[Congressional Record Volume 146, Number 108 (Thursday, September 14, 2000)]
[House]
[Pages H7583-H7599]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DISTRICT OF COLUMBIA APPROPRIATIONS ACT, 2001
The SPEAKER pro tempore (Mrs. Biggert). Pursuant to House Resolution
563 and rule XVIII, the Chair declares the House in the Committee of
the Whole House on the State of the Union for the further consideration
of the bill, H.R. 4942.
{time} 1116
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union for the further consideration of
the bill (H.R. 4942) making appropriations for the government of the
District of Columbia and other activities chargeable in whole or in
part against revenues of said District for the fiscal year ending
September 30, 2001, and for other purposes, with Mr. Barrett of
Nebraska (Chairman pro tempore) in the chair.
The Clerk read the title of the bill.
The CHAIRMAN pro tempore. When the Committee of the Whole rose on
Wednesday, July 26, 2000, pending was amendment number 23 printed in
the Congressional Record by the gentlewoman from the District of
Columbia (Ms. Norton).
The gentlewoman from the District of Columbia (Ms. Norton) has 9
minutes remaining in debate and the gentleman from Oklahoma (Mr.
Istook) has 11\1/2\ minutes remaining in debate.
The gentlewoman from the District of Columbia (Ms. Norton) is
recognized.
Ms. NORTON. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, Members will recall that the matter involving
contraception turned on when a veto would take place. The mayor had
promised a veto. He believed that a pocket veto was the appropriate way
to proceed because, as this body well knows, if a veto is straight out
that is a declaration of war. There may be a compromise thereafter, but
it is a little more difficult. So my amendment addressed the notion
that the mayor should be allowed to pocket veto and we should respect
his word that a pocket veto would take place. That pocket veto has
taken place.
The chairman knows that he had written language that was otherwise
acceptable to me. It is perhaps not the exact language I would have
written with respect to contraception, but I had discussions with him
concerning his language. I understand his concern on his side of the
aisle. I have asked my own Members on this side of the aisle to
consider that what we are trying to do is to get some kind of
understanding that we can all live with to get this bill passed. I am
not prepared to ask for anything further now that the bill has been
vetoed, except that I would like to ask the chairman if that is
satisfactory to him and, if so, if he would accept my amendment.
Mr. ISTOOK. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, as the gentlewoman from the District of Columbia (Ms.
Norton) correctly states, we were in a situation where her amendment
was simply trying to strike language from the bill which would
disapprove pending legislation in the District of Columbia. That
legislation, since we were here last on this bill, has been pocket
vetoed by the mayor of the District of Columbia. Therefore, there is no
need to have the language in the bill whereby Congress disapproves that
local legislation because, indeed, it has already been disapproved by
the action of the mayor. Therefore, there is no need for the language
in the bill and certainly I am ready to accept, and I believe our side
is ready to accept, the amendment from the gentlewoman.
For clarification, for anyone, lest there be any confusion, the
amendment that is under consideration right now offered by the
gentlewoman from the District of Columbia (Ms. Norton) simply says that
Congress is not taking action to disapprove this legislation by the
District. However, there remains intact, it is not affected by the
amendment, the congressional instructions to the District that any
legislation regarding mandatory coverage of contraceptives and
insurance must include a conscience clause. The amendment of the
gentlewoman from the District of Columbia (Ms. Norton) does not touch
that language in the bill. That language remains.
I think that is what she is referring to as far as the good faith
concerns of a great many Members. Since the item in the bill is moot,
there is no need for the language in subsection (a) and I certainly
agree to accept the amendment of the gentlewoman from the District of
Columbia (Ms. Norton), and if the gentlewoman from the District of
Columbia (Ms. Norton) is agreeable, I would like to ask that we both
yield back the remainder of our time so we may be done with this item.
Ms. WOOLSEY. Mr. Chairman, I rise in strong support of the Norton
amendment.
[[Page H7584]]
I am appalled that this House is trying to stop the D.C. City Council
from implementing a measure they've already approved!
This is a true sign that some of my colleagues want to trample the
rights of the city council and people of this district.
I know that the people of our districts wouldn't stand for this!
The language in this bill that prohibits health care coverage for
contraceptives discriminates against the women of D.C.--just because
they live here.
We must stand up for the rights of all women to have access to
contraceptive coverage, by voting to allow access to contraceptives
here in the District of Columbia.
Contraceptive care gives our mothers and families the ability to make
important choices that affect their lives. And, we know that unwanted
pregnancy and abortion rates drop when women have access to preventive
reproductive health care.
Let's let women make decisions about their reproductive health with
their doctors.
I urge my colleagues to support the Norton amendment to make
contraceptive coverage accessible to the women of D.C.
Ms. NORTON. Mr. Chairman, I yield back the balance of my time.
Mr. ISTOOK. Mr. Chairman, I ask that the amendment be accepted, and I
yield back the balance of my time.
The CHAIRMAN pro tempore. The question is on the amendment offered by
the gentlewoman from the District of Columbia (Ms. Norton).
The amendment was agreed to.
The CHAIRMAN pro tempore. Without objection, the remainder of the
bill is considered as read, printed in the Record, and open to
amendment at any point.
There was no objection.
The text of the remainder of the bill is as follows:
Sec. 169. (a) Chapter 23 of title 11, District of Columbia,
is hereby repealed.
(b) The table of chapters for title 11, District of
Columbia, is amended by striking the item relating to chapter
23.
(c) The amendments made by this section shall take effect
on the date on which legislation enacted by the Council of
the District of Columbia to establish the Office of the Chief
Medical Examiner in the executive branch of the government of
the District of Columbia takes effect.
prompt payment of appointed counsel
Sec. 170. (a) Assessment of Interest for Delayed
Payments.--If the Superior Court of the District of Columbia
or the District of Columbia Court of Appeals does not make a
payment described in subsection (b) prior to the expiration
of the 45-day period which begins on the date the Court
receives a completed voucher for a claim for the payment,
interest shall be assessed against the amount of the payment
which would otherwise be made to take into account the period
which begins on the day after the expiration of such 45-day
period and which ends on the day the Court makes the payment.
(b) Payments Described.--A payment described in this
subsection is--
(1) a payment authorized under section 11-2604 and section
11-2605, DC Code (relating to representation provided under
the District of Columbia Criminal Justice Act);
(2) a payment for counsel appointed in proceedings in the
Family Division of the Superior Court of the District of
Columbia under chapter 23 of title 16, DC Code; or
(3) a payment for counsel authorized under section 21-2060,
DC Code (relating to representation provided under the
District of Columbia Guardianship, Protective Proceedings,
and Durable Power of Attorney Act of 1986).
(c) Standards for Submission of Completed Vouchers.--The
chief judges of the Superior Court of the District of
Columbia and the District of Columbia Court of Appeals shall
establish standards and criteria for determining whether
vouchers submitted for claims for payments described in
subsection (b) are complete, and shall publish and make such
standards and criteria available to attorneys who practice
before such Courts.
(d) Rule of Construction.--Nothing in this section shall be
construed to require the assessment of interest against any
claim (or portion of any claim) which is denied by the Court
involved.
(e) Effective Date.--This section shall apply with respect
to claims received by the Superior Court of the District of
Columbia or the District of Columbia Court of Appeals after
the expiration of the 90-day period which begins on the date
of the enactment of this Act.
This Act may be cited as the ``District of Columbia
Appropriations Act, 2001.''
Amendment No. 3 Offered by Mr. Bilbray
Mr. BILBRAY. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 3 offered by Mr. Bilbray:
At the end of the bill, insert after the last section
(preceding the short title) the following new section:
banning possession of tobacco products by minors
Sec. __. (a) In General.--It shall be unlawful for any
individual under 18 years of age to possess any cigarette or
other tobacco product in the District of Columbia.
(b) Exceptions.--
(1) Possession in course of employment.--Subsection (a)
shall not apply with respect to an individual making a
delivery of cigarettes or tobacco products in pursuance of
employment.
(2) Participation in law enforcement operation.--Subsection
(a) shall not apply with respect to an individual possessing
products in the course of a valid, supervised law enforcement
operation.
(c) Penalties.--Any individual who violates subsection (a)
shall be subject to the following penalties:
(1) For any violation, the individual may be required to
perform community service or attend a tobacco cessation
program.
(2) Upon the first violation, the individual shall be
subject to a civil penalty not to exceed $50.
(3) Upon the second and each subsequent violation, the
individual shall be subject to a civil penalty not to exceed
$100.
(4) Upon the third and each subsequent violation, the
individual may have his or her driving privileges in the
District of Columbia suspended for a period of 90 consecutive
days.
(d) Effective Date.--This section shall apply during fiscal
year 2001 and each succeeding fiscal year.
The CHAIRMAN pro tempore. Pursuant to House Resolution 563, the
gentleman from California (Mr. Bilbray) and a Member opposed each will
control 5 minutes.
The Chair recognizes the gentleman from California (Mr. Bilbray).
Mr. BILBRAY. Mr. Chairman, I yield myself such time as I may consume.
(Mr. BILBRAY asked and was given permission to revise and extend his
remarks.)
Mr. BILBRAY. Mr. Chairman, I am sorry that we have to be discussing
this item again this year. It is an item that I had brought before this
body two previous years. Last year, I agreed, after a request by the
legislative body of the City of Washington, D.C., and the mayor, that
they be allowed to address this issue. I withdrew it last year, as a
courtesy to the local city council and the mayor, on the possibility
that they could address a gap in the law that governs our Federal
District.
Sadly to say, Mr. Chairman, the action after 12 months has not been
forthcoming as indicated at that time. All my bill does, Mr. Chairman,
is point out the fact that when we talk about tobacco possession use
and abuse by minors, we need to do everything that we can to avoid the
problem before it starts.
Now I think that we all agree that the most critical thing we can do
in the United States to avoid the hideous deaths related to tobacco
consumption is to keep our young people from getting involved at an
early age. The strategies in many States across the country, including
my own State of California, has been to address the purchase and use
issue, among minors and adults. The use in public is very strongly
restricted in California, but then California and many States have
realized that there was a gaping hole in the tobacco approach. The
anti-tobacco approach had a gaping hole that sent the wrong message to
our young people, and that wrong message was, well, one cannot legally
buy it but once they have possession they can smoke it all they want;
they can possess it all they want.
Mr. Chairman, I would just like to point out how inconsistent that
message is to our young people. I am a parent of five children. My
children have spent a lot of time here in the Federal District and,
frankly, I think all of us should be concerned about the message that
we send to young people about the possession and use of tobacco.
I do not think any reasonable parent would want the United States
Government to send a message that underage use and possession of
tobacco is okay, but we also would not want to send the same message
about alcohol consumption.
Now, I cannot fathom how we have overlooked this issue for so long.
We would not do it with alcohol. If young people were walking down the
street with a six pack of beer, we would expect the law to address the
item. Sadly, here in Washington, D.C., the law does not address
children walking down the street with a pack of cigarettes.
This mixed message needs to be corrected, and I know there are those
that like us, as the Congress, to look the
[[Page H7585]]
other way, not get involved with this issue, but I think for all of us,
especially somebody like myself who not only have children but serve on
the Subcommittee on Health and Environment, to say that Washington will
set the example that underage purchase, possession, and use of tobacco
is not acceptable and it is not something we will stand by and ignore
for any longer.
Mr. Chairman, all my bill proposes to do is to apply the same
regulation technique here in Washington, D.C., as is applied in
Virginia and in Maryland. We have both States surrounding this Federal
District that have said that minors' possession and use of tobacco is
not acceptable and should be outlawed. All I am asking is, as Congress,
under our responsibility under the Constitution, as the legislative
body that would serve very parallel to what the State legislature in
Maryland and Virginia have done and that is to say that minor
possession is no longer acceptable within our jurisdiction.
All we are saying is that we will no longer stand by while
Washington, D.C., remains an oasis, a sanctuary, for underage
consumption of tobacco and that we will support the surrounding
communities in this strategy of eradicating as much of minor
consumption as possible, starting by setting the example that
possession and use of tobacco by minors is not only inappropriate it is
wrong and it should be illegal.
District of Columbia Code
Sec. Sec. 25-130. Purchase, possession or consumption by
persons under 21; misrepresentation of age; penalties.
(a) No person who is under 21 years of age shall purchase,
attempt to purchase, possess, or drink any alcoholic beverage
in the District, except that a person who is under 21 years
of age may temporarily possess an alcoholic beverage if the
temporary possession is necessary to perform lawful
employment responsibilities.
(b) No person shall falsely represent his or her age, or
possess or present as proof of age an identification document
which is in any way fraudulent, for the purpose of procuring
an alcoholic beverage in the District.
(b-1) Any person under 21 years of age who falsely
represents his or her age for the purpose of procuring
alcoholic any beverage shall be deemed guilty of a
misdemeanor and be fined for each offense not more than $300,
and in default in the payment of the fine shall be imprisoned
not exceeding 30 days.
(b-2) A civil fine may be imposed as an alternative
sanction for any infraction of this section, or any rules or
regulations issued under the authority of this chapter,
pursuant to Sec. Sec. 6-2701 to 6-2723 (``Civil Infractions
Act''). Adjudication of any infraction of this section shall
be pursuant to Sec. 6-2723.
(c) In addition to the penalties provided in subsections
(b-1) and (b-2) of this section, any person who violates any
provision of this section shall be subject to the following
additional penalties:
(1) Upon the first violation, shall have his or her driving
privileges in the District suspended for a period of 90
consecutive days;
(2) Upon the second violation, shall have his or her
driving privileges in the District suspended for a period of
180 days; and
(3) Upon the third violation and each subsequent violation,
shall have his or her driving privileges in the District
suspended for a period of 1 year.
____
Congress of the United States,
House of Representatives,
Washington, DC, May 23, 2000.
Hon. Anthony Williams,
Mayor, District of Columbia
Washington, DC.
Dear Mayor Williams: Thank you for your correspondence
regarding the recent hearing by the City Council of the
District of Columbia on legislation related to the
prohibition of tobacco product sales to minors.
I appreciate your response to my letter dated April 10,
2000 and I am encouraged that the City Council is addressing
the issue of tobacco use by minors. As mentioned in my
previous letter, the amendment that I have introduced each of
the last two years, and which we personally discussed last
year, focuses on minor possession and use of tobacco.
Virginia, Maryland, and over twenty other states have
enacted youth possession and consumption laws. It is my
belief that we can crack down on the possession of youth
tobacco by passing a common sense law similar to what I have
introduced in the past and at the same time continue to
increase efforts at the point of sales to hold negligent
merchants accountable for their illegal actions when they
sell tobacco products illegally to minors.
I would like to see parity between youth possession of
tobacco and youth possession of alcohol. In all cities across
the country, alcohol consumption and possession by minors is
prohibited. This is because alcohol is an adult product,
tobacco needs to receive the same type of recognition and
enforcement.
If we want to be serious about combating the use of tobacco
by minors we need to approach this issue on several fronts.
As a former mayor myself, I appreciate your hard work on this
issue, the progress being made and the inherent challenges of
leadership on such issues of controversy. However, as we get
deeper into the appropriations process in this second session
of the 106th Congress, I want to inform you of my intention
to reintroduce my amendment.
