[Congressional Record Volume 146, Number 111 (Tuesday, September 19, 2000)]
[Senate]
[Pages S8759-S8768]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. ASHCROFT:
  S. 3066. A bill to amend titles XVIII and XIX of the Social Security 
Act to require criminal background checks for nursing facility workers; 
to the Committee on Finance.


                   the senior care safety act of 2000

  Mr. ASHCROFT. Mr. President, I rise today to introduce the Senior 
Care Safety Act of 2000. This bill prohibits nursing homes and other 
long-term care facilities operating under the Social Security and 
Medicaid systems from employing individuals with a demonstrated history 
of violent, criminal behavior or drug dealing. To that end, it requires 
these nursing facilities to conduct criminal background checks on all 
of their prospective employees as part of the hiring process. Nursing 
facilities that fail to conduct a background check prior to hiring an 
employee are subject to a civil fine of up to $5,000. The reason for 
these requirements is simple: we must ensure that our most defenseless 
senior Americans--those in need of long-term nursing care--are attended 
not by people with a demonstrated history of violent, criminal 
behavior, but by the most qualified and trustworthy individuals 
available.
  The Senior Care Safety Act provides nursing facilities with the tools 
necessary to accomplish this objective. It requires the Department of 
Justice to open federal databases of criminal background information to 
nursing homes so that they can promptly determine if prospective 
employees have a criminal record. The act provides that the Department 
of Justice provide this information without charge to the facility or 
the applicant. Furthermore, it ensures that those who comply with the 
background check requirement are insulated from liability for refusing 
to hire someone prohibited from working in a nursing facility by this 
provision. Finally, it guarantees the privacy of those individuals who 
are denied such employment due to a criminal record by prohibiting the 
use by a nursing facility of an individual's background information for 
any purpose other than complying with this act.
  It is tragic that a bill like this is necessary. But, while the 
overwhelming majority of those who care for the more than 40,000 senior 
citizens receiving 24-hour care in my home state of Missouri, and the 
more than 1.5 million of such seniors nationwide are dedicated and 
caring individuals, there are unfortunately too many examples of those 
who take advantage of this position of trust. There are far too many 
stories of convicted violent felons who have slipped through the cracks 
in the hiring process and have physically or mentally abused our 
frailest citizens in the very institutions that their families have 
entrusted them for care. This bill will play an important role in 
ensuring that when a family entrusts

[[Page S8760]]

their loved ones to a nursing facility, they can rest assured that 
those who are looking after them are not violent felons. I look forward 
to working with my fellow Senators to pass this important legislation 
in the time remaining this year.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3066

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Senior Care Safety Act of 
     2000''.

     SEC. 2. CRIMINAL BACKGROUND CHECKS FOR NURSING FACILITY 
                   WORKERS.

       (a) Medicare.--
       (1) Requirement to conduct criminal background checks.--
     Section 1819(d)(4) of the Social Security Act (42 U.S.C. 
     1395i-3(d)(4)) is amended--
       (A) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (B) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Screening of workers.--
       ``(i) In general.--A skilled nursing facility shall not 
     knowingly employ an individual unless the individual has 
     passed a criminal background check conducted in accordance 
     with the requirements of clause (ii).
       ``(ii) Requirements.--

       ``(I) Notification.--Not later than 180 days after the date 
     of enactment of this subparagraph, the Secretary, in 
     consultation with the Attorney General, shall notify skilled 
     nursing facilities of the requirements of this subparagraph.
       ``(II) Skilled nursing facility requirements.--

       ``(aa) Provision of statements to applicants.--Not later 
     than 180 days after a skilled nursing facility receives a 
     notice in accordance with subclause (I), the skilled nursing 
     facility shall adopt and enforce the requirement that each 
     applicant for employment at the skilled nursing facility 
     shall complete the written statement described in subclause 
     (III).
       ``(bb) Transmittal of completed statements.--Not later than 
     5 business days after a skilled nursing facility receives 
     such completed written statement, the skilled nursing 
     facility shall transmit such statement to the Attorney 
     General.

       ``(III) Statement described.--The written statement 
     described in this subclause shall contain the following:

       ``(aa) The name, address, and date of birth appearing on a 
     valid identification document (as defined section 1028(d)(2) 
     of title 18, United States Code) of the applicant, a 
     description of the identification document used, and the 
     applicant's social security account number.
       ``(bb) A statement that the applicant has never been 
     convicted of a crime of violence or of a Federal or State 
     offense consisting of the distribution of controlled 
     substances (as that term is defined in section 102(6) of the 
     Controlled Substances Act (21 U.S.C. 802(6)).
       ``(cc) The date the statement is made.

       ``(IV) Attorney general requirements.--

       ``(aa) In general.--Upon receipt of a completed written 
     statement from a skilled nursing facility, the Attorney 
     General, using information available to the Department of 
     Justice, shall notify the facility of the receipt of such 
     statement and promptly determine whether the applicant 
     completing the statement has ever been convicted of a crime 
     described in subclause (III)(bb).
       ``(bb) Notification of failure to pass.--Not later than 5 
     business days after the receipt of such statement, the 
     Attorney General shall inform the skilled nursing facility 
     transmitting the statement if the applicant completing the 
     statement did not pass the background check. A skilled 
     nursing facility not so informed within such period shall 
     consider the applicant completing the statement to have 
     passed the background check.
       ``(cc) No fee.--In no case shall a skilled nursing facility 
     or an applicant be charged a fee in connection with the 
     background check process conducted under this clause.
       ``(iii) Limitation on use of information.--A skilled 
     nursing facility that obtains criminal background information 
     about an applicant pursuant to this subparagraph may use such 
     information only for the purpose of determining the 
     suitability of the worker for employment.
       ``(iv) No action based on failure to hire.--In any action 
     against a skilled nursing facility based on a failure or 
     refusal to hire an applicant, the fact that the applicant did 
     not pass a background check conducted in accordance with this 
     subparagraph shall be a complete defense to such action.''.
       (2) Penalties.--Section 1819(h)(1) of the Social Security 
     Act (42 U.S.C. 1395i-3(h)(1)) is amended--
       (A) by striking the heading and inserting ``State 
     authority'';
       (B) in the first sentence--
       (i) by redesignating subparagraphs (A) and (B) as clauses 
     (i) and (ii) and indenting such clauses appropriately; and
       (ii) by striking ``If a State'' and inserting the 
     following:
       ``(A) In general.--If a State'';
       (C) in the second sentence, by striking ``If a State'' and 
     inserting the following:
       ``(C) Penalties for prior failures.--If a State''; and
       (D) by inserting after subparagraph (A) (as added by 
     subparagraph (B)(ii) of this paragraph) the following new 
     subparagraph:
       ``(B) Required penalties.--A civil money penalty of not 
     more than $5000 shall be assessed and collected, with 
     interest, against any facility which is or was out of 
     compliance with the requirements of clause (i), (ii)(II), or 
     (iii) of subsection (d)(4)(B).''.
       (b) Medicaid.--
       (1) Requirement to conduct criminal background checks.--
     Section 1919(d)(4) of the Social Security Act (42 U.S.C. 
     1396r(d)(4)) is amended--
       (A) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (B) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Screening of workers.--
       ``(i) In general.--A nursing facility shall not knowingly 
     employ an individual unless the individual has passed a 
     criminal background check conducted in accordance with the 
     requirements of clause (ii).
       ``(ii) Requirements.--

       ``(I) Notification.--Not later than 180 days after the date 
     of enactment of this subparagraph, the Secretary, in 
     consultation with the Attorney General, shall notify nursing 
     facilities of the requirements of this subparagraph.
       ``(II) Nursing facility requirements.--

       ``(aa) Provision of statements to applicants.--Not later 
     than 180 days after a nursing facility receives a notice in 
     accordance with subclause (I), the nursing facility shall 
     adopt and enforce the requirement that each applicant for 
     employment at the nursing facility shall complete the written 
     statement described in subclause (III).
       ``(bb) Transmittal of completed statements.--Not later than 
     5 business days after a nursing facility receives such 
     completed written statement, the nursing facility shall 
     transmit such statement to the Attorney General.

