits to veterans suffering long-term side effects
of exposure to agent orange as well as for those veterans suffering
health problems from their service in the Persian Gulf.
Most important, it also recognizes the National Academy of Sciences
categorical list of diseases and their respective association to agent
orange exposure and provides priority health care for veterans from
diseases in the first three categories.
In doing this, this bill gives the veterans the benefit of the doubt,
allowing treatment for any disease conceivably related to wartime
herbicide exposure unless scientific evidence clearly shows that no
association exists. Additional conditions may be added for coverage at
the VA secretary's discretion, if based upon credible evidence of an
association.
This legislation also extends through 1997 the VA policy of offering
care to veterans suffering from ailments that may have been caused by
exposure to ionized radiation during atomic weapons testing after World
War II.
Finally, this bill extends the authority of the VA to provide health
care on a priority basis for Persian Gulf veterans through December 31,
1998, and extends coverage to those veterans serving in Israel and
Turkey during the conflict.
Mr. Speaker, this legislation addresses many longstanding critical
issues in veterans' health care and is a fitting response to the
service provided by these dedicated veterans on behalf of their
country.
Mr. MONTGOMERY. Mr. Speaker, I yield 2 minutes to the gentleman from
Wisconsin [Mr. Kleczka].
Mr. KLECZKA. Mr. Speaker, let me thank the gentleman from Mississippi
[Mr. Montgomery] for yielding time to me.
Let me echo the remarks of my friend, the gentleman from New York
[Mr. Gilman], in support of H.R. 3643. Not only does the bill provide
priority health care for those veterans who were exposed to a agent
orange, but also broadens the definition for the veterans who served in
the Persian Gulf.
I think a more important portion of the bill requires the Veterans'
Administration to promulgate mammography quality standards for our
service men and women.
The last portion of the bill, which I asked be inserted, and I want
to thank the gentleman from Arizona [Mr. Stump] and the minority
leaders, the gentleman from Mississippi [Mr. Montgomery] and the
gentleman from Illinois [Mr. Evans], my friends, for helping me out on
this; the situation is that in Milwaukee County the current baseball
stadium lies on three parcels of land owned by the Veterans'
Administration. Two of the parcels were transferred way back in 1948,
and the third was transferred in 1954.
Now there is a new stadium being contemplated, the financing is
almost put together on the new ball park, and we found that two of the
parcels already have been transferred by the Secretary's authority. The
third needed congressional legislation.
The provision in the bill today provides that since the use is going
to be the same, for a public purpose, that the Veterans' Administration
Secretary, at his authority or on his authority, can
[[Page H7552]]
transfer the land. I want to thank the chairman for helping us out on
this situation.
Mr. STEARNS. Mr. Speaker, the legislation we consider today, H.R.
3643, is a credit to the Veterans Committee. I want to compliment both
Chairman Bob Stump and ranking minority member Representative Sonny
Montgomery for the bipartisan spirit they have shown in getting this
bill to the House floor. This bill extends priority health care for
veterans exposed to agent orange and those who served in the Persian
Gulf war through December 31, 1998.
Mr. Speaker, my commitment to providing priority health care to the
Vietnam veterans who were exposed to agent orange and to those who
served in gulf war is longstanding. As you know, I have long supported
efforts to find a link between exposure to agent orange and the
plethora of illnesses which have occurred in Vietnam veterans.
With respect to what has been known as the gulf war syndrome, I took
a deep interest in requesting that we aggressively seek answers to the
many unexplained illnesses experienced by gulf war veterans. One of
first casualties of this mysterious group of disease was a constituent
of mine, Michael C. Adcock of Ocala, FL, who died at the age of 22
after serving in Operation Desert Storm.
After returning home from the gulf war, Michael suffered from a
number of symptoms which had befallen many other gulf war veterans,
including persistent nausea, skin rashes, aching joints, hair loss,
bleeding gums, blurred vision, and lack of energy, among others.
Michael died in 1993, 3 years after coming home from the Desert Storm
operation. We are still looking for answers to the causes of this
mysterious syndrome which appears to be indigenous to those who served
in the gulf war.
I think we all know how terribly urgent it is that we continue with
our research efforts until we find the answer to the cause for this
syndrome which is so ubiquitous to veterans of Desert Storm.
In light of the controversy surrounding unexplained illnesses Desert
Storm veterans are experiencing, the VA, DOD, NIH, and HHS have been
conducting extensive research into possible causes of the unexplained
illnesses associated with this military campaign.
On March 19, 1995, Dr. Kizer testified that the VA would be
initiating a national survey of Persian Gulf veterans and that this
study that would involve selecting a random sample of 15,000 Persian
Gulf veterans and 15,000 contemporaneous non-Persian Gulf era veterans.
The survey would include a mail-in health questionnaire as well as
physical examinations for a subgroup of those veterans included in a
broader survey. Hopefully, the data collected will shed further light
and provide us with additional clues surrounding the various illnesses
being experienced by the men and women who served in Desert Storm.
I believe the results of the VA mortality followup study comparing
Persian Gulf veterans with a control group of Persian-Gulf-era veterans
could produce some answers to several troubling questions.
