[Congressional Record Volume 147, Number 132 (Thursday, October 4, 2001)]
[Senate]
[Pages S10304-S10307]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORZINE (for himself, Mr. Reed, and Mr. Torricelli):
  S. 1508. A bill to increase the preparedness of the United States to 
respond to a biological or chemical weapons attack; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. CORZINE. Mr. President, I rise today to introduce the Biological 
and Chemical Attack Preparedness Act, legislation that would help 
prepare our public health infrastructure for the possibility of a 
future biological or chemical attack.
  The attacks of September 11 have focused attention on the threat 
posed to our entire Nation by terrorists, especially the threat of 
biological and chemical attacks. My office has received numerous 
letters and phone

[[Page S10305]]

calls from constituents alarmed by recent news reports that the Federal 
Aviation Administration grounded crop dusters. Some speculate that the 
small propeller planes might be used to deliver chemical or biological 
weapons over a broad area, threatening the health and well being of the 
people below. The implications of such an attack are enormous. One 
analysis from the Centers for Disease Control predicted that a few 
kilograms of anthrax delivered over a major metropolitan area would 
kill more people than the atomic bomb dropped on Hiroshima.
  While the US is fortunate to have avoided a biological or chemical 
attack thus far, the threat of such an attack is very real. In 1995, it 
was hard to imagine that Japan would be targeted for such an attack. 
But that year, an apocalyptic cult did just that in a Tokyo subway 
station. The highly sophisticated cult counted scientists among its 
adherents and developed a deadly chemical weapon: sarin gas. They 
employed a crude form of delivery, filling soda cans and lunch boxes 
with sarin gas and puncturing the improvised containers as they left a 
rail car.
  While technical expertise and considerable resources are required, it 
is clear that a motivated terrorist group can unleash a chemical or 
biological weapon on a complacent population. The possibility of such 
an attack seems even greater when one realize that many of the 
countries considered to be active state sponsors of terrorism by the 
State Department are also believed to be developing chemical and 
biological weapons.
  The events of September 11 have brought our country's vulnerability 
to an attack with chemical and biological weapons into even greater 
focus. However, the challenge of maintaining the functionality of key 
infrastructure in the event of a chemical or biological emergency has 
been a concern for some time. The well-regarded Hart-Rudman report 
calls for careful preparation and explains that in a biological attack, 
``citizen cooperation with government authorities will depend on public 
confidence that those authorities can manage the emergency.'' A recent 
Newsweek poll found that 46 percent of respondents were not convinced 
that national and local governments are prepared to handle an attack 
with biological or chemical weapons.
  Unfortunately, Americans have reason to be skeptical about the extent 
or which our public health system is prepared for a chemical or 
biological attack. The overwhelming consensus among public health 
officials is that our health care infrastructure today is not equipped 
to address a mass casualty incident involving chemical and biological 
weapons.
  The attack in Japan in 1995 was the first time in history when 
chemical weapons were turned on a civilian population. As such, it is a 
valuable and instructive case study. The attack itself killed eleven 
Japanese civilians and injured several hundred, a tragedy by any 
measure, but with a limited death count. The incident has broader 
significance for what it shows about the failure of an advanced public 
health system to respond to a biological or chemical weapon emergency. 
Specifically, the attack highlighted unfortunate weaknesses in Japan's 
ability to coordinate a comprehensive public health response.
  To put it mildly, the subway attack caught Japan's public health 
system off guard. St. Luke's International Hospital received most 
victims of the attack, treating over six hundred Japanese patients. 
Although even before the attack the hospital maintained a high level of 
emergency preparedness and conducted periodic emergency drills, it was 
not ready for the tremendous surge of acutely ill patients that 
overwhelmed the emergency room. The hospital was not prepared to treat 
victims manifesting the symptoms characteristics of sarin gas 
poisoning. It was not prepared to guarantee the health and safety of 
the healthcare workers employed there. And, although terribly 