       ``(III) Statement described.--The written statement 
     described in this subclause shall contain the following:

       ``(aa) The name, address, and date of birth appearing on a 
     valid identification document (as defined section 1028(d)(2) 
     of title 18, United States Code) of the applicant, a 
     description of the identification document used, and the 
     applicant's social security account number.
       ``(bb) A statement that the applicant has never been 
     convicted of a crime of violence or of a Federal or State 
     offense consisting of the distribution of controlled 
     substances (as that term is defined in section 102(6) of the 
     Controlled Substances Act (21 U.S.C. 802(6)).
       ``(cc) The date the statement is made.

       ``(IV) Attorney general requirements.--

       ``(aa) In general.--Upon receipt of a completed written 
     statement from a nursing facility, the Attorney General, 
     using information available to the Department of Justice, 
     shall notify the facility of the receipt of such statement 
     and promptly determine whether the applicant completing the 
     statement has ever been convicted of a crime described in 
     subclause (III)(bb).
       ``(bb) Notification of failure to pass.--Not later than 5 
     business days after the receipt of such statement, the 
     Attorney General shall inform the nursing facility 
     transmitting the statement if the applicant completing the 
     statement did not pass the background check. A nursing 
     facility not so informed within such period shall consider 
     the applicant completing the statement to have passed the 
     background check.
       ``(cc) No fee.--In no case shall a nursing facility or an 
     applicant be charged a fee in connection with the background 
     check process conducted under this clause.
       ``(iii) Limitation on use of information.--A nursing 
     facility that obtains criminal background information about 
     an applicant pursuant to this subparagraph may use such 
     information only for the purpose of determining the 
     suitability of the worker for employment.
       ``(iv) No action based on failure to hire.--In any action 
     against a nursing facility based on a failure or refusal to 
     hire an applicant, the fact that the applicant did not pass a 
     background check conducted in accordance with this 
     subparagraph shall be a complete defense to such action.''.
       (2) Penalties.--Section 1919(h)(2)(A) of the Social 
     Security Act (42 U.S.C. 1396r(h)(2)(A)) is amended by 
     inserting after clause (iv) the following new clause:
       ``(v) A civil money penalty of not more than $5000 shall be 
     assessed and collected, with interest, against any facility 
     which is or was out of compliance with the requirements of 
     clause (i), (ii)(II), or (iii) of subsection (d)(4)(B).''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2000.

     SEC. 3. REPORT ON CRIMINAL BACKGROUND CHECKS.

       (a) In General.--Not later than 3 years after the date of 
     enactment of this Act, the Attorney General shall conduct a 
     study of the effects of background checks in nursing 
     facilities and submit a report to Congress that includes the 
     following:
       (1) The success of conducting background checks on nursing 
     facility employees.
       (2) The impact of background checks on patient care in such 
     facilities.

[[Page S8761]]

       (3) The need to conduct background checks in other patient 
     care settings outside of nursing facilities.
       (4) Suggested methods for further improving the background 
     check system and the estimated costs of such improvements.
       (b) Definition of nursing facility.--In subsection (a), the 
     term ``nursing facility'' has the meaning given that term in 
     section 1919(a) of the Social Security Act (42 U.S.C. 
     1396r(a)) and includes a skilled nursing facility (as defined 
     in section 1819(a) of such Act (42 U.S.C. 1395i-3(a))).
                                 ______
                                 
      By Mr. JEFFORDS (for himself, Mr. Enzi, Mr. Kennedy, and Mr. 
        Reid):
  S. 3067. A bill to require changes in the bloodborne pathogens 
standard in effect under the Occupational Safety and Health Act of 
1970; to the Committee on Health, Education, Labor and Pensions.


               THE NEEDLESTICK SAFETY and PREVENTION ACT

  Mr. JEFFORDS. Mr. President, I am pleased to be able to introduce 
today, along with Senators Enzi, Kennedy, and Reid, the Needlestick 
Safety and Prevention Act. This legislation will ensure that our 
nation's health care workers, who tend to our citizens when care is 
urgently needed, will no longer be risking their own health, and, 
perhaps, their own lives, when providing this life giving work.
  Statistics paint a stark picture of the risks from accidental sharps 
injuries that health care workers face daily on the job, injuries that 
can be prevented, and, when Congress passes this legislation, will be 
prevented. The Centers for Disease Control and Prevention has estimated 
that as many as 800,000 injuries from contaminated sharps occur 
annually among health care workers. Due to these injuries, numerous 
health care workers have contracted fatal or other serious viruses and 
diseases, including the human immunodeficiency virus (HIV), hepatitis 
B, and hepatitis C.
  ``Needlesticks'' refer to the broad category of injuries suffered by 
workers in health care settings who are exposed to sharps, including 
items such as disposable syringes with needles, IV catheters, lancets, 
and glass capillary tubes/pipettes. The true shame in these alarming 
statistics is that accidental needlestick injuries can be prevented. 
Technological advancements have led to the development of safer medical 
devices, such as syringes with needle guards or sheaths.
  The heart of the ``Needlestick Safety and Prevention Act'' is its 
requirement that employers identify, evaluate, and make use of 
effective safer medical devices. And the legislation emphasizes 
training, education, and the participation of those workers exposed to 
sharps injuries in the evaluation and selection of safer devices. The 
Act also creates new record keeping requirements, a ``sharps injury 
log,'' to aid employers in identifying high risk areas, and in 
determining the types of engineering controls and devices most 
effective in reducing or eliminating the risk of exposure. Importantly, 
the legislation we introduce today will not impede, but will encourage 
technological development, as it does not favor the use of a specific 
device, but requires an employer to evaluate the effectiveness of 
available devices.
  I urge all my colleagues to join us in supporting the ``Needlestick 
Safety and Prevention Act.''
  I ask unanimous consent that a copy of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3067

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Needlestick Safety and 
     Prevention Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Numerous workers who are occupationally exposed to 
     bloodborne pathogens have contracted fatal and other serious 
     viruses and diseases, including the human immunodeficiency 
     virus (HIV), hepatitis B, and hepatitis C from exposure to 
     blood and other potentially infectious materials in their 
     workplace.
       (2) In 1991 the Occupational Safety and Health 
     Administration issued a standard regulating occupational 
     exposure to bloodborne pathogens, including the human 
     immunodeficiency virus, (HIV), the hepatitis B virus (HBV), 
     and the hepatitis C virus (HCV).
       (3) Compliance with the bloodborne pathogens standard has 
     significantly reduced the risk that workers will contract a 
     bloodborne disease in the course of their work.
       (4) Nevertheless, occupational exposure to bloodborne 
     pathogens from accidental sharps injuries in health care 
     settings continues to be a serious problem. In March 2000, 
     the Centers for Disease Control and Prevention estimated that 
     more than 380,000 percutaneous injuries from contaminated 
     sharps occur annually among health care workers in United 
     States hospital settings. Estimates for all health care 
     settings are that 600,000 to 800,000 needlestick and other 
     percutaneous injuries occur among health care workers 
     annually. Such injuries can involve needles or other sharps 
     contaminated with bloodborne pathogens, such as HIV, HBV, or 
     HCV.
       (5) Since publication of the bloodborne pathogens standard 
     in 1991 there has been a substantial increase in the number 
     and assortment of effective engineering controls available to 
     employers. There is now a large body of research and data 
     concerning the effectiveness of newer engineering controls, 
     including safer medical devices.
       (6) 396 interested parties responded to a Request for 
     Information (in this section referred to as the ``RFI'') 
     conducted by the Occupational Health and Safety 
     Administration in 1998 on engineering and work practice 
     controls used to eliminate or minimize the risk of 
     occupational exposure to bloodborne pathogens due to 
     percutaneous injuries from contaminated sharps. Comments were 
     provided by health care facilities, groups representing 
     health care workers, researchers, educational institutions, 
     professional and industry associations, and manufacturers of 
     medical devices.
       (7) Numerous studies have demonstrated that the use of 
     safer medical devices, such as needleless systems and sharps 
     with engineered sharps injury protections, when they are part 
     of an overall bloodborne pathogens risk-reduction program, 
     can be extremely effective in reducing accidental sharps 
     injuries.
       (8) In March 2000, the Centers for Disease Control and 
     Prevention estimated that, depending on the type of device 
     used and the procedure involved, 62 to 88 percent of sharps 
     injuries can potentially be prevented by the use of safer 
     medical devices.
       (9) The OSHA 200 Log, as it is currently maintained, does 
     not sufficiently reflect injuries that may involve exposure 
     to bloodborne pathogens in health care facilities. More than 
     98 percent of health care facilities responding to the RFI 
     have adopted surveillance systems in addition to the OSHA 200 
     Log. Information gathered through these surveillance systems 
     is commonly used for hazard identification and evaluation of 
     program and device effectiveness.
       (10) Training and education in the use of safer medical 
     devices and safer work practices are significant elements in 
     the prevention of percutaneous exposure incidents. Staff 
     involvement in the device selection and evaluation process is 
     also an important element to achieving a reduction in sharps 
     injuries, particularly as new safer devices are introduced 
     into the work setting.
       (11) Modification of the bloodborne pathogens standard is 
     appropriate to set forth in greater detail its requirement 
     that employers identify, evaluate, and make use of effective 
     safer medical devices.

