Testimony

Statement by
Richard H. Carmona, M.D., M.P.H., F.A.C.S., Surgeon General
U.S. Public Health Service
Department of Health and Human Services

on
Hearing: Meeting Our Nation's Important Public Health Challenges: Transformation of the Public Health Service Commissed Corps
before the
The Committee on Government Reform, United States House of Representatives

October 30, 2003

Thank you Mr. Chairman for this opportunity to address the Committee on Government Reform about the Administration's efforts to transform the Public Health Service (PHS) Commissioned Corps into a more mobile and responsive national resource for meeting some of our Nation's most important public health challenges. I am particularly pleased to have this opportunity to describe to you and the members of this committee the Department's vision of this transformation, to delve into the overall objectives, and to clear up many of the misconceptions about what the Transformation is, and what it is not.

I want to start my prepared statement with a clear message. The Public Health Service Commissioned Corps has a long and proud history. I am proud of their service to this country, and the officers who serve in the Corps are justly proud of their accomplishments. I have pride in the achievements of people such as RADM Craig Vanderwagen, whom Secretary Thompson deployed from the Indian Health Service to serve, currently, in Iraq. There is no better way to illustrate his service than to quote from his recent e-mail message back to us. He wrote:

"The Ministry of Health [in Iraq] has some marvelous professionals who are very happy to have the opportunity to do good things for their country after years of neglect. We will build a primary care system that has not existed here before, to complement the improvements in public health systems. I am happy to be here and growing immensely in this environment, and thankful every day for the opportunity to be part of this."

I applaud the work of Commissioned Corps Officers like Captain Ken Martinez, of the National Institutes for Occupational Health, a component of the Centers for Disease Control and Prevention (CDC), and Commander Tim Cote, M.D. of the Food and Drug Administration. Captain Martinez, an engineer who works in the field of industrial hygiene was among the officers responding to the anthrax release on Capitol Hill. He was deployed from CDC and served 24/7 for several weeks. Commander Cote, who is currently the Chief of Therapeutics and Blood Safety at the Center for Biologics at the FDA, not only served during the anthrax release, when he was assigned to the National Institutes of Health, but he also volunteered to deploy for duty in Iraq. It is the dedication of individuals like Commander Cote, Captain Martinez and RADM Vanderwagen that exemplifies the best of the Corps' past, and present–but more importantly, its future.

Why is the Transformation Needed?

While the Corps has responded well during many public health emergencies, including most prominently the September 11th attack, and the anthrax release on October 15th, Secretary Thompson and I believe that our capabilities will have to be broader, our resources deeper, and our flexibility enhanced if we are going to be ready to address the needs of our citizens when they are faced with future national emergencies. We need to be ready should local and state public health resources be overwhelmed by urgent public health needs whether engendered by a terrorist attack, a natural disaster such as a significant earthquake or a nationwide disease threat such as would be created by an influenza pandemic. In fact, during the past few weeks, in preparation for and in response to the havoc created by Hurricane Isabel, Secretary Thompson deployed 176 Commissioned Officers to several communities, to seven state emergency operation centers, and to six state health departments. These Officers served with distinction and I am very proud of what they accomplished.

In addition to addressing public health emergencies, ongoing Corps deployments across the country are essential to protect public health. For example, the Indian Health Service is facing both significant recruiting problems and a large number of vacancies, half of them for nurses, in providing care for our American Indian and Alaska Native populations.

Similarly, the President and the Secretary, from the beginning of this Administration, have recognized that we need thousands of health care professionals to overcome shortages in Health Centers and National Health Service Corps placement sites where recruitment efforts have fallen short of expectations.

Secretary Thompson and I am equally concerned that we do not have a sufficiently large force, appropriately trained, suitably experienced, and readily deployable to address special needs, such as the critical issue of childhood immunization. Across our nation, there are urban and rural areas where the percentage of children unprotected from preventable diseases is a serious concern to all of us. Further, we need to strengthen our national prevention effort. For example, early diagnosis of diabetes is important, and particularly among some of the most needy members of our society. That Public Health professionals are attuned to the early signs of diabetes is crucial to controlling the progress of the disease as well as controlling the cost of treatment of the more serious conditions connected with the progression of the disease. Another example is the need to respond to the difficult health care issues we face along our Southwestern border. The fact of the matter is that when it comes to national resources to address urgent and unexpected national public health demands such as these, there are too few readily accessible Public Health professionals at our disposal to deploy as needed.

Over the last several decades, ever since the PHS hospital system was disbanded, the management of the Corps has become more and more decentralized and the structure of the Corps less and less distinguishable from the civil service. The requirements that were placed on the Department during the events of September 11th and the anthrax attack underscored the importance of the PHS Commissioned Corps as well as the need for more direct responsibility exercised by the Secretary. Therefore, the Secretary has asked his principal health official, the Assistant Secretary for Health, to be responsible for policy and oversight of the Corps, and for the Surgeon General to implement these policies and be responsible for the operation of the Commissioned Corps.

