[Congressional Record Volume 146, Number 82 (Monday, June 26, 2000)]
[Senate]
[Pages S5781-S5784]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
                 RELATED AGENCIES APPROPRIATIONS, 2001

  The PRESIDING OFFICER. Under the previous order, the Senate will now 
resume consideration of H.R. 4577, which the clerk will report.
  The legislative clerk read as follows:

       A bill (H.R. 4577) making appropriations for the 
     Departments of Labor, Health and Human Services, and 
     Education, and related agencies for the fiscal year ending 
     September 30, 2001, and for other purposes.

  Pending:

       McCain amendment No. 3610, to enhance protection of 
     children using the Internet.

  The PRESIDING OFFICER. The Senator from Mississippi is recognized.


                           Amendment No. 3625

  (Purpose: To implement pilot programs for antimicrobial resistance 
                       monitoring and prevention)

  Mr. COCHRAN. Madam President, I send an amendment to the desk and ask 
that it be stated.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The legislative clerk read as follows:

       The Senator from Mississippi [Mr. Cochran], for himself, 
     Mr. Kennedy, and Mr. Frist, proposes an amendment numbered 
     3625.

  Mr. COCHRAN. Madam President, I ask unanimous consent reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       On page 27, before the colon on line 4, insert the 
     following: ``, and of which $25,000,000 shall be made 
     available through such Centers for the establishment of 
     partnerships between the Federal Government and academic 
     institutions and State and local public health departments to 
     carry out pilot programs for antimicrobial resistance 
     detection, surveillance, education and prevention and to 
     conduct research on resistance mechanisms and new or more 
     effective antimicrobial compounds.''

  Mr. COCHRAN. Madam President, I offer this amendment to H.R. 4577, 
the Labor, Health and Human Services, and Education appropriations bill 
to implement pilot programs for antimicrobial resistance monitoring and 
prevention.
  Antimicrobial resistance has become a worldwide problem. Emerging, 
drug-resistant infections threaten the health and stability of 
countries across the world. Diseases such as malaria and tuberculosis 
have become resistant to treatment in many countries, and we are 
beginning to see these drug-resistant infections reemerging in the 
United States.

[[Page S5782]]