     SEC. 3. BLOODBORNE PATHOGENS STANDARD.

       The bloodborne pathogens standard published at 29 C.F.R. 
     1910.1030 shall be revised as follows:
       (1) The definition of ``Engineering Controls'' (at 29 
     C.F.R. 1930.1030(b)) shall include as additional examples of 
     controls the following: ``safer medical devices, such as 
     sharps with engineered sharps injury protections and 
     needleless systems''.
       (2) The term ``Sharps with Engineered Sharps Injury 
     Protections'' shall be added to the definitions (at 29 C.F.R. 
     1910.1030(b)) and defined as ``a nonneedle sharp or a needle 
     device used for withdrawing body fluids, accessing a vein or 
     artery, or administering medications or other fluids, with a 
     built-in safety feature or mechanism that effectively reduces 
     the risk of an exposure incident''.
       (3) The term ``Needleless Systems'' shall be added to the 
     definitions (at 29 C.F.R. 1910.1030(b)) and defined as ``a 
     device that does not use needles for (A) the collection of 
     bodily fluids or withdrawal of body fluids after initial 
     venous or arterial access is established, (B) the 
     administration of medication or fluids, or (C) any other 
     procedure involving the potential for occupational exposure 
     to bloodborne pathogens due to percutaneous injuries from 
     contaminated sharps''.
       (4) In addition to the existing requirements concerning 
     exposure control plans (29 C.F.R. 1910.1030(c)(1)(iv)), the 
     review and update of such plans shall be required to also--
       (A) ``reflect changes in technology that eliminate or 
     reduce exposure to bloodborne pathogens''; and
       (B) ``document consideration and implementation of 
     appropriate commercially available and effective safer 
     medical devices designed to eliminate or minimize 
     occupational exposure''.
       (5) The following additional recordkeeping requirement 
     shall be added to the bloodborne pathogens standard at 29 
     C.F.R. 1910.1030(h): ``The employer shall establish and 
     maintain a sharps injury log for the recording of 
     percutaneous injuries from contaminated sharps. The 
     information in the sharps injury log shall be recorded and 
     maintained in such manner as to protect the confidentiality 
     of the injured employee. The sharps injury log shall contain, 
     at a minimum--

[[Page S8762]]

       ``(A) the type and brand of device involved in the 
     incident,
       ``(B) the department or work area where the exposure 
     incident occurred, and
       ``(C) an explanation of how the incident occurred.''.

     The requirement for such sharps injury log shall not apply to 
     any employer who is not required to maintain a log of 
     occupational injuries and illnesses under 29 C.F.R. 1904 and 
     the sharps injury log shall be maintained for the period 
     required by 29 C.F.R. 1904.6.
       (6) The following new section shall be added to the 
     bloodborne pathogens standard: ``An employer, who is required 
     to establish an Exposure Control Plan shall solicit input 
     from non-managerial employees responsible for direct patient 
     care who are potentially exposed to injuries from 
     contaminated sharps in the identification, evaluation, and 
     selection of effective engineering and work practice controls 
     and shall document the solicitation in the Exposure Control 
     Plan.''.

     SEC. 4. EFFECT OF MODIFICATIONS.

       The modifications under section 3 shall be in force until 
     superseded in whole or in part by regulations promulgated by 
     the Secretary of Labor under section 6(b) of the Occupational 
     Safety and Health Act of 1970 (29 U.S.C. 655(b)) and shall be 
     enforced in the same manner and to the same extent as any 
     rule or regulation promulgated under section 6(b).

     SEC. 5. PROCEDURE AND EFFECTIVE DATE.

       (a) Procedure.--The modifications of the bloodborne 
     pathogens standard prescribed by section 3 shall take effect 
     without regard to the procedural requirements applicable to 
     regulations promulgated under section 6(b) of the 
     Occupational Safety and Health Act of 1970 (29 U.S.C. 655(b)) 
     or the procedural requirements of chapter 5 of title 5, 
     United States Code.
       (b) Effective Date.--The modifications to the bloodborne 
     pathogens standard required by section 3 shall--
       (1) within 6 months of the date of enactment of this Act, 
     be made and published in the Federal Register by the 
     Secretary of Labor acting through the Occupational Safety and 
     Health Administration; and
       (2) take effect on the date that is 90 days after the date 
     of such publication.

  Mr. ENZI. Mr. President, I am pleased to be part of the introduction 
today of S. 3067, a bipartisan bill to provide protection for our 
nations health care workers against accidental needlesticks and sharps 
injuries. I want to acknowledge and commend my colleagues Senators 
Jeffords, Kennedy and Reed in the Senate and the Honorable Mr. 
Ballenger and Honorable Major Owens in the House for their work on this 
important safety issue.
  Since the mid-1980's, injuries to health care workers from needles or 
other ``sharps,'' such as IV catheters or lancets, have presented an 
increasingly troubling issue. As the spread of bloodborne pathogens 
such as HIV and Hepatitis B and C has escalated over the last 15 years, 
so has the danger to health care workers of contracting one of these 
diseases through sharps contaminated with bloodborne pathogens, such as 
HIV and Hepatitis B and C. Even where the injured worker does not 
ultimately contract a bloodborne disease, the uncertainty and fear of 
infection created by such injuries can be excruciating and destructive 
to the lives of the injured health care workers.
  In response to this problem, in 1991 the Occupational Safety and 
Health Administration, or ``OSHA,'' issued a standard requiring 
workplace safety measures to be used to protect against occupational 
exposure to bloodborne pathogens. This was a laudable step in the fight 
against worker infection, and its implementation brought a reduction in 
the risk of contracting a bloodborne disease in the workplace. The 
success of this measure, however, was limited by the effectiveness of 
the safety technology available at the time, and occupational exposure 
to bloodborne pathogens from accidental sharps injuries has continued 
to be a problem. In March 2000, the Centers for Disease Control 
estimated that between 600,000 and 800,000 needlesticks still occur 
among health care workers annually.
  Fortunately, since the publication of the bloodborne pathogens 
standard there has been a substantial increase in the number and 
assortment of new medical devices, such as needless systems and 
retractable needles, that protect against needlesticks. Numerous 
studies have shown that the use of these safer devices, as part of an 
overall bloodborne pathogen risk reduction program, can be extremely 
effective in reducing accidental sharps injuries.
  The legislation we introduce today will ensure that these safer 
devices are used, and lives will be saved as a result. The bill 
provides narrowly tailored instruction to OSHA to amend its bloodborne 
pathogen standard to make certain that employers understand they must 
identify, evaluate, and, where appropriate, make use of these safer 
medical devices to eliminate or reduce occupational exposure to 
bloodborne pathogens. OSHA issued similar instructions in a compliance 
directive published December 1998. Because OSHA's directive is merely 
agency guidance and does not have the force of law, however, I felt it 
was important that both employers and employees be given formal 
regulatory instruction on this vitally important safety issue. This 
legislation provides this security and improves protection for 
employees while still allowing employers the necessary flexibility to 
determine the best technology to use in the particular circumstances 
presented. This legislation even goes a step further to ensure that 
employers will have valuable input from the front line employees when 
it makes these determinations.
  This bill is an important step for safety in the workplace, and I 
hope it will bring some peace of mind to the more than 8 million 
workers who perform the vitally important service of providing health 
care in this country. I am extremely proud to be a part of legislation 
which will save lives and help stop the spread of bloodborne diseases.
  Mr. KENNEDY. Mr. President, it is a privilege to join my colleagues 
in introducing the Needle Stick Safety and Prevention Act. I commend 
Senators Jeffords, Enzi and Reid for their effective work on this bill 
that is vitally important to health care professionals and all 
Americans who come in contact with them.
  The need for needle stick protection is compelling. Last year alone, 
there were almost 800,000 needle stick injuries to health care 
professionals. Over 1,000 health care workers were infected with 
serious diseases, including HIV, Hepatitis B and Hepatitis C. Sadly, 
all of these injuries were preventable. The good news is that through 
the provisions of this bill, many future needle stick injuries will be 
prevented. In fact, the Center for Disease Prevention estimates that 
needle stick injuries will be reduced by as much as 88 percent.
  But as is so often the case, numbers alone cannot convey the full 
story of human tragedy resulting from these injuries. One of my 
constituents, Karen Daley of Boston, is the President of the 
Massachusetts Nurses Association and was a registered nurse, a job she 
loved and found very fulfilling. In January 1999, while working in an 
emergency room in Boston, Karen was accidentally stuck by a 
contaminated needle. Six months later, she tested positive for HIV and 
Hepatitis C. Fortunately, Karen is in relative good health, although 
she will never again be able to practice her chosen profession of 
nursing.
  The Needle Stick Safety and Prevention Act is intended to prevent 
tragic accidents like this. This bill requires employers to implement 
the use of safety-designed needles and sharps to reduce the potential 
transmission of disease to health care workers and patients. This bill 
also provides that employers establish an injury log to record the kind 
of devices, and the location, of all needle stick accidents.
  Equally important, this bill allows non-managerial employees--those 
on the front lines of service delivery--to be involved in determining 
the appropriate devices used in health care settings.
  This bill has bipartisan support in the Senate and the House. It also 
is supported by the American Hospital Association, the American Nurses 
Association, the Service Employees International Union and the American 
Federation of Federal, State County and Municipal Employees.
  I urge all of my colleagues, on both sides of the aisle, to join us 
in supporting this important bill, and I am hopeful that it can be 
enacted into law before this session of Congress ends.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself and Mr. Kohl):
  S. 3070. A bill to amend title 18, United States Code, to establish 
criminal penalties for distribution of defective products, to amend 
chapter 111 of title 28, United States Code, relating to protective 
orders, sealing of cases, and

