Testimony

Statement by
William F. Raub, Ph.D.
Principal Deputy Assistant Secretary,
Office of the Assistant Secretary for
Public Health Emergency Preparedness
Department of Health and Human Services
on
HHS, the Department of Homeland Security and H.R. 3266
before the
The Subcommittee on Health
Committee on Energy and Commerce
United States House of Representatives

May 11, 2004

Good afternoon, Mr. Chairman and members of the Subcommittee.

I am William F. Raub, Principal Deputy Assistant Secretary for Public Health Emergency Preparedness, at the Department of Health and Human Services (HHS). I welcome this opportunity to share the Department’s views on H.R. 3266, the proposed legislation for “Faster and Smarter Funding for First Responders,” introduced by Congressman Christopher Cox, Chairman of the House Select Committee on Homeland Security, as reported by that Committee.

Before I provide the Department’s comments on the contents of the bill, I want to take this opportunity to underscore the many collaborative and coordinated activities that HHS has undertaken with the Department of Homeland Security over the last year. Whether the issues deal with state and local emergency preparedness, the planning for and deployment of the Strategic National Stockpile, the development of medical countermeasures under Project BioShield, or the development of the National Response Plan and the National Incident Management System, our two Departments have worked diligently to keep each other apprised and involved. The relevant personnel in the two Departments (myself included) have strived on an ongoing basis to coordinate our respective activities at both the policy and planning level as well as at the implementation and deployment level. This approach lays the foundation not only for enhancing interagency coordination but also for creating a more robust and harmonized response capacity at the state and local levels.

H.R. 3266 contains several provisions that overlap with mandates of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (referred to hereafter as the Public Health Security Act), the legislation that authorizes most of the bioterrorism preparedness and response programs within HHS, particularly those that address state and local readiness. In particular, I will address new sections 1802, 1803 and 1806 of the Homeland Security Act of 2002, as would be added by H.R. 3266.

In new section 1802, the Secretary of Homeland Security is directed to “establish clearly defined essential capabilities for State and local government preparedness for terrorism”. The bill language defines “essential capabilities” as “the levels, availability, and competence of emergency personnel, planning, training, and equipment across a variety of disciplines needed to effectively and efficiently prevent, prepare for, and respond to acts of terrorism consistent with established practices.”

Further, HR 3266 defines “first responders” as “emergency response providers” and the latter are defined, in the Homeland Security Act of 2002, to include emergency medical personnel and hospital emergency personnel as well as Federal, State, and local emergency public safety, law enforcement, emergency response and related personnel, agencies, and authorities. Thus the cross-over of the definition of “first responders” to include what are traditional health care workers may create a situation whereby the DHS Task Force on Essential Capabilities for First Responders (to be established under Section 1803) will be undertaking an activity, i.e., establishing “essential capabilities,” for a community of health providers that generally look to HHS to establish standards and priorities for public health emergency preparedness.

Furthermore, there is currently a Working Group on Bioterrorism and Other Public Health Emergencies (referred to hereafter as the Working Group), authorized by the Public Health Security Act, that is to provide an “assessment of the priorities for and enhancement of the preparedness of public health institutions, providers of medical care, and other emergency service personnel (including firefighters) to detect, diagnose, and respond (including mental health response) to a biological threat or attack” (see section 319F(a)(1)(F), as added by section108 of the Public Health Security Act). It is clear that, without further clarification and delineation of functions in H.R. 3266, the bill may engender activities that duplicate statutorily mandated initiatives of HHS.

To advise the Secretary of Homeland Security on establishing essential capabilities for terrorism preparedness at the state and local level, the Task Force on Essential Capabilities is expected to produce a draft report of recommendations “for the essential capabilities all State and local first responders should possess, or to which they should have access, to enhance terrorism preparedness”.

Although the proposed legislation does not identify public health professionals and health care providers as first responders, the bill does identify such individuals as members of the Task Force. We assume that, as members of the Task Force, these public health and medical professionals would contribute to the identification of “essential capabilities for state and local preparedness for terrorism”. We further assume that their contributions would most likely be in their areas of expertise and experience.

At a time in which states and local jurisdictions are looking to the Federal Government to provide clear and explicit guidance in all areas of terrorism preparedness and response, I cannot overemphasize the importance of providing clear and consistent federal recommendations and guidelines. We recommend, therefore, that the proposed legislation be revised to include language that would explicitly identify the Secretary of Health and Human Services among those with whom the Secretary of Homeland Security must consult when establishing “essential capabilities”.