  Here in the U.S., resistance is developing in both large, urban areas 
and rural communities. We are seeing widespread resistance develop to 
common drugs such as Penicillin. Some microbes are even becoming 
resistant to our last line of therapy, Vancomycin. We are approaching 
the point where such common ailments as a sore throat or an ear 
infection could become life threatening. The problem is not limited to 
a certain line of microbes. We are seeing the development of resistance 
in all major groups of microorganisms--viruses, fungi, parasites, and 
bacteria.
  We must address this problem on several levels. We must build our 
public health infrastructure for both surveillance of and response to 
resistance and outbreaks. We need to educate practitioners and patients 
in the responsible use of antimicrobials, and we need to continue to 
invest in research on the mechanisms of resistance and the development 
of new treatment.
  This amendment begins to address the global threat posed by 
antimicrobial resistant infections. We must aggressively act over the 
course of the next several years to avert the situation of a half 
century ago when infectious diseases were the greatest threat to human 
health.
  Specifically, this amendment provides $25 million to be available 
through such centers as the Centers for Disease Control and Prevention 
for the establishment of partnerships between the Federal Government 
and academic institutions and State and local public health departments 
to carry out pilot programs for antimicrobial resistance detection, 
surveillance, education, and prevention, and to conduct research on 
resistance mechanisms and new or more effective antimicrobial 
compounds.
  For the information of the Senate, authorizing legislation is being 
introduced and referred to the Health, Education, Labor and Pensions 
Committee. The purpose of the new legislation, which is being sponsored 
here in the Senate by the Senator from Tennessee, Dr. Frist, and the 
Senator from Massachusetts, Mr. Kennedy, will provide a framework of 
legislative authorization for activities and appropriations of dollars 
such as that reflected by this appropriations bill amendment. I also am 
pleased to have the cosponsorship on this specific amendment of Senator 
Kennedy and Senator Frist, as well.
  I am hopeful the majority leader will be able to permit us to 
announce that a vote will occur on this amendment as the next order of 
business for the Senate. It will not likely occur today but probably 
tomorrow at sometime to be announced by the leader. I hope we will be 
able to make that announcement for the information of all Senators very 
soon.
  The funding that is provided as an addition to that included in the 
bill for microbial research into resistance to diseases, viruses, and 
illnesses is a matter that is emerging as one of the most serious 
challenges we face in medical science today. I am hopeful the Senate 
will approve this amendment and increase the funding for this important 
area of inquiry.
  Madam President, I ask unanimous consent to proceed as in morning 
business to discuss two related pieces of legislation for the 
Department of Education that I will introduce today.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Cochran pertaining to the introduction of S. 2788 
and S. 2789 are printed in today's Record under ``Statements on 
Introduced Bills and Joint Resolutions.'')
  Mr. COCHRAN. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Madam President, I send an amendment to the desk and ask 
for its immediate consideration.
  The PRESIDING OFFICER. Is there objection to setting aside the 
pending amendment?
  Mr. COCHRAN. I object, Madam President.
  The PRESIDING OFFICER. Objection is heard.
  Mr. COCHRAN. I will find out what is going on, and I may withdraw my 
objection. So I will reserve the right to object at this point, and I 
will ask the distinguished Senator a question or two.
  There is a consent request that I am told was being circulated on 
both sides of the aisle to have a vote on the pending amendment that I 
have offered at a time certain. In fact, it would occur at 9:40 a.m. 
tomorrow and would provide for some remarks to be made before the vote. 
I would like to know whether or not we can expect to get consent to 
that proposed agreement before permitting the amendment to be set aside 
and proceeding to another amendment and possibly never getting back to 
the pending amendment. That is the purpose for my concern.
  Mr. REID. Madam President, we have the proposed unanimous consent 
agreement here and we are giving it every consideration. I thought it 
would be more appropriate, in that we are trying to move the bill 
along, to try to get some amendments offered and get them out of the 
way. We have dozens of amendments on this bill of which we need to try 
to dispose. We in the minority certainly have no problem with having a 
vote in the morning. It is just that we have some people to check with 
before we agree to the unanimous consent request. We would be happy to 
schedule votes on my amendments. We are not trying to avoid votes. We 
are happy to get votes.
  Mr. COCHRAN. Why don't we get consent on the agreement----
  Mr. REID. Because I don't have authority to offer my approval of the 
agreement at this time.
  Mr. COCHRAN. I don't have the authority to set aside my amendment and 
proceed to other matters until we get consent. So we have a problem.
  The PRESIDING OFFICER. Objection is heard.
  Mr. REID. Madam President, I also want to make sure everyone 
understands that we are trying to offer amendments to move the bill 
along. We don't want people to be complaining that people are trying to 
slow up movement of this bill. There is no problem at all with having 
the vote sometime tomorrow. As you know, there are scores of amendments 
that are going to be offered. We need to have a number of votes. What 
about if we had that vote at noon tomorrow rather than 9:40? Would the 
Senator agree to that?
  Mr. COCHRAN. Madam President, I don't have any indication from our 
leadership as to what alternatives would be available to substitute for 
the consent being circulated.
  Mr. REID. If my friend will check, that would be good.
  Mr. COCHRAN. We will find out an answer and get back to you.
  Mr. HARKIN. If the Senator will yield, I just saw the unanimous-
consent request, I might say, and there is a part in there--I don't 
mind the time, but there is a clause that says ``with no second-degree 
amendments in order.'' I am checking to find out whether or not that is 
going to be standard fare for the remainder of this bill. I support the 
Senator's amendment, but if we have a unanimous consent where some 
don't get an opportunity to offer second degrees and others do--we 
ought to play under the same rules is what I am saying. I ask the 
minority whip whether or not we are going to do that.
  Mr. REID. Madam President, that certainly is a question. That is one 
of the reasons we were holding off agreeing to this. I say to my friend 
from Mississippi, it appears we can agree to his amendment. It appears 
what is happening here is the majority wants a vote sometime tomorrow 
morning. If we agree to the Senator's amendment, how about having a 
vote on one of my amendments in the morning?
  Mr. COCHRAN. If the Senator will yield, he is negotiating with the 
wrong guy. He is down the hall. I will show you the direction how to 
get there. I am the author of this amendment and that is about as high 
as I get in this discussion. I appreciate Senator Reid's support for 
the amendment, and also Senator Harkin's support. If it were up to the 
three of us, we could probably get this worked out.
  Mr. REID. Maybe we can have our very competent staff walk down the 
hall and discuss that. In the meantime, I will speak about my 
amendment, and if it is appropriate at a subsequent time to offer it, I 
will do so.