[[Page S8763]]

discovery information in civil actions, and for other purposes; to the 
Committee on the Judiciary.


                     DEFECTIVE PRODUCT PENALTY ACT

  Mrs. FEINSTEIN. Mr. President, I rise with my colleague from 
Wisconsin, Senator Kohl, to introduce legislation to better protect 
American consumers from irresponsible companies who knowingly allow 
defective vehicles or vehicle parts to remain on the market.
  Our bill, the ``Defective Product Penalty Act,'' would significantly 
increase the responsibility of companies to test products for defects, 
to recall those products when necessary, and to report to authorities 
when defects are found.
  Recent news stories about Firestone tires have grabbed the headlines, 
but this bill really addresses some long-standing and serious 
deficiencies within our current laws. The Firestone case has 
highlighted the need for these overdue proposals, and it is our hope 
that this legislation receives swift and serious consideration. The 
time has come to close some loopholes and impose some real 
responsibility on company executives who ignore public safety.
  Let me describe specifically what this bill does:
  First, this legislation will increase civil penalties for failure to 
recall a defective vehicle or part or withholding information from the 
National Highway Traffic Safety Administration (NHTSA). Current 
penalties are $1,000 per violation with a maximum penalty in these 
cases of $925,000. The Defective Product Penalty Act would increase the 
penalty to $10,000 per violation, and would eliminate the maximum 
penalty altogether. A penalty of $925,000 for a multi-billion dollar, 
multinational business is not even enough to cause the company to think 
twice about releasing or recalling a defective vehicle. We need to give 
the NHTSA some real teeth.
  Second, this legislation will establish criminal penalties for 
knowingly distributing a defective vehicle or part, or for failing to 
recall or tell authorities about a defective product, if that defect 
results in death or injuries. If death results, the legislation calls 
for a penalty of up to 15 years in prison. If serious injury results, 
the legislation calls for penalties of up to 5 years.
  Third, this legislation would extend the statute of limitations for 
NHTSA to mandate recalls, from 8 to 10 years for vehicles, and from 3 
to 5 years for tires.

  Fourth, the bill would require companies to actually test vehicle 
products before self-certifying that the product is in compliance with 
NHTSA standards.
  Next, the legislation clarifies federal law to make it clear that in 
cases involving vehicle products sold in the U.S., a company must send 
the NHTSA copies of all notices sent to dealers and owners, even if the 
notices are sent only to owners and dealers in foreign countries.
  Finally, this legislation includes provisions from Senator Kohl's 
``Sunshine in Litigation Act'' (S. 957), to:
  Prohibit federal courts from issuing protective orders that prohibit 
individuals from disclosing potential defects or dangers to regulatory 
agencies; and
  Prohibit federal courts from enforcing secrecy agreements without 
first balancing the need for privacy against the public's need to know 
about potential health and safety hazards. In other words, no longer 
can a company put other consumers at risk by forcing a plaintiff to 
keep quiet about a potential threat to public safety.
  Mr. President, this legislation will send a clear signal to 
irresponsible companies and individuals who intentionally put the 
public at risk from defective products--you will now be held 
responsible for your actions. I urge my colleagues to join us in this 
effort.
  Mr. KOHL. Mr. President, I rise today to join my colleague Senator 
Feinstein in introducing the Defective Product Penalty Act of 2000.
  As the Firestone/Bridgestone tire controversy sadly demonstrates, 
current consumer protection laws do not provide sufficient incentive 
for some manufacturers to put the health and safety of consumers at the 
forefront of their business decisions. Although most of us would find 
it very difficult to believe that a company knowingly introduced a 
defective product into the marketplace, or failed to recall one once a 
defect was discovered, the families of the Firestone/Bridgestone 
casualties do not need to be reminded that it does happen. Most 
companies are responsible corporate citizens, of course--and for them 
this legislation will not affect their behavior--but for the others who 
need to be ``incentivized'' to make consumer health and safety a 
foremost priority, the Defective Product Penalty Act (``DPPA'') should 
serve as sufficient notice.
  Specifically, the DPPA creates tough criminal penalties for those who 
knowingly introduce defective products into the stream of commerce with 
the realization that the product may cause death or bodily harm to an 
unsuspecting consumer. Risking the lives of millions of Americans 
because a cost-benefit analysis suggests that profits earned from a 
product outweigh the potential costs of liability is not only wrong, 
but also criminal. And it should be treated as such. Indeed, Mr. 
President, whenever a company adheres to the bottom line instead of 
respecting the health and safety of their consumers, they deserve 
severe, immediate, and strict punishment.
  This bill also incorporates S. 957, the Sunshine in Litigation Act. 
This part of the bill ensures that consumers are better informed about 
product defects that may affect consumer health and safety. All too 
often our Federal courts allow vital information that is discovered in 
litigation--and which bears directly upon public health and safety--to 
be covered up, to be shielded from mothers, fathers and children whose 
lives are potentially at stake, and from the public officials we have 
asked to protect our public health and safety.
  All this happens because of the use of so-called ``protective 
orders''--really gag orders issued by courts--that are designed to keep 
information discovered in the course of litigation secret and 
undisclosed. Typically, injured victims agree to a defendant's request 
to keep lawsuit information secret. They agree because defendants 
threaten that, without secrecy, they will fight every document 
requested and will refuse to agree to a settlement. Victims cannot 
afford to take such chances. And while courts in these situations 
actually have the legal authority to deny requests for secrecy, 
typically they do not--because both sides have agreed.
  The problem of excessive secrecy orders in cases involving public 
health and safety has been apparent for many years. The Judiciary 
Committee first held hearings on this issue in 1990 and again in 1994. 
In 1990, Arthur Bryant, the executive director of the Trial Lawyers for 
Public Justice, told us, ``The one thing we learned .  .  . is that 
this problem is far more egregious than we ever imagined. It goes the 
length and depth of this country, and the frank truth is that much of 
civil litigation in this country is taking place in secret.''
  The Defective Product Penalty Act will go a long way to ensuring that 
the health and safety of consumers will receive the consideration it 
deserves in the boardrooms and courtrooms across our country. I urge my 
colleagues to support it.
                                 ______
                                 
      By Mr. HATCH (for himself, Mr. Leahy, Mr. Bayh, Mr. Bingaman, 
        Mrs. Boxer, Mr. Domenici, Mr. Edwards, Mrs. Feinstein, Mr. 
        Graham, Mr. Inouye, Mr. Kerrey, Mrs. Murray, Mr. Reid, Mr. 
        Robb, and Mr. Schumer) (by request):
  S. 3071. A bill to provide for the appointment of additional Federal 
circuit and district judges, and for other purposes; to the Committee 
on the Judiciary.


                      federal judgeship act of 200

  Mr. HATCH. Mr. President, today, at the request of the Judicial 
Conference of the United States, Senator Leahy and I are introducing 
the Federal Judgeship Act of 2000. This legislation was drafted by the 
Judicial Conference and is based upon the recently completed biennial 
survey of judgeship needs conducted by the Judicial Conference, which 
analyzed caseload statistics for each federal district court and 
circuit court of appeals. The legislation sets forth the Judicial 
Conference's recommendation that the Congress create 63 new federal 
judgeships throughout the country--10 new circuit court judgeships and 
53 new district court judgeships.