I am optimistic that through such efforts we might find the missing
link that will explain this rash of perplexing illnesses which seem to
be indigenous to these particular veterans. We all know how invaluable
the research being conducted is and the need to find answers as to what
is causing thousands of gulf war veterans to be plagued by a rash of
unexplained symptoms.
I hope that the DOD and the VA will continue to both aggressively
treat symptoms associated with Desert Storm syndrome and investigate
its cause or causes.
My reason for sounding skeptical is that the medical follow up agency
of medicine [IOM] made an independent study of the collective efforts
to date. The IOM was rather harsh in its evaluation of the piecemeal
study and the duplication of efforts between DOD, VA, and HHS. The IOM
made several suggestions regarding the data and databases, the
coordination process, and the consideration of study design needs.
Hopefully, implementation of these suggestions will prove beneficial.
I also noted that the IOM concluded that it could not find any
reliable intelligence of medical or biological justification for
allegations that U.S. troops were exposed to chemical warfare agencies.
Unfortunately, this seems to be at odds with statements from our troops
both then and now.
On March 14, 1996, ``Veterans and Agent Orange: Update 1996'' found
sufficient evidence between herbicide exposure and soft tissue sarcoma,
non-Hodgkin's lymphoma, Hodgkin's disease, chloracne, and porphyria
cutanea tarda. The primary focus in these updated studies was whether
or not there is a connection between birth defects of children of those
servicemen who were sprayed with herbicides while serving in Vietnam.
Previous studies conducted by the National Academy of Sciences for the
Department of Veterans Affairs at the direction of Congress found a
link between agent orange and that at certain levels it caused a
plethora of cancers and other health hazards.
It is my hope that further studies may be conducted so that we have a
final pronouncement as to whether or not agent orange is culpable for
causing such deformities in children born to Vietnam veterans. This
bill would also establish five centers of excellence for mental
illness, research, education and clinical activities [MIRECC]. I have
long advocated that we provide our veterans with access to mental
health services and care. In fact, I proposed a 120-bed psychiatric
unit be a component of the ambulatory care addition in Gainesville.
While I am gratified by the fact the VA in Gainesville just received a
$19.8 million grant for this ambulatory care center, I suggest here
today that one of these proposed centers, be housing in the VA in
Gainesville, FL.
Another important component of this bill is that it requires VA to
promulgate mammography quality standards, and it also directs the VA to
report to Congress and efforts being made by the Department to ensure
privacy and safety for women veterans who require hospitalization for
psychiatric reasons.
Mr. Speaker, I strongly support this important legislation and urge
my colleagues to give it their full support and pass this bill today.
Mrs. SMITH of Washington. Mr. Speaker, I rise today in strong support
of H.R. 3643. This legislation will provide priority health care for
Persian Gulf veterans suffering from the gulf war syndrome. In
addition, this bill ensures our commitment to these veterans by
providing funding to establish five centers for mental illness
research, education and clinical activities, and improve VA health care
services for women veterans.
Mr. Speaker, I recently had the opportunity to read some disturbing
testimony from the Department of Defense at the House Government Reform
and Oversight Committee hearing on the gulf war syndrome. The Pentagon
admitted that when an Army unit blew up an Iraqi ammunition depot,
soldiers might have been exposed to nerve gas. This announcement may
help explain some of the mysterious illnesses reported by Americans who
served in the gulf.
I will continue to do all that I can to ensure that VA resources are
focused and coordinated to yield answers for Persian Gulf veterans. I
will not tolerate the Federal Government dragging its feet for the fear
of the financial consequences as it did with agent orange. This bill
sends a message that we will not abandon our soldiers when they get in
harm's way. Mr. Speaker, I urge my colleagues to support this important
legislation.
Mr. EDWARDS. Mr. Speaker, H.R. 3643, as amended, is an omnibus health
care bill which tackles a broad spectrum of issues affecting special
veteran populations--women, veterans exposed to toxic and hazardous
substances, and veterans suffering with chronic mental illness.
Mr. Speaker, I'm very pleased that this bill includes two provisions
I introduced last year. One calls for VA to establish a committee of
experts to assess its mental health programs and make recommendations
for improvements. The other authorizes appropriations for VA to
establish up to five centers of excellence that would provide mental
health research, education, and clinical care.
Mr. Speaker, I think it's important to appreciate that more than 50
percent of all eligible veterans who suffer from severe mental illness
rely on VA for care; that's more than five times the proportion of
veterans in the general population who use VA for any health care. The
Department reports that 64 percent of those veterans are service-
connected for a psychiatric condition. I believe these data underscore
the importance of VA mental health programs, and the need for this
legislation.
I urge Members to support H.R. 3643.
Mr. MONTGOMERY. Mr. Speaker, I have no more requests for time and I
yield back the balance of my time.
Mr. STUMP. Mr. Speaker, I have no further requests for time, and I,
too, yield back the balance of my time.
The SPEAKER pro tempore (Mr. Gutknecht). The question is on the
motion offered by the gentleman from Arizona [Mr. Stump] that the House
suspend the rules and pass the bill, H.R. 3643, as amended.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended, and the bill, as amended, was
passed.
A motion to reconsider was laid on the table.
____________________