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C O N T E N T S
June 23, 2010

Emergency Preparedness: Evaluating the U.S. Department of Veterans Affairs' Fourth Mission

OPENING STATEMENTS

Chairman Harry E. Mitchell
    Prepared statement of Chairman Mitchell
Hon. David P. Roe, Ranking Republican Member
    Prepared statement of Congressman Roe

WITNESSES

U.S. Department of Health and Human Services, Kevin Yeskey, M.D., Director, Office of Preparedness and Emergency Operations, Deputy Assistant Secretary, Office of Preparedness and Emergency Response
    Prepared statement of Dr. Yeskey
U.S. Department of Homeland Security, Federal Emergency Management Agency, Steven C. Woodard, Director of Operations Division, Response Directorate
    Prepared statement of Mr. Woodard
U.S. Department of Defense, Captain D.W. Chen, M.D., MPH, USN, Director of Civil-Military Medicine, Force Protection and Readiness Policy and Programs, Office of the Assistant Secretary of Defense for Health Affairs
U.S. Department of Veterans Affairs, Hon. José D. Riojas, Assistant Secretary for Operations, Security, and Preparedness
    Prepared statement of Mr. Riojas

American Legion, Barry A. Searle, Director, Veterans Affairs and Rehabilitation Commission
    Prepared statement of Mr. Searle
American Red Cross, Washington, DC, Neal Denton, Senior Vice President, Government Relations and Strategic Partnerships
    Prepared statement of Mr. Denton
bt Marketing, The Woodlands, TX, John N. Hennigan, President and Chief Executive Officer
    Prepared statement of Mr. Hennigan
Healthcare Coalition for Emergency Preparedness, Washington, DC, Darrell Henry, Executive Director
    Prepared statement of Mr. Henry

EMERGENCY PREPAREDNESS: EVALUATING THE U.S. DEPARTMENT OF VETERANS AFFAIRS' FOURTH MISSION

Wednesday, June 23, 2010
U. S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:05 a.m., in Room 334, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding.

Present:  Representatives Mitchell, Adler, and Roe.

OPENING STATEMENT OF CHAIRMAN MITCHELL

Mr. MITCHELL.  Good morning, ladies and gentlemen.  The Committee on Veterans' Affairs, Subcommittee on Oversight and Investigations, hearing on Emergency Preparedness:  Evaluating the U.S. Department of Veterans Affairs' (VA's) Fourth Mission will come to order.  This hearing is held on June 23, 2010.  I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks, and that statements may be entered into the record.  Hearing no objection, so ordered.

I would also like to recognize Terry Araman, a veteran from Arizona, who is in attendance today.  I want to personally thank Terry for your service and the good work you are doing to help veterans, especially the homeless veterans back home in Phoenix.  Would you please stand, Terry?  Thank you.

[Applause]

On September 11, 2001, we witnessed one of the greatest tragedies in American history.  Still today we all remember the horrific scenes of these terrorist attacks.  Four years later in 2005, the Gulf Coast was hit by one of the biggest natural disasters the region has ever seen as Hurricane Katrina swept through the region, killing thousands and leaving many homeless and displaced.  And sadly again, today, we see Gulf States struggling with yet another major disaster as the oil continues to spill.

These types of events highlight the critical need for Federal agencies to proactively prepare to effectively execute their Federal obligation, especially when called upon during emergencies.  Today we will evaluate and examine the U.S. Department of Veterans Affairs' emergency management, preparedness security, and law enforcement activities to ensure the Department can perform the mission essential functions under all circumstances across the spectrum of threats, including natural disasters. 

With several health care facilities and hundreds of doctors and health care professionals, the VA emergency preparedness posture, also known as the Fourth Mission, must be able to respond when needed and when called upon.  The Federal Response Plan (FRP) is an important mechanism for providing coordination of Federal assistance and resources to areas that have been overwhelmed by disaster and emergency situations while supporting the implementation of the Robert Stafford Disaster Relief and Emergency Assistance Act.  The VA's Office of Operations Security and Preparedness is responsible for directing and providing oversight for the Department's planning, response, and security programs in support of the FRP.

I am looking forward to hearing from the VA their emergency preparedness plans and how they coordinate and communicate with the other agencies, such as the Federal Emergency Management Agency (FEMA) and the U.S. Department of Health and Human Services (HHS), who are here today, to carry out their Fourth Mission.  Every day we are reminded of the potential threats that are out there that may disrupt the American way of life and the freedoms we enjoy each day.  The VA must be prepared to respond to these threats and offer their full support and resources to ensure that their role in the Federal Response Plan is integrated with other agencies to execute its mission.

[The prepared statement of Chairman Mitchell appears in the Appendix.]

Mr. MITCHELL.  Before I recognize the Ranking Republican Member for his remarks I would like to swear in our witnesses.  I ask that all witnesses from all three panels if they would please stand and raise their right hand?

[Witnesses sworn.]

Mr. MITCHELL.  Thank you.  I would now like to recognize Dr. Roe for opening remarks. 

OPENING STATEMENT OF DAVID P. ROE

Mr. ROE.  Thank you, Mr. Chairman, and thank you for holding this hearing today.  Early in this decade our country faced two major incidents that reinforced the need for emergency preparedness.  On September 11, 2001, our country was attacked in a blatant act of terrorism as the World Trade Centers in New York fell and the Pentagon burned.  The first responders were called to action and a Nation mourned.  Again in 2005, Hurricane Katrina struck the Gulf Coast with an unprecedented fury.  People's homes were flooded or ripped apart and major evacuations occurred.  The Gulf Coast is still rebuilding today.