[[Page S8764]]

  Perhaps the federalism decisions that have marked the tenure of the 
Rehnquist Court ultimately will serve to check the expansion of federal 
jurisdiction and the caseload burdens and need for new judges that 
necessarily follow such expansion. Presently, however, many of our 
judges--especially those in the border states of Texas, New Mexico, 
Arizona and California--are overburdened by heavy caseloads. Caseload 
statistics compiled by the Judicial Conference have convinced me of the 
need for a debate about new judgeships. In this debate, we must ask 
ourselves: How large do we really want our federal judiciary to be?
  It should be noted that over the past 22 years, the judiciary has 
grown substantially. Currently, there are 848 judgeships created 
pursuant to article III of the Constitution. By contrast, just 23 years 
ago, there were only 509 Article III judgeships. this growth in the 
size of the federal judiciary--a 67 percent increase--has outpaced 
growth in the size of the United States. During the same period, the 
population of the United States has grown by just 24 percent, from 220 
million to 275 million.
  Given that there are only a few weeks remaining in this Congress, it 
is going to be difficult to achieve consensus on a comprehensive 
judgeship bill. Nevertheless, it is important that the views of the 
Judicial Conference on the issue of judgeship be brought to the 
attention of the Congress and given the appropriate level of 
consideration. Still, it is possible that consensus may be reached on 
legislation authorizing new judgeships. I know that many of my 
colleagues share my concerns about the expansion of the federal 
judiciary. It is my judgment, however, that the Judicial Conference's 
recommendation that additional judgeships be created be brought to the 
attention of the Congress. I look forward to a dialogue with my 
colleagues on this issue.
  Mr. LEAHY. Mr. President, today Senator Hatch and I are introducing 
the Federal Judgeship Act of 2000. I am pleased that Senators 
Feinstein, Schumer, Boxer, Graham, Reid, Robb, Inouye, Edwards, Murray, 
Bingaman, Bayh, Kerrey, and Domenici are joining us as original 
cosponsors of this measure.
  Our bill creates 70 judgeships across the country to address the 
workload needs of the federal judiciary. This bill incorporates the 
recommendations for additional judgeships most recently forwarded to us 
by the Judiciary Conference of the United States. Specifically, our 
legislation would create 6 additional permanent judgeships and 4 
temporary judgeships for the U.S. Courts of Appeal; 30 additional 
permanent judgeships and 23 temporary judgeships for the U.S. District 
Courts; and convert 7 existing temporary district judgeships into 
permanent positions.
  The Judicial Conference of the United States is the nonpartisan 
policy-making arm of the judicial branch. Federal judges across the 
nation believe that the increasingly heavy caseloads of our courts 
necessitate these additional judges. The Chief Justice of the United 
States in his annual year-end reports over the last several years has 
commented on the serious problems facing our federal courts having too 
much work and too few judges and other resources.
  The Judicial Conference and Chief Justice Rehnquist are right. 
According to his 1999 year-end report, the filings in our federal 
courts have reached record heights. In fact, the numbers of criminal 
cases and defendants have reached their highest levels since the 
Prohibition Amendment was repealed in 1933. In 1999, overall growth in 
appellate court caseload included a 349 percent upsurge in original 
proceedings. This sudden expansion resulted from newly implemented 
reporting procedures, which more accurately measure the increased 
judicial workload generated by the Prisoner Litigation Reform Act and 
the Antiterrorism and Effective Death Penalty Act, both passed in 1996.
  District court activity was characterized by an increase in criminal 
filings and a smaller increase in civil filings. Criminal case filings 
rose 4 percent from 57,691 in 1998 to 59,923 in 1999, and the number of 
defendants grew 2 percent from 79,008 to 80,822. Criminal case filings 
per authorized judgeship went up almost 5 percent. Since the last 
significant expansion of the federal judiciary in 1990, felony criminal 
case filings have increased almost 50 percent, from 31,727 in 1990 to 
46,789 in 1999.
  Despite these dramatic increases in case filings, Congress has failed 
to authorize new judgeships since 1990, thus endangering the 
administration of justice in our nation's federal courts. Without the 
extraordinary contributes of our senior judges, the administration of 
justice could well have broken down entirely.
  Over the last several decades, a 6-year cycle for reviewing the needs 
of the judiciary and authorizing additional judgeships had been 
followed by Democrats and Republicans alike. For example, in 1978, 
Congress passed legislation to address the need for additional 
judgeships. Six years later, in 1984, Congress passed legislation 
creating additional judgeships. Then, again six years later, in 1990, 
Democratic majorities in both Houses of Congress fulfilled their 
constitutional responsibilities and enacted the Federal Judgeship Act 
of 1990 because of a sharply increasing caseload, particularly for 
drug-related crimes. At that time President Bush was in the middle of 
his first term in office.
  That type of bipartisan effort broke down in 1996. It has now been 10 
years since Congress made a systematic evaluation of the needs of the 
federal judiciary and acted to meet those needs. For each of the last 
two Congresses, the Republican majority has resisted any such action. 
Three years ago, the Judicial Conference requested an additional 55 
judgeships to address the growing backlog. I introduced the Federal 
Judgeship Act of 1997, S. 678, legislation based on the Judicial 
Conference's 1997 recommendations. That legislation languished in the 
Judicial Committee without action during both sessions of the last 
Congress. Again last year, the Judicial Conference updated its request 
and recommended an additional 72 judgeships. I, again, introduced those 
recommendations in the Federal Judgeship Act of 1999, S. 1145. There 
was no action on it by the Judiciary Committee.
  This year, the Judiciary Conference took the unusual step of updating 
last year's recommendations yet again. Those updated recommendations 
affect 70 judgeships. Today may signal a turning point in our efforts. 
Today Republicans are joining with us. I welcome them to this effort 
and look forward to working with them to pass the Federal Judgeship Act 
of 2000.
  Included within our bill are the additional judgeships that would be 
authorized by S. 2730, the Southwest Border Judgeship Act of 2000. 
Senator Feinstein has been tenacious in seeking the resources needed 
the federal courts of our southwest border States, including southern 
California. She is right. Those 13 judgeships for California, Arizona, 
New Mexico and Texas are included in our bill.
  Implicit in our legislation is acknowledgment that the federal 
judiciary does not just have 64 current vacancies with 9 of the 
horizon, but that even if all those vacancies were filled, the federal 
judiciary would remain 70 judges short of those it needed to manage its 
workload, try the cases and provide the individual attention to matters 
that have set a high standard for the administration of justice in our 
federal system. In other words, considering vacancies and taking into 
account the judgeships authorized by our bill, the federal judiciary is 
today in need of more than 130 more judges.
  We have the greatest judicial system in the world, the envy of people 
around the globe who are struggling for freedom. It is the independence 
of our third, co-equal branch of government that gives it the ability 
to act fairly and impartially. It is our judiciary that has for so long 
protected our fundamental rights and freedoms and served as a necessary 
check on overreaching by the other two branches, those more susceptible 
to the gusts of the political winds.
  Let us act to ensure that justice in our federal courts is not 
delayed or denied for anyone. I urge the Senate to do in this last 
month of this Congress what the Republican majority has so strenuously 
resisted for the last four years: Enact the Federal Judgeship Act 
without further delay.
                                 ______
                                 
      Mr. GRAMS (for himself and Mr. Hagel):

[[Page S8765]]

  S. 3072. A bill to assist in the enhancement of the development of 
expansion of international economic assistance programs that utilize 
cooperatives and credit unions, and for other purposes; to the 
Committee on Foreign Relations.


            support for overseas cooperative development act

  Mr. GRAM. Mr. President, I ask unanimous consent that the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3072

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE

       This Act may be cited as the ``Support for Overseas 
     Cooperative Development Act''.