As mentioned previously, my amendment is very
straightforward. It contains a penalty section, which was
modeled after the state of Virginia's penalty section for
minors found in violation of tobacco possession. For the
first violation, the minor would, at the discretion of the
judge, be subject to a civil penalty not to exceed $50. For
the second violation, the minor would be subject to a civil
penalty not to exceed $100. For a third or subsequent
violation, the minor would have his or her driver's license
suspended for a period of 90 consecutive days. The 90 day
suspension is consistent with penalties for minor possession
of alcohol in the District of Columbia. Any minor found to be
in possession of tobacco may also be required to perform
community service or attend a tobacco cessation program. Each
of these penalties are at the judge's discretion. it contains
a provision to exempt from this prohibition a minor
individual ``making a delivery of cigarettes or tobacco
products in his or her employment'' while on the job.
As an original cosponsor of the strongest anti-tobacco bill
in the 105th Congress, the Bipartisan NO Tobacco for Kids Act
(H.R. 3868), the intentions of my amendment is to encourage
youth to take responsibility for their actions. Mayor
Williams, I look forward to working with you on this issue
and on legislation that will deter youth in the District of
Columbia from ever starting the deadly habit of smoking in
the first place.
Sincerely,
Brian P. Bilbray,
Member of Congress.
____
Congress of the United States,
House of Representatives,
Washington, DC, April 10, 2000.
Hon. Anthony Williams,
Mayor, District of Columbia,
Washington, DC.
Dear Mayor Williams: I am writing to make you aware of my
intentions to introduce an amendment to the Fiscal Year 2001
D.C. Appropriations Act that will prohibit individuals under
the age of 18 years old from possessing and consuming tobacco
products in the District of Columbia.
As you remember, we discussed this issue last year during
the debate on the FY 2000 D.C. Appropriation Act (H.R. 2587).
At that time I had introduced the same amendment, but
withdrew it after receiving direct confirmation from you that
this issue would be addressed on the local level. However, I
have been informed that local action on this initiative has
not, to date. I understand that legislation was sent to the
Judiciary Committee of the D.C. Council, but was recently
withdrawn. As a former mayor myself, I appreciate your hard
work on this issue and the inherent challenges of leadership
on such issues of controversy. However, as we get deeper into
the appropriations process in the second session of the 106th
Congress, I believe the time has come to act.
I think it is important that all levels of government work
together to help stop children from smoking. I also believe
we should send the right message to our children, and the
first step in this process would be for the District of
Columbia to join Virginia, Maryland, and the twenty other
states who have passed youth possession and consumption laws.
I would appreciate knowing of your intentions, and to work
with you and Members on both sides of the aisle in 2000 to
make sure this important piece of legislation becomes law.
To give you some background on this issue. I first
introduced this amendment during the 105th Congress, where it
received strong bipartisan support and passed through the
House by a 238-138 vote on August 6, 1998; however it was not
included in the final conference report. At the time I
initially introduced this amendment only 21 states in the
nation had minor possession laws outlawing tobacco, and my
amendment would have added the District of Columbia to this
growing list of states.
My amendment is very straight forward and easy to
understand. It contains a provision to exempt from this
prohibition a minor individual ``making a delivery of
cigarettes or tobacco products in his or her employment''
while on the job. My amendment also contains a penalty
section, which was modified after the state of Virginia's
penalty section for minors found in violation of tobacco
possession. For the first violation, the minor would, at the
discretion of the judge, be subject to a civil penalty not to
exceed $50. For the second violation, the minor would be
subject to a civil penalty not to exceed $100. For a third or
subsequent violation, the minor would have his or her
driver's license suspended for a period of 90 consecutive
days. The 90 day suspension is consistent with penalties for
minor possession of alcohol in the District of Columbia. Any
minor found to be in possession of tobacco may also be
required to perform community service or attend a tobacco
cessation program. Each of these penalties are at the judge's
discretion.
I understand that the District of Columbia already has
tough laws on the books to address the issue of sales of
tobacco to minors.
[[Page H7586]]
My amendment focuses specifically on the possession of
tobacco products by minors in order to put minor possession
of tobacco with minor possession of alcohol. All three cities
in my district have passed anti-possession laws, so I am not
asking the District to do anything my own communities have
not already done.
As an original cosponsor of the strongest anti-tobacco bill
in the 105th Congress, the Bipartisan NO Tobacco for Kids Act
(H.R. 3638), the intentions of my amendment is to encourage
youth to take responsibility for their actions. Mayor
Williams, I look forward to your response on this issue and
to working together on legislation that will deter youth in
the District of Columbia from ever starting the deadly habit
of smoking in the first place.
Sincerely,
Brian P. Bilbray,
Member of Congress.
____
American Lung Association,
New York, NY, July 26, 2000.
Dear Representative: The American Lung Association opposes
the Bilbray amendment to the District of Columbia
Appropriations bill that penalizes kids for the possession of
tobacco products.
Penalizing children has not been proven to be an effective
technique to reduce underage tobacco usage. In fact,
penalties may adversely affect existing programs that are
proven to work and are required, such as compliance checks
utilizing young people. The Bilbray amendment would make
these checks illegal. The Synar Amendment on marketing
tobacco to children could not be enforced because it would be
illegal for supervised teens to attempt to purchase tobacco.
Attempts to put the blame on our children, the pawns of
decades of sophisticated marketing by the tobacco industry,
instead of the manufacturers and retailers, is just another
smokescreen by big tobacco. The tobacco industry favors
shifting both the blame and the attention away from their
marketing efforts onto the shoulders of young persons.
For example, a 1995 study by the Maryland Department of
Health and Mental Hygiene discovered that 480 minors were
penalized for possessing tobacco but no merchants were fined
for selling tobacco to minors. On July 16 and 21, 1998, the
American Lung Association conducted an undercover ``sting''
operation to determine whether teens could purchase tobacco
in the U.S. Capitol complex. Five out of nine attempts were
successful, and in the House office buildings, all attempts
were successful. Here is clear proof that existing laws
regarding selling to teens are not being enforced. Existing
laws and regulations need to be enforced.
The tobacco industry favors criminalizing our kids. This
alone should be adequate reason to reject the Bilbray
amendment to the D.C. appropriations bill.
Sincerely,
John R. Garrison,
Chief Executive Officer.
____
District of Columbia, May 21, 1999.
Hon. Brian Bilbray,
House of Representatives,
Washington, DC.
Dear Congressman Bilbray: Thank you for your letter sharing
your concern about teenage smoking in the District and your
congratulations on my November election to the Office of
Mayor.
In response to your inquiry, the District of Columbia is
addressing the issue of teen smoking through a variety of
methods. DC Public Schools has two programs--The Great
American Smoke-out and ``2 Smart 2 Smoke''--to raise
children's awareness of the dangers of smoking. Additionally,
the Department of Health supports the efforts of local and
community-based initiatives like ``Ad-Up, Word-Up and Speak-
Out,'' which encourages school age children to perform their
own research on the effects of advertising directed at
children.
Finally, the school system recently elevated possession of
tobacco to a ``level one'' infraction--which means violators
could incur the most severe disciplinary measures, including
possible suspension. To assess our progress, the District is
tracking youth smoking related data through grants provided
by the Center for Disease Control.
I want to assure you that I share your concerns about
teenage smokers. Sandra Allen, Chairperson of the City
Council's Committee on Human Services, and I are working
diligently to strengthen enforcement which should, in
combination with the other initiatives, result in a real
reduction in teenage smoking. We believe that the cumulative
effect of these initiatives will have marked improvement on
the incidence of teen smoking.
Again thank you for bringing this issue to the forefront of
my attention. I agree that discouraging our youth from
engaging in this terrible habit of smoking is very important
in the fight to curtail tobacco's tragic and inevitable long-
term effects.
Sincerely,
Anthony A. Williams,
Mayor.
____
District of Columbia, May 16, 2000.
Hon. Brian P. Bilbray,
House of Representatives,
Washington, DC.
Dear Congressman Bilbray: Thank you for contacting me
regarding legislation to prohibit minors from the possession
and consumption of tobacco products.
I am committed to working with the City Council of the
District of Columbia to protect our children from harmful
tobacco products. As part of my commitment to limiting
tobacco use, my Fiscal Year 2001 Budget directs the use of
Tobacco Settlement Fund dollars for tobacco control,
prevention efforts, health promotion and education.
The Council's Committee on Consumer and Regulatory Affairs
will consider legislation to prohibit youth consumption of
tobacco products, Bill 13-60, the ``Enforcement of the
Prohibition of Tobacco Product Sales to Minors Act.'' The
bill prohibits the sale of tobacco to minors, increases fines
for the sale of tobacco to minors, and prohibits self-service
displays, certain advertisements and vending machine sales of
tobacco products. Under the legislation, the Department of
Health would also be authorized to conduct random inspections
of retail establishments that sell tobacco products. On
Wednesday, May 10, 2000, the Committee on Consumer and
Regulatory Affairs held a public hearing on this bill. Given
your concern on this issue, I have asked the Chair,
Councilwoman Sharon Ambrose to allow your amendment to be
debated during the hearing.
Clearly, restricting access of tobacco sales and penalizing
any business that targets or sells to youth is a priority of
our local leaders. Therefore, I respectfully request that you
withhold introducing your proposed legislation so that we can
move forward our local proposal. As a former City Mayor, I am
certain that you understand the importance of local
government in these public policy issues.
Thank you for your concern for the health and safety of
children in the District of Columbia.
Sincerely,
Anthony A. Williams,
Mayor.
Mr. Chairman, I reserve the balance of my time.
The CHAIRMAN pro tempore. The gentleman from Virginia (Mr. Moran) is
recognized for 5 minutes in opposition.
Mr. MORAN of Virginia. Mr. Chairman, I yield myself such time as I
may consume.
Mr. Chairman, I want to respond on this amendment. Mr. Chairman, I
want to put into the Record the fact that the American Lung Association
opposes the Bilbray amendment because it penalizes kids for the
possession of tobacco products.
Mr. Chairman, the American Lung Association opposes this because it
is not an effective technique to reduce underage tobacco usage. The
reality is that the compliance checks that are currently going on would
be made illegal by this amendment.
The Synar amendment on marketing tobacco to children could not be
enforced because it would be illegal for supervised teens to attempt to
purchase tobacco. This an attempt to put the blame on our children, the
pawns of decades of sophisticated marketing by the tobacco industry,
instead of manufacturers and retailers. It shifts the blame
inappropriately.
A study by the Maryland Department of Health and Mental Hygiene
discovered that 480 minors were penalized for possessing tobacco and no
merchants were penalized.
On July 16 and 21 of 1998, the American Lung Association conducted an
undercover sting operation to determine whether teens could purchase
tobacco in the U.S. Capitol complex. Five out of nine attempts were
successful, and in the House office buildings all attempts were
successful in the House office buildings. This is clear proof that
existing laws regarding selling to teens are not being enforced. They
need to be enforced first. Let us not criminalize our kids.
Mr. Chairman, I yield the balance of my time to the gentlewoman from
the District of Columbia (Ms. Norton).
(Ms. NORTON asked and was given permission to revise and extend her
remarks.)
Ms. NORTON. Mr. Chairman, I thank the gentleman from Virginia (Mr.
Moran) for yielding me this time.
Mr. Chairman, I would like to put the American Lung Association
letter in the Record and the Tobacco Free Kids letter in the Record
opposing the Bilbray amendment.
I am outraged at the amendment of the gentleman from California (Mr.
Bilbray). He brings forward this amendment when the city council is in
the midst of considering the Bilbray amendment. This amendment went
through the House in 1999, the first year of Mayor Williams' term,
despite a personal plea from Mayor Williams that he would like to try
another approach in the District.
That provision, the Bilbray provision, was one reason why the bill
was vetoed in 1999. The provision was removed and sent back here and
here comes the Bilbray amendment again.
[[Page H7587]]
Mayor Williams knows his city. The gentleman from California (Mr.
Bilbray) does not know Mayor Williams' city.
The mayor again wrote the gentleman from California (Mr. Bilbray) in
May, after another threat by the gentleman from California (Mr.
Bilbray) to intrude in local affairs was received. Mayor Williams had
already partially responded to the gentleman from California (Mr.
Bilbray). His budget that we are considering now funds a smoking
prevention program for minors.
{time} 1130
This in addition to the bill that is in the council, the mayor wrote
to the gentleman from California (Mr. Bilbray). And I am quoting, ``I
respectfully request that you withhold introducing your proposed
legislation.'' I thank the gentleman for his respect of our mayor.
He continued, ``so that we can move forward to consider your proposal
along with our own local proposal.'' And he said, ``as a former city
mayor, I am certain that you understand the importance of local
government in these public policy issues.''
The gentleman apparently understands how important local knowledge
and local prerogatives are as applied to his city of Imperial Beach,
California, and he understands it in all the gentleman speeches about
devolution, but like an authoritarian rule, the gentleman is trying to
impose legislation on a city that is already going strong on a tough
issue and in the midst of considering the gentleman's approach among
others.
In the District, elevation of possession of tobacco to a level 1
infraction in the D.C. public schools has to be very carefully
considered. Shall we do that or not when the measure imposes suspension
on a city with one of the highest dropout rates in the country, is that
the best thing for my city? I do not think so.
I do not even think I know, but I do think that the mayor of this
city knows. He asked the gentleman not to introduce it, and I am asking
this Congress not to move forward with it. The mayor and the council
have done the gentleman from California (Mr. Bilbray) a courtesy.
The gentleman has refused to do them that today. They are considering
the gentleman's approach. Hearings have been held. I am sorry we do not
move at the pace the gentleman would like. There are other matters that
have to be considered, like our own appropriations that are here, like
the fact that our city is just out of insolvency.
But we have said that we will consider the gentleman's approach. We
are considering the gentleman's approach. This debate is not about
inaction. Our city has moved to put before the entire city council Mr.
Bilbray's approach. He wants his action. This is a free country I say
to the gentleman.
We do not impose smoking codes on cities. We allow cities to decide
what is best for themselves.
American Lung Association,
Washington, DC, July 25, 2000.
Dear Representative: The American Lung Association opposes
the Bilbray amendment to the District of Columbia
Appropriations bill that penalizes kids for the possession of
tobacco products.
Penalizing children has not been proven to be an effective
technique to reduce underage tobacco usage. In fact,
penalties may adversely effect existing programs that are
proven to work and are required, such as compliance checks
utilizing young people. The Bilbray amendment would make
these checks illegal. The Synar Amendment on marketing
tobacco to children could not be enforced because it would be
illegal for supervised teens to attempt to purchase tobacco.
Attempts to put the blame on our children, the pawns of
decades of sophisticated marketing by the tobacco industry,
instead of the manufactures and retailers, is just another
smokescreen by big tobacco. The tobacco industry favors
shifting both the blame and the attention away from their
marketing efforts onto the shoulders of young persons.
For example, a 1995 study by the Maryland Department of
Health and Mental Hygiene discovered that 480 minors were
penalized for possessing tobacco but no merchants were fined
for selling tobacco to minors. On July 16 and 21, 1998, the
American Lung Association conducted an undercover ``sting''
operation to determine whether teens could purchase tobacco
in the U.S. Capitol complex. Five out of nine attempts were
successful, and in the House office buildings, all attempts
were successful. Here is clear proof that existing laws
regarding selling to teens are not being enforced. Existing
laws and regulations need to be enforced.
The tobacco industry favors criminalizing our kids. This
alone should be adequate reason to reject the Bilbray
amendment to the D.C. appropriations bill.
Sincerely,
John R. Garrison,
Chief Executive Officer.
____
July 25, 2000.
Hon. Henry A. Waxman,
House of Representatives,
Washington, DC.
Dear Representative Waxman: The Campaign for Tobacco-Free
Kids opposes the amendment that may be offered tomorrow by
Representative Bilbray to the District of Columbia
appropriations bill. This amendment would penalize youth for
possession of tobacco products without creating a thoughtful,
comprehensive plan to reduce tobacco use among children and
without first ensuring that adults who illegally sell tobacco
to kids are held responsible.