[[Page S5783]]

  I also extend my appreciation to the Senator from Mississippi, who is 
always so cordial and easy to work with. I recognize that we all have 
things to do, sometimes over which we have no control. It happens to me 
all the time.
  I have spent a lot of time in hospitals in the last 10 or so years 
because of the illness of my wife. She is doing very fine now, but she 
has spent a lot of time in the hospital. Last August, she spent 18 days 
in the hospital. Prior to that, she spent a month in the hospital.
  During her hospitalizations, the one thing I recognized more than 
anything else was the extremely important work of nurses. I understand 
how we depend on the doctors and that they are lifesavers, to say the 
least. But the personnel who are underappreciated and undercompensated 
are nurses. They work so hard and do so much for so little. We need to 
do more to protect nurses, and the amendments that I am going to offer, 
when I have that opportunity, relate to nurses.
  First of all, I am going to offer an amendment that is going to 
recognize how dangerous nurses' work is. Nurses spend every day of 
their lives afraid that they are going to be stuck by mistake with a 
needle.
  One of my amendments would allow the Secretary of Labor to amend 
OSHA's blood-borne pathogen standard to require that employers use 
needle-less or safe needles and to require that employers create a 
sharp injury log to keep detailed information about on-the-job needle-
stick injuries.
  My second amendment would establish a new clearinghouse within the 
National Institutes of Occupational Safety and Health to collect data 
on engineered safety technology designed to prevent the risk of needle 
sticks. I have worked with the Senator from California, Mrs. Boxer, for 
a number of years on this problem. This amendment would relate directly 
to that problem.
  Keep in mind that needle sticks occur routinely. About 600,000 needle 
sticks occur in America every year--not 60,000, not 600--600,000. Every 
39 seconds, a nurse in America is accidentally stuck with a needle. 
This is a tremendously difficult problem. We could give example after 
example. I know we don't want to do that. But I am going to give a 
couple of examples.
  In October 1997, a woman from Reno, NV, by the name of Lisa Black, a 
registered nurse, was nursing a man who had a terminal case of AIDS 
when a needle that had been used on him accidentally stuck her. Today, 
she is a very sick woman. She is infected not only with HIV, but she 
also has hepatitis C. Lisa Black, who was a totally healthy person 
prior to that day in October 1997 when she was accidentally stuck in 
the hand with a needle, now takes 22 pills a day to keep her HIV 
infection from progressing to full-blown AIDS and to delay the effects 
of hepatitis C.
  Karen Daley is a nurse from Massachusetts. In fact, she is presently 
in a nurses association in Massachusetts. She had been a nurse for more 
than 20 years when she sustained a needle-stick injury when she reached 
her gloved hand into a needle box to dispose of the needle from which 
she had drawn blood. She was stuck with another needle.
  Just last week, in testimony before the House Subcommittee on 
Workforce Protection, Karen Daley described how the needle-stick injury 
caused her to contract both hepatitis C and HIV, which changed her 
life. I quote from part of her testimony.

       In the first year of my treatment I took a daily regimen 
     that consisted of 21 pills a day and an injection that caused 
     a wide range of side effects, among them: weight loss, 
     nausea, loss of appetite, hair loss, headaches, skin rashes, 
     severe fatigue and bone marrow depression. To say these side 
     effects interfered with my normal day-to-day routine is a 
     gross understatement. The single moment when my injury 
     occurred 18 months ago has changed many other things for me. 
     In addition to the emotional turmoil it has created for 
     myself, my family, my friends, my colleagues--it has cost me 
     much more than I can ever describe in words. As a result of 
     my injury, I have given up direct nursing practice, work that 
     I love.

