[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
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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.
____________________