There is no silver bullet to reducing tobacco use among
kids, but this amendment, in the absence of other effective
policies, will do little to end tobacco's grip on the
children of D.C. There is little evidence to indicate that in
the absence of a concerted, comprehensive program, penalizing
kids will work to reduce tobacco use rates. A comprehensive,
effective program should include not only vigorous
enforcement of laws against selling tobacco to kids, but also
public education efforts, community and school-based
programs, and help for smokers who want to quit.
The narrow focus of this amendment will further divert
resources away from effective enforcement of the current laws
that prohibit retailers from selling to kids. Although the
District of Columbia penalizes retailers for selling to kids,
this law is not being enforced adequately. According to
Department of Health and Human Services, compliance checks
showed that 46.8 percent of retailers in D.C. sell tobacco
products to minors.
Additionally, this amendment does not address the fact that
the tobacco industry spends more than $6.8 billion a year
marketing its products. Kids in D.C. continually see tobacco
ads on storefronts and in magazines. The tobacco industry's
marketing tactics work: 85 percent of kids who smoke use the
three most heavily advertised brands (Marlboro, Camel and
Newport). In addition, the success of the tobacco industry
targeted marketing efforts is evidenced by the fact that 75
percent of young African Americans smoke Newport, a brand
heavily marketed to this group.
Any discussion of holding children responsible for their
addiction to tobacco should only come after or as part of a
comprehensive approach, which insures that adults are being
held responsible for marketing and selling to children.
Therefore, we ask that you oppose this amendment. Thank you.
Sincerely,
Matthew L. Myers,
President.
Mr. BILBRAY. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the Lung Association's concern about the sting
operations, have been clarified by the legislative council. My bill
does not obstruct sting operations or conflict with provisions in the
Synar amendment. These objections are misplaced. All I have to say to
the gentlewoman from Washington, D.C. (Ms. Norton), the City of
Alexandria, the City of Baltimore had their legislature require them to
treat tobacco possession and use by minors as a law. They were not
violated by that.
Cities have certain responsibilities, as a mayor I know that, but so
do legislatures. We serve as that legislature, like it or not. It is a
constitutional obligation and for those of us who have spent a lot of
time fighting the tobacco industry and fighting consumption for
tobacco, for us to walk away from this opportunity for another year, it
shows the hypocrisy of an institution that cannot do its fair share of
fighting underage consumption.
Mr. WAXMAN. Mr. Chairman, I rise in opposition to the Bilbray
amendment.
For decades the tobacco companies have acted more recklessly and
caused more harm than any other industry in America. They lied to the
American public. They manipulated nicotine in order to addict. And they
deliberately targeted our children.
Yet this Congress has failed to act.
Earlier this year, when the Supreme Court ruled that the Congress has
not given the Food and Drug Administration explicit authority to
regulate tobacco, the Court recognized that tobacco use ``poses perhaps
the single most significant threat to public health in the United
States.'' The Court decision placed responsibility to deal with this
crisis squarely in Congress' lap.
But since that decision in March, this Congress has done nothing. The
Republican leadership has not held a single hearing on the problem nor
brought any tobacco reform legislation to the floor.
[[Page H7588]]
In fact, the only tobacco legislation we considered was a rider to
block the tobacco lawsuit and deny veterans their day in court.
This Congress should pass meaningful tobacco legislation. We should
grant the FDA explicit authority to regulate tobacco. We should pass
performance standards to give the industry meaningful economic
incentives to reduce the number of children that smoke. We should pass
a national policy on environmental tobacco smoke and put in place a
nationwide public education campaign. Together these measures will
succeed in reducing the number of children who smoke and will save
million of lives for generations to come.
The amendment before us today may not do any harm--but there is
little evidence it will do any significant good. Public health
organizations oppose it. The Campaign for Tobacco-Free Kids says that
this amendment will ``do little to end tobacco's grip on the children
of D.C.'' The American Lung Association states that penalizing children
``may adversely effect existing programs that are proven to work.''
This Congress has abandoned any meaningful national effort to
regulate tobacco and to reduce tobacco use among our children. Instead,
it is now proposing to legislate questionable policy for just one city.
The Mayor and the City Council of D.C. should be given the
opportunity to decide what comprehensive tobacco control policies work
best for the children of this city. Just this past May, the City
Council held a public hearing on the Bilbray amendment and other
measures to prohibit youth consumption of tobacco products. They expect
to take up the issue when they meet again this fall. We should allow
D.C. to continue with its process and decide what tobacco control
policies work best for the city--just like thousands of other city
councils in the rest of the country.
In considering this amendment, don't delude yourself and believe that
this approach will reduce tobacco use among our children. The reality
is that we need to pass comprehensive tobacco control legislation. We
bear the responsibility to protect our children and to hold the tobacco
companies accountable for their actions.
Mr. BILBRAY. Mr. Chairman, I yield back the balance of my time.
The CHAIRMAN pro tempore (Mr. Barrett of Nebraska). The question is
on the amendment offered by the gentleman from California (Mr.
Bilbray).
The question was taken; and the Chairman pro tempore announced that
the ayes appeared to have it.
Mr. BILBRAY. Mr. Chairman, I demand a recorded vote.
The CHAIRMAN pro tempore. Pursuant to the rule, further proceedings
on the amendment offered by the gentleman from California (Mr. Bilbray)
will be postponed.
Amendment No. 4 Offered by Mr. Tiahrt
Mr. TIAHRT. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 4 offered by Mr. Tiahrt:
At the end of the bill, insert after the last section
(preceding the short title) the following new section:
Sec. __. (a) No person may distribute any needle or syringe
for the hypodermic injection of any illegal drug in any area
of the District of Columbia which is within 1000 feet of a
public or private day care center, elementary school,
vocational school, secondary school, college, junior college,
or university, or any public housing project, public swimming
pool, park, playground, video arcade, or youth center, or an
event sponsored by any such entity.
(b) Whoever violates subsection (a) shall be fined not more
than $500 for each needle or syringe distributed in violation
of such subsection.
(c) Notwithstanding any other provision of law, any amount
collected by the District of Columbia pursuant to subsection
(b) shall be deposited in a separate account of the General
Fund of the District of Columbia and used exclusively to
carry out (either directly or by contract) drug prevention or
treatment programs. For purposes of this subsection, no
program of distributing sterile needles or syringes for the
hypodermic injection of any illegal drug may be considered a
drug prevention or treatment program.
The CHAIRMAN pro tempore. Pursuant to House Resolution 563, the
gentleman from Kansas (Mr. Tiahrt) and a Member opposed each will
control 5 minutes.
The Chair recognizes the gentleman from Kansas (Mr. Tiahrt).
Mr. TIAHRT. Mr. Chairman, I yield myself such time as I may consume.
The amendment that I am offering gives us a clear choice between
protecting the children of the District of Columbia or protecting the
drug addicts. The District of Columbia City Council has designated drug
free school zones in hopes of protecting the children from drug
pushers. Hopefully, it will keep kids from being pressured to take
illegal drugs that would cheat them from a bright future.
What this amendment does is take the very same language the District
of Columbia City Council has used to protect the children and to extend
it to the needle exchange program. We would then have needle-free
school zones around the areas where children attend school and play.
Mr. Chairman, now, this is not new language or a new concept. It
simply clarifies that the exchange of needles to drug addicts should be
kept out of the reach of our children, the same as we have tried to
keep drugs out of their reach.
Currently, Prevention Works, a drug needle exchange program here in
Washington runs 10 needle exchange sites. Of those sites, six needle
exchange sites are located within 1,000 feet of at least one public
school. These sites pose a very real threat to our children.
I have a map, Mr. Chairman, that was given to me by the police
department here in the District of Columbia, showing the locations of
where the drug free school zone applies. Those areas are designated in
gray, green and pink. The pins that are pointed out here show the 10
needle exchange sites with the four that would currently not be
affected by this amendment, and the six that would be affected by this
amendment.
At the corner of 15th and A Street, Northeast location, a member of
my staff found a piece of a needle, across the street from Eastern
Senior High School, just a few feet away from where three little girls
were jumping rope. I worry that contaminated needles, discarded needles
from the needle exchange site may infect children just like these three
girls. It is an unnecessary risk for children.
This amendment is designed to protect these girls and all children in
the District of Columbia. This is a clear choice, Mr. Chairman. My
colleagues can either choose to protect the children or protect the
drug addicts. I hope the House will choose to protect the children.
Mr. Chairman, I reserve the balance of my time.
Mr. MORAN of Virginia. Mr. Chairman, I rise to claim the time in
opposition.
The CHAIRMAN pro tempore. The gentleman from Virginia (Mr. Moran) is
recognized for 5 minutes in opposition.
Mr. MORAN of Virginia. Mr. Chairman, I yield myself such time as I
may consume.
Mr. Chairman, we are adamantly opposed to this. On the face of it, it
looks like it might be reasonable, but it is a thousand feet away from
every place, every activity where children may be involved, parks,
recreation, schools, video arcades. This is a small city. If we take a
1,000 feet around the perimeter of all of these activities, the only
place left to conduct this program that has been so effective, has been
the most effective way of combatting a scourge that is worse than in
any other city in the country, particularly affecting women and
children, and that is HIV infection. This is the program that works,
but we cannot conduct this program under the Tiahrt amendment, except
in the Potomac River, on the White House lawn, at Bolling Air Force
Base or at the Old Soldier's Home, there may be a couple other places,
but there are very few, probably the Washington Mall, but there are
very, very few places under this amendment that could ever conduct a
program.
Effectively what it does is to say, you cannot conduct this program.
It is an allegedly clever way to kill a program that works. We are
adamantly opposed to it. If this stays in, I will tell my colleagues
this bill will be vetoed, because we have a program that works for
people who desperately need it to work.
Mr. Chairman, I yield 2 minutes to the gentlewoman from the District
of Columbia (Ms. Norton).
Ms. NORTON. Mr. Chairman, here is more veto bait. This is an attempt
by the gentleman from Kansas (Mr. Tiahrt) to do what he could not do
last year and to do what he was not even able to do in the Committee on
Appropriations, and that is to kill the program. It is a poison bill.
It is designed to kill a program that is saving the lives of children,
innocent children in the District of Columbia.
[[Page H7589]]
Children do find needles, but the gentleman has no evidence that
those needles come from the needle exchange program. They come from
addicts where there are not, in fact, programs. The gentleman is not
expert on how needles infect school children in the District, but the
D.C. Police Chief Charles Ramsey does, and I am now quoting him from a
letter he wrote the House, ``the current needle exchange program is
well managed and has an exemplary return rate. I have no reports that
indicate that the program has been abused in any way or created serious
public policy problems in the District.''
I ask Members to listen to our police chief and not the gentleman
from Kansas about what should happen in this city. This is a disease
that has become a black and brown disease. It is killing African
Americans. It is killing minorities. It has moved from gays to people
of color.
People of color see this directed against them. They know what saves
lives, and those who vote for this amendment are voting to kill men,
women, and children in my district. I am asking Members to oppose this
amendment and go back to what we have reluctantly accepted, and that is
an amendment that is before this House that would leave us with no
local funds, no Federal funds, and only a very modest and hardly
standing private program that must fish for money wherever it can.
Mr. MORAN of Virginia. Mr. Chairman, I ask unanimous consent that
both sides be granted an additional minute.
The CHAIRMAN pro tempore. Is there objection to the request of the
gentleman from Virginia?
There was no objection.
Mr. MORAN of Virginia. Mr. Chairman, I yield 1 minute to the
gentleman from Massachusetts (Mr. Delahunt).
Mr. DELAHUNT. Mr. Chairman, there are plenty of needles within 1000
feet of schools, housing projects and playgrounds. Unfortunately, they
are dirty needles and their use is spreading AIDS and promoting drug
abuse, but this amendment will do nothing, nothing to change that
tragic reality. We are really kidding ourselves if we believe we can
stop drug abuse by banning one of the few public health measures that
actually makes a difference in the real world.
When I was prosecuting and putting people in jail for drug use, for
drug trafficking, I supported local needle exchange efforts because
they work. They do not encourage drug abuse, and they do save lives by
halting AIDS and other serious diseases transmitted by dirty needles.
Serious problems demand serious solutions. Reject this amendment.
Mr. MORAN of Virginia. Mr. Chairman, I yield 1 minute to the
gentlewoman from California (Ms. Pelosi).
Ms. PELOSI. Mr. Chairman, I rise in opposition to the Tiahrt
amendment, because it would interfere with the District's ability to
save lives, put very simply, by operating needle exchange programs
which have been proven to reduce new HIV infections in this country,
especially among children.
Three quarters of new HIV infection in children are a result of
injection drug use by a parent. Why would we pass up an opportunity to
save a child's life by shutting down programs that work? HIV/AIDS
remains the leading cause of death among African Americans ages 25 to
44 in the District.
In spite of these statistics, this amendment attempts to shut down
the very program that the local community has established to reduce new
HIV infections. This Congress should be supporting decisions that local
communities make about their healthcare, not limiting their control.
Mr. Chairman, I would just like to mention a number of organizations,
the American Medical Association, the American Public Health
Association have concluded that needle exchange programs are effective.
The Surgeon General's Report has said that it found conclusively that
needle exchange programs reduce HIV transmission and do not increase
drug use. Support local control and oppose the Tiahrt amendment.
Mr. TIAHRT. Mr. Chairman, I yield myself the balance of the time.
Mr. Chairman, this is a clear choice. This is not about the needle
exchange program. This is about protecting children. One of the
comments that was made by the gentleman from Virginia (Mr. Moran) was
that this will keep the needle exchange program 1,000 feet away from
the children from where they are playing; that is exactly the point. We
want to protect the children.
The gentlewoman from the District of Columbia (Ms. Norton) said there
is no evidence that these needles come from the needle exchange
program. Yet Calvin Fay, the director of the International Scientific
and Medical Forum on Drug Abuse says, and I quote, ``first, most needle
exchange programs are not exchanges at all, but are needle giveaways,
since participants rarely exchange a dirty needle for a clean one,
which means that the dirty needles remain on the streets.''
{time} 1145
The only way we can protect the children is to keep these needle
exchange programs away from the kids.
Mr. Chairman, my concern is that if this is not passed, and since
there is no accounting for needles that are passed out to drug addicts,
that they will be available for children to become infected by. While
members may disagree on the effectiveness of the needle exchange
program, I think we can all agree we do not want these infected needles
in our children's midst, near public playgrounds or public pools.
Besides the immediate danger of needles themselves, I worry about the
threat to children's safety that needle exchange programs do when they
invite drug pushers and addicts into places where children should be
safe.
I also worry the needle exchange program will send the wrong message
about drug use to our children. We try to send children an unequivocal
message that drugs are wrong and that they can kill you. I worry that
if these drug addicts receive needles, rather than condemnation, they
will not understand that drugs are wrong.
As our drug czar, Barry McCaffrey, stated: ``Above all, we have a
responsibility to protect our children from ever falling victim to the
false allure of drugs. We do this, first and foremost, by making sure
that we send one clear, straightforward message about drugs: they are
wrong, and they can kill you.''
This amendment is about the safety of our children. It is not about
the effectiveness of a needle exchange program. It is a very simple
choice. Those who oppose my amendment will argue that the Tiahrt
amendment, if adopted, would shut down a needle exchange program in the
District of Columbia. This is not true. There still are plenty of sites
in the District of Columbia to conduct a needle exchange program.