Since the attacks of 9/11, the Committee on Veterans' Affairs has held four hearings on the subject of emergency preparedness.  The last hearing was held on August 26, 2004.  Today we will reexamine the role performed by the Department of Veterans Affairs in emergency preparedness and its response to national crisis, whether the role continues to need serious upgrading or updating and reform. 

In particular we will focus on the VA's role during wartime, natural disasters, or major terrorist attacks on U.S. soil.  While FEMA and the Department of Health and Human Services tend to take the lead role when an emergency occurs, one cannot deny the large importance of emergency preparedness at the VA.  With 153 hospitals and hundreds of outpatient clinics spread across the country, VA stands in a unique position to provide emergency medical assistance in the event of an emergency. 

VA has defined roles currently in both the National Disaster Medical System (NDMS) and the National Response Framework (NRF)  in the event of national emergencies.  Among the specialized duties of the VA are conducting and evaluating disaster and terrorist attack simulation exercises; managing the Nation's stockpile of pharmaceuticals for biological and chemical toxins; maintaining a rapid response team for radiological events; and training public and private National Disaster Medical Systems, medical center personnel in responding to biological, chemical, or radiological events.  Among the emergency support functions (ESF) assigned to VA, which relate directly to the mission of the VA, are ESF 6, which includes mass care, emergency assistance, housing and human services; and ESF 8, which includes public health and medical services. 

I am interested in discovering today what VA has learned from the events of 9/11, Katrina, and Hurricane Isabel, and how their roles relate to the overall emergency response mechanisms. 

Following Hurricane Katrina in September of 2005, the Speaker of the House called together a special Bipartisan Committee to Investigate the Preparedness For and Response to Hurricane Katrina.  The report, "A Failure of Initiative," was issued on February 15, 2006.  I understand that Ranking Member Buyer was selected as a part of that Committee and worked on the report, and one of our own Subcommittee staff, Mr. Wu, was detailed to work on the bipartisan investigative committee.  I expect that we will hear from the Department that improvements have been made following this report as well as on recommendations made by the report from the Office of Inspector General (OIG) issued in January of 2006. 

I am also curious as to what the VA commitment is to emergency management with both dollars and manpower. 

And again, Mr. Chairman, I appreciate your holding this important meeting.  And it is my hope that there will be good news, this will be a good news hearing that the VA is much better prepared to handle emergencies that come in the future. 

And just as a point, both the Chairman and myself have been mayors of our respective cities at home.  And after 9/11 as the local City Commissioner and as a physician, and having a VA in our community, we were assigned, or really I assigned myself, to really evaluate local preparedness.  And it was woefully inadequate, I found out.  Whether it be smallpox, when I got myself immunized, whether it be H1N1, I know on a local level, where the boots hit the ground, we have made huge strides in being able to meet these needs.  And I look forward today, Mr. Chairman, I know you have dealt with this as the Mayor of Tempe, and I look forward to hearing the testimony. 

[The prepared statement of Congressman Roe appears in the Appendix.]

Mr. MITCHELL.  Thank you, Dr. Roe.  At this time I would like to welcome Panel One to the witness table.  Joining us on our first panel is John Hennigan, President and Chief Executive Officer for bt Marketing; Darrell Henry, Executive Director of the Healthcare Coalition for Emergency Preparedness; Barry Searle, Director of Veterans Affairs and Rehabilitation Commission for the American Legion; and Neal Denton, Senior Vice President for Government Relations and Strategic Partnerships of the American Red Cross.  And I ask that all witnesses please stay within the 5 minutes of their opening remarks, and your complete statements will be made part of the record. 

First I would like to recognize Mr. Hennigan. 

STATEMENTS OF JOHN N. HENNIGAN, PRESIDENT AND CHIEF EXECUTIVE OFFICER, BT MARKETING, THE WOODLANDS, TX; DARRELL HENRY, EXECUTIVE DIRECTOR, HEALTHCARE COALITION FOR EMERGENCY PREPAREDNESS, WASHINGTON, DC; BARRY A. SEARLE, DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; AND NEAL DENTON, SENIOR VICE PRESIDENT, GOVERNMENT RELATIONS AND STRATEGIC PARTNERSHIPS, AMERICAN RED CROSS, WASHINGTON, DC

STATEMENT OF JOHN N. HENNIGAN

Mr. HENNIGAN.  Thank you, Mr. Chairman.  Chairman Mitchell and Members of the Subcommittee, I would like to thank you for the opportunity to come here today as a citizen who has been involved with not just the medical industry here and abroad, but as an elected official in Montgomery County, Texas.

I have been fortunate enough to travel extensively throughout South America, Europe, and here in the States in the health care arena.  I have witnessed firsthand the differences between government facilities and those in the private sector, and can state without question that improvements I have seen in the VA facilities.  A perfect example is the Michael E. DeBakey VA Medical Center (VAMC) in Houston, Texas.  Prior to this health care system being built, in my opinion, our facilities were old and less than adequate for the veterans in our area. 

Before going into my testimony I would like to give this Subcommittee a brief background of myself for you to have a better understanding of why I feel privileged to be able to speak to the future needs of our veterans, and to offer a fresh pair of eyes to emergency preparedness and planning within the VA Department going forward. 

