[Congressional Record Volume 166, Number 134 (Wednesday, July 29, 2020)]
[Senate]
[Pages S4593-S4596]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION

      By Mr. KAINE (for himself, Mr. Young, Mr. Reed, and Mr. Cassidy):
  S. 4349. A bill to address behavioral health and well-being among 
health care professionals; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. KAINE. Mr. President, Lorna Breen was a talented and dynamic 
physician who served as the medical director of the emergency 
department at New York-Presbyterian Allen Hospital. Lorna was from 
Charlottesville, VA, and very devoted to her family there. She attended 
Cornell University and then the Medical College of Virginia. She was 
deeply religious, an avid skier, a volunteer with senior citizens, a 
salsa dancer, and a musician.

[[Page S4594]]

  Mostly, Lorna Breen was a beloved, compassionate, and demanding 
doctor. A colleague said of her: ``She had something that was a little 
bit different and that was this optimism that her persistent effort 
will save lives.''
  Dr. Breen suffered from something very common among health 
professionals--the deep stress of dealing with patients day in and day 
out--helping them, worrying about them, celebrating with them, praying 
for them, and mourning for them.
  Healthcare professionals routinely experience high levels of stress. 
As many as 45 to 55 percent of this critical workforce suffers from 
burnout. Physicians have the highest rate of death by suicide of any 
profession in this country, with a suicide rate more than twice that of 
the general population. That was the case before COVID-19.
  In November 2019, Dr. Breen and three colleagues published a short 
article in the American Journal of Emergency Medicine titled: 
``Clinician burnout and its association with team-based care in the 
Emergency Department.'' The article that she coauthored begins this 
way:

       Recent work has noted the alarming prevalence of clinician 
     burnout among providers, particularly among acute care 
     physicians. Burnout is characterized by emotional exhaustion, 
     physical fatigue, and cognitive weariness, which may lead to 
     feelings of depersonalization and reduced accomplishment.

  The article went on to describe how staffing models--in this case, 
the use of fixed working teams--could mitigate the effects of stress on 
staff and also improve patient outcomes. Within just a few months of 
the publication of this article, healthcare professionals like Dr. 
Breen, already dealing with high stress levels, faced a new foe: 
coronavirus.
  Dr. Breen's hospital was overrun by the virus in March and April, as 
were others in New York, as are others in this country. By late March, 
the Allen, a small community hospital serving a low-income population 
in Northern Manhattan, was blitzed with an emergency department clogged 
with nearly three times its normal number of patients. Dr. Breen shared 
the sense of anxiety now understood by the whole country: ``People I 
work with are so confused by all the mixed messages and constantly 
changing instructions.'' And then Dr. Breen got the virus herself, 
coming down with fever and exhaustion on March 18 and quarantining in 
her New York City apartment as she tried to recover. While she was 
trying to recover, she was texting her colleagues to see if they were 
OK. She was trying to help them find supplies that they could buy to 
use at the hospital.
  Finally, she returned to work on April 1, and the situation in her 
emergency room, her hospital, her city, was even grimmer. Her sister, 
Jennifer Breen Feist, described what Lorna faced.

       When [Lorna] returned to the hospital, she was confronted 
     by an overwhelming, relentless number of incredibly sick 
     patients. She and her colleagues worked 24/7 during the peak 
     in New York with limited personal protective equipment, 
     insufficient supplies, not enough beds, not enough help. Many 
     of her colleagues were out on medical furlough. She told me 
     patients were dying in the waiting rooms and hallways. . . . 
     There was so much suffering, so much death.

  During the peak of the crisis in New York City, nearly a quarter of 
all patients admitted to the Allen for COVID-19 would die. Dr. Breen 
messaged her Bible study group: ``I'm drowning right now--may be AWOL 
for a while.'' She kept right on working.
  By mid-April, Dr. Breen reached out for help to deal with the stress 
she was feeling by talking to colleagues and family. She admitted that 
she had thought about hurting herself. She told one friend:

       I couldn't help anyone. I couldn't do anything. I just 
     wanted to help people and I couldn't do anything.

  Dr. Breen was admitted to a psychiatric hospital for 11 days and went 
home when she was discharged to be with her family in Charlottesville 
to recover, and on April 26, Dr. Breen died by suicide, leaving no 
note.
  Dr. Breen was a victim of coronavirus, even though her death is not 
counted among the 151,000 people who have succumbed to the virus. But 
she was also a victim of another condition that is a preventable 
condition that affects our healthcare professionals. We place enormous 
demands upon our healers. Our society, including the medical profession 
itself, does not do enough to recognize the real cost that the work 
inflicts upon the mental health of our caregivers. Perhaps even our use 
of the term ``hero,'' meant as the highest praise, subtly communicates 
an expectation that our healers must be strong superheroes, placed high 
on a pedestal by society, thereby making it even more difficult for a 
caregiver to admit vulnerability and simply ask for help.
  Loice Swisher, an emergency room physician in Philadelphia, puts it 
this way:

       We don't want to be seen as a weak link. We don't want to 
     be seen as incompetent or place an extra burden on our 
     colleagues. It's almost like you're being kicked off the 
     island--you don't belong any more--if you admit to [needing 
     help].