Mr. Chairman, I ask the House to pass this amendment and protect the
children of the District of Columbia, and I hope we will give them a
higher priority than we do those who inject illegal drugs into their
veins. It is a very simple choice. It is not about the needle exchange
program; it is about children. You can choose between protecting the
children, or protecting the drug addicts.
(Mrs. MORELLA asked and was given permission to revise and extend her
remarks.)
Mrs. MORELLA. Mr. Chairman, I rise to speak against the Tiahrt
amendment because I think it is not sound public health policy.
Mr. Chairman, I rise in strong opposition to the Tiahrt amendment
which would prevent the exchange of needles within 1000 feet of
schools, day care centers, playgrounds, public housing and other areas
which are gathering places for children. This amendment, is nothing
more than a backdoor approach to prohibit the District of Columbia from
using even its own funds for needle exchange programs. The Tiahrt
amendment severely limits the physical space in which a needle exchange
could operate and is written so broadly that virtually no area in the
District of Columbia would be eligible to have a needle exchange
program.
Mr. Chairman, a July report found that one in twenty adults in the
District of Columbia is currently living with HIV or AIDS. The District
of Columbia has the highest rate of new HIV infections of any
jurisdiction in the country. From July 1998 to June of 1999, the rate
of AIDS cases reported in women was more than nine times the national
rate. HIV transmission in the District via intravenous drug use
disproportionately affects women and African-Americans. For women, IV
drug use is the most prevalent mode of transmission. Ninety-six percent
of those infected in D.C., due to IV drug use, are African-Americans.
[[Page H7590]]
There are currently more than 113 needle exchange programs operating
in 30 states, including my State of Maryland. In 1994, the Baltimore
City Health Department established a needle exchange program. The
program exchanges sterile for contaminated syringes, as well as
provides public health services including referrals to drug abuse
treatment, HIV testing and counseling, and tuberculosis screening,
testing and treatment. Two years after the program began, 4,756
injection drug users had been enrolled, 603,968 needles had been
distributed and 252,293 needles had been removed from circulation. An
evaluation of this program has been conducted and no evidence has been
found that the program increases crime or encourages drug use among
youth. In fact, a June 2000 study published in the American Journal of
Public Health indicates that the needle exchange program did not
increase the number or distribution of discarded needles.
Mr. Chairman, the prohibition on the District's needle exchange
program is not based on sound public health policies backed up by
scientific evidence, but on politics.
Exhaustive studies funded by the NIH, the CDC as well as the U.S.
Surgeon General have all concluded that needle exchange programs, as
part of a comprehensive HIV prevention strategy are an effective public
heath intervention that reduces the transmission of HIV and does not
encourage the use of illegal drugs.
The District's Chief of Police, Charles Ramsey, who has been tough on
illegal drug use, supports a needle exchange program for the District
as a way to reduce the spread of HIV. Additionally, the needle exchange
programs are supported by the American Medical Association, the
National Academy of Sciences, the American Academy of Pediatrics, the
American Bar Association, the American Nurses Association, the American
Public Health Association, the Association of State and Territorial
Health Officials, the National Black Caucus of State Legislators, the
U.S. Conference of Mayors and the U.S. Department of Health and Human
Services.
Mr. Chairman, when the District's needle exchange program began in
1997, by using its own funds, through 1999, the number of new HIV/AIDS
cases due to intravenous drug uses has fallen more than 65 percent.
This represents the most significant decline in new AIDS cases, across
all transmission categories, over this time period.
Why reverse this trend? Why accept this amendment which will only
continue to spread HIV and intravenous drug users will lose an
important gateway to drug treatment programs?
Vote against the Tiahrt amendment.
Mr. MALONEY of Connecticut. Mr. Chairman, our children should be
protected from exposure to drug use and be kept safe from the threat of
contaminated needles. For that reason, I supported the Tiahrt amendment
to the Fiscal Year 2001 District of Columbia Appropriations Act. This
amendment is simply a logical extension of the ``Drug Free School
Zone'' legislation, and I urge all of you to support it as well.
The Tiahrt amendment prevents Needle Exchange Programs from existing
within 1,000 feet of schools, playgrounds, day care centers, public
swimming pools, and other places where children generally play. My
colleagues, by voting for this amendment we are helping to ensure that
our children are not exposed to drugs, drug paraphernalia, or
unnecessary health risks. Children should not have to face the risk of
coming into contact with contaminated needles in the places they learn,
live or play.
Simply put, this amendment is about keeping children safe. I voted
``yes'' on the Tiahrt amendment because ``yes'' is a vote for the
health and safety of our children.
The CHAIRMAN pro tempore (Mr. Barrett of Nebraska). The question is
on the amendment offered by the gentleman from Kansas (Mr. Tiahrt).
The amendment was agreed to.
Mr. MORAN of Virginia. Mr. Chairman, I move to strike the last word.
I believe that the gentleman from Oklahoma (Mr. Istook) and I will each
take 5 minutes to summarize the vote on the underlying bill before us.
Mr. Chairman, we are going to urge those who believe in home rule for
the District and recognize the kind of economic and social progress
that has been achieved in the District of Columbia to vote no on this
appropriations bill.
We had an opportunity to have a bill that would have sailed through
conference with the Senate and would have been signed by the President.
It would have been taken care of. We have got 11 appropriations bills,
most of which, if not all of which, are likely to get vetoed now. Only
defense and military construction have been signed. This is one that
should be signed. The District of Columbia needs its money, it needs it
now, and all we would do if we had the opportunity is to ask, let us
pass the Senate bill.
Now, what is the difference? In the Senate bill we restore $17
million to New York Avenue Metro station. They cannot begin that Metro
station, which is a desperately needed economic development initiative,
unless they have the full $25 million. All the money has to be
identified. The private sector says they will put up $25 million, the
city will put up $25 million, they budgeted for it, all we have to put
up is our own $25 million and then we can go forward. This does not do
that. This shortchanges economic development.
We need $3 million for those seniors in high school in D.C. to make
the College Tuition Access Program available to everyone in a fair
manner. The Mayor has asked for this money. $3 million should be
included.
We need $3 million for Poplar Point remediation, a brownfield site.
There is $10 million in the budget, the city needs $10 million, we only
ask for $3 million. Those are the kinds of things we ask for, plus the
Tiahrt amendment, which negates a program which is working and is
desperately needed in the city.
We are not asking for much. We ought to get it, get the bill signed.
Why we have to go through all these motions that are so destructive and
such a waste of time is beyond me.
Mr. Chairman, I yield to the gentleman from Wisconsin (Mr. Obey), the
ranking member of the full Committee on Appropriations, to put this
bill in context. Could I ask how much time is remaining?
Mr. OBEY. Mr. Chairman, I thought that at least on this bill we would
reach a compromise between the two parties. The gentleman from Virginia
(Mr. Moran) has described the compromise which he offered the majority
party. Once again, it is my understanding that that compromise was
turned down by the majority whip, or those in his office, who evidently
prefer to try to pass a bill totally in the Republican image. I find
that unfortunate. Two and one-half weeks before the end of the fiscal
year, we ought to be looking for ways that we can agree. Instead,
apparently, people are finding new ways to rehash old arguments.
Surely this fits the pattern which has been going on all year, where
the Committee on Appropriations explores a compromise, but then the
majority leadership says no, and gives orders to pass the bill on the
Republican side alone. That results in presidential vetoes; it gets no
one anywhere near a closure.
With less than 3 weeks to go, this is not the way we ought to be
going. I am sorry that the majority prefers to go this way, in light of
the compromise offer of the gentleman from Virginia (Mr. Moran). We
could have taken either the package of the gentleman from Virginia (Mr.
Moran) or the Senate bill and had a perfectly reasonable compromise,
but evidently we are not going to do that. So I very regrettably am
going to urge a no vote on the bill.
Mr. MORAN of Virginia. Mr. Chairman, reclaiming my time, we have the
opportunity to do the right thing. Vote no on this bill. Then we can
get a bill that is acceptable to the Senate, to the White House, and,
most importantly, to the citizens of the District of Columbia. We owe
them that.
The citizens have elected a good mayor, they have got a good D.C.
City Council, they are making progress, economic and social progress.
They are not asking for much. They are asking that their kids have a
chance to go to college and make it affordable. They are asking that we
put up one-third of the cost of a Metro station that is desperately
needed on the New York Avenue corridor. They are asking to clean up
some of their brownfield sites. We have the money to do it. Let us do
it. Do the right thing; vote no on the bill.
Mr. ISTOOK. Mr. Chairman, I move to strike the last word.
Mr. Chairman, in closing debate on this bill, first I want to take
the opportunity to thank the staff who have worked so hard on this:
John Albaugh of my personal staff and the Committee on Appropriations;
Chris Stanley, a Congressional Fellow who has been assisting in our
office from the U.S. Secret Service; Mary Porter, who is detailed to us
from the District Government, and I will say more about her in a
moment; the committee staff for
[[Page H7591]]
the majority, Migo Miconi; the committee staff for the minority, Tom
Forhan; and from the personal staff of the gentleman from Virginia (Mr.
Moran), Tim Aiken.
Each of them has put in untold hours of hard work and effort to help
bring this bill to the floor, and regardless of where we may stand on
different issues, I want to express my appreciation to all of them.
In regard to Mary Porter, this Fall she is retiring after 40 years of
dedicated service to the District government and to our Committee. She
came to the Washington area from Tennessee, worked for an insurance
company until 1960 when she went to work for the District Government,
and, for the last 40 years has been assisting through the Mayor's
office and then on loan to Congress to follow the budget through with
the city council, with the Congress, the House, the Senate, and is the
undisputed expert of so many things.
So, Mary, on behalf of all the subcommittee and the Members, we
appreciate your many years of hard effort. I do not know how we could
tackle the technical problems we have to face, were it not for your
efforts. We appreciate you and we want to thank you.
Mr. Chairman, as I stated earlier, Mary Porter has provided more than
40 years of dedicated service to the District of Columbia government
and to our Committee. That is an absolutely remarkable achievement--in
fact, it is almost unbelievable. For all of those years, Mary has been
with the Mayor's office where the budget is prepared. She follows the
budget to the Council, and then she comes to Congress and follows it
through the House, the Senate and finally the House/Senate conference.
She is the technical expert and without question the single most
knowledgeable person at any level when it comes to all aspects of the
District's budget. In every organization or office there is one person
who keeps everything together and running smoothly and who knows not
only what needs to be done but also what it takes to get it done. Mary
Porter is that person when it comes to the District government's
budget. Her technical expertise, knowledge and temperament in putting
the bill and report together cannot be matched. Many times Mary has
worked 18-hour days and weekends but she was always back on the job
bright and early. Mary has always set high standards that others find
difficult to attain.
Mary came to the District of Columbia from a little town called Deer
Lodge in Tennessee in May 1954 just out of high school and found her
first job with the Equitable Life Insurance Company. She worked there
until the birth of her first child in 1960 when she went to work in the
District government's budget office. Back then the District's total
budget was $196 million; today 40 years later it is $3.3 billion, a
1,584 percent increase over what it was when she started. I don't
believe we can blame Mary for that phenomenal increase. Mary also
witnessed the evolution of the governmental structure of the District
of Columbia from a three-member Presidentially-appointed commission to
a single appointed mayor-commissioner with appointed city council
members to an elected mayor and city council form of government. I'm
sure she could tell us first hand which form of government was the most
efficient and effective in delivering services, but we will not ask
her.
Mr. Chairman, there is only one Member of this House who was here
when Mary first started working for the District government back in
July 1960, and he is the Dean of the House. She has assisted the
Committee under seven Committee Chairmen: Chairman Clarence Cannon of
Missouri, Chairman Mahon, Chairman Whitten, Chairman Natcher, Chairman
Obey, Chairman Livingston, and now Chairman Young. On the District of
Columbia Subcommittee, she has served under Chairman Rabaut, Chairman
Natcher, Chairman Wilson, Chairman Dixon, Chairman Walsh, Chairman
Taylor, and now during my tenure. Mr. Chairman, I can attest to the
fact that she is a ``professional'' in every sense of the word and has
served chairmen and members of our subcommittee of both parties
equally, providing them with her best advice and technical support.
Mr. Chairman, Mary is not one dimensional. Although she has been
employed for the last 46 years, she and her husband Al have managed to
raise a wonderful family. Their four children, Harvey, Lorne, Vance,
and Vera are successful in their own right.
Mary, I know that I speak for the entire subcommittee and for this
entire House in wishing you well in your retirement. Your 40 years with
the District of Columbia government and your professionalism are a
credit to our subcommittee, to the Committee and to the Congress. You
are truly a remarkable person.
We all thank you very much.
Mr. MORAN of Virginia. Mr. Chairman, will the gentleman yield?
Mr. ISTOOK. I yield to the gentleman from Virginia.
Mr. MORAN of Virginia. Mr. Chairman, that was very gracious of you to
recognize the personnel that make this bill work. I should have done
it. I appreciate the fact that you did it on both sides of the aisle.
I do not know what Migo Miconi is going to do without Mary Porter,
but she is going to be able to spend more time in my congressional
district, I trust. She has been wonderful, invaluable, and, more
importantly than what Migo is going to do without her, I do not know
what the Congress is going to do without her and what the citizens of
the District of Columbia are going to do without her. She is a great
public servant and we thank her for the great job she has done and wish
her many years of health and happiness in her retirement. I appreciate
the fact that the gentleman recognized her.
Mr. ISTOOK. MR. Chairman, to address the bill, I ask unanimous
consent that I be granted an additional 2 minutes.
The CHAIRMAN pro tempore. Is there objection to the request of the
gentleman from Oklahoma?
There was no objection.
Mr. ISTOOK. Mr. Chairman, it is important that we address the bill
itself. I heard the gentleman from Virginia (Mr. Moran) say ``Let's
pass the Senate bill.'' Well, there is no Senate bill. The Senate is
just beginning their work. The House receives from its Budget Committee
an allocation for the District, the Senate receives from its Budget
Committee an allocation. There is a difference.
I think what the gentleman is referring to is that the Senate
Subcommittee on the District of Columbia has been granted $30 million
more by the Senate Budget Committee than the House Subcommittee has
received from its Budget Committee, and the gentleman wants that
additional money. Maybe when we get to conference, some of that
additional money will be added and we will have the ability to do some
things the gentleman wants to do.
But the whole tenor of comments, Mr. Chairman, to say, ``oh, you are
not doing this for the District and you are not doing that for the
District,'' my goodness, what is the District not doing for itself?
This bill has $414 million in direct Federal appropriations for the
Government of the District of Columbia, and that is on top of the $1.5
billion they receive from all the Federal programs in which they
already participate that other communities around the country are able
to participate in. This $414 million is on top of that $1.5 billion and
it's given to the city to run their prisons, to run their court system,
to run their probation and parole system.
On top of that, we have these other things, but they say it is not
enough, it is not enough, it is not enough. Why? Because they say
``well, we want another $17 million for the subway project, we want
another $3 million for Poplar Point, we want another $3 million for
education.''
Let me suggest, Mr. Chairman, that if the District were more diligent
in conducting its duties, they would not have these problems. We have
the D.C. General Hospital that this Congress has been telling the
District for years you have got to get on top of that. They give a $45
million a year annual subsidy to it, and, on top of that, they have
been running a deficit of $35 million a year for the last 3 years.
If they want to have that money, then the District ought to stop the
feather bedding, the cronyism and the mismanagement at D.C. General
Hospital. It is long overdue. Some people are trying to do it now, and
I applaud them for it, but some others in the District are saying slow
down, do not do it.
If the District wants money for these projects, why do they not get
serious about internal reform? Why do they not take a look at the $20
million that was spent on a payroll system that they have said they now
have to scrap because of their incompetence in trying to get things
done right? There is money, if you want to have it, for some other use.