I mentioned earlier that I am an elected official in Montgomery County, Texas.  I am a Board Member of the Montgomery County Hospital District (MCHD) and have been since 2006.  I am currently serving as Vice Chair of this Board for my third consecutive year and in addition Chair our Legislative Committee.  The Montgomery County Hospital District is the sole provider of emergency ambulance service for Montgomery County, Texas, serving a rapidly growing population of 460,000 residents.  MCHD responds to 42,000 calls for service each year. 

The Montgomery County Hospital District serves a pivotal role during disaster response.  The agency and staff has taken a lead role in developing the tools to coordinate emergency medical service (EMS), mass response for coastal community evacuation, and post-land fall responses.  MCHD dispatch center was the coordinating point for the mass EMS response into East Texas following Hurricane Rita.  The lessons learned from that incident contributed greatly to the Statewide success during Hurricane Ike, the largest EMS deployment in United States history. 

MCHD coordinates public health preparedness and medical branch operations in Montgomery County during large scale operations, including the 2009 H1N1.  Currently, MCHD is coordinating a regional effort to develop EMS mass response to no notice catastrophic situations as part of the regional catastrophic planning grant program.  Our Hospital District Chief Executive Officer serves as the Chairman of the Southeast Texas Regional Advisory Council.  This organization is the grant recipient and administrative entity overseeing hospital preparedness using funding for the nine counties of the Houston region. 

Mr. Chairman, Subcommittee Members, my company has been involved with several start up organizations or corporations that are attempting to rise to another level.  These companies have asked me to come in and assess current status, where they have been, set goals to achieve where they would like to get.  Through this process I have had clients who have benefitted by programs that were well intended but lacked long-ranged planning.  The reason I am here today is that I believe that I can plant the seed for new ideas in the hope that this Committee, and our Veterans Affairs Department, can nurture those ideas to benefit our veterans.

And finally, I want to once again thank you for this opportunity to testify before this Subcommittee. 

[The prepared statement of Mr. Hennigan appears in the Appendix.]

Mr. MITCHELL.  Thank you very much.  Next, Mr. Henry?

STATEMENT OF DARRELL HENRY

Mr. HENRY.  Thank you for inviting us to testify today.  Natural disasters such as earthquakes, hurricanes, and floods are often frequent reminders that we must be prepared when disaster strikes.  And since 2001 the Nation has understood the importance of planning for acts of aggression against innocent citizens.  The Healthcare Coalition for Emergency Preparedness was formed in an effort to raise awareness and educate people about often overlooked issues in plans to maintain health care facility operations during a crisis, and to develop efficient methods to reduce health care costs in that area.  One of the largest hindrances to what we call operational security revolves around transportation constraints to the hospital itself, or such impacts on key suppliers and vendors. 

While we address a lot of issues in our full testimony today I would like to focus on one of the issues we have found often overlooked in operational sustainable planning, and that is adequate attention relating to the safe disposal of regulated medical waste, also known as infectious waste. 

Until the mid-1990's, most health care facilities incinerated materials onsite, but the Federal Government banned that practice.  The current practice for most health care facilities is to manage infectious and contagious waste by transporting such materials over our Nation's highways, through our cities and neighborhoods, by non-clinical commercial truck drivers to a regional facility to be treated and disposed of.  Under a widespread community emergency, facilities would be inundated and supply management would be stressed.

The Joint Commission requires health care facilities to be self-sufficient for 96 hours.  However, the volume of hazardous medical waste would dramatically increase when there is a surge on a hospital's capacity due to a large population suddenly contracting a contagious disease, such as in a pandemic, or a natural, or manmade disaster.  In addition, the U.S. Government Accountability Office (GAO) and other reports have warned that waste disposal would be near impossible for quarantined or isolated health care facilities that have outsourced the responsibility of sterilizing contagious materials. 

Because the primary method of controlling the spread of infection and avoiding pandemic is quarantining, the developing of an onsite approach to waste disposals appears to be the most appropriate one.  Further, various reports by health officials and other experts have recognized that onsite medical waste treatment is the best practice for emergency preparedness and pandemic response.

Taking an onsite sustainability approach not only helps address a hospital's ability to handle a crisis, but also issues with offsite providers that would occur in the case of a pandemic or crisis.  Vendor problems, including transportation constraints and staff shortages, would be out of control of a health care facility.  Fortunately, modern, affordable technologies exist that can cleanly, safely, and economically sterilize infectious and contagious medical waste on the premises of health care facilities. 

We would also like to point out that installing onsite waste sterilization equipment at VA facilities would provide ancillary and immediate benefits for the VA beyond emergency preparedness, including cost savings and carbon emission reductions.  Expenditures for onsite treatment of infectious waste is perhaps the only preparedness tool that would pay for itself from the day of installation as this equipment often produces a return on investment, a pay back between 18 and 36 months.

We estimate that onsite treatment using sterilization equipment can produce an average cost savings of $1.6 million per hospital, which would equate to about $190 million if installed at all 117 VA medical center hospitals that are currently relying on offsite vendors to haul and treat their waste.  Further, regarding the VA's ability to comply with Executive Order 13514 to reduce carbon emissions, the Coalition has developed a carbon footprint calculator that can calculate in real numbers the reduction in pounds of CO2 emissions each year for those facilities that install onsite waste processing.

