[Congressional Record Volume 156, Number 103 (Tuesday, July 13, 2010)]
[Senate]
[Pages S5768-S5770]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
APPOINTMENT OF DONALD BERWICK
Mr. WHITEHOUSE. Mr. President, I came to the Senate floor earlier
today to speak about the nomination of Don Berwick to run the CMS and
talked a little bit this morning about the area in which he
specializes, which is how to lower the cost of the American health care
system by improving the quality of care; that it is a win-win and to
call it rationing is incredibly misleading and raises a legitimate
question about whose side somebody is on who wants to attack this kind
of reform of the health care system.
I went back to my office and found an article in the Washington Post
today, which is entitled ``Hospital infection deaths caused by
ignorance and neglect, survey finds.'' So if I could just read a few
pieces from it, then I will ask unanimous consent to have this article
printed in the Record.
An estimated 80,000 patients per year develop catheter-
related bloodstream infections, or CRBSIs. . . . About 30,000
patients die as a result, according to the Centers for
Disease Control and Prevention, accounting for nearly a third
of annual deaths from hospital-acquired infections in the
United States.
So 80,000 people get hospital-acquired infections in their blood from
the catheters that go into them when they are
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in a hospital. Of those 80,000, 30,000 die, and that is about one-third
of the annual deaths from all hospital-acquired infections, which means
about 90,000 Americans die every year from hospital-acquired
infections.
This article goes on to say those deaths are preventable. We have
known this for a long time. This article is confirming something that
has been studied for a long time.
. . . evidence suggests hospital workers could all but
eliminate [catheter-related bloodstream infections] by
following a five-step checklist that is stunningly basic: (1)
Wash hands with soap; (2) clean patient's skin with an
effective antiseptic; (3) put sterile drapes over the entire
patient; (4) wear a sterile mask, hat, gown and gloves; (5)
put a sterile dressing over the catheter site.
A lot of this came out of original work that was done in Michigan,
the so-called Keystone Project. We have taken that in Rhode Island and
adapted it to try to reduce these hospital-acquired intensive care unit
infections. But this is preventable. The point is, when we prevent it,
we save money because those 80,000 patients per year developing
catheter-related bloodstream infections--as to the last information I
saw, I believe it costs about $60,000 to treat hospital-acquired
infections. So I cannot do the math in my head, but multiply $60,000
times 80,000 patients per year getting these catheter-related
bloodstream infections and we get into very big money very quickly.
Don Berwick is the leader of the health care reform effort that tries
to take exactly that kind of problem and solve it so this process, this
stunningly basic process that can prevent these infections, actually
gets implemented over and over and over, every time, so we can
eliminate these infections. When we eliminate them, we eliminate the
cost of treating it; we eliminate the excess days that had to be spent
in the hospital while the patient was treated for the infection; and,
of course, most importantly, we eliminate 30,000 people dying from a
hospital-acquired, catheter-related bloodstream infection every year.
What is not to like about that? That is the theory of health care
reform that Don Berwick is the lead proponent of. So I came back to the
floor because this story is so clearly on point as to exactly the kind
of reform he has been a proponent of--from his years on the Clinton
Consumer Quality and Protection Commission--I do not have its exact
name right now, but it was a Clinton-era quality reform initiative--
from his leadership writing ``To Err Is Human,'' the initial report
that kicked off the health care quality reform movement, and the
follow-on report, ``Crossing the Quality Chasm.''
This is what this guy specializes in and this ability to go into the
American health care system and find these ways where, by improving the
quality of care, we lower the cost. Again, whatever 80,000 patients is
times--I may have the number wrong, but my recollection is about
$60,000 per infection--we get into pretty big money in a pretty big
hurry. It is preventible, and it is that kind of savings that is going
to help turn the corner for American health care.
So I ask unanimous consent that this Washington Post article entitled
``Hospital infection deaths caused by ignorance and neglect, survey
finds'' by N.C. Aizenman, dated Tuesday, July 13, 2010, be printed in
the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Washington Post, July 13, 2010]
Hospital Infection Deaths Caused by Ignorance and Neglect, Survey Finds
(By N.C. Aizenman)
Deadly yet easily preventable bloodstream infections
continue to plague American hospitals because facility
administrators fail to commit resources and attention to the
problem, according to a survey of medical professionals
released Monday.