Why do they not take the $32 million in other reform efforts that are
now in jeopardy? Why do they not look at these things, at this waste,
rather than
[[Page H7592]]
just saying whatever you are doing Congress, it is never enough, it is
never enough.
But the money they say they want for that New York Avenue Metro
station, which is attracting private development money too, that money
is in the bill. The $25 million they want for it is in the bill. Their
objection is saying, ``oh, wait a minute, but $18 million is coming out
of this interest-bearing account held by the Control Board that is
under the direction of Congress, and we want you to get it from some
other account instead.'' Why? Because the Control Board in its last
year of operation wants to double its own budget and wants to give
golden parachutes to its people, instead of having that money go to the
Metro station at New York Avenue.
Do not put the bug on Congress for mismanagement by the District of
Columbia. There are many people working hard to correct that
mismanagement and abuse, and I applaud those officials, but accept
responsibility for the problems that the District brings upon itself,
and do not try to shift the blame and say it is because Congress has
failed to do enough.
{time} 1200
Yet, we do have funds in here for the unique program that started
last year to enable kids from the District of Columbia to go to college
since the District does not have a State system of colleges. We have
the money in here for that program. We have every penny that all
estimates say are needed for the program and then some. But they still
say, we want more, no matter what it is, we want more, we want more.
We have the money in here for the program of drug testing and drug
treatment to a greater extent than anyplace else in the Nation, and
yet, they say it is not enough. That program is Federally funded. We
have not done that for Detroit, we have not done it for Cincinnati, we
have not done it for Minneapolis or Phoenix or many other cities that
say, we would like to have some help too. It is about time that some
people in the District recognize what this Congress has done to fulfill
its responsibility toward the Nation's Capital, what the people in
America have supported for the Nation's Capital, and start working
together instead of constantly just griping that it is never enough, no
matter what we do.
We have gone above and beyond, and when we get to conference we may
find that we have the ability to get a little more money to do even
more. But for goodness sakes, to hear people say ``vote against this
bill because we are not doing enough for the District of Columbia'' is
nonsense. It is spin, and it is about time people got called on that
spin.
Mr. Chairman, this is a good, solid, responsible bill. It moves
reform in the District of Columbia, it requires accountability, it puts
a stop to this endless drain by D.C. General Hospital that if left
unchecked will take the city back into insolvency. It requires
strengthening of the charter schools which education bureaucrats are
trying to strangle right now, even as parents are saying, ``I want my
kids in this charter school because it is a public school that gives
them an opportunity instead of being trapped in a dead end,
nonperforming, dangerous school,'' as many of them are now stuck in.
Mr. Chairman, this bill is a bill to take care of the needs of the
District of Columbia, to move along reform in the District of Columbia,
and to promote responsibility and futures of hope, growth and
opportunity.
Mr. Chairman, I would like to include in the Record an article on
mismanagement and other serious problems, including what some might
consider medical malpractice, at DC General Hospital. The article was
the cover story in the August 18, 2000 edition of the Washington City
Paper.
[From the Washington City Paper, Aug. 18-24, 2000]
First, Do No Harm
(By Stephanie Mencimer)
When some D.C. General Hospital doctors talk about putting
patients first, they're not being Hippocratic. They're being
hypocritical.
About a year and a half ago, an inmate from the D.C.
Department of Corrections came to D.C. General Hospital for
hernia surgery. He hadn't seen his surgeon, Dr. Norma Smalls,
in at least a month. But when the man arrived for his
procedure, Smalls didn't do a fresh pre-op physical exam--a
step that most surgeons regard as routine. Instead, according
to former Chief Medical Officer Ronald David and three other
hospital sources, Smalls just had the man put under
anesthesia and then cut him open--on the wrong side of his
body.
Finding no hernia, David says, Smalls walked out of the
operating room, wrote some notes in the charges, and then
looked over the medical records. Realizing her mistake,
Smalls had her patient anesthetized once more and cut him
open again.
Fortunately, the patient recovered. Still, such a
``sentinel event,'' as a blunder like wrong-side surgery is
known in the hospital business, is a very big deal, as
serious a hospital disaster as an abducted baby or a rape by
a staff members. The reason, of course, is that the kind of
mistakes that lead to wrong-side hernia operations can lead
to amputating the wrong leg or removing a healthy kidney.
If D.C. General were a normal hospital, Smalls' blunder
would have come under intense scrutiny. The Joint Commission
on the Accreditation of Healthcare Organizations (JCAHO)
requires hospital medical staff to conduct a ``root-cause
analysis'' of any wrong-side surgery and to implement an
action plan to prevent such incidents from recurring. A
hospital's accreditation is partly based on how its medical
staff handles sentinel events.
Initially, though, the medical staff wasn't even planning
to investigate Smalls' wrong-side surgery, according to
David. When pressed by the administration, a committee made
up of the chief of surgery, the chief of anesthesiology, and
the head of the nursing staff eventually did review each
department's role in the case. The nursing administration
promptly fired a nurse who was found to be partially
culpable. The doctors, however, found no problem with Smalls'
performance in the operating room. Dr. Richard Holt, the
hospital's chief of surgery, would not comment on the case.
Smalls declined to discuss the surgery other than to say,
``I am a physician and citizen of high ethical standards,''
and that the JCAHO, the hospital accrediting body, was
satisfied with the hospital's review process. ``I have reams
of documentation to show how well that was done,'' she
says.
Nonetheless, the story of Smalls' surgical mistake spread
through the hospital like a staph infection, raising eyebrows
among nurses and other technical staff members who had heard
constant rumors about her competency, according to several
hospital sources. But that didn't stop the physicians from
later electing Smalls as president of the D.C. General
medical/dental staff. And today, she is head of quality
assurance for the hospital's department of surgery.
Smalls and some of her colleagues on the D.C. General
medical staff have been among the loudest voices complaining
about the many problems ailing the District's only public
hospital. They have taken their complaints about the hospital
administration to the mayor, to the D.C. Council, and
directly to Congress. They have demanded the ouster of former
CEO John Fairman and even summoned various investigative
agencies to scrutinize the hospital, which has run up $109
million in budget overruns and is at risk of being closed
down completely.
Patients themselves are deserting the hospital in droves:
More than 90 percent of Medicaid patients and 97 percent of
Medicare patients now go to other, private D.C. hospitals, as
do two-thirds of the city's 80,000 uninsured residents,
according to D.C. Department of Health figures.
Yet during all the recent debate over the future of the
city's ailing public health system, few people have ever
stopped to ask whether Smalls and some of her medical
colleagues might themselves be part of the problem.
For years, the medical staff has eluded the demands for
accountability that have slowly started to take hold in other
parts of D.C. government. Instead, the doctors have
successfully portrayed themselves as the lone champions of
health care for the poor, which is the one thing that D.C.
General inarguably dispenses.
Yet internal memos from the D.C. Health and Hospitals
Public Benefit Corp. (PBC), the body that oversees the public
hospital and its clinics, show that far from improving
patient care, Smalls and some of the elected leadership of
the medical staff have fought to overturn disciplinary
actions against poorly performing physicians and defend
doctors' shoddy work habits. Even as they have complained
about the quality of the nursing staff and hospital
administrators, many of the physicians have fought off
requirements to update their own skills, see more patients,
and otherwise raise the standards of D.C. public health care.
Moreover, past and present hospital administrators say that a
vocal minority of those same doctors have played a key role
in obstructing the very reforms that might put the PBC on
better financial footing.
Deairich Hunter is the PBC's former chief of staff and a
former staff member for Ward 8 Councilmember Sandy Allen,
chair of the Health and Human Services Committee, which
oversees the PBC. When he worked for the council, Hunter
spent much of his time trying to save D.C. General. When he
came to work for the PBC last year, though, he says, ``I
started to wonder what it was that I was saving.''
To be sure, many of the 170 doctors who work for the PBC
are devoted professionals who have a real commitment to
public
[[Page H7593]]
health care and labor under difficult circumstances. But then
there are the others: the twice-bankrupt, many-times-sued OB-
GYN and the former chief of trauma who allegedly saw only
eight patients in a month, despite being paid for full-time
work.
The city's doctors are emboldened by the same civil-service
protections that make all D.C. government employees nearly
impossible to fire, and they are largely immune from outside
accreditation investigators, who evaluate hospital
procedures, not physician competency. Duly insulated, the
PBC's doctors have successfully chased out reform-minded
administrators who have attempted to rein them in. ``Using a
good offense as their best defense, the medical staff has
avoided accountability for years,'' says one hospital
administrator, who wishes to remain anonymous.
The bureaucrats' attack on reformers is a time-honored D.C.
government tradition. Such behavior has made city agencies
like the Department of Motor Vehicles merely infuriating, but
in a hospital, the consequences can be deadly. It's no
surprise that even as D.C. councilmembers go to bat for the
jobs of city doctors, the poorest city residents are taking
their business elsewhere.
Last August, D.C. General OB-GYN John S. Selden III
featured prominently in a front-page story in the New York
Times about racial disparities among women who die in
childbirth. ``Most obstetricians are afraid to talk about
losing patients,'' the story read. ``But the doctors at D.C.
General are surprisingly direct. Dr. John S. Selden, who has
worked at the hospital on and off for the last 13 years, told
of a death that occurred just a few months ago.'' The woman
Selden described died on the operating table, moments after a
Caesarean section at D.C. General.
Selden was something of an odd choice for the hospital to
offer up as a national expert. Had the Times interviewed some
of his former patients, the paper might have discovered that
Selden has a somewhat blemished record as a physician. But
his story helps illustrate why some doctors at D.C. General
are often so militant about protecting their jobs.
In the past 20 years, Selden has been sued at least six
times, racking up some huge settlements. In 1984, Selden
treated a pregnant woman named Vanessa Black who had come to
Greater Southeast Community Hospital suffering from vaginal
bleeding. Selden discharged her the next day with
instructions for strict bed rest, without determining whether
it was safe for her to move. Black was still spotting, and a
day later, she went into labor, had a emergency C-section
because of hemorrhaging, and delivered a brain-damaged baby.
In 1993, Greater Southeast settled a suit filed by Black's
family for $1.3 million.
Another case is currently pending, filed by Cherif Abraham
Haidara, alleging that during a 1997 delivery at D.C.
General, Selden caused traumatic nerve injury to her baby's
arm, rendering the arm useless. In this case, the family
isn't likely to get a dime if it prevails in court, because
Selden has no assets to speak of, having filed for bankruptcy
protection twice in the past 15 years. And at the time of
Haidara's delivery, he had no malpractice insurance.
Ordinarily, as a city employee, Selden wouldn't have needed
malpractice insurance, because he would have been insured by
the District. But Selden was working at D.C. General on a
contract with the Medical Services Group, a private practice
consisting of several OB-GYNs who had retired from D.C
General in 1995 and had immediately gotten a $2.9 million
emergency contract from the hospital. The contract allowed
the doctors to earn significantly more than they would have
as hospital employees. After the Office of the D.C. Auditor
criticized the contract for various improprieties, the
hospital canceled it in 1997.
D.C. General provided most of the group's clients, so when
it canceled the contract, the practice shut down. During that
last year, when Haidara's baby was born, the Medical Services
Group doctors were carrying no malpractice insurance. They
blamed the city, which they claimed was supposed to pay for
the insurance. (The doctors are currently suing the District
over the issue.)
According to his deposition in the Haidara case, Selden
remained unemployed for about a year after his practice
collapsed, and he eventually filed for bankruptcy protection.
Later, he went to work for Planned Parenthood for about six
months before D.C. General rehired him in March of last year.
Selden could not be reached for comment.
Given Selden's history, it might seem strange that D.C.
General would be eager to have him back. But thanks to city
pay-scale restrictions, the hospital is fairly desperate for
specialists like OB-GYNs, whom it needs to maintain its
accreditation. D.C. law bars city employees from making more
than the mayor's salary, which for most of the 1990s was
about $90,000. The going salary for an OB-GYN in the private
sector is nearly $300,000. (The mayor's salary has since gone
up, to about $120,000, but doctors' salaries have remained
capped at $99,000.)
Lawrence Johnson, the medical director at D.C. General for
15 years until 1997, says the salary cap has always been
problematic in keeping the hospital staffed up. ``We couldn't
keep a full-time specialist in some cases,'' he says, adding
that the hospital has always relied on a patchwork quilt of
coverage. ``It's not the kind of arrangement that lends
itself to building stability.''
The PBC's poor pay--among the worst in the nation--combined
with difficult working conditions and old-fashioned crony
politics has helped make D.C. General a virtual dumping
ground for troubled doctors. Alongside doctors like Selden,
the hospital employs physicians who have left other troubled
city facilities, like the D.C. Jail and the old city-run
nursing home, D.C. Village, which was closed after a suit by
the Justice Department, following the deaths of more than 30
residents from poor medical care.
Another of the hospital's former medical directors is Dr.
William Hall, former Mayor Marion S. Barry Jr.'s longtime eye
doctor, who was the medical director of the D.C. Department
of Corrections when the jail medical services landed in
receivership for abysmal treatment of inmates in 1995. A
federal judge seized control of the services shortly after an
inmate with AIDS died while tied to a wheelchair, where he
has sat in his own feces, neglected, for several days. Hall
went on to do a brief stint as D.C. General's medical
director and is still employed at the hospital as an
ophthalmologist.
Conventional wisdom holds that the trauma surgeons at D.C.
General are among the hospital's best doctors, because of
their experience in handling life-threatening gunshot wounds
and other medical crises. Despite their reputation, though,
no data exist to prove whether D.C. General trauma surgeons
are any better than, say, Washington Hospital center's. And
there's some evidence to suggest that they might be worse.
In 1995, an ambulance transported a transgendered man,
Tyrone Michael (aka Tyra) Hunter, to the emergency room at
D.C. General, where he later died after doctors failed to
drain blood that had pooled near his heart, according to a
lawsuit filed by Hunter's mother, Margie Hunter. Her lawyer,
Richard Silber, learned during the litigation that Joseph
Bastien, the trauma surgeon who had treated Hunter in the
emergency room, had flunked his surgical board exams three
times and was not certified as a surgeon.
In fact, out of the eight attending physicians in the
trauma unit at the time, five were not board-certified,
including the unit's acting chief, Dr. Paul Oriaifo. (Two of
those noncertified doctors still work at the hospital.) In
1998, a jury awarded Margie Hunter $2.3 million, and the city
last week settled the case for $1.75 million.
Silber says he was astonished at the poor qualifications of
some of the trauma surgeons at D.C. General. ``There are
terrific public hospitals in this country. Just because they
are public doesn't mean they have to have incompetent care,''
he notes.
It's 8:30 a.m. on Wednesday, July 5, and already the D.C.
General orthopedic clinic is full of people on crutches or in
wheelchairs, or sporting casts, slings, or metal staples in
their knees. A man in a wheelchair with a full head rack and
pins keeping his neck straight closes his eyes and exhales
slowly. Almost 50 people have arrived in the basement of the
hospital. Kenneth Reid, here for his broken knee, knows he's
in for a long wait.
``Last time I was here, I had a 9 a.m. appointment, and I
didn't get done until 4,'' Reid says.
The clinic is open only on Mondays and Wednesdays, and the
staff schedules patients for appointments between 8 a.m. and
10:30 a.m. Even then, it's first come, first served. So
people line up early and then hunker down in front of the TV.
With luck, they'll get their blood pressure taken by the time
Bob Barker wraps up The Price Is Right. If you feel really
bad, Reid says, you can go to the emergency room.