We have constructively urged that onsite sterilization capabilities be added to the VA's list of best standards and practices, as well as to the list of mission critical components in their emergency plan.  Currently, 24 VA facilities process their waste onsite.  We know that many facilities would like to add this component to their capital budgets but thus far have not done so.  We do know that there are groups within the VA that are looking at this very issue and recognize that onsite medical waste treatment could benefit VA facilities from an everyday operational aspect as well as emergency preparedness. 

Our Nation remains vulnerable in the area of contagious waste management during a pandemic or crisis.  We have produced alternatives that should be a best practice for emergency preparedness and facility operations at the VA.  Again, thank you for the opportunity and I look forward to your questions.

[The prepared statement of Mr. Henry appears in the Appendix.]

Mr. MITCHELL.  Thank you, Mr. Henry.  Next, Mr. Searle?

STATEMENT OF BARRY A. SEARLE

Mr. SEARLE.  Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to present the views of the American Legion concerning this extremely important, but sometimes neglected topic.  The American Legion applauds the foresight of this Subcommittee in bringing this topic back to a place of importance.

As was seen during Hurricane Katrina, the flooding in Oklahoma City and Nashville this year, as well as Iowa, and the Dakotas last year, and tornadoes across the U.S., a natural disaster is only days, hours, or minutes away.  Additionally, a weapon of mass destruction can turn an urban area into a mass casualty area, crippling communications and overwhelming traditional emergency services.  Prior planning and coordination are the difference between managing a disaster effectively and adding to the chaos and suffering. 

The Department of Veterans Affairs has developed policies and has given guidance concerning emergency preparedness.  There is no question that the VA Central Office understands and accepts its responsibility to prepare for and execute its Fourth Mission, support of national emergency preparedness.  While the American Legion applauds VA for its approach to preparedness, we are concerned that there may be a lack of oversight and feedback at the regional office, Veterans Integrated Service Network (VISN), and facility levels.  The American Legion is concerned that preparedness may be overshadowed by primary day-to-day operations.  This would potentially lead to confusion and delay in a disaster situation in an attempt to organize a response. 

A January 2006 OIG report on emergency preparedness in Veterans Health Administration (VHA) facilities stated that at the national level VHA has developed comprehensive initiatives and directives to address emergency preparedness training, community participation, and decontamination activities.  However, at the facility level, VA employees do not consistently receive emergency preparedness training and emergency plans do not always include some critical training elements as required. 

VA's Emergency Management Strategic Healthcare Group has as part of its mission statement an approach that, “assures the execution of VA's Fourth Mission, to improve the Nation's preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to veterans as well as to support national, State, and local emergency management, public health, safety, and homeland security efforts.” 

VA's 2009 Emergency Management Guidebook, a well-organized framework identifying duties and responsibilities, goes into great detail concerning training to include sample scenarios, which cover a wide range of incidents including hurricanes, earthquakes, multiple bus accidents involving numerous injuries.  What we were not able to determine is a feedback mechanism to confirm implementation at the regional office, VISN, or facility level.  The American Legion's System Worth Saving Task Force annually conducts site visits at VA Medical Centers nationwide to assess the quality and timeliness of VA health care.  We have found there is a wide range of actual response preparedness across VHA.  We believe that this range is symptomatic of the decentralized nature of VA. 

The American Legion and other veterans service organizations have been briefed on 38-foot vans primarily tasked with providing veterans counseling outreach, but specifically designed and adapted for medical purposes during disaster relief efforts.  In particularly, each has satellite communications capability critical in a disaster situation.  This is an excellent program that shows how a specific component can be utilized to fulfill multiple roles when the demand exists.  During 2009, massive flooding which overwhelmed portions of the Midwest, in Fargo, North Dakota, where regular VA Medical Center operations were impacted by the flooding, VA dispatched three mobile Vet Centers for use as triage clinics to help bridge the gap for the community until regular operations could be restored.  However, during recent discussions with a group of facilities directors it was found that some had no knowledge of the mobile clinics' existence.  Such a valuable resource must be a part of a ingrained knowledge of any facility director or the value of these tools will be lost.

Also, the Atlanta Medical Center coordinated with and utilized staff members at local hospitals to provide medical services for individuals injured in the Haitian earthquake under the National Management Disaster Assistance Program.  Unfortunately, we have also found that at the local level there is in some cases a lack of awareness of the responsibility of facilities to prepare for non-veteran casualty assistance.  Additionally, it was discovered that turnover and shortage of personnel at most facilities require emphasis on standardized procedures, quality review, and individual training, as well as documentation of that training. 

Emphasis on rural health care clinics and telehealth in order to assist veterans will continue to expand the VA's outreach and disburse critical assets and make them available in the case of an emergency.  As was shown during the flooding in Fargo, North Dakota, should a VAMC's operation be degraded due to natural disaster, a relatively close rural clinic or clinics with functional telecommunications could be developed as a staging area for direct resources and to some degree triage areas for evacuating casualties until the VAMC could resume full operation.

In conclusion, the American Legion realizes the importance of VA's Fourth Mission, not only to the veterans that the VA serves but to the Nation as a whole.  In our resolution in 2008 we urged the Secretary of Veterans Affairs to take an active role in development and implementation of plans to enhance Federal homeland security initiatives, and that Congress provide VA with the funding necessary to further enhance its capability to act as a backup to the U.S. Department of Defense (DoD) and FEMA.  We believe that at the national level VA is serious in this mission.  However, we feel that additional follow up and reporting on activities on the local level is essential to ensure that Central Office policies actually are being executed.