An estimated 80,000 patients per year develop catheter-
related bloodstream infections, or CRBSIs--which can occur
when tubes that are inserted into a vein to monitor blood
flow or deliver medication and nutrients are improperly
prepared or left in longer than necessary. About 30,000
patients die as a result, according to the Centers for
Disease Control and Prevention, accounting for nearly a third
of annual deaths from hospital-acquired infections in the
United States.
Yet evidence suggests hospital workers could all but
eliminate CRBSIs by following a five-step checklist that is
stunningly basic: (1) Wash hands with soap; (2) clean
patient's skin with an effective antiseptic; (3) put sterile
drapes over the entire patient; (4) wear a sterile mask, hat,
gown and gloves; (5) put a sterile dressing over the catheter
site.
The approach also calls for clinicians to continually
reconsider whether the benefits of keeping the catheter in
for another day outweigh the risks and to use electronic
monitoring systems that allow them to spot infections quickly
and assemble a rapid response team to treat them.
A federally funded program implementing these measures in
intensive-care units in Michigan hospitals reduced the
incidence of CRBSIs by two-thirds, saving more than 1,500
lives and $200 million in the first 18 months. Similar
initiatives across the country helped bring the overall
national rate of these and related bloodstream infections
down by 18 percent in the first six months of 2010, according
to the CDC.
``Our research shows that the cost of implementing [such
programs] is about $3,000 per infection, while an infection
costs between $30,000 to $36,000,'' said Peter Pronovost, a
professor at Johns Hopkins University School of Medicine who
led the program. ``That means an average hospital saves $1
million.''
So why aren't hospitals leaping to adopt these best
practices?
The survey released Monday, which was conducted by the
Association for Professionals in Infection Control and
Epidemiology and funded by Bard Access Systems, a maker of
catheters, pointed to ignorance and neglect at the top.
More than half of the 2,075 respondents, most of whom were
infection control nurses employed by hospitals, reported that
they use a cumbersome paper-based system for tracking
patients' conditions that makes it harder to spot infections
in real time. Seven in 10 said they are not given enough time
to train other hospital workers on proper procedures. Nearly
a third said enforcing best practice guidelines was their
greatest challenge, and one in five said administrators were
not willing to spend the necessary money to prevent CRBSIs.
Pronovost said part of the problem was that many hospital
chief executives aren't even aware of their institution's
bloodstream infection rates, let alone how easily they could
bring them down.
When hospital leaders decide to create a culture in which
preventing infections is a priority, he added, nurses feel
empowered to remind physicians to follow the checklist when
inserting catheters, physicians are provided antiseptic soaps
as part of their catheter kits and infection control
personnel have the best tools to monitor patients.
``If anyone in that chain of accountability doesn't work,
you won't get your [infection] rates down,'' he said. ``But
it's the hospital's senior leadership that is ultimately
responsible.''
Mr. WHITEHOUSE. Mr. President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant editor of the Daily Digest proceeded to call the roll.
Mr. KYL. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. KYL. Mr. President, I just want to take a moment to ask unanimous
consent to have printed in the Record, at the conclusion of my remarks,
an editorial dated today from the Arizona Republic. That is my hometown
newspaper in Phoenix, AZ.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. KYL. The editorial is entitled ``End run denies public a debate
on health care.'' The point of the editorial is that while we had a
very long debate over the so-called health care legislation--I think
the name of the act was the Patient Protection and Affordable Health
Care Act--we never had the kind of debate that would have edified the
American public on the general question of a government-run health care
system versus one that was more amenable to the doctor-patient
relationship and the privacy that Republicans were suggesting was a
better way to go.
What the editorial says is that the President's recess appointment of
Dr. Berwick obviated the kind of debate that could have occurred had he
gone through the regular nomination process and had a hearing at which
his views could be elicited, and we could have then debated whether he,
with his views, was the right person to head the CMS, which is the
entity that will be running the program.