overburdened with patients being treated in the chapel and cafeteria, 
it was unable to release patients to other hospitals, knowing that 
other hospitals were even less prepared to deal with the unique 
challenges posed by victims of chemical weapons. Because of the use of 
chemical weapons, standards already established for mass casualty 
incidents were found to be inadequate, and the staff was forced to 
improvise. According to a study conducted by the hospital, more than 
twenty-percent of the health professionals assisting the victims 
developed sarin gas poisoning themselves.
  Healthcare workers helping the sick were put into harm's way. Had the 
chemical or biological agent been more severe or had the health 
professionals received a greater dose, the implications of Japan's lack 
of preparation could have been even more serious.
  The United States must learn from the nightmare experienced by Japan 
and shore up our public health infrastructure before it is too late.
  Unfortunately, despite several programs that have moved us in the 
right direction, including the historic Frist-Kennedy emerging threats 
legislation passed in the last Congress that I hope will receive the 
funding it deserves, the United States' public health system is not 
much more prepared than Japan's in 1995.
  A study appearing in the May 2001 issue of the respected American 
Journal of Public Health reveals a troubling situation. Of the 
hospitals that responded to a survey, fewer than 20 percent had any 
plans for biological or chemical weapons incidents. That means only 
one-fifth of hospitals nationwide had even considered the implications 
of a chemical or biological attack on delivery of care. And only 6 
percent had the minimum recommended physical resources for a 
hypothetical sarin incident. It is clear, that the U.S. is not 
prepared.
  The study outlines that the ``Domestic Preparedness Program . . . has 
included no systemic efforts to integrate hospitals into response 
plans, and it has provided only limited funds to acquire resources for 
state and local responders and none for hospitals.'' It is time to 
ensure that our public health system is up to the challenges of the new 
threat environment, including the possibility that chemical weapons or 
biological agents will be released on the United States.
  A report published by the American Hospital Association in 
conjunction with the Office of Emergency Preparedness, found that the 
fundamental problem is, and I quote, ``there is no general societal 
support for the preparedness role of the hospital.'' Up until this 
point, there was no requirement for individual hospitals or departments 
of health to plan for the possibility of a chemical or biological 
attack. Nor was there any funding to help them in this important 
process. In our previous approach to bioterrorism, we have focused on 
stockpiling medical supplies and creating additional laboratory 
capacity, but we have ignored the emergency preparedness of our 
hospitals.
  The Biological and Chemical Attack Preparedness Act seeks to overcome 
this failing of our public health system in several important ways. 
First, it would require States to develop public health disaster plans 
in consultation with local governments. It is vital that the various 
state governments rapidly devise and implement plans based on their own 
specific needs and strengths. The public health disaster plan developed 
by Nebraska will be very different from the one developed by New 
Jersey, and for good reason. The public health challenges posed by a 
rural population are different than those posed by a suburban or urban 
population. State plans must take into account the distribution and the 
pre-existing capabilities of hospitals in their states. They must 
address issues surrounding proximity to care and the financial costs of 
implementing a system. Simply put, they must devise a mechanism for 
providing care to all affected state residents in the event of an 
attack.
  This being said, as with national security issues generally, there is 
an important federal role. It is the job of the Department of Health 
and Human Services to establish broad guidelines and oversee the 
implementation of the various plans. Just as we need coordination 
between States, localities, and hospitals, we need coordination with 
the national health system. To ensure that states comply, Medical 
funding would be withheld for any state that failed to meet the broad 
requirements of the legislation.
  Second, as part of the public health disaster plan, States would be 
required to designate hospitals so that all state residents affected by 
a chemical or biological weapons disaster would have access to 
treatment. Each designated

[[Page S10306]]