Thank you again for the opportunity to provide insight and analysis on this issue on behalf of the American Legion and its more than 2.5 million members.

[The prepared statement of Mr. Searle appears in the Appendix.]

Mr. MITCHELL.  Thank you, Mr. Searle.  Mr. Denton?

STATEMENT OF NEAL DENTON

Mr. DENTON.  Good morning, Chairman Mitchell, Dr. Roe, Mr. Adler, thank you for your attention to emergency preparedness today.  Your timing is impeccable.  This is a critical time of the year, as the Red Cross is currently responding to tornadoes,  floods, and wildfires.  At the same time we are preparing for what looks to be a very active hurricane season.  I am going to highlight three points in my written testimony that speak a little bit to the partnership between the Red Cross, the Department of Veterans Affairs, and others here in this room when it comes to disaster response. 

You are familiar with our mission to provide relief and help communities prevent, prepare for and respond to emergencies.  What you may not know is that we meet our mission through a national network of nearly 700 chapters that respond to around 70,000 disasters annually.  That is about 200 disasters every day.  The Red Cross also provides support to members of the military, veterans, and their families, and supplies nearly half of the Nation's blood supply, and teaches life saving skills in communities across the country. 

The Red Cross is a charitable organization, not a government agency.  We depend on volunteers, and the generosity of the American public to perform our mission, including donations of time, of money, and of blood.  Whether it is a hurricane, or a heart attack, a call for blood, or a call for help, the American Red Cross is there.  And that is my first point.  Trained and experienced Red Cross volunteers and staff in your hometowns are on the front lines when emergencies occur in their communities.  Our national system supplements the local chapter presence with staff or additional resources whenever necessary.

My second point speaks to the importance of strong partnerships.  Identifying new partners and strengthening existing partnerships is a key priority for our organization. We strive to be an effective leader and valuable partner before, during, and after a disaster strikes.  In recent years, we focused more of our resources on coordinating and strengthening key relationships with our Federal partners like the VA and FEMA.  With support from FEMA, we have full time Red Cross employees to staff each of the FEMA regional offices, the National Disaster Housing Task Force, and FEMA headquarters.  In a disaster response capacity, the American Red Cross sits at the same table with the VA during planning and exercises and operations.  We both serve as a support agency for the National Response Framework, and work closely together on ESF 6, providing technical support for mass care, emergency assistance, housing, and human services. 

The VA and the Red Cross also are collaborating with the DoD, HHS, and FEMA as we develop a more reliable patient and evacuee tracking system.  The Red Cross is also excited about a possible opportunity with the VA to address the challenges of caring for loved ones who suffer from chronic illness or temporary or permanent disabilities.  Red Cross Family Caregiving and Nursing Assistant programs help develop skills in personal care, nutrition, home safety, and legal and financial issues.  Training builds confidence and instills knowledge that a caregiver will need when providing support to a veteran.

Our partner outreach extends beyond traditional disaster response agencies.  We are committing to fostering a culture of collaboration, diversity, and inclusion in all of our partnering efforts.  We continue to rely on a list of longstanding partners in a disaster, such as Southern Baptist Disaster Relief, Salvation Army, Catholic Charities, Hope Worldwide, the National Association for the Advancement of Colored People (NAACP), the National Council of La Raza, Legal Services Corporation, the National Baptist Convention, National Disabilities Rights Network, Save the Children, Tzu Chi Buddhist Foundation, and on and on.  These groups provide invaluable expertise and together, as partners, we continue to strengthen the country's capacity to better meet the needs of the diverse communities we serve.

My last point, and perhaps the most important point, is encouraging community and citizen preparedness.  Last summer the American Red Cross Emergency Preparedness Survey indicated that half of Americans have experienced at least one significant emergency where they have lost utilities for 3 days, they could not return home, they were unable to communicate with family members, or had to provide first aid to others.  Although 89 percent of those surveyed believe it is important to be prepared, far fewer are actually ready for an emergency.  Families need to gather together at the dinner table to make an emergency communication plan and identify a meeting place should they become separated during a disaster.

To help military families prepare for emergencies, the American Red Cross, FEMA, ready.gov, and others co-hosted the military family preparedness event held recently at Fort Belvoir, June 5th.  Together, we distributed some 1,500 preparedness kits to active duty, retired, Reserve soldiers and their families in the parking lot at the Post Exchange (PX).  This September, as part of the National Preparedness Month, we are planning to conduct similar events at three military installations across the U.S. and two locations overseas in order to raise awareness of being prepared and to help families prepare for emergencies.  It is a promising start but there is still much more we can do.

In conclusion, as we enter this 2010 hurricane season we are pleased to be working with FEMA's strong leadership team with Administrator Fugate and the leadership in the Executive Branch.  The Red Cross stands ready to help those in need.  We are working hard to improve our efficiencies and to increase individual community preparedness.  Thank you for allowing us to be here today.  I look forward to any questions you may have.

[The prepared statement of Mr. Denton appears in the Appendix.]

Mr. MITCHELL.  Thank you.  I have a question for anybody who would like to answer this.  In reviewing the National Response Plan there is a myriad of Federal resources called upon in response to a crisis.  How do we determine if the agencies will be able to work together?  Yes, just go ahead. 

