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Remarks as prepared; not a transcript
Testimony
Before the Committee on Government Reform
United States House of Representatives
“Meeting Our Nation’s Important Public Health Challenges:
Transformation of the Public Health Service Commissioned Corps”
Statement of
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
For Release on Delivery
Expected at 10:00 AM
on Thursday, 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 are 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.
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.
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.
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.
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