Or you can employ Monica Parker's strategy; the fake faint.
Parker, who recently broke both her legs, says she once got
so tired of waiting that she staged a collapse on the way to
the ladies' room. ``I got right in,'' she says with a laugh.
``You got to fall out right where everyone can see.''
An elderly man who gives his name only as Oscar, who has
been waiting almost a year for surgery on his hip, knows the
system pretty well. ``The whole thing is not to have
the doctors waiting to see the patients,'' he explains.
There's no chance any doctors will be waiting today.
Medical residents doing training as part of the Howard
University Medical School do most of the work here, but they
haven't arrived yet. That's because on Wednesday mornings,
the residents have to attend a meeting at Howard University
Hospital. They usually don't show up at the clinic until 10
a.m., even though patients have been sitting here for two
hours by then. And as for the staff doctors, well, none of
the patients seem to know when they get in.
Oscar says the attending physicians alternate covering the
clinic because most of them also work somewhere else.
Elaborating some common hospital folklore, Oscar explains
confidently, ``The hospital can't afford to pay doctors for
40 hours a week.'' The hospital does in fact pay the clinic's
attending physicians almost $100,000 annually for full-time
work, but conversations with other patients make it easy to
see how Oscar came to that conclusion.
While dozens of patients watch Maury Povich berating moms
for dressing so sexy that they embarrass their children, a
woman in a bright-red dress and heels storms out of the
clinic door, cursing the people behind Booth 2. She comes
back later and throws herself into a chair. ``I had three
appointments. They made me come in. The doctor wasn't here,''
fumes Mary E. Muschette. ``This is the fourth appointment.
One day I
[[Page H7594]]
was here at 7:30 and left at 3 after I found out that they
had discharged me without seeing me. I've made this
appointment since April for a jammed finger. Every time I've
been here, no doctor.'' Muschette says she is supposed to see
a specialist, but adds, ``He's never here. If I had a job and
did that, I'd be in trouble.''
Muschette's furious tirade is more entertaining than
Povich, and it sets off a round of complaints and
affirmations from the other patients. ``I never see the
doctor who signs the prescriptions,'' Parker says, ``I've
only seen him once, and that was at Howard. He is on all my
paperwork, though.''
Dr. Easton Manderson, the chief of orthopedics, is himself
the subject of patient complaints about scheduling. An inmate
at Lorton, David Spencer, is currently suing Manderson in
federal court for allegedly bumping him off the surgical
schedule for more than a year, delaying a bone graft on his
arm and, he says, causing partial paralysis. Spencer filed
the suit pro se, but a federal judge believed Spencer had a
strong enough complaint that he took the unusual step of
appointing a lawyer to represent Spencer.
But Manderson is a busy man. Along with his full-time job
at D.C. General, he also has two private practices. On
Tuesdays, Wednesday, Fridays, and some Saturdays, he works at
his Providence Hospital office. Then, on Tuesdays after 5
p.m., he works at his Eastern Avenue office in Maryland. Yet
Manderson managed to collect $23,866 in overtime at D.C.
General last year, according to documents provided by the
PBC.
Manderson disputes this figure, and in a letter to the
Washington City Paper, he said he spends only 12 of the 72
hours he works each week at his private office.
``I perform more surgery and see more patients than any
other surgeon at D.C. General,'' Manderson said in his
letter.
Moonlighting by full-time PBC doctors is a common practice,
which the doctors justify because of their low salaries, and
there's no rule against it. But the doctors are still
expected to fulfill their duties for the PBC. It's clear from
the stories at the orthopedic clinic, however, that the
hospital is not getting its money's worth from some of its
physicians.
The experience of the orthopedic patients was backed up in
a recent review by Cambio Health Solutions, a consulting firm
brought in by the PBC to analyze the hospital's management
problems. Cambio found that doctors' overtime billing was
based on the honor system and that the PBC had no system to
document how much time doctors actually worked on behalf of
the PBC. ``Productivity standards are not existent,'' the
consultants wrote. An operational review found that clinics
failed to start on time because most of the physicians had
practices in other parts of the District.
Absentee doctors are problematic for a variety of reasons.
Medical residents, because of their junior status, can't sign
any of the paperwork needed for billing, so patients
routinely leave their charts with a physician's assistant
whose job it is to track down the attending doctors for their
signatures. As the paperwork stacks up, patients are often
left waiting for weeks to get disability claims filed, for
instance. Or, as happened in Oscar's case, the signature
problem can delay treatment.
Oscar says that every time he comes in to the clinic,
staffers treat him like a new patient and repeat the same
tests, because they can't find his medical records. The
doctors' failure to keep up on the paperwork also takes a
financial toll on the hospital itself, because it can't bill
for services unless physicians document them--a problem
highlighted by consultants from Cambio.
For years, the PBC doctors have gotten away with such poor
performance because they could count on their patients to
keep quiet. Parker, for example, says that even though she
usually plans to wait between five and 12 hours whenever she
comes to the clinic, it would never occur to her to complain
to hospital officials. ``I'm not going to cuss you out about
not getting what I pay for when I'm not paying anything,''
she says. Besides, she adds, ``Nobody else will take me.''
When she broke her legs--she tripped in the grass while
walking in high heels--Parker says she was taken to Howard.
But when the hospital discovered she didn't have insurance,
it sent her by ambulance to D.C. General. ``If I could go
somewhere else, I would,'' she says.
For years, D.C. General patients have told horror stories
about being unwittingly operated on by what they call ``ghost
doctors''--unsupervised residents who have not yet completed
their medical training. In a place where such legends are as
common as bedpans, most malpractice lawyers and others who
regularly heard the stories never quite believed them. But
Debra Burton says that, in her case at least, not only is the
legend true, she can prove it.
In November 1992, Burton saw Manderson, the orthopedic
surgeon, at Providence Hospital on a referral from a doctor
at Howard University Hospital, who believed she needed
surgery to have a bone spur removed from her foot. Burton
says she saw Manderson for ``about five minutes.'' She
says he agreed to do the surgery but told her she had to
have it done at D.C. General. So on Jan. 21, 1993, Burton
checked into D.C. General, gave her Medicaid information,
and was headed for the operating room when, she says,
residents told her that Manderson wasn't at the hospital
but was on his way.
Burton had the surgery, but she never did see Manderson. A
few months later, she was still in excruciating pain. After
several more visits to other doctors. Burton learned several
startling facts: A nerve had been cut in her foot, but the
bone spur was still here. And, most troubling, Burton says,
she learned that Manderson hadn't actually performed--or
supervised--the surgery as promised. Instead, she had been
operated on by a couple of residents--doctors in training.
Burton has been disabled by the pain and unable to work
ever since. She had hoped to file a malpractice suit, but she
says her lawyer botched the case, and she eventually reported
him to legal disciplinary authorities. She didn't give up,
though. Burton has been on a mission ever since to find some
justice, and she has collected an assortment of documentation
about her case.
Among her papers is a 1997 letter Manderson wrote to the
D.C. Board of Medicine in response to a complaint Burton
filed against him. In the letter, Manderson claims he never
told Burton he would take her as a private patient, but that
``I would arrange to have her surgery done at D.C. General.''
However, Manderson's name appears on all Burton's D.C.
General records as the admitting and attending physician, and
her admission and consent form states that she agreed to
surgery that would either performed or supervised by Easton
Manderson.
Ronald David, the hospital's former chief medical officer,
says that at D.C. general, attending physicians of record are
expected to be responsible for their patients before, during,
and after surgery--guidelines also specified by the American
College of Surgeons.
In his letter to the medical board, Manderson maintains
that even if he had agreed to do the surgery, he was not
required to be in the operating room when residents were
operating. He repeated this claim in his letter to the City
Paper. In fact, in 1995, two years after Burton's surgery,
D.C. General almost lost its Medicaid accreditation for,
among other things, allowing residents to operate
unsupervised, according to reports in the Washington Post.
And David says, ``If he is the attending of record, he was
supposed to be there.'' Nevertheless, the board of medicine
dismissed the complaint without any further investigation.
When she discovered that Manderson had billed Medicaid for
part of the procedure, Burton filed a compliant with the
city. Doctors at D.C. General are salaried employees and may
not bill Medicaid individually for services they provide
there; Medicaid pays the hospital directly. But Manderson and
another doctor whom Burton claims she never saw both billed
and were paid for services related to her surgery. In 1998,
according to a letter sent to Burton in response to her
complaint, the Medicaid office sought to recoup the money for
what it called ``erroneous billing.'' No investigation was
ever launched. PBC officials declined any comment on
Manderson's practice at D.C. General.
On Jan. 15, 1998, 93-year-old Ernest Higgins ran a stop
sign at 10th and Constitution NE and was hit by a truck. He
was admitted to D.C. General by trauma surgeon Dr. Chinwe
Agugua suffering from some swelling on the side of his neck,
but otherwise, he didn't have any other obvious injuries. The
hospital kept him overnight for observation, and the next
morning a nurse called Higgins' son, Daniel Higgins, and told
him to come to take his father home.
The lifelong Washingtonian and former auto-parts store
owner had been active for his advanced age, and his medical
records even noted that he lived alone in a two-story house
at 18th and Franklin Streets NE and was fully able to care
for himself. But before Ernest Higgins was discharged, a
nurse had to carry him to the bathroom.
``I thought this was odd, since the day before, he had been
driving,'' says Daniel Higgins. As it turned out, his father
couldn't walk, but no one at the hospital seemed to think
this was unusual, so Higgins took him home. ``I checked on
him after [The Tonight Show], and he was sleeping. The next
morning when I got up, he had passed away,'' he says. An
autopsy revealed that the elder Higgins had suffered two
broken vertebrae in his neck and had died from a major
spinal-cord injury.
The Higgins family decided to pursue legal action against
the hospital. They went to three different lawyers before the
last one told them--wrongly--that they would never be able to
collect any money from the broke D.C. government, and in any
event, because Ernest Higgins had been so old, there wouldn't
be much in the way of damages to recover. Before they had a
chance to pursue the case further, the statute of limitations
for filing a suit ran out. Still, Higgins' granddaughter
continued to demand that the PBC investigate the handling of
the case, but she never got an answer. Dr. Richard Holt, who
had been Higgins' attending physician, said last month in an
interview that he did not remember Higgins.
Doctors who work for the PBC are protected by civil service
rules and the hospital's peer review committees. As the
Higgins case demonstrates, they are also largely insulated
from scrutiny by the most effective, if de facto, medical
regulators: malpractice attorneys.
Higgins' claim was one of 17 notices sent to the District
government since January 1998 declaring intentions to sue the
hospital for wrongful deaths. Of those, 12 cases never went
to court, including the Higgins case. Some were denied
because the potential plaintiff failed to adhere to the
strict filing
[[Page H7595]]
timetable required under D.C. law. Anyone intending to sue
D.C. General must notify the city within six months of the
alleged malpractice. A lawsuit in a wrongful-death case must
then be filed within a year; other malpractice cases must be
filed within three years.
Diane Littlepage, a malpractice attorney in Baltimore who
has successfully sued D.C. General, says that very few people
are able to make the six-month deadline, which doesn't exist
for private hospitals. In addition, attorneys generally don't
regard D.C. General patients as attractive clients. That's
because wrongful-death awards are based on the value of a
person's life, which a civil suit reduces to a cold calculus
of economic activity and life expectancy. If a patient was
poor or unemployed, or had any kind of lifestyle issues
that might shorten life span, such as criminal activity or
drug abuse--all common issues with many D.C. General
patients--that patient's life doesn't add up to much in a
lawsuit.
Malpractice cases are also extremely costly to litigate, so
lawyers who do take them pick up only clients whose potential
awards will more than cover the costs of trying the case.
Bill Lightfoot, a prominent malpractice attorney and former
D.C. councilmember, says be routinely spends $50,000 to
$100,000 to litigate a wrongful-death case.
Because of the lawyers' informal vetting system, when
malpractice suits do go forward against doctors at D.C.
General, they are fairly serious. Here are a few recent
examples:
Tammara Kilgore, 22, arrived at D.C. General on April 26,
1998, suffering from nausea, fever, and highly abnormal liver
functions. Doctors allegedly diagnosed Kilgore with a
urinary-tract infection--without performing a urinalysis--
gave her some antibiotics, and sent her home, according to
the suit filed by her family. Kilgore died a few days later
from liver failure stemming from hepatitis.
Darryl Kelley, 19, arrived at D.C. General suffering from a
gunshot wound to the face in February 1997. The bullet had
broken his jaw, but he could talk, swallow, and breathe. Dr.
Norma Smalls did exploratory surgery on his neck and put a
tube in his windpipe so he could be hooked up to a ventilator
after oral surgeons wired his teeth together. Two days later,
Kelly was dead--but not from the bullet wound. An autopsy
later showed that he had suffocated to death from a blockage
in the tracheotomy tube. On April 11 of this year, the city
settled a wrongful-death suit brought by Kelley's family for
$175,000.
In November 1998, Gloria Porter, 50, was admitted to D.C.
General to have a benign polyp removed from her duodenum.
Instead of just removing the polyp, Dr. Paramjeet Sabharwal
and two residents allegedly performed a risky surgery
designed for excising advanced cancer, removing her gall
bladder, part of her duodenum, and part of her pancreas. A
week later, Porter, who didn't have cancer, died from a
massive hemorrhage--a complication of the surgery--according
to a suit filed by her daughter last August.
Bruce Klores, one of the city's leading malpractice
attorneys, who has won several large verdicts against D.C.
General, says that the hospital has ``probably the most
underreported malpractice of any hospital in the city.''
When David accepted the position of chief medical officer
for the PBC in 1997, he was looking forward to having a hand
in patient care once again. For the previous six years, he
had been teaching health policy at Harvard University's
Kennedy School of Government. Before that, he had served as
deputy secretary of health, and then acting secretary of
health, under Pennsylvania Gov. Robert P. Casey. An African-
American neonatologist and pediatrician who grew up in a mean
South Bronx neighborhood, David was an idealist who believed
passionately in the public service aspect of medicine.
But David quickly discovered that D.C. General was like no
place he had ever experienced. To be sure, it had the usual
problems of any public hospital: too little money,
insufficient equipment and supplies, and an aging building
that was suffering from disrepair. But that wasn't what he
found most troubling about the place.
When David arrived at D.C. General, he recounts in an
interview, as patients waited hours upon hours in the
emergency room, doctors were not coming to work on time, they
were leaving early, and they were often sleeping on the job,
in part because they were working full-time jobs elsewhere.
The celebrated trauma surgeons refused to see other,
``ordinary'' emergency room patients who weren't suffering
from major injuries such as gunshot wounds, even when those
surgeons weren't busy with other patients.
After interviewing patients, David also discovered that
some of the OB-GYNs were skimming off patients with insurance
and Medicaid, sending them to their private-practice offices
and delivering their babies at other hospitals, where doctors
could bill the insurers or Medicaid for their services. ``In
some instances, doctors would actively dissuade patients from
going to D.C. General,'' says David. ``We had patients tell
us that doctors had told them not to come back.''
He also found that doctors weren't showing up on time for
clinics and were occasionally working in their private
practices when they were expected to be at D.C. General.
About six months after David took over as chief medical
officer, someone in the emergency room paged Manderson, who
was supposed to be on duty. The page was returned by a nurse
at Providence Hospital, who said Manderson wasn't available
because he was in surgery.
The event was one of a long line of problems that prompted
David to draw up a memo in which he told the medical/dental
staff that he would be giving them a one-month amnesty period
in which to clean up their act. After that, he told the
doctors, they would be disciplined severely for a number of
practices that had long been tolerated at the hospital.