Mr. HENNIGAN.  Thank you, Mr. Chairman.  I can speak from experience in Montgomery County when we had Ike occur.  We first had Rita hit the Gulf Coast and it was truly total confusion.  And what we found, contra lanes in the freeway to try to evacuate people on the Gulf Coast, was a disaster.  It was done too late.  Communications between EMS, fire stations, police, sheriff, State police, was inappropriate. 

Since that time, prior to Ike, we all went on the same frequencies.  We developed a program where contra flow of lanes were done well in advance versus a 24-hour mandate, get out of town.  So I think a lot of it is can the communities, in this case with the VA, can the community officials communicate to the VA's and vice-versa on the same frequencies?  Whether it is radio, whether there is a set plan or one organization that coordinates all the different entities as we are doing in Montgomery County right now.  Can that happen?  And when that happens, it just makes life a lot easier for everybody.  Because you only have one source to go to and they will do the, they will delegate the appropriate things to do. 

Mr. MITCHELL.  You know, there is again a myriad of agencies involved in all of the emergency preparedness.  And again, let me just ask others, how do we determine if these agencies are able to work together?  Sometimes I think there is a miscommunication of who has what role to play.  How can we determine that? 

Mr. SEARLE.  Well sir, as far as the DoD/VA interaction, one of the things that we see that is very positive is on a day-to-day basis now in the attempt to develop the lifetime virtual records.  It has established communications between DoD, VA, and the public sector, actually, as far as transferring public information on veterans.  The hope by the American Legion is that that will have started a crack in the dyke, if you will.  There is no question that stove piping exists and it has to be broken down through the national framework, response framework.  And people have assigned positions, jobs and responsibilities.  For example, the American Legion is not telling VA how to do that, but it is reasonable that they would be under the ESR 8 as a support function, that they would not be in a lead function in this case.  But there is a framework there for telling people what they should be doing and feeding into it.  But I think that VA has taken some serious steps into making a coordination with other entities, be it DoD and civilian doctors for example, which will eventually help with the system.  It is not going solve the whole thing but at least it is a starting point. 

Mr. DENTON.  Mr. Chairman, if you do not mind I would like to say something on this, too.  So much of this builds on exercises, the national level exercises that bring groups together for tabletop exercises in advance so that we get to know who the players are and what their capacities are, what it is they are going to bring to the table and what it is that they thought we were going to bring.  During these exercises, we discovered, “No, that is actually something we need to resolve somewhere else.”  So much of this really happens on a local level too. 

You know, I mentioned in my testimony the event we just held at Fort Belvoir, where we had a military family preparedness event.  At that parking lot there in the PX, all of the players who would respond to a disaster at Fort Belvoir were there.  It was a bright, sunny day and we were handing out preparedness kits.  But the other thing that was going on was we were meeting the others in the community who would be responding to a disaster if something were to happen there.  Having a chance to talk to each other, connect with each other, and talk a little bit about what our roles and responsibilities are if something were to happen.   The more of these that happen on a local level, I think, the more success we are going to have.

Mr. MITCHELL.  I just was looking at the Federal Response Plan and the VA has a support role, with four different agencies that have the primary response.  We have a support role with DoD, there is one with the American Red Cross, there is one with the General Services Administration (GSA), and also HHS.  And I just want to make sure that everybody understands their role, in a support of a primary role.  Thank you.  Dr. Roe?

Mr. ROE.  Just a brief comment, Mr. Chairman.  To start with, I think in my background as a battalion surgeon in the military, and as a physician, and we have a hospital, a VA hospital, a mile from our main hospital, a 500-bed hospital with a medical school in our community, and Mr. Denton you are absolutely right.  I have participated as a surgeon in mass casualties.  And they will overwhelm any system.  The planning has to start at your house.  In my home, we have a benevolent dictator, that is my wife.  But we have a communications plan in our own family that we get together.  As the Mayor of our city, just as the Chairman did, we have a book that establishes command and control.  You have to know who is in charge when you start.  When a disaster occurs there has to be someone who is responsible in a chain of command.  Otherwise, it is a disaster.  So we very carefully in our city planned and had many training exercises, on what happens if we have a hazmat spill on the interstate?  What happens if we have a smallpox outbreak?  I got myself re-inoculated to participate in that because I had to go down to the hospital and provide the health care that we need. 

So you are absolutely right.  All this nationally is good a few days later.  As I explained to the people at home, we have 150 police officers, we have 60,000 people in this town.  You do the math.  We cannot get by your house every day.  You are going to have to make sure you have water, blankets, canned food, and so on.  And we go over that, and we sent a briefing packet out to every family in our community that this is what you need to plan for.  And we have 110 firemen, and so on.  So that is correct.

These services come in later.  And obviously what you learn very quickly in a hospital is, is you do not, you know, your bunion now is not an emergency.  You put that off for 3 years, you can put it off another 3 years.  You stop all elective procedures and you go strictly to your emergency.  And even that will be overwhelmed very quickly in a mass casualty of over 25 or 30 people.  It does not take very many to overwhelm a system.

And I agree with the Chairman very clearly, you need to know who supports what because this is a very complicated national system and we found out the failures of it in Katrina.  And I think the local folks in New York City did an incredible job on 9/11.  I was absolutely amazed at how the local police, fire, and EMS did their job. 

A comment, Mr. Denton, on what you said.  If you would just, I will stop right there and let you make a comment, and then I have one more question, Mr. Chairman. 