  It is still common practice in this country for State medical boards 
and hospitals to ask doctors seeking licensing and credentialing 
whether they have ever been treated for depression or other mental 
illness. This heightens the barriers to asking for help when we should 
be making it easier to do so. Lorna's sister Jennifer attests to this:

       And when [Lorna] became so overworked and despondent that 
     she was unable to move, do you know what she was worried 
     about? Her job. She was worried that she would lose her 
     medical license, or be ostracized by her colleagues because 
     she was suffering burnout due to her work on the front lines 
     of the Covid19 crisis. She was afraid to get help.

  Lorna's worries were not unusual. A 2019 survey of physicians by the 
American Medical Association showed that nearly 40 percent of surveyed 
physicians are wary about seeking mental health counseling, while 
another 12 percent indicate that they would only do so in secret.
  Dr. Breen's family is devastated by her passing, but they are 
honoring her by advocating for the cause of a more humane profession, 
one in which mental health challenges are acknowledged, mental health 
resources are available, and the healer accessing those services is 
encouraged.
  I am proud today to introduce the Dr. Lorna Breen Health Care 
Provider Protection Act, together with my colleagues, Senators Young, 
Reed, and Cassidy. The act aims to reduce and prevent suicide, burnout, 
and other mental and behavioral health conditions among healthcare 
professionals. In particular, the act would establish grants for 
training healthcare professionals, students, and residents with 
strategies to improve their mental well-being and job satisfaction; 
identify and disseminate evidence-based best practices for combating 
burnout and suicide; establish a national education and awareness 
campaign targeting healthcare professionals to encourage them to seek 
support and treatment for mental and behavioral health concerns; create 
grants for employee education, peer support programming, and mental and 
behavioral health treatment with a priority for providers in COVID-19 
hotspots; and initiate a comprehensive study on healthcare professional 
mental health needs, including the impact of COVID-19 on our providers, 
that can produce recommendations for all levels of government and the 
medical professions themselves.
  We introduced this bill mindful of the many priorities that are 
currently being discussed while we negotiate our continuing response to 
the Nation's coronavirus challenge. It is our hope that this bill might 
make it into the next COVID-19 bill as a tribute to Lorna Breen and so 
many like her.
  How should we honor the work and sacrifice of a Lorna Breen? How do 
we honor those healthcare frontline workers whom we call heroes every 
day? How do we recognize the tremendous work they are doing and also 
the tremendous burden that they carry? Let's pass this bill and show 
that we care about our healers and are committed to providing them the 
resources and the culture they need to keep healing.
                                 ______
                                 
      By Mrs. FEINSTEIN:
  S. 4352. A bill to provide for the water quality restoration of the 
Tijuana River and the New River, and for other purposes; to the 
Committee on Environment and Public Works.
  Mrs. FEINSTEIN. Mr. President, I rise today to introduce the ``Border 
Water Quality Restoration and Protection Act of 2020.''
  For over two decades, cleaning up the Tijuana River Valley has been 
one of

[[Page S4595]]

my top priorities for Southern California. The wastewater, trash and 
sediment that continues to flow into San Diego and Imperial Counties is 
a danger to public health and our economy and it must be addressed.
  This legislation is a key piece of addressing this decades-long 
issue.


                          What the Problem Is

  Polluted water from the Tijuana and New Rivers flows north across the 
border into the United States causing unsanitary water conditions, 
pollution and beach closures across Southern California. It also 
jeopardizes military training exercises for Navy Seals in Camp 
Pendleton.
  Three-quarters of the 1,700-square-mile Tijuana River watershed lies 
in Mexico. However, the watershed, along with all its pollutants, 
drains into San Diego County and the Tijuana River Valley.


                     Impacts of the Water Pollution

  In addition to jeopardizing human health and safety, two of the most 
drastic effects from this cross-border water pollution are harm to 
wildlife and damage to the tourism industry, integral to Southern 
Californian communities.
  Pollution from Mexico harms sensitive areas that provide critical 
habitat for more than 300 species of birds as well as marine animals 
like leopard sharks and bottlenose dolphins, including: Tijuana River's 
National Estuarine Research Reserve, the River Mouth State Marine 
Conservation Area and River Valley Regional Park Preserve.
  The beaches in the region are vital to San Diego's tourism economy. 
Beaches in the communities of Coronado and Imperial Beach have been 
closed for more than 200 days this year alone due to pollution.
  Health and safety of residents and workers are also at risk. In 
recent years, local Border Patrol union officials reported that 80 
officers suffered from contamination, rashes, infections, chemical 
burns and lung irritation due to toxic cross-border flows.
  The harmful effects of pollution in the Tijuana River Valley on our 
residents, businesses, economy and environment are simply unacceptable.