hospital would be required to devise and implement a chemical and 
biological weapons response that complies with their responsibilities 
as a component of the State's overall response. Right now, with only 6 
percent of hospitals providing a high level of chemical and biological 
weapons attack readiness, we are far from the goal of ensuring that any 
person affected by chemical or biological weapons can receive 
treatment. Hospitals designated as part of the plan must be prepared 
with equipment, trained personnel, and pharmaceutical products 
sufficient to meet the anticipated need in the event of chemical or 
biological attack.
  I know we are asking a lot of our States and of our hospitals. 
Certainly, the additional precautions taken to prepare for an 
unconventional attack will be expensive. To address this real concern, 
the bill would create a new grant program administered by the Office of 
Emergency Preparedness of HHS to fund the implementation of biological 
and chemical attack preparedness strategies by health care providers. 
Hospitals could use the funds to purchase Class-A suits to protect 
healthcare professionals, filtration equipment to clean the air, shower 
units to remove chemical agents, antibiotics and vaccines to treat 
patients, and, perhaps most importantly, training for the staff to 
recognize the warning signs of an attack. And, because we are asking 
for additional preparation on the part of designated hospitals, they 
will receive preferential treatment in the grant program. Not 
incidentally, local governments would be eligible for the grants as 
well, providing a level of local control and oversight that is a vital 
component of a truly coordinated response.
  The Biological and Chemical Attack Preparedness Act would help ensure 
that our national public health system is prepared to orchestrate a 
skillful, quick and coordinated response to an attack with chemical or 
biological weapons. The bill would provide the resources necessary to 
assist hospitals and local governments in getting up to speed. And it 
would ensure that the various jurisdictions in our public health system 
are working together towards a single compelling goal: preparing for 
the devastating implications of a chemical or biological weapons 
attack. It would be far better to spend the money now than suffer the 
grim consequences later.
  I urge my colleagues to support this important piece of legislation, 
and 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. 1508

       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 ``Biological and Chemical 
     Attack Preparedness Act''.

     SEC. 2. STATE PUBLIC HEALTH DISASTER PLANS.

       (a) In General.--Not later than 120 days after the 
     publication of the standards developed by the Secretary of 
     Health and Human Services (in this Act referred to as the 
     ``Secretary'') under subsection (c), each State shall develop 
     a State public health disaster plan for responding to 
     biological or chemical attacks. Not later than 180 days after 
     the publication of such standards, each State shall fully 
     implement the State's plan.
       (b) Requirements of Plan.--A State public health disaster 
     plan developed under subsection (a) shall--
       (1) comply with the standards developed under subsection 
     (c);
       (2) require designated hospitals and health care providers 
     in the State to have procedures in place to provide health 
     care items and services (including antidotes, vaccines or 
     other drugs or biologicals) to all State residents in the 
     event of a biological or chemical attack;
       (3) require that hospitals and health care providers 
     designated under paragraph (2) conduct drills, on a 
     semiannual or other basis determined appropriate by the 
     Secretary, to ensure the readiness of such hospital or 
     provider to receive and treat victims of a biological or 
     chemical attack;
       (4) be developed in consultation with affected local 
     governments and hospitals; and
       (5) meet such other requirements as the Secretary 
     determines appropriate.
       (c) Standards.--Not later than 120 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall develop, and publish in the Federal Register, 
     standards relating to State public health disaster plans, 
     including requirements relating to the equipment, training, 
     treatment, and personnel that a hospital or health care 
     provider must have to be a designated hospital or provider 
     under such plan.
       (d) Submission to Secretary.--
       (1) In general.--Not later 360 days after the date on which 
     standards are published under subsection (c), and annually 
     (or at such other regular periods as the Secretary may 
     determine appropriate) thereafter, a State shall submit to 
     the Secretary for approval the disaster plan developed by the 
     State under this section. The Secretary may only approve such 
     plan if the Secretary determines that the plan complies with 
     such standards.
       (2) Monitoring.--The Secretary shall monitor the States to 
     determine whether each State has developed and implemented a 
     State disaster plan in accordance with this section.
       (e) Medicaid State Plan Requirement.--Section 1902(a) of 
     the Social Security Act (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (64), by striking ``and'' at the end;
       (2) in paragraph (65), by striking the period at the end 
     and inserting ``; and'', and
       (3) by inserting after paragraph (65) the following:
       ``(66) provide that the State shall develop, for approval 
     by the Secretary, and have in effect a State public health 
     disaster plan for responding to biological or chemical 
     attacks in accordance with section 2 of the Biological and 
     Chemical Attack Preparedness Act, except that this paragraph 
     shall not apply to a State if the Secretary waives the 
     application of this paragraph because of the existence of 
     exceptional circumstances.''.

     SEC. 3. GRANTS FOR TRAINING, EQUIPMENT, AND PERSONNEL.