New section 1806 as added by of H.R. 3266 directs the Secretary of Homeland Security to “support the development of, promulgate and update” a series of “national voluntary consensus standards” for first responder equipment that is to be supported by the homeland security grants envisioned in the bill.

Currently, funds awarded to the states by HHS for public health preparedness and hospital readiness may be applied to the purchase and acquisition of certain equipment. Some of this equipment appears to fall within H.R. 3266’s definition of first responder equipment; for example, equipment for biological detection and analysis, chemical detection and analysis, decontamination and sterilization, personal protective equipment, respiratory protection, interoperable communications, and data networks. Furthermore, the HHS Working Group is currently tasked with “development of shared standards for equipment to detect and to protect against biological agents and toxins.”

For the “required categories” of equipment that the Secretary of Homeland Security is directed to consider for the development of national voluntary consensus standards, we recommend modifying the language to circumscribe the type of equipment as “first responder equipment intended for use in the field”. This would eliminate coverage of equipment used in hospitals and other facilities, e.g., biological safety cabinets in clinical laboratories and mass spectrometers in chemical laboratories.

H.R. 3266 does not include a definition for “national voluntary consensus standards.” Consequently, it is not clear what is meant or covered by this phrase. Moreover, will these standards be truly voluntary, that is to say, are they to be adopted at the discretion of the states or local jurisdictions? If so, this may create a number of technical as well as compliance problems for the user communities.

To maximize the likelihood that DHS and HHS will develop a set of mutually consistent standards for essentially the same equipment, we recommend that this provision of the bill be revised to state that the two Departments shall collaborate in jointly developing standards for equipment that will be used by both DHS funded first responders and HHS-supported state and local health departments, hospitals and supporting health care entities.

New section 1806 also calls upon the Secretary of Homeland Security to support the development of, promulgate and regularly update national voluntary consensus standards for first responder training. Within its own programs, HHS continues to work towards ensuring the most effective application of funding to training and education efforts at the state and local levels. Without exception, every jurisdiction funded by HHS for bioterrorism preparedness and response is planning and implementing education and training activities, some of which are carried out jointly with traditional first responders.

In this arena, the HHS Working Group is also tasked with the “development and enhancement of the quality of joint planning and training programs that address the public health and medical consequences of a biological threat or attack on the civilian population between (i) local firefighters, ambulance personnel, police and public security officers, or other emergency response personnel (including private response contractors); and (ii) hospitals, primary care facilities, and public health agencies.” This area of overlap between DHS and HHS provides a clear opportunity for coordination and collaboration between the two Departments. Since a response to any kind of terrorist attack will require a seamless response among all emergency responders, joint training and exercises involving public safety and law enforcement personnel as well as public health and health care workers in a variety of scenarios are both appropriate and feasible.

To ensure the effectiveness of such joint efforts, it is essential that the national voluntary consensus standards reflect the appropriate roles of all response personnel. To this end, the development of these standards should involve not only DHS and HHS but also relevant professional organizations (both those identified in new section 1806 and the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations, and the American College of Emergency Physicians), government agencies such as the Occupational Safety and Health Administration, and others.

It is critical that, in supporting the enhancement of state and local emergency response capabilities and capacities, DHS and HHS provide guidance to their respective awardees that is mutually consistent and reinforcing. To that end, we recommend the insertion of language in HR3266 requiring the Secretary of Homeland Security to consult with the Secretary of HHS and requiring the Task Force on Essential Capabilities to coordinate with the Working Group on Bioterrorism to ensure that, to the extent possible, the development of “national voluntary consensus standards” for both equipment and training is a collaborative and coordinated process. This would minimize, if not eliminate, any duplication of effort and inconsistency in recommendations.

Given the mission of the Department of Homeland Security and the goals of the HHS bioterrorism preparedness and response programs, there are naturally a variety of opportunities for collaboration. We have taken advantage of many of these. At the same time we are mindful of the mandates of our own authorizing legislation, the Public Health Security Act, which directs HHS to carry out a broad array of tasks intended to prepare the nation to respond more effectively to bioterrorism, other outbreaks of infectious diseases and other public health threats and emergencies. Thus language in H.R. 3266 should not alter, or impede the ability to carry out, the authorities of the Department of Health and Human Services to perform its responsibilities under law.

Thank you. I will be glad to respond to any questions that the Subcommittee may have.

Last Revised: May 11, 2004