                             Current Status

  In February 2020, the Government Accountability Office issued a 
comprehensive report, ``International Boundary Water Commission: 
Opportunities Exist to Address Water Quality Problems.'' My office 
worked closely with the GAO to utilize their findings to craft 
meaningful change through this legislation.
  Simultaneously, we were able to secure $300 million in the U.S.-
Mexico-Canada trade agreement to address pollution in the Tijuana River 
Valley Watershed.
  With significant funding and detailed findings by the GAO 
investigation, we developed this legislation in concert with federal, 
state and local agency input.


                           What the bill does

  The Border Water Quality Restoration and Protection Act includes some 
key reforms to advance concrete solutions.
  One of the problems is that no one agency is in charge of this 
problem. A whole range of agencies--EPA, International Boundary and 
Water Commission, State Department, Department of Homeland Security, 
Customs and Border Protection, Defense Department--all have 
jurisdiction or interest in this international issue.
  What we need is one agency in charge, taking input from the others so 
decisions can be made. This approach is similar to other large, 
regional environmental challenges like the Great Lakes, Gulf of Mexico, 
Everglades and Chesapeake Bay. Here in California, we have also seen 
great success with this model of interagency coordination at Lake 
Tahoe.
  Here's how the bill would work:
  The EPA would be officially named the agency with overall control of 
this effort.
  The EPA, along with its federal, state and local partners, would be 
directed to identify a list of priority projects. It also would be 
authorized to accept and distribute funds to build, operate and 
maintain those projects.
  Would permanently authorize the Border Water Infrastructure Program 
to manage storm water runoff and water reuse projects.
  State and local authorities would also be authorized to contribute 
funding to federal projects, which is currently not allowed.
  The International Boundary and Water Commission would be authorized 
to mitigate storm water from Mexico and the pollution that comes with 
it and is required to construct, operate and maintain projects on the 
priority list developed by the agencies within the U.S. that improve 
water quality.


                               Conclusion

  We need a new and comprehensive approach to this issue that has 
plagued border communities for too long. This bill creates a formal 
process to consider effective, long-term solutions and additional 
wastewater infrastructure to mitigate cross-border pollution and I hope 
the Senate can move on this bill quickly.
  I want to thank California Environmental Protection Agency, 
California Natural Resources Agency, San Diego and Imperial counties, 
cities of Imperial Beach and Coronado, Mayor of Chula Vista, Mary 
Casillas Salas, Mayor of San Diego, Kevin Faulconer, and the Port of 
San Diego for supporting this legislation. These communities, and 
others, have been negatively impacted by this issue for far too long.
  It's past time that we finally solve this problem to safeguard local 
health and economic growth.
  Thank you, Mr. President. I yield the Floor.
                                 ______
                                 
      By Mr. REED (for himself and Mr. Bennet):
  S. 4361. A bill to automatically extend and adjust enhanced 
unemployment assistance for the duration of the COVID-19 emergency and 
economic crisis, and for other purposes; to the Committee on Finance.
  Mr. REED. Mr. President, the unemployment crisis we are facing due to 
the pandemic has devastated the lives of tens of millions of 
Americans--many of whom may not see their jobs come back for the 
foreseeable future. The expanded unemployment insurance we passed in 
the CARES Act--especially the coverage for gig workers and the self-
employed and the $600 weekly boost--have enabled workers to keep a roof 
over their heads, feed their children, and pay for health insurance.
  If these benefits expire or are drastically reduced, it could cause 
an eviction and hunger crisis. It could also tank consumer spending 
while increasing business closings that will lead to even more 
unemployment. Additionally, it could further exacerbate this public 
health and economic crisis by forcing more Americans into desperate 
situations, instead of ensuring that people can return to the workforce 
when it is safe.
  And yet knowing this, the Republican have proposed to slash weekly 
benefits to $200 a week for the next two months, after which benefits 
would be limited to no more than 70% of previous wages. This plan, 
which would cut the average worker's unemployment benefits by roughly 
43%, would take states months to get up and running. This would further 
delay benefits at a time when some workers are still waiting for 
assistance.
  Instead of this half-baked, inefficient, and disingenuous proposal, 
we must work together on a bipartisan basis to enact targeted, 
effective, and smart measures that will offer families, businesses, and 
the economy the needed stability to get us through this crisis. That is 
why I am introducing the Worker Relief and Security Act, along with 
Senator Bennet and Congressman Beyer. Our legislation, which reflects 
input from top economists, would take politics out of the equation, 
basing continued enhanced unemployment insurance benefits on 
``automatic stabilizers'' that are tied to the public health emergency 
and economic conditions. Specifically, this legislation would 
automatically extend the $600 weekly boost and additional benefit 
weeks, on top of regular state unemployment, through the duration of 
the public health crisis. Once we begin to enter the recovery phase, 
this legislation would continue providing supplemental weekly 
compensation and additional benefit weeks until national and state 
total unemployment rates get closer to pre-crisis levels.
  Time is of the essence, so I urge our colleagues to join us in 
pressing for immediate action on this legislation. We must extend and 
enhance unemployment insurance benefits, tying them to economic and 
health conditions--as

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well as expand work sharing as I have discussed previously--to help 
keep families, businesses, and states solvent through this crisis.
  Mr. President, I yield back.

                          ____________________