  Karen Daley did everything in her power and took all the necessary 
precautions--including wearing gloves and following proper procedures--
to reduce risk of exposure to bloodborne pathogens. Her injury did not 
occur because she was careless or distracted or not paying attention to 
what she was doing.
  These needlesticks just occur. Karen Daley has good reason to believe 
that had a safer needle and disposal system been in place at her 
hospital, she would not be sick today. According to the CDC, eighty 
percent of all needlestick injuries can be prevented through the use of 
safer needles.
  Senator Boxer and I have introduced legislation that would 
dramatically reduce the risk of needlestick injuries by requiring 
hospitals and health-care facilities to use safe needles and keep 
better track of needlestick injuries.
  When I offered this bill as an amendment last year, many of my 
colleagues, including the chairman of the HELP Committee, assured me 
that they were concerned about this problem and were committed to 
working on it.
  Another year has passed, and still, nothing has been accomplished.
  In the year since I offered this amendment,there have been 
approximately 600,000 accidental needle wounds--that is one injury 
every 39 seconds.
  If we don't do something this coming year, there will be 600,000 more 
needle sticks, and a number of them will wind up as did Karen Daley and 
Lisa Black--infected with HIV, hepatitis C, and other debilitating 
diseases.
  The actual number of needlestick injuries is probably much higher, 
because these injuries are considered to be widely under-reported. 
Several studies show needlestick under-reporting rates of between 40 
and 90 percent.
  We could have over 1 million needle sticks every year instead of 
every 39 seconds and every 15 seconds. Some people do not report their 
injuries.
  The longer we wait, the more people--nurses, housekeeping staff, and 
anyone who handles blood, blood products, and biological samples--will 
be at risk of contracting a number of debilitating, if not deadly, 
diseases.
  There are more than a score of diseases we know of to which nurses 
and other related personnel are subject to being infected. I mentioned 
HIV. Hepatitis B and C and malaria may be transferred from just a speck 
of blood--a very small amount of blood.
  Despite the fact that safer devices have been available since the 
1970s and that we know that more than 80 percent of needlestick 
injuries can be prevented through their use, fewer than 15 percent of 
U.S. hospitals have switched over to these safer devices, except in 
states that have enacted laws requiring them.
  My amendments would ensure that the necessary tools--better 
information and better medical devices--are made available to front-
line health care workers in order to reduce the injuries and deaths 
that result from needle sticks.
  My amendment would establish a new clearinghouse within NIOSH to 
collect data on engineering safety technology designed to help prevent 
the risk of needle sticks, would allow the Secretary of Labor to amend 
OSHA's blood-borne pathogen standard to require employers to use 
needle-less or safe needles, and would require that employers create a 
sharp injury log to keep data on on-the-job needle-stick injuries.
  The companion measure Senator Boxer and I sponsored in the House 
received overwhelming support. To date, it has 181 cosponsors. In the 
Senate, we also have support for our legislation, in addition to 
Senator Boxer and the Senator offering the amendment at this time.
  Protecting the health and safety of our front-line health care 
workers should not be a partisan issue.
  I urge my colleagues to work with me to have the amendments agreed to 
so that injuries and deaths from needle-stick injuries can be avoided.
  Again, having spent time in hospitals and seeing how hard the nurses 
work, I had not realized that in America every 15 to 30 seconds women 
or men working as nurses stab themselves accidentally and subject 
themselves to these terrible diseases.
  I ask the Senator from Mississippi if we have any word from down the 
hall yet.
  Mr. COCHRAN. Madam President, if the Senator will yield, I am advised 
that we have not received any word from down the hall yet. I am not in 
a position to consent to the request at this time.
  Mr. REID. I understand that.
  I say to the Senator from Iowa, who was not on the floor at the time, 
that

[[Page S5784]]

I want him to understand we are doing the best we can, along with the 
majority, about this bill. Remember that I had two amendments to offer, 
but we weren't able to offer them because of a procedural problem.
  I hope we can move this bill along quicker. There are lots of 
amendments.
  I think the Senator has already talked to the Appropriations 
Committee, and we would agree to getting a list of who wants to offer 
amendments so we have a finite number. We are doing what we can.
  Mr. HARKIN. I respond by saying to my whip that we are trying to get 
a finite list of amendments together so we know how many we have. 
Hopefully, we can dispose of those in the next couple of days.
  We are definitely open for business. I want to start moving 
amendments. Hopefully, we will get an agreement shortly to offer 
amendments to be lined up to vote tomorrow.
  Mr. REID. My friend has done such a tremendous job of comanaging this 
very difficult piece of legislation. We agree to accept the amendment 
of the Senator from Mississippi and vote on my amendment.
  Madam President, Senator Boxer is to be listed as cosponsoring this 
bill. As I have stated, she has been stalwart in working with this. She 
is the main sponsor of the underlying amendment, the bill last year. We 
are both working on this amendment. She should be listed as a 
cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________