In the amnesty memo, David told doctors that he expected
them to work the hours that they were scheduled and paid for
and that they were recording on their time sheets. He barred
them from doing union work or private-practice work during
regular hours and then working for the PBC afterward to
collect overtime.
He required the full-time community health center staff to
show up five days a week. He demanded that surgeons be in the
operating room to supervise surgeries and that they be
available to the patients immediately before and after
surgery for follow-up. He barred doctors from ordering
supplies and equipment for use in their private offices. And
he asked that they fill out medical records on time.
Finally, David warned that if he caught any physicians
collecting insurance information from PBC clients for the
purpose of sending paying patients to their private offices,
they would be in serious trouble. In his memo, David wrote,
``Please know that my intent is to hold us to high standards
of performance and integrity despite the prevailing political
and economic forces that serve to undermine the PBC. I will
not allow us to assume the role of victims.''
Although David's demands seem rather basic--things one
would expect from competent doctors who care about patients--
the D.C. General medical staff was outraged. The doctors
declared war on David.
Leading the charge against David was Oriaifo, then the
acting head of trauma and later president of the medical/
dental staff. A charismatic Nigerian who went to medical
school in the former Soviet Union, Oriaifo had been active in
the doctors' union at the hospital, where he has worked for
the past 16 years. David and Oriaifo first butted heads when
David removed Oriaifo as acting chief of trauma and placed
the trauma unit under the supervision of Dr. Howard Freed,
the new director of emergency medicine.
The demotion prompted Oriaifo to call an emergency meeting
of the medical/dental staff, alleging that he had been
persecuted for speaking out about the administration's
failure to support clinicians. In a memo to the PBC board,
Oriaifo claimed that Freed was not qualified to supervise him
because Freed wasn't a surgeon.
In fact, Freed was the first person ever to run D.C.
General's emergency department who had been both trained and
board-certified in emergency medicine. He had more than 20
years of experience working in trauma centers and fixing
troubled emergency rooms.
Oriaifo, on the other hand, is not board-certified in
surgery or any other specialty. Furthermore, under his
leadership, the hospital's trauma unit has lost its Level 1
trauma designation from the American College of Surgeons--a
designation that qualifies a trauma center to treat the most
severe cases. (Oriaifo blames this loss on a lack of
institutional support from the PBC, not any shortcomings of
his leadership.) Nonetheless, Oriaifo soon got his job back
after Mayor Barry intervened on his behalf.
Undaunted, David continued to discipline wayward doctors.
He suspended and later fired a doctor for failing to complete
medical records; he demoted a podiatrist who had refused to
treat inmates and who the nursing staff had complained wasn't
starting clinics on time. After he discovered what outside
consultants would later confirm--that the hospital had too
many managers--David also demoted a physician who had been
getting extra pay as the administrator of the ``Neurology
Department,'' which had only two doctors in it.
David really angered the medical staff when he started
showing up early at hospital clinics to see whether the
doctors were at work on time. Nurses had complained that one
particular doctor's tardiness was pushing a clinic to stay
open later in the afternoon, requiring the hospital to pay
the nurses overtime. David caught the doctor red-handed,
contacting her on her cell phone. She was dropping her kids
off at school an hour and a half after she was supposed to be
at the clinic.
The personal investigators prompted Oriaifo to stand up at
a PBC board meeting one day and protest that David was
``spying'' on the doctors, which he said the staff considered
highly inappropriate for the chief medical officer. David
says Oriaifo didn't get much sympathy from the board.
Oriaifo and the elected medical leadership defended the
disciplined doctors, claiming that they had been singled out
for criticizing the PBC. The medical staff believes itself to
be an independent governing body under city law, and it often
argues that only staff doctors can discipline other doctors,
even for administrative rather than clinical matters. As
a result, the group has tried to overturn many
disciplinary actions imposed by the hospital
administration.
In a 1998 memo to the PBC board complaining about David,
Oriaifo wrote: ``Dr. David has done nothing to support the
practitioners as we struggle to render care to our patients.
. . . For all intents and purposes, and based on all
available credible evidence,
[[Page H7596]]
Dr. Ronald David appears to be a clueless enforcer and not a
leader. WHERE DO WE GO FROM HERE?'' A month later, Oriaifo
helped organize the first of two votes of no confidence
against David. The votes were largely symbolic, but they
constituted a direct demand by the doctors to the PBC to oust
David.
In an interview, Oriaifo contended that David was a failure
as an administrator because he was an outsider: ``Ron David
just blew out of Harvard. What does he know about D.C.
General?''
Nevertheless, David held on to his job. When PBC board
member Victor Freeman, the medical director for quality for
INOVA Health Care, voiced his support for David's actions,
the medical staff attacked Freeman, too. In a letter dated
Feb. 3, 1999, Oriaifo wrote to Bette Catoe, the chair of the
PBC board, complaining about Freeman. ``How many more victims
will be claimed by this scorched-earth, slash-and-burn, take-
no-prisoner tactics before someone acts to stop the
madness??'' Oriaifo wrote. ``WE ARE FRIGHTENED. . . . We are
UNDER SIEGE. We are at the brink of cataclysm. . . . PLEASE
HEAR MY CRY, PLEASE HEED MY CRY!''
David says his critics were mostly interested in covering
up their malfeasance and laziness. ``They threw up smoke
screens,'' he says, noting that they went after anyone who
tried to discipline them. For example, David says, as Freed
put pressure on the emergency-room doctors to be more
productive and see more patients, they responded by calling
in the D.C. Office of the Inspector General, filing sexual
harassment and discrimination charges against him with the
Equal Employment Opportunity Commission.
Despite the doctors' resistance--and the dire warnings from
the medical staff that the hospital was on the brink of
disaster--David says Freed managed to reduce waiting times in
the emergency room by better than 50 percent.
Finally, David attempted to put to rest the constant rumors
about the surgical competency of Smalls. In March 1999, the
JCAHO had approved the hospital's procedures for reviewing
Smalls' wrong-side surgery. But the agency evaluated only the
process, not the outcome, with which David was still
dissatisfied. So he consulted Freeman, the PBC board's
quality-assurance expert, and they decided to send the case
to an impartial committee of physicians from the D.C. Medical
Society.
Late last summer, the medical society found significant
problems with the surgery, which David used as justification
to review some of Smalls' past cases. He also ordered the
doctors to create an action plan that would prevent such
mistakes in the future. In the end, though, David says, his
effort to compel the doctors to discipline themselves
amounted to very little. Forcing them to put the patients'
interests before their own, says David, was a monumental
fight.
When he first came to D.C. General, David says, he
sustained faith in the miracles performed at the hospital,
where he found that most doctors managed to do good work
under very difficult conditions. For a while, he had even
felt comfortable bringing his wife there for treatment for
sickle-sell anemia. But when the medical staff failed to
institute an effective peer-review system, David decided that
he couldn't maintain high standards at the hospital. He
resigned last September. In a few weeks, he will be entering
a seminary, where he hopes to learn some language of healing
to bring to the practice of medicine. ``It was just so
dispiriting,'' David says of his time at D.C. General.
After David left as chief medical officer, Dr. Robin
Newton, a popular doctor who had recently been the president
of the medical/dental staff, took over. She continued to
pursue David's quality objectives, and in February of this
year, the hospital fired Oriaifo.
For many years, Oriaifo had also held a job at Providence
Hospital, and the PBC administration believed he wasn't
putting in the time he was being paid for at D.C. General. An
audit concluded that Oriaifo had seen only eight patients
while working 24 hours a week from Oct. 15 to Nov. 15 of last
year. Oriaifo disputed the veracity of the audit, and the
medical staff organized a vote of support for him. Then the
doctors called in the JCAHO, which sent surprise inspectors
into the hospital in early March, prompting yet another
crisis for the beleaguered institution.
Oriaifo has since filed a $1 million whistle-blower suit
against the PBC, contending that he was fired for criticizing
the hospital management, which he alleges retaliated against
him, even going so far as to revoke his reserved-parking
privileges. ``When you give your whole life to a service and
you end it with a kick in the pants, it hurts,'' he says.
Oriaifo says he was only looking out for patient care,
calling attention to the administration's failure to respond
to doctors' complaints about a CT scanner that broke down
twice a week, defibrillators that malfunctioned regularly,
and incompetent nurses in the trauma center. He says the
hospital has seen its patient count dwindle by 20,000 since
1995 because the emergency room has been closed down
repeatedly for lack of beds. ``Is it your fault when people
say you're not productive? The problem is not the employees.
The problem is leadership and management,'' Oriaifo contends.
To make his points, he has charts he sent to the PBC board
outlining a proposed reorganization of the emergency
department and memos with long lists of complaints about poor
management. In the course of an interview in which Oriaifo
talks almost nonstop for three hours, it becomes clear that
he believes that he personally should be running the
hospital. ``I, Paul Oriaifo, was one of the doctors who
received [Capitol shooter] Russell Weston! I was running the
service of excellence!'' he says, gesticulating wildly. ``We
[staff doctors] are the main engine of the PBC. We
revolutionized that hospital. We are victims here.''
Since Oriaifo's departure, the PBC's medical staff has
directed its attacks at Newton. On July 3, Dr. Michal Young,
the new president of the medical/dental staff, wrote to the
PBC board complaining that Newton had, among other
wrongdoings, ignored Oriaifo's request to volunteer in the
trauma unit. (Oriaifo has offered to volunteer 20 hours a
week in the trauma unit because of his ``deep commitment'' to
the hospital. He also admits that by doing so, he would be
able to keep his leadership job with the elected medical
staff.)
Perhaps Newton's biggest offense in the eyes of the
doctors, however, was her support for legislation in the D.C.
Council that would have designated the doctors ``at-will''
employees--which would have made them much easier to fire.
(The legislation was withdrawn after a flurry of lobbying by
the medical staff.) Late last month, the medical staff staged
a vote of no confidence against Newton.
Meanwhile, all the complaining by the medical staff has had
an effect in one respect, at least: Former CEO John Fairman
has been removed, and now everyone from the General
Accounting Office to Congress is scrutinizing the PBC. But
the end result may not be exactly what the doctors had in
mind.
The PBC is preparing to lay off hundreds of workers,
including doctors, to avert a shutdown of the hospital
entirely. Services to the poor will likely be severely
curtailed. Trauma surgeons are in all likelihood going to be
phased out altogether. Their special designation as an
independent unit within the emergency department--which has
other surgeons on which to draw--was always an anomaly, and
outside consultants found them to be vastly inefficient.
And in the end, the people who are going to suffer the most
are the city's poor and uninsured--the very people the
medical staff has claimed to be standing up for all along.
Mr. Chairman, I urge my colleagues to vote aye on this bill.
Mr. MOORE. Mr. Chairman, I rise today in opposition to H.R. 4942, the
District of Columbia appropriations bill.
As reported by the Appropriations Committee, this bill contains an
appropriation that is $22 million below last year's funding level.
Additionally, this bill provides 7 percent less funding than the
District requested. But Mr. Speaker, what bothers me the most about
this bill is its inherently undemocratic nature. H.R. 4942 contains
dozens of general provisions that preempt local decision-making power
from the District and redistribute it to the Federal Government.
Through these unnecessary and burdensome provisions, this legislation
undermines local control and intrudes into the internal affairs of the
District of Columbia.
H.R. 4942 contains numerous underfunded priorities, including the
following cuts from last year's levels and the administration's
requests:
A $3 million reduction in the fiscal year 2000 funding level for the
program that assists District of Columbia students who must pay out-of-
state college tuition costs. This funding cut is particularly insidious
because the District is not a state, and therefore local high school
graduates do not have the access to a state system of higher education
offered to students in the rest of the country. Education must be one
of our highest priorities as a nation, and this bill neglects that
goal.
No funds for adoption incentives for children in the District of
Columbia foster care system. The administration requested $5 million
for this priority, which helps remove children from the foster care
system while seeking to place them with a loving and stable family.
In addition to the concerns about funding levels, H.R. 4942 includes
a number of legislative riders, several of which have been attached to
the bill in prior years. I support the amendments offered by Delegate
Eleanor Holmes Norton from the District that would strike approximately
70 general legislative provisions in the bill. These provisions contain
regulations and restrictions related to the management and finances of
the District Government, as well as a rider that would ban the use of
funds for activities intended to secure voting representation in
Congress for the District of Columbia.
Mr. Chairman, the residents of the District deserve to be represented
in the Congress of the United States, just like the residents of the
Third District of Kansas deserve to be represented. District residents
deserve the right to advocate the support or defeat of pending
legislation before Congress, a right currently enjoyed by residents in
all 50 states. The founding Fathers fought the Revolutionary War to
protest taxation without representation, and all that the District's
residents are requesting is full access to this inherent American
right.
[[Page H7597]]
Mr. Chairman, I have supported and will continue to support both the
theory and practice of ``home rule'' for the District of Columbia. The
District's nearly 600,000 residents deserve the same right to self-
government that the rest of America enjoys. I urge my colleagues to
stand up today for the principle of local government and the belief
that all Americans have the inherent right to govern themselves without
unnecessary Federal intervention.
Mr. ISTOOK. Mr. Chairman, I urge adoption of the bill.
Sequential Votes Postponed in Committee of the Whole
The CHAIRMAN pro tempore (Mr. Barrett of Nebraska). Pursuant to House
Resolution 563, proceedings will now resume on those amendments on
which further proceedings were postponed in the following order:
Amendment No. 3 in House Report 106-790 offered by Mr. Bilbray of
California, followed by Amendment No. 2 in House Report 106-790 offered
by Mr. Souder of Indiana.
The Chair will reduce to 5 minutes the time for the electronic vote
after the first vote in this series.