To strengthen our Corps and broaden its mission to include the new dimensions that are clearly necessary, we need to revamp and strengthen our recruitment efforts; use our promotion systems to reinforce and reward the best of the qualities of a truly national, mobile public health force; bring our administrative management systems into the 21st century; and adapt the best of DOD personnel practices for use in managing the PHS Commissioned Corps.

For years, authority has existed in the Public Health Service Act to appoint warrant officers as part of the professional PHS Commissioned Corps. Secretary Thompson now needs to use that authority to expand the capacity of the Commissioned Corps. We need to be able to access the clinical resources of registered, associate-degree trained nurses that every State recognizes and licenses to provide clinical nursing services. Appointing them as warrant officers permits us to expand the service delivery capacity of the Corps. At the same time, we want to give them access to the education that would be required if they wanted to be commissioned after receiving a baccalaureate degree in nursing. Likewise, we want to use this rank structure to add other members of the health team such as laboratory assistants, physical therapy assistants, and paramedics.

As part of this effort and at the direction of Secretary Thompson I am already strengthening our Basic Officer Training Course to ensure that newly recruited officers are fully aware of our readiness standards and deployment systems when they first enter on duty. Also, as part of the transformation of the Corps, Secretary Thompson and I believe we should explore ways to strengthen and expand our reserves as a readily available source of additional officers should we be required to respond to public health emergencies and other urgent requirements that exceed our active duty capacities. Therefore, the Secretary has tasked me, working with the Assistant Secretary for Health, to look into options for that aspect of the Transformation. Growing and maintaining a healthy, robust Reserve could be instrumental in the pursuit of easing the maldistribution of public health professionals without significantly adding to the size of the Federal payroll. These public health professional reservists, could practice their professions within communities all across this nation, and strengthen the capacity to respond to emergencies at the local level without the need for massive relocation of people and assets in times of localized emergency.

There are several other reforms that we are developing as part of this transformation initiative. I have mentioned reforms directly affecting the lives of officers currently serving in the Corps. The continued dedication and commitment of Commissioned Corps Officers to the public health of this nation is very important to both the Secretary and me. We will move to strengthen the development of those members of the Commissioned Corps who have devoted their careers to research and public health practice by establishing more formally structured career tracks. This will provide officers with clear growth opportunities to which they can aspire. Our nation asks much of these dedicated individuals, many of whom could migrate to the more lucrative private sector. Instead, these dedicated officers choose to serve in the Corps, to the benefit of the entire nation.

In the past, the mission statement of the Commissioned Corps has been tailored to focus on supporting the activities of the agencies that comprise the Department of Health and Human Services. Secretary Thompson and I believe we need to revise that statement to better emphasize all of the values that have long been part of the Commissioned Corps - to protect, promote and advance the public health, science and security of the Nation domestically and globally as America's uniformed service of uniquely qualified health professionals.

Misconceptions

Because much has been speculated about the impact of this Transformation on existing officers and the potential for disruption of their service, I want to conclude, and emphasize what the Transformation is NOT. Much information has been printed, and contrary to characterizations in the media and misconceptions elsewhere that have caused concern among officers, I would like to make two points. First, with regard to deployment of officers, any deployments undertaken will be congruent with an officer's skills, competencies, and physical capabilities. To be clear, sending officers, such as bench scientists, FDA regulatory specialists, or epidemiologists from CDC, to achieve mission objectives that are not consistent with their specific training and physical capabilities makes no sense. This Transformation contemplates no such thing.

Second, with regard to promotion standards, no system will be adopted that places undue demands on an officer with regard to training or physical strength. In fact, the three-tiered readiness standards we are proposing will impose no new physical fitness standards at the basic level through the calendar year 2004, and will establish, as other uniformed services do, a medical waiver provision. There will be phased-in incentives for officers to seek higher levels of training and deployment capability, but no officer will be disadvantaged for promotion by physical fitness standards in the 2004 promotion cycle.

Mr. Chairman, for over two hundred years, the United States Public Health Service Commissioned Corps has served our country well. But today, faced with new challenges and new threats, Transformation of the Commissioned Corps is a necessity. As envisioned, the Transformed Corps will provide this and future presidents with a more highly trained, capable, and mobile cadre of public health professionals. We can accomplish this without disadvantaging any current members of the Corps and we can accomplish this within the limits provided us by Congress for the size of the Commissioned Corps.

That concludes my statement, Mr. Chairman, and I am ready to respond to your questions.

Last Revised: October 30, 2003