     SEC. 2. FINDINGS

       The Congress makes the following findings:
       (1) It is in the mutual economic interest of the United 
     States and peoples in developing and transitional countries 
     to promote cooperatives and credit unions.
       (2) Self-help institutions, including cooperatives and 
     credit unions, provide enhanced opportunities for people to 
     participate directly in democratic decision-making for their 
     economic and social benefit through ownership and control of 
     business enterprises and through the mobilization of local 
     capital and savings and such organizations should be fully 
     utilized in fostering free market principles and the adoption 
     of self-help approaches to development.
       (3) The United States seeks to encourage broad-based 
     economic and social development by creating and supporting--
       (A) agricultural cooperatives that provide a means to lift 
     low income farmers and rural people out of poverty and to 
     better integrate them into national economies;
       (B) credit union networks that serve people of limited 
     means through safe savings and by extending credit to 
     families and microenterprises;
       (C) electric and telephone cooperatives that provide rural 
     customers with power and telecommunications services 
     essential to economic development;
       (D) housing and community-based cooperatives that provide 
     low income shelter and work opportunities for the urban poor; 
     and
       (E) mutual and cooperative insurance companies that provide 
     risk protection for life and property to under-served 
     populations often through group policies.

     SEC. 3. GENERAL PROVISIONS.

       (a) Declarations of Policy.--The Congress supports the 
     development and expansion of economic assistance programs 
     that fully utilize cooperatives and credit unions, 
     particularly those programs committed to--
       (1) international cooperative principles, democratic 
     governance and involvement of women and ethnic minorities for 
     economic and social development;
       (2) self-help mobilization of member savings and equity, 
     retention of profits in the community, except those programs 
     that are dependent on donor financing;
       (3) market-oriented and value-added activities with the 
     potential to reach large numbers of low income people and 
     help them enter into the mainstream economy;
       (4) strengthening the participation of rural and urban poor 
     to contribute to their country's economic development; and
       (5) utilization of technical assistance and training to 
     better serve the member-owners.
       (b) Development Priorities.--Section 111 of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 2151i) is amended by adding 
     at the end the following: ``In meeting the requirement of the 
     preceding sentence, specific priority shall be given to the 
     following:
       ``(1) Agriculture.--Technical assistance to low income 
     farmers who form and develop member-owned cooperatives for 
     farm supplies, marketing and value-added processing.
       ``(2) Financial systems.--The promotion of national credit 
     union systems through credit union-to-credit union technical 
     assistance that strengthens the ability of low income people 
     and micro-entrepreneurs to save and to have access to credit 
     for their own economic advancement.
       ``(3) Infrastructure.--The support of rural electric and 
     telecommunication cooperatives for access for rural people 
     and villages that lack reliable electric and 
     telecommunications services.
       ``(4) Housing and community services.--The promotion of 
     community-based cooperatives which provide employment 
     opportunities and important services such as health clinics, 
     self-help shelter, environmental improvements, group-owned 
     businesses, and other activities.''.

     SEC. 4. REPORT.

       Not later than 6 months after the date of enactment of this 
     Act, the Administrator of the United States Agency for 
     International Development, in consultation with the heads of 
     other appropriate agencies, shall prepare and submit to 
     Congress a report on the implementation of section 111 of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2151i), as amended 
     by section 3 of this Act.
                                 ______
                                 
      By Mr. DURBIN (for himself and Mr. Brownback):
  S. 3073. A bill to amend titles V, XVIII, and XIX of the Social 
Security Act to promote smoking cessation under the Medicare Program, 
the Medicaid Program, and the Maternal and Child Health Program; to the 
Committee on Finance.


 THE MEDICARE, MEDICAID AND MCH SMOKING CESSATION SERVICES ACT OF 2000

  Mr. DURBIN. Mr President, I rise today to introduce legislation that 
expands treatment to millions of Americans suffering from a deadly 
addiction: tobacco. I am pleased to have Senator Brownback join me in 
this effort. The Medicare, Medicaid and MCH Smoking Cessation Promotion 
Act of 2000 will help make smoking cessation therapy accessible to 
recipients of Medicare, Medicaid, and the Maternal and Child Health 
Program.
  We have long known that cigarette smoking is the largest preventable 
cause of death, accounting for 20 percent of all deaths in this 
country. It is well documented that smoking causes virtually all cases 
of lung cancer and a substantial portion of coronary heart disease, 
peripheral vascular disease, chronic obstructive lung disease, and 
cancers of other sites. And the harmful effects of smoking do not end 
with the smoker. Women who use tobacco during pregnancy are more likely 
to have adverse birth outcomes, including babies with low birth weight, 
which is linked with an increased risk of infant death and a variety of 
infant health disorders.
  Still, despite enormous health risks, 48 million adults in the United 
States smoke cigarettes--approximately 22.7 percent of American adults. 
The rates are higher for our youth--36.4 percent report daily smoking. 
In Illinois, the adult smoking rate is about 24.2 percent. And perhaps 
most distressing and surprising, data indicate that about 13 percent of 
mothers in the United States smoke during pregnancy.
  We have also learned the hard way that in addition to the heavy 
health toll of tobacco, the economic costs of smoking are also high. 
The total cost of smoking in 1993 in the U.S. was about $102 billion, 
with over $50 billion in health care expenditures directly linked to 
smoking. The Centers for Disease Control and Prevention (CDC) reports 
that approximately 43 percent of these costs were paid by government 
funds, primarily Medicaid and Medicare. Smoking costs Medicaid alone 
more than $12.9 billion per year. According to the Chicago chapter of 
the American Lung Association, my state of Illinois spends $2.9 billion 
each year in public and private funds to combat smoking-related 
diseases.
  Today, however, we also know how to help smokers quit. Advancements 
in treating tobacco use and nicotine addiction have helped millions 
kick the habit. While more than 40 million adults continue to smoke, 
nearly as many persons are former smokers living longer, healthier 
lives. In large part, this is because new tools are available. 
Effective pharmacotherapy and counseling regimens have been tested and 
proven effective. The just-released Surgeon General's Report, Reducing 
Tobacco Use, concluded that ``pharmacologic treatment of nicotine 
addiction, combined with behavioral support, will enable 10 to 25 
percent of users to remain abstinent at one year of posttreatment.''
  Studies have shown that reducing adult smoking through tobacco use 
treatment pays immediate dividends, both in terms of health 
improvements and cost savings. Creating a new nonsmoker reduces 
anticipated medical costs associated with acute myocardial infarction 
and stroke by $47 in the first year and by $853 during the next seven 
years in 1995 dollars. And within four to five years after tobacco 
cessation, quitters use fewer health care services than continued 
smokers. In fact, in one study the cost savings from reduced use paid 
for a moderately priced effective smoking cessation intervention in a 
matter of three to four years.
  The health benefits tobacco quitters enjoy are undisputed. They are 
living longer. After 15 years, the risk of premature death for ex-
smokers returns to nearly the level of persons who have never smoked. 
Male smokers who quit between age 35 and 39 add an average of five 
years to their lives; women can add three years. Even older Americans 
over age 65 can extend their life expectancy by giving up cigarettes.
  Former smokers are also healthier. They are less likely to die of 
chronic lung diseases. After ten smoke-free