Amendment No. 3 Offered by Mr. Bilbray
The CHAIRMAN pro tempore. The pending business is the demand for a
recorded vote on Amendment No. 3 offered by the gentleman from
California (Mr. Bilbray) on which further proceedings were postponed
and on which the ayes prevailed by a voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN pro tempore. A recorded vote has been demanded.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 265,
noes 155, not voting 13, as follows:
[Roll No. 472]
AYES--265
Aderholt
Archer
Armey
Baca
Bachus
Baker
Baldacci
Barcia
Barr
Barrett (NE)
Bartlett
Barton
Bass
Bentsen
Bereuter
Biggert
Bilbray
Bilirakis
Bishop
Bliley
Blunt
Boehlert
Bono
Boswell
Brady (TX)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Canady
Cannon
Capps
Castle
Chabot
Chambliss
Chenoweth-Hage
Clay
Clement
Coble
Coburn
Collins
Combest
Cook
Costello
Cox
Cramer
Crane
Cubin
Cunningham
Danner
Davis (VA)
Deal
DeGette
DeLay
DeMint
Deutsch
Diaz-Balart
Dickey
Doolittle
Dreier
Dunn
Edwards
Ehlers
Ehrlich
Emerson
English
Etheridge
Everett
Ewing
Fletcher
Foley
Forbes
Fossella
Fowler
Franks (NJ)
Frelinghuysen
Gallegly
Ganske
Gekas
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Goode
Goodlatte
Goodling
Gordon
Goss
Graham
Granger
Green (TX)
Green (WI)
Greenwood
Gutknecht
Hall (TX)
Hansen
Hastings (WA)
Hayes
Hayworth
Hefley
Herger
Hill (MT)
Hilleary
Hobson
Hoekstra
Holden
Holt
Hooley
Horn
Hostettler
Houghton
Hulshof
Hunter
Hyde
Inslee
Isakson
Istook
Jackson-Lee (TX)
John
Johnson (CT)
Johnson, Sam
Jones (NC)
Kasich
Kelly
King (NY)
Kingston
Kleczka
Knollenberg
Kolbe
Kuykendall
LaHood
Largent
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lofgren
Lucas (KY)
Lucas (OK)
Luther
Manzullo
Martinez
Mascara
McCrery
McHugh
McInnis
McIntyre
McKeon
McKinney
McNulty
Menendez
Metcalf
Mica
Miller (FL)
Miller, Gary
Moore
Moran (KS)
Myrick
Nethercutt
Ney
Northup
Norwood
Nussle
Ortiz
Ose
Oxley
Packard
Pallone
Pastor
Payne
Pease
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pitts
Pombo
Porter
Portman
Price (NC)
Pryce (OH)
Quinn
Radanovich
Ramstad
Regula
Reyes
Reynolds
Riley
Rodriguez
Roemer
Rogan
Rogers
Ros-Lehtinen
Rothman
Roukema
Royce
Ryan (WI)
Ryun (KS)
Salmon
Saxton
Scarborough
Schaffer
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simpson
Skeen
Skelton
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Spence
Spratt
Stabenow
Stearns
Stenholm
Stump
Sununu
Sweeney
Talent
Tancredo
Tauzin
Taylor (MS)
Taylor (NC)
Terry
Thomas
Thornberry
Thune
Tiahrt
Toomey
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Visclosky
Vitter
Walden
Walsh
Watkins
Watts (OK)
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson
Wolf
Wu
Young (FL)
NOES--155
Abercrombie
Ackerman
Allen
Andrews
Baird
Baldwin
Ballenger
Barrett (WI)
Berkley
Berman
Berry
Blagojevich
Blumenauer
Boehner
Bonilla
Bonior
Borski
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Capuano
Cardin
Carson
Clyburn
Condit
Conyers
Cooksey
Coyne
Crowley
Cummings
Davis (FL)
Davis (IL)
DeFazio
Delahunt
DeLauro
Dicks
Dingell
Dixon
Doggett
Dooley
Doyle
Duncan
Engel
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Frost
Gejdenson
Gonzalez
Hall (OH)
Hastings (FL)
Hill (IN)
Hilliard
Hinchey
Hinojosa
Hoeffel
Hoyer
Hutchinson
Jackson (IL)
Jefferson
Jenkins
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind (WI)
Kucinich
LaFalce
Lampson
Lantos
Larson
Lee
Levin
Lewis (GA)
Lowey
Maloney (CT)
Maloney (NY)
Markey
Matsui
McCarthy (MO)
McCarthy (NY)
McDermott
McGovern
Meehan
Meek (FL)
Meeks (NY)
Millender-McDonald
Miller, George
Minge
Mink
Moakley
Mollohan
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Oberstar
Obey
Olver
Owens
Pascrell
Paul
Pelosi
Pickett
Pomeroy
Rahall
Rangel
Rivers
Rohrabacher
Roybal-Allard
Rush
Sabo
Sanchez
Sanders
Sandlin
Sanford
Sawyer
Schakowsky
Scott
Serrano
Sherman
Shows
Sisisky
Slaughter
Smith (WA)
Snyder
Stark
Strickland
Stupak
Tanner
Tauscher
Thompson (CA)
Thompson (MS)
Thurman
Tierney
Towns
Velazquez
Wamp
Watt (NC)
Waxman
Weiner
Wexler
Weygand
Woolsey
Wynn
Young (AK)
NOT VOTING--13
Becerra
Campbell
Clayton
Eshoo
Gutierrez
Klink
Lazio
McCollum
McIntosh
Neal
Vento
Waters
Wise
{time} 1226
Mrs. JONES of Ohio, Mrs. NAPOLITANO, and Messrs. WAMP, HUTCHINSON,
and EVANS changed their vote from ``aye'' to ``no.''
Mrs. NAPOLITANO, Ms. DEGETTE, and Messrs. EVANS, DEUTSCH, PRICE of
North Carolina, ROTHMAN, and PAYNE changed their vote from ``no'' to
``aye.''
So the amendment was agreed to.
The result of the vote was announced as above recorded.
Stated for:
Mr. DUNCAN. Mr. Chairman, on rollcall No. 472 I inadvertently pressed
the ``nay'' button. I meant to vote ``aye.''
Announcement by the Chairman
The CHAIRMAN. Pursuant to House Resolution 563, the Chair announces
that he will reduce to a minimum of 5 minutes the period of time within
which a vote by electronic device will be taken on the remaining
amendment on which the Chair has postponed further proceedings.
Amendment No. 2 Offered by Mr. Souder
The CHAIRMAN. The pending business is the demand for a recorded vote
on amendment No. 2 offered by the gentleman from Indiana (Mr. Souder)
on which further proceedings were postponed and on which the noes
prevailed by voice vote.
The Clerk will redesignate the amendment.
The text of the amendment is as follows:
Amendment No. 2 offered by Mr. Souder:
In section 150, strike ``Federal''.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The CHAIRMAN. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 239,
noes 181, not voting 14, as follows:
[Roll No. 473]
AYES--239
Aderholt
Archer
Armey
Baca
Bachus
Baker
Ballenger
Barcia
Barr
Barrett (NE)
Bartlett
Barton
Bass
Bereuter
Biggert
Bilbray
Bilirakis
Blagojevich
Bliley
Blunt
Boehner
Bono
Boswell
Brady (TX)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Canady
Cannon
Chabot
Chambliss
Clement
Coble
Coburn
Collins
Combest
Cook
Costello
[[Page H7598]]
Cox
Cramer
Crane
Cubin
Cunningham
Danner
Davis (VA)
Deal
DeLay
DeMint
Diaz-Balart
Dickey
Doolittle
Dreier
Duncan
Dunn
Ehrlich
Emerson
English
Etheridge
Evans
Everett
Ewing
Fletcher
Forbes
Fossella
Fowler
Franks (NJ)
Gallegly
Gekas
Gibbons
Gilchrest
Gilman
Goode
Goodlatte
Goodling
Goss
Graham
Granger
Green (TX)
Green (WI)
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastert
Hastings (WA)
Hayes
Hayworth
Hefley
Herger
Hill (IN)
Hill (MT)
Hilleary
Hobson
Hoekstra
Holden
Hostettler
Hulshof
Hunter
Hutchinson
Hyde
Isakson
Istook
Jenkins
John
Johnson, Sam
Jones (NC)
Kasich
Kelly
King (NY)
Kingston
Knollenberg
Kuykendall
LaHood
Largent
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lucas (KY)
Lucas (OK)
Luther
Manzullo
Martinez
Mascara
McCrery
McHugh
McInnis
McIntyre
McKeon
McNulty
Metcalf
Mica
Miller, Gary
Moran (KS)
Myrick
Nethercutt
Ney
Northup
Norwood
Nussle
Ortiz
Ose
Oxley
Packard
Pascrell
Paul
Pease
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pitts
Pombo
Pomeroy
Portman
Pryce (OH)
Quinn
Radanovich
Ramstad
Regula
Reynolds
Riley
Rodriguez
Roemer
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Roukema
Royce
Ryan (WI)
Ryun (KS)
Salmon
Sandlin
Sanford
Saxton
Scarborough
Schaffer
Sensenbrenner
Sessions
Shadegg
Shaw
Sherwood
Shimkus
Shows
Shuster
Simpson
Skeen
Skelton
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Spence
Spratt
Stearns
Stenholm
Strickland
Stump
Sununu
Sweeney
Talent
Tancredo
Tanner
Tauzin
Taylor (MS)
Terry
Thornberry
Thune
Tiahrt
Toomey
Traficant
Turner
Velazquez
Visclosky
Vitter
Walden
Walsh
Wamp
Watkins
Watts (OK)
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson
Wolf
Young (AK)
Young (FL)
NOES--181
Abercrombie
Ackerman
Allen
Andrews
Baird
Baldacci
Baldwin
Barrett (WI)
Bentsen
Berkley
Berman
Berry
Bishop
Blumenauer
Boehlert
Bonilla
Bonior
Borski
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Capps
Capuano
Cardin
Carson
Castle
Clay
Clayton
Clyburn
Condit
Conyers
Cooksey
Coyne
Crowley
Cummings
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Dixon
Doggett
Dooley
Doyle
Edwards
Ehlers
Engel
Farr
Fattah
Filner
Foley
Ford
Frank (MA)
Frelinghuysen
Frost
Ganske
Gejdenson
Gephardt
Gillmor
Gonzalez
Gordon
Greenwood
Hastings (FL)
Hilliard
Hinchey
Hinojosa
Hoeffel
Holt
Hooley
Horn
Houghton
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (CT)
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind (WI)
Kleczka
Kolbe
Kucinich
LaFalce
Lampson
Lantos
Larson
Lee
Levin
Lewis (GA)
Lofgren
Lowey
Maloney (CT)
Maloney (NY)
Markey
Matsui
McCarthy (MO)
McCarthy (NY)
McDermott
McGovern
McKinney
Meehan
Meek (FL)
Meeks (NY)
Menendez
Millender-McDonald
Miller (FL)
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Oberstar
Obey
Olver
Owens
Pallone
Pastor
Payne
Pelosi
Pickett
Porter
Price (NC)
Rahall
Rangel
Reyes
Rivers
Rothman
Roybal-Allard
Rush
Sabo
Sanchez
Sanders
Sawyer
Schakowsky
Scott
Serrano
Shays
Sherman
Sisisky
Slaughter
Smith (WA)
Snyder
Stabenow
Stark
Stupak
Tauscher
Thomas
Thompson (CA)
Thompson (MS)
Thurman
Tierney
Towns
Udall (CO)
Udall (NM)
Upton
Watt (NC)
Waxman
Weiner
Wexler
Weygand
Woolsey
Wu
Wynn
NOT VOTING--14
Becerra
Campbell
Chenoweth-Hage
Eshoo
Gutierrez
Klink
Lazio
McCollum
McIntosh
Neal
Taylor (NC)
Vento
Waters
Wise
{time} 1235
So the amendment was agreed to.
The result of the vote was announced as above recorded.
The CHAIRMAN pro tempore (Mr. Barrett of Nebraska). Under the rule,
the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
LaHood) having assumed the chair, Mr. Barrett of Nebraska, Chairman pro
tempore of the Committee of the Whole House on the State of the Union,
reported that that Committee, having had under consideration the bill
(H.R. 4942) making appropriations for the government of the District of
Columbia and other activities chargeable in whole or in part against
revenues of said District for the fiscal year ending September 30,
2000, and for other purposes, pursuant to House Resolution 563, he
reported the bill back to the House with sundry amendments adopted by
the Committee of the Whole.
The SPEAKER pro tempore (Mr. LaHood). Under the rule, the previous
question is ordered.
Is a separate vote demanded on any amendment? If not, the Chair will
put them en gros.
The amendments were agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
Under clause 10 of rule XX, the yeas and nays are ordered.
The vote was taken by electronic device, and there were--yeas 217,
nays 207, not voting 10, as follows:
[Roll No. 474]
YEAS--217
Aderholt
Archer
Armey
Bachus
Baker
Ballenger
Barrett (NE)
Bartlett
Barton
Bass
Bereuter
Biggert
Bilbray
Bilirakis
Bliley
Blunt
Boehlert
Boehner
Bonilla
Bono
Brady (TX)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Canady
Cannon
Castle
Chabot
Chambliss
Chenoweth-Hage
Coble
Coburn
Collins
Combest
Cook
Cooksey
Cox
Crane
Cubin
Cunningham
Davis (VA)
Deal
DeLay
DeMint
Diaz-Balart
Dickey
Doolittle
Dreier
Dunn
Ehlers
Ehrlich
Emerson
English
Everett
Ewing
Fletcher
Foley
Fossella
Fowler
Franks (NJ)
Frelinghuysen
Gallegly
Ganske
Gekas
Gibbons
Gilchrest
Gillmor
Gilman
Goode
Goodlatte
Goodling
Goss
Graham
Granger
Green (WI)
Greenwood
Gutknecht
Hansen
Hastert
Hastings (WA)
Hayes
Hayworth
Hefley
Herger
Hill (MT)
Hilleary
Hobson
Hoekstra
Horn
Hostettler
Houghton
Hulshof
Hunter
Hutchinson
Hyde
Isakson
Istook
Jenkins
Johnson (CT)
Johnson, Sam
Jones (NC)
Kasich
Kelly
King (NY)
Kingston
Knollenberg
Kolbe
Kuykendall
LaHood
Largent
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (KY)
Lucas (OK)
Manzullo
Martinez
McCrery
McHugh
McInnis
McIntyre
McKeon
Metcalf
Mica
Miller (FL)
Miller, Gary
Moran (KS)
Myrick
Nethercutt
Ney
Northup
Norwood
Nussle
Ose
Oxley
Packard
Pease
Peterson (PA)
Petri
Pickering
Pitts
Pombo
Porter
Portman
Pryce (OH)
Quinn
Radanovich
Ramstad
Regula
Reynolds
Riley
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Roukema
Royce
Ryan (WI)
Ryun (KS)
Salmon
Sanford
Saxton
Scarborough
Schaffer
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simpson
Skeen
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Spence
Stearns
Stump
Sununu
Sweeney
Talent
Tancredo
Tauzin
Taylor (NC)
Terry
Thomas
Thornberry
Thune
Tiahrt
Toomey
Traficant
Upton
Vitter
Walden
Walsh
Wamp
Watkins
Watts (OK)
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson
Wolf
Young (AK)
Young (FL)
NAYS--207
Abercrombie
Ackerman
Allen
Andrews
Baca
Baird
Baldacci
Baldwin
Barcia
Barr
Barrett (WI)
Bentsen
Berkley
Berman
Berry
Bishop
Blagojevich
Blumenauer
Bonior
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Capps
Capuano
Cardin
Carson
Clay
Clayton
Clement
Clyburn
Condit
Conyers
Costello
Coyne
Cramer
Crowley
Cummings
Danner
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Dixon
Doggett
Dooley
Doyle
Duncan
Edwards
Engel
Etheridge
Evans
Farr
Fattah
Filner
[[Page H7599]]
Forbes
Ford
Frank (MA)
Frost
Gejdenson
Gephardt
Gonzalez
Gordon
Green (TX)
Hall (OH)
Hall (TX)
Hastings (FL)
Hill (IN)
Hilliard
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Hooley
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E.B.
Jones (OH)
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind (WI)
Kleczka
Kucinich
LaFalce
Lampson
Lantos
Larson
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Luther
Maloney (CT)
Maloney (NY)
Markey
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McDermott
McGovern
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Millender-McDonald
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Neal
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Phelps
Pickett
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Rivers
Rodriguez
Roemer
Rothman
Roybal-Allard
Rush
Sabo
Sanchez
Sanders
Sandlin
Sawyer
Schakowsky
Scott
Sensenbrenner
Serrano
Sherman
Shows
Sisisky
Skelton
Slaughter
Smith (WA)
Snyder
Spratt
Stabenow
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Thurman
Tierney
Towns
Turner
Udall (CO)
Udall (NM)
Velazquez
Visclosky
Waters
Watt (NC)
Waxman
Weiner
Wexler
Weygand
Woolsey
Wu
Wynn
NOT VOTING--10
Becerra
Campbell
Eshoo
Gutierrez
Klink
Lazio
McCollum
McIntosh
Vento
Wise
{time} 1252
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. LaHood) (during the vote). The chair
notes a disturbance in the gallery in contravention of the law and
rules of the House.
The Sergeant-at-Arms will remove those persons responsible for the
disturbance and restore order to the gallery.
{time} 1253
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________