Mr. DENTON.  Well, I agree entirely and I would take it one step further.  Once you have a plan for your family, once you have a plan for your loved ones, think of your neighbors alike the elderly resident across the street, or that person down the road who may have some disability that require some sort of special attention.  Are we thinking about those folks, too?  Because it might be 24, 48 hours before somebody can get down your street, before one of those Red Cross emergency response vehicles can come down the street.  How folks are prepared to take care of themselves and their community is the beginning of this entire discussion. 

Mr. ROE.  I think you are right.  I think you saw that in Nashville, when folks did take care of your neighbors.  That is a great point, and you do that.  I think, Mr. Henry, I mean just a couple of questions on the waste.  The reason I think hospital systems have done this is that they feel like it can be more efficiently done somewhere else.  If they felt like it would save them money I think they would do it.  And I would like to see some more data on that for VA.  Because if 24 VAs are doing that and I guess another 130 are not, then the question is if it saves money why has VA not done that?  I think local hospitals where we are typically turf this out because it saves them money.  They do it for that reason.  Not because of a mass casualty, they do it just for the, I mean, you may deal with one mass casualty or you may never deal with one. 

Mr. HENRY.  And that is why we looked at the cost estimates separate.  We found that when you install the stuff on site it is about a third less cost than shipping it offsite.  The offsite came as by accident, as a convenience when the Federal Government pretty much, vis-à-vis the Environmental Protection Agency regulations banned onsite incineration.  Most of the facilities shut down their incinerators as a temporary fix.  They moved to bringing in haulers to take the stuff offsite and treat it.  Over time, that function kind of moved into the environmental section of the hospital.  And it just became more of a janitorial exercise.  And when you are looking at installing this equipment this is capital budget costs, and the evaluation for purchasing capital budget costs are different.  And it is a multiple year thing.  And certainly on the first year basis to bring that in, the cost would be higher to install the capital equipment than that budget line item for that year to haul it offsite.  However, when we are looking, you know, over a 5-year payback period there is significant savings for the facilities themselves. 

Mr. ROE.  I am going to just very briefly, I would, I agree with that.  I mean, but any business would look at not just the first, if any business looked at capital costs the first year nobody would do anything, because nothing ever pays back, or if you are the luckiest human being in the world it pays you back in the first year, you have got it.  So I would like to look at that.  I think you said, I think we need further study on that.  If it saves the VA $190 million, we can look at the pros and cons of it. 

Mr. HENRY.  Okay, right.

Mr. ROE.  I yield back, and thank you.

Mr. MITCHELL.  Thank you very much.  And I thank you for your service to your communities, and for coming here today and testifying at this important event.  Thank you. 

Mr. HENNIGAN.  Mr. Chairman?  With your indulgence?

Mr. MITCHELL.  Sure.

Mr. HENNIGAN.  I was under the impression we would have an opening statement, and come back and give testimony.  I failed to give you the testimony that I have brought forth to this Committee.  It is in writing, it will certainly be in the record.  But if you could allow me the 3 minutes remaining on the time that I did not use to give my testimony?

Mr. MITCHELL.  Yes, go ahead.

Mr. HENNIGAN.  Thank you very much.  Mr. Chairman and Committee Members, in evaluating the request to speak to you today concerning emergency preparedness of the VA systems along with the companies I am involved with in both the private and public sector, I drew from our lessons learned in Montgomery County, Texas.  Those lessons taught us that there are key topics necessary to address in preparation of such catastrophes.  Those areas include communications, action, and review of the new programs available.

In our case in the Gulf Coast, hurricane season repeats itself every year so that preparation becomes a fine tuning issue versus starting from the unknown.  In my review of the VA Web site, I found it easy to find information and locate facilities.  This is a large part of the successes we have had in Montgomery County, with the ability to community with our residents and it falls under the communications necessary to serve the people the VA is charged with caring for.  The need for our veterans to be able to communicate to the VA is essential and in scrolling through the Web site there are several toll-free numbers to do this.  My question to this Committee, and I do not know the answer, is are we doing enough for them communicating using other forms of contact?

In addition, since every area of the country has known weather disasters, fires, mudslides, earthquakes in the west, tornadoes in the mid-section of our country, hurricanes and flooding in the Southeast and Northeast, are there plans in place through the Veterans Administration that educate our veterans where to go and what to do to prepare?  Since the Veterans Administration has divided the country into what I now know as 21 VISNs, would it be beneficial for each zone with known potential catastrophic issues to communicate to their constituency what to do, where to go, if such an issue occurs? 

Are our facilities prepared in case of catastrophic event in each zone?  An example, what we did after Rita was to identify what went wrong, and there was plenty, to determine how best to resolve those problems.  A few problems MCHD incurred during Rita that we addressed and solutions found: power outages, no fuel, no refrigeration, evacuation problems.  Again, I believe advance solutions can be found with our knowledge of weather-related issues in geographic areas in the United States. 

The new programs, does the VA integrate new communications programs to benefit our veterans on an ongoing basis?  Is it working with local officials with this communication?  Is there a method that rewards staff members that create programs to better serve our veterans?  What is the mission of the VA, and is it communicated with those who have to achieve it?  There are always entrepreneurs who can identify problems and create solutions.  Are we taking the opportunities available to them to introduce themselves and become aspire to the VA?  I was pleased locally to find out that there was support from the Veterans Affairs on H.R. 114, in assisting our veterans who have been inside the ropes, understand the problems, and have creative solutions.  Are we listening to them? 

And I will not go through the rest.  I know it is on the record, sir.  But I wanted just to take a chance to thank you again for allowing us to speak before this Committee, and hopefully come up with some solutions. 