[[Page S8766]]

years, their risk of lung cancer drops to as much as one-half that of 
those who continue to smoke. After five to fifteen years the risk of 
stroke and heart disease for ex-smokers returns to the level of those 
who have never smoked. They have fewer days of illness, reduced rates 
of bronchitis and pneumonia, and fewer health complaints.
  New Public Health Service Guidelines released this summer conclude 
that tobacco dependence treatments are both clinically effective and 
cost-effective relative to other medical and disease prevention 
interventions. The guideline urges health care insurers and purchasers 
to include the counseling and FDA-approved pharmacotherapeutic 
treatments as a covered benefit.
  Unfortunately, the Federal Government, a major purchaser of health 
care through Medicare and Medicaid, does not currently adhere to its 
own published guidelines. It is high-time that government-sponsored 
health programs catch up with science. As a result, I am introducing, 
along with my colleague Senator Brownback, legislation to improve 
smoking cessation benefits in government-sponsored health programs.
  The Medicare, Medicaid and MCH Smoking Cessation Promotion Act of 
2000 improves access to and coverage of smoking cessation treatment 
therapies in four primary ways.
  Our bill adds a smoking cessation counseling benefit to Medicare. By 
2020, 17 percent of the U.S. population will be 65 years of age or 
older. It is estimated that Medicare will pay $800 billion to treat 
tobacco-related diseases over the next twenty years. In a study of 
adults 65 years of age or older who received advice to quit, behavioral 
counseling and pharmocotherapy, 24.8 percent reported having stopped 
smoking six months following the intervention. The total economic 
benefits of quitting after age 65 are notable. Due to a reduction in 
the risk of lung cancer, coronary heart disease and emphysema, studies 
have found that heavy smokers over age 65 who quit can avoid up to 
$4,592 in lifelong illness-related costs.
  Our measure provides coverage for both prescription and non-
prescription smoking cessation drugs in the Medicaid program. The bill 
eliminates the provision in current Federal law that allows states to 
exclude FDA-approved smoking cessation therapies from coverage under 
Medicaid. Ironically, State Medicaid programs are required to cover 
Viagra, but not to treat tobacco addiction. Despite the fact that the 
States are now receiving the full benefit of their federal lawsuit 
against the tobacco industry, less than half the States provide 
coverage for smoking cessation in their Medicaid program. On average, 
states spend approximately 14.4 percent of their Medicaid budgets on 
medical care related to smoking.

  Our legislation clarifies that the maternity benefit for pregnant 
women in Medicaid covers smoking cessation counseling and services. 
Smoking during pregnancy causes about 5-6 percent of perinatal deaths, 
17-26 percent of low-birth-weight births, and 7-10 percent of preterm 
deliveries, and increases the risk of miscarriage and fetal growth 
retardation. It may also increase the risk of sudden infant death 
syndrome (SIDS). The Surgeon General recommends that pregnant women and 
parents with children living at home be counseled on the potentially 
harmful effects of smoking on fetal and child health. A new study shows 
that, over seven years, reducing smoking prevalence by just one 
percentage point would prevent 57,200 low birth weight births and save 
$572 million in direct medical costs.
  Our bill ensures that the Maternal and Child Health (MCH) Program 
recognizes that medications used to promote smoking cessation and the 
inclusion of anti-tobacco messages in health promotion are considered 
part of quality maternal and child health services. In addition to the 
well-documented benefits of smoking cessation for maternity care, the 
Surgeon General's report adds, ``Tobacco use is a pediatric concern. In 
the United States, more than 6,000 children and adolescents try their 
first cigarette each day. More than 3,000 children and adolescents 
become daily smokers each day, resulting in approximately 1.23 million 
new smokers under the age of 18 each year.'' The goal of the MCH 
program is to improve the health of all mothers and children. This goal 
cannot be reached without addressing the tobacco epidemic.
  I hope my colleagues will join me not only in cosponsoring this 
legislation but also in working with me to see that its provisions are 
adopted before the year is out. As the Surgeon General states in his 
report: ``Although our knowledge about tobacco control remains 
imperfect, we know more than enough to act now.''
                                 ______
                                 
      Mr. GREGG (for himself and Mr. Smith of New Hampshire):
  S.J. Res. 52. A joint resolution granting the consent of Congress to 
the International Emergency Management Assistance Memorandum of 
Understanding; to the Committee on the Judiciary.
  Mr. GREGG. Mr. President, I ask unanimous consent that the joint 
resolution be printed in the Record.
  There being no objection, the joint resolution was ordered to be 
printed in the Record, as follows:

                              S.J. Res. 52

       Resolved by the Senate and House of Representatives of the 
     United States of America in Congress assembled,

     SECTION 1. CONGRESSIONAL CONSENT.

       Congress consents to the International Emergency Management 
     Assistance Memorandum of Understanding entered into between 
     the States of Maine, New Hampshire, Vermont, Massachusetts, 
     Rhode Island, and Connecticut and the Provinces of Quebec, 
     New Brunswick, Prince Edward Island, Nova Scotia and 
     Newfoundland. The compact is substantially as follows:

     ``Article I--International Emergency Management Assistance 
       Memorandum of Understanding Purpose and Authorities

       ``The International Emergency Management Assistance 
     Memorandum of Understanding, hereinafter referred to as the 
     `compact,' is made and entered into by and among such of the 
     jurisdictions as shall enact or adopt this compact, 
     hereinafter referred to as `party jurisdictions.' For the 
     purposes of this agreement, the term `jurisdictions' may 
     include any or all of the States of Maine, New Hampshire, 
     Vermont, Massachusetts, Rhode Island, and Connecticut and the 
     Provinces of Quebec, New Brunswick, Prince Edward Island, 
     Nova Scotia and Newfoundland, and such other states and 
     provinces as may hereafter become a party to this compact.
       ``The purpose of this compact is to provide for the 
     possibility of mutual assistance among the jurisdictions 
     entering into this compact in managing any emergency or 
     disaster when the affected jurisdiction or jurisdictions ask 
     for assistance, whether arising from natural disaster, 
     technological hazard, manmade disaster or civil emergency 
     aspects of resources shortages.
       ``This compact also provides for the process of planning 
     mechanisms among the agencies responsible and for mutual 
     cooperation, including, if need be, emergency-related 
     exercises, testing, or other training activities using 
     equipment and personnel simulating performance of any aspect 
     of the giving and receiving of aid by party jurisdictions or 
     subdivisions of party jurisdictions during emergencies, with 
     such actions occurring outside actual declared emergency 
     periods. Mutual assistance in this compact may include the 
     use of emergency forces by mutual agreement among party 
     jurisdictions.

     ``Article II--General Implementation

       ``Each party jurisdiction entering into this compact 
     recognizes that many emergencies may exceed the capabilities 
     of a party jurisdiction and that intergovernmental 
     cooperation is essential in such circumstances. Each 
     jurisdiction further recognizes that there will be 
     emergencies that may require immediate access and present 
     procedures to apply outside resources to make a prompt and 
     effective response to such an emergency because few, if any, 
     individual jurisdictions have all the resources they need in 
     all types of emergencies or the capability of delivering 
     resources to areas where emergencies exist.
       ``The prompt, full, and effective utilization of resources 
     of the participating jurisdictions, including any resources 
     on hand or available from any other source that are essential 
     to the safety, care, and welfare of the people in the event 
     of any emergency or disaster, shall be the underlying 
     principle on which all articles of this compact are 
     understood.
       ``On behalf of the party jurisdictions participating in the 
     compact, the legally designated official who is assigned 
     responsibility for emergency management is responsible for 
     formulation of the appropriate inter-jurisdictional mutual 
     aid plans and procedures necessary to implement this compact, 
     and for recommendations to the jurisdiction concerned with 
     respect to the amendment of any statutes, regulations, or 
     ordinances required for that purpose.

     ``Article III--Party Jurisdiction Responsibilities

       ``(a) Formulate Plans and Programs.--It is the 
     responsibility of each party jurisdiction to formulate 
     procedural plans and programs for inter-jurisdictional 
     cooperation in