The editorial concludes with these comments, after noting that even
Democratic leaders in the Senate were perplexed by the recess
appointment, noting Senate Finance Committee chairman, Max Baucus,
saying he was ``troubled'' by the move. The editorial concludes:
[[Page S5770]]
Considering how dubious the public remains about Obamacare,
there is every reason to believe the Republicans really did
want an exchange with the candid, erudite Berwick. The recess
appointment strongly suggests the White House simply did not
want to have another fight over the contentious health care
issue.
Political parties can be devious. History is littered with
appointments delayed to death out of little more than spite.
This wasn't one of those appointments. Dr. Berwick will
head a federal agency that spends $800 billion a year. The
public deserves to know what he thinks.
The point is, we would have had an opportunity to know what Dr.
Berwick thinks and for the American people to express themselves on
that issue through their representatives in the Senate had we gone
through the regular nomination process. But because the President
decided to short-circuit that while we were off and back home on our
July 4th recess, and made the recess appointment, we will never have
that opportunity. As the editorial notes, that is lamentable. It denies
the public an opportunity they would have had to understand better what
his point of view was and perhaps to have a debate about the general
underlying nature of the health care bill that was passed.
Exhibit 1
[From the Arizona Republic, July 13, 2010]
End Run Denies Public a Debate on Health Care
Crazy as it sounds, we did not have a real ``debate'' over
health care lo those many months prior to the passage of the
Patient Protection and Affordable Care Act in March.
Basically, the warring factions had an 18-month fight over
interpretations.
President Barack Obama and Democrats interpreted the new
law as one that would, affirmatively, lower costs, preserve
existing options, extend coverage near-universally and
improve care overall.
On defense against the interpretations of mostly Republican
critics, they argued the plan did not constitute socialized
medicine, was not a Washington power grab, would not explode
costs, would not create ``death panels,'' would not reduce
insurance options, would not foist new burdens on the states,
and wouldn't increase federal deficit spending.
It was a debate over the meaning of a constantly evolving
bill, not one of competing philosophies.
But a debate over the efficacy of a centralized, govemment-
led health-care system vs. a decentralized, mostly private
system? Rarely was the epic struggle ever that
straightforward.
Senate hearings on the appointment of Obama's nominee to
head the Centers for Medicare & Medicaid Services, Dr. Donald
Berwick, would have been a great opportunity to hear those
debates, at long last.
Unfortunately, that isn't going to happen. The president
short-circuited those hearings by using his power to make
appointments during congressional recesses. According to a
White House spokesman, the president anticipated Republican
obstructionism, and so performed the end run. That
explanation is debatable. There was no discernable
``impasse'' on the Berwick appointment.
Republicans claim they greatly anticipated the Berwick
hearings, given the Harvard-educated pediatrician's candid
commentary over the years about his enthusiasm for a single-
payer health-care system similar to that of Great Britain.
Likewise, Democratic leaders in the Senate also were
perplexed at the recess appointment. Senate Finance Committee
Chairman Max Baucus of Montana said he was ``troubled'' by
the move.
Considering how dubious the public remains about Obamacare,
there is every reason to believe the Republicans really did
want an exchange with the candid, erudite Berwick. The recess
appointment strongly suggests the White House simply did not
want to have another fight over the contentious health-care
issue.
Political parties can be devious. History is littered with
appointments delayed to death out of little more than spite.
This wasn't one of those appointments. Dr. Berwick will
head a federal agency that spends $800 billion a year. The
public deserves to know what he thinks.
Mr. KYL. I suggest the absence of a quorum.
The PRESIDING OFFICER (Mrs. Gillibrand). The clerk will call the
roll.
The assistant editor of the Daily Digest proceeded to call the roll.
Mr. BROWN of Ohio. Madam President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER (Mrs. Hagan). Without objection, it is so
ordered.
Mr. BROWN of Ohio. Madam President, I ask unanimous consent to speak
for up to 10 minutes as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________