Mr. MITCHELL.  I thank you, and those are very good questions.  Thank you very much..

At this time I would like to welcome Panel Two to the witness table.  For our second panel we will hear from Captain D.W. Chen, Director of Civil-Military Medicine, U.S. Department of Defense, who is accompanied by Christy Music, Director of Health Medical Policy, Office of Homeland Defense and Americas' Security Affairs, U.S. Department of Defense.  Also joining us is Dr. Kevin Yeskey, Deputy Assistant Secretary and Director for the Office of Preparedness and Emergency Operations, Department of Health and Human Services, and Steve Woodard, Director of Response Operations, Response Directorate, Office of Response and Recovery, Federal Emergency Management Agency, U.S. Department of Homeland Security (DHS). 

Because of a delay in DoD finding a witness that could speak to their role amongst other Federal agencies in emergency planning, they will not be giving an opening statement but will be available for questions.  

I would now like to recognize Dr. Yeskey for the Department of Health and Human Services. 

STATEMENTS OF KEVIN YESKEY, M.D., DIRECTOR, OFFICE OF PREPAREDNESS AND EMERGENCY OPERATIONS, DEPUTY ASSISTANT SECRETARY, OFFICE OF PREPAREDNESS AND EMERGENCY RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; STEVEN C. WOODARD, DIRECTOR OF OPERATIONS DIVISION, RESPONSE DIRECTORATE, FEDERAL EMERGENCY MANAGEMENT AGENCY, U.S. DEPARTMENT OF HOMELAND SECURITY; CAPTAIN D.W. CHEN, M.D., MPH, USN, DIRECTOR OF CIVIL-MILITARY MEDICINE, FORCE PROTECTION AND READINESS POLICY AND PROGRAMS, OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, U.S. DEPARTMENT OF DEFENSE; ACCOMPANIED BY CAPTAIN FRANCESCA C. MUSIC, MS, MS, MT (ASCP) SBB, DIRECTOR OF HEALTH MEDICAL POLICY, OFFICE OF HOMELAND DEFENSE AND AMERICA'S SECURITY AFFAIRS, U.S. DEPARTMENT OF DEFENSE

STATEMENT OF KEVIN YESKEY

Dr. YESKEY.  Chairman Mitchell and Dr. Roe, I appreciate the opportunity to testify today on my Department's role in the National Response Framework, and how we coordinate with the Department of Veterans Affairs in our response efforts.

HHS supports DHS as the overall lead in the coordination of incident response.  The HHS Secretary leads all Federal public health and medical response to emergencies and incidents covered under Emergency Support Function 8 of the National Response Framework.  Within HHS, ASPR, the Assistant Secretary for Preparedness and Response, coordinates the national ESF 8 preparedness and response actions, including medical care, public health surveillance, patient movement, and fatalities management.  In carrying out this responsibility, we depend on support from our interagency partners, including the Department of Veterans Affairs. 

There is a longstanding tradition of collaboration between HHS and VA staff in emergency preparedness activities, beginning with extensive collaboration on the creation and management of the National Disaster Medical System.  HHS deploys public health and medial assets to an affected area utilizing personnel from NDMS.  When NDMS Disaster Medical Assistance Teams that provide acute care for victims need to be augmented with additional clinicians, we have turned to the VA and they have provided us with appropriate personnel.  Most recently, the VA provided three surgeons and two anesthesiologists for our medical teams deployed in response to the earthquake disaster in Haiti.  In the hurricane season of 2008 VA provided personnel to completely staff two of our Federal medical stations. 

HHS, Department of Defense, and VA all have key functions in moving patients through the management of Federal Coordinating Centers (FCC), which recruit hospitals to participate in the NDMS and coordinate in the receipt of evacuated patients in host cities.  FCCs are critical to both patient movement and definitive care for those evacuated in a public health emergency.  During the 2008 hurricane season VA-managed FCCs coordinated the receipt of medically evacuated patients in Arkansas and Oklahoma.  When NDMS was activated for the Haiti earthquake, VA personnel coordinated the receipt and distribution of patients evacuated to Florida and Georgia to receive life saving definitive care.

HHS has developed playbooks for 14 of the 15 national planning scenarios as a guide to our response to disasters such as earthquakes and hurricanes.  The VA provides significant input into these playbooks as they are developed and revised.  At the request of the VA, HHS has placed a full-time liaison in the VA's Office of Public Health and Environmental Hazards to provide continuity of communications between the two Departments in the area of preparedness and response.  Similarly, the VA provides liaison officers to the HHS operations center when HHS responds to events.  Finally, HHS and VA participate in joint training exercises at a variety of levels.  Our regional emergency coordinators and VA area emergency managers participate in exercises at the State and local levels.  VA staff participate in tabletop exercises at the HHS headquarters level, and VA and HHS jointly participate in national level exercises.  VA staff also participate in our annual ESF-8 Integrated Training Summit.   

In conclusion, HHS regards the VA as an integral partner in our preparedness and response activities.  The VA has provided expertise in the development of our preparedness plans and clinical support needed for crucial medical care required by victims of disasters.  HHS's partnership with the VA is strong and extremely cooperative.  It is one that enables both Departments to serve our Nation in times of emergency.

Thank you for the opportunity to testify today, and I will be happy to answer questions that you may have. 

[The prepared statement of Dr. Yeskey appears in the Appendix