[[Page S8767]]

     the performance of the responsibilities listed in this 
     section. In formulating and implementing such plans and 
     programs the party jurisdictions, to the extent practical, 
     shall--
       ``(1) review individual jurisdiction hazards analyses that 
     are available and, to the extent reasonably possible, 
     determine all those potential emergencies the party 
     jurisdictions might jointly suffer, whether due to natural 
     disaster, technological hazard, man-made disaster or 
     emergency aspects of resource shortages;
       ``(2) initiate a process to review party jurisdictions' 
     individual emergency plans and develop a plan that will 
     determine the mechanism for the inter-jurisdictional 
     cooperation;
       ``(3) develop inter-jurisdictional procedures to fill any 
     identified gaps and to resolve any identified inconsistencies 
     or overlaps in existing or developed plans;
       ``(4) assist in warning communities adjacent to or crossing 
     jurisdictional boundaries;
       ``(5) protect and ensure delivery of services, medicines, 
     water, food, energy and fuel, search and rescue, and critical 
     lifeline equipment, services and resources, both human and 
     material to the extent authorized by law;
       ``(6) inventory and agree upon procedures for the inter-
     jurisdictional loan and delivery of human and material 
     resources, together with procedures for reimbursement or 
     forgiveness; and
       ``(7) provide, to the extent authorized by law, for 
     temporary suspension of any statutes or ordinances, over 
     which the province or state has jurisdiction, that impede the 
     implementation of the responsibilities described in this 
     subsection.
       ``(b) Request Assistance.--The authorized representative of 
     a party jurisdiction may request assistance of another party 
     jurisdiction by contacting the authorized representative of 
     that jurisdiction. These provisions only apply to requests 
     for assistance made by and to authorized representatives. 
     Requests may be verbal or in writing. If verbal, the request 
     must be confirmed in writing within 15 days of the verbal 
     request. Requests must provide the following information:
       ``(1) A description of the emergency service function for 
     which assistance is needed and of the mission or missions, 
     including but not limited to fire services, emergency 
     medical, transportation, communications, public works and 
     engineering, building inspection, planning and information 
     assistance, mass care, resource support, health and medical 
     services, and search and rescue.
       ``(2) The amount and type of personnel, equipment, 
     materials, and supplies needed and a reasonable estimate of 
     the length of time they will be needed.
       ``(3) The specific place and time for staging of the 
     assisting party's response and a point of contact at the 
     location.
       ``(c) Consultation Among Party Jurisdiction Officials.--
     There shall be frequent consultation among the party 
     jurisdiction officials who have assigned emergency management 
     responsibilities, such officials collectively known 
     hereinafter as the International Emergency Management Group, 
     and other appropriate representatives of the party 
     jurisdictions with free exchange of information, plans, and 
     resource records relating to emergency capabilities to the 
     extent authorized by law.

     ``Article IV--Limitation

       ``Any party jurisdiction requested to render mutual aid or 
     conduct exercises and training for mutual aid shall undertake 
     to respond as soon as possible, except that it is understood 
     that the jurisdiction rendering aid may withhold or recall 
     resources to the extent necessary to provide reasonable 
     protection for that jurisdiction. Each party jurisdiction 
     shall afford to the personnel of the emergency forces of any 
     party jurisdiction, while operating within its jurisdictional 
     limits under the terms and conditions of this compact and 
     under the operational control of an officer of the requesting 
     party, the same powers, duties, rights, privileges, and 
     immunities as are afforded similar or like forces of the 
     jurisdiction in which they are performing emergency services. 
     Emergency forces continue under the command and control of 
     their regular leaders, but the organizational units come 
     under the operational control of the emergency services 
     authorities of the jurisdiction receiving assistance. These 
     conditions may be activated, as needed, by the jurisdiction 
     that is to receive assistance or upon commencement of 
     exercises or training for mutual aid and continue as long as 
     the exercises or training for mutual aid are in progress, the 
     emergency or disaster remains in effect or loaned resources 
     remain in the receiving jurisdiction or jurisdictions, 
     whichever is longer. The receiving jurisdiction is 
     responsible for informing the assisting jurisdictions of the 
     specific moment when services will no longer be required.

     ``Article V--Licenses and Permits

       ``Whenever a person holds a license, certificate, or other 
     permit issued by any jurisdiction party to the compact 
     evidencing the meeting of qualifications for professional, 
     mechanical, or other skills, and when such assistance is 
     requested by the receiving party jurisdiction, such person is 
     deemed to be licensed, certified, or permitted by the 
     jurisdiction requesting assistance to render aid involving 
     such skill to meet an emergency or disaster, subject to such 
     limitations and conditions as the requesting jurisdiction 
     prescribes by Executive order or otherwise.

     ``Article VI--Liability

       ``Any person or entity of a party jurisdiction rendering 
     aid in another jurisdiction pursuant to this compact are 
     considered agents of the requesting jurisdiction for tort 
     liability and immunity purposes. Any person or entity 
     rendering aid in another jurisdiction pursuant to this 
     compact are not liable on account of any act or omission in 
     good faith on the part of such forces while so engaged or on 
     account of the maintenance or use of any equipment or 
     supplies in connection therewith. Good faith in this article 
     does not include willful misconduct, gross negligence, or 
     recklessness.

     ``Article VII--Supplementary Agreements

       ``Because it is probable that the pattern and detail of the 
     machinery for mutual aid among 2 or more jurisdictions may 
     differ from that among the jurisdictions that are party to 
     this compact, this compact contains elements of a broad base 
     common to all jurisdictions, and nothing in this compact 
     precludes any jurisdiction from entering into supplementary 
     agreements with another jurisdiction or affects any other 
     agreements already in force among jurisdictions. 
     Supplementary agreements may include, but are not limited to, 
     provisions for evacuation and reception of injured and other 
     persons and the exchange of medical, fire, public utility, 
     reconnaissance, welfare, transportation and communications 
     personnel, equipment, and supplies.

     ``Article VIII--Workers' Compensation and Death Benefits

       ``Each party jurisdiction shall provide, in accordance with 
     its own laws, for the payment of workers' compensation and 
     death benefits to injured members of the emergency forces of 
     that jurisdiction and to representatives of deceased members 
     of those forces if the members sustain injuries or are killed 
     while rendering aid pursuant to this compact, in the same 
     manner and on the same terms as if the injury or death were 
     sustained within their own jurisdiction.

     ``Article IX--Reimbursement

       ``Any party jurisdiction rendering aid in another 
     jurisdiction pursuant to this compact shall, if requested, be 
     reimbursed by the party jurisdiction receiving such aid for 
     any loss or damage to, or expense incurred in, the operation 
     of any equipment and the provision of any service in 
     answering a request for aid and for the costs incurred in 
     connection with those requests. An aiding party jurisdiction 
     may assume in whole or in part any such loss, damage, 
     expense, or other cost or may loan such equipment or donate 
     such services to the receiving party jurisdiction without 
     charge or cost. Any 2 or more party jurisdictions may enter 
     into supplementary agreements establishing a different 
     allocation of costs among those jurisdictions. Expenses under 
     article VIII are not reimbursable under this section.

     ``Article X--Evacuation

       ``Each party jurisdiction shall initiate a process to 
     prepare and maintain plans to facilitate the movement of and 
     reception of evacuees into its territory or across its 
     territory, according to its capabilities and powers. The 
     party jurisdiction from which the evacuees came shall assume 
     the ultimate responsibility for the support of the evacuees, 
     and after the termination of the emergency or disaster, for 
     the repatriation of such evacuees.

     ``Article XI--Implementation

       ``(a) This compact is effective upon its execution or 
     adoption by any 2 jurisdictions, and is effective as to any 
     other jurisdiction upon its execution or adoption thereby: 
     subject to approval or authorization by the United States 
     Congress, if required, and subject to enactment of provincial 
     or State legislation that may be required for the 
     effectiveness of the Memorandum of Understanding.
       ``(b) Any party jurisdiction may withdraw from this 
     compact, but the withdrawal does not take effect until 30 
     days after the governor or premier of the withdrawing 
     jurisdiction has given notice in writing of such withdrawal 
     to the governors or premiers of all other party 
     jurisdictions. The action does not relieve the withdrawing 
     jurisdiction from obligations assumed under this compact 
     prior to the effective date of withdrawal.
       ``(c) Duly authenticated copies of this compact in the 
     French and English languages and of such supplementary 
     agreements as may be entered into shall, at the time of their 
     approval, be deposited with each of the party jurisdictions.

     ``Article XII--Severability

       ``This compact is construed to effectuate the purposes 
     stated in Article I. If any provision of this compact is 
     declared unconstitutional or the applicability of the compact 
     to any person or circumstances is held invalid, the validity 
     of the remainder of this compact and the applicability of the 
     compact to other persons and circumstances are not affected.

     ``Article XIII--Consistency of Language

       ``The validity of the arrangements and agreements consented 
     to in this compact shall not be affected by any insubstantial 
     difference in form or language as may be adopted by the 
     various states and provinces.

     ``Article XIV--Amendment

       ``This compact may be amended by agreement of the party 
     jurisdictions.''.

     SEC. 2. INCONSISTENCY OF LANGUAGE.

       The validity of the arrangements consented to by this Act 
     shall not be affected by

[[Page S8768]]

     any insubstantial difference in their form or language as 
     adopted by the States and provinces.

     SEC. 3. RIGHT TO ALTER, AMEND, OR REPEAL.

       The right to alter, amend, or repeal this Act is hereby 
     expressly reserved.

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