[Congressional Record (Bound Edition), Volume 156 (2010), Part 9]
[Senate]
[Pages 12813-12814]
[From the U.S. 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 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

[[Page 12814]]

     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:

       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.

                          ____________________