       (a) In General.--The Secretary, acting through the Director 
     of the Office of Emergency Preparedness, shall award grants 
     to hospitals and health care providers to enable such 
     hospitals and providers to provide training, give treatment, 
     purchase equipment, and employ personnel.
       (b) Eligibility.--
       (1) In general.--To be eligible for a grant under 
     subsection (a), a hospital or health care provider shall in 
     consultation with the State, prepare and submit to the 
     Director of the Office of Emergency Preparedness, an 
     application at such time, in such manner, and containing such 
     information as the Director may require.
       (2) Preference for designated hospitals and providers.--In 
     awarding grants under this section, the Director shall give 
     priority to applicant hospitals and health care providers 
     that are designated hospitals or providers under the State 
     public health disaster plan under section 2.
       (3) Governmental entities.--Notwithstanding paragraph 
     (1)(A), the Director may award a grant under this section to 
     a State or local governmental entity if the Secretary 
     determines that such an award is appropriate.
       (c) Use of Funds.--
       (1) In general.--A grantee shall use amounts received under 
     a grant under this section to provide training, give 
     treatment (including the provision of antidotes, vaccines or 
     other drugs or biologicals), purchase equipment, and employ 
     personnel as determined to be appropriate by the Director of 
     the Office of Emergency Preparedness to enable the grantee to 
     carry out its duties under the State public health disaster 
     plan.
       (2) Technical expertise.--A grantee may use amounts 
     received under a grant under this section to acquire 
     technical expertise to enable the grantee to develop 
     appropriate responses to biological or chemical attacks.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated, such sums as may be necessary to carry 
     out this section.
                                  ____

  Mr. REED. Mr. President, I am pleased to join my colleagues, Senators 
Corzine and Torricelli of New Jersey in introducing this timely and 
important legislation. The Biological and Chemical Attack Preparedness 
Act seeks to address a critical need that currently exists in our 
health care emergency preparedness network.
  Since the devastating attacks of September 11, it has become apparent 
that we as a Nation face many threats for which we must be prepared. 
Over the past decade, the Federal Government has made significant 
investments in research, planning and implementation of procedures 
designed to deal with a variety of terrorist attacks, including 
strengthening our public health system so that it may respond 
effectively to a potential biological or chemical terrorist event. In 
that time, we have made great progress in solidifying our level of 
preparedness for these kinds of insidious events. Nevertheless, the 
events of last month have also made us keenly aware of our 
vulnerabilities, particularly when it comes to State and local health 
systems, where our ability to resond to a major catastrophic event is 
not what it should be.
  Specifically, while the 1996 Defense Against Weapons of Mass 
Destruction Act required the development of a Domestic Preparedness 
Program, including efforts to improve capacity of local emergency 
response agencies, only limited funds were provided to state and local 
responders and none for hospitals. For those hospitals that have 
devised

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plans, the challenge is often finding the resources to acquire the 
appropriate equipment and training necessary to respond to a chemical 
or biological event.
  The Biological and Chemical Attack Preparedness Act we are 
introducing today would address this urgent problem by requiring all 
States to think strategically about their health systems and how they 
might be called to respond to a biological or chemical attack. Each 
State would submit to the Department of Health and Human Services for 
review and approval a disaster preparedness plan that would designate 
certain hospitals and providers to respond to a terrorist attack. These 
facilities would devise and implement chemical and biological weapons 
response plans that conform to their responsibilities as a component of 
the State's overall disaster response. To help defray these additional 
costs, the bill authorizes a new grant program administered by HHS' 
Office of Emergency Preparedness to fund the implementation of 
biological and chemical attack preparedness strategies.
  This legislation compliments ongoing efforts to enhance our public 
health capability to minimize casualties should a biological or 
chemical attack occur within our borders. Indeed, it is absolutely 
essential that every link in the health system chain, from the 
individual provider to our Federal health agencies, has the tools it 
needs to carry out the tasks for which it is responsible in this new 
world.
  I thank my colleagues for the opportunity to join them today in this 
important endeavor and urge the Senate to take quick action to adopt 
this important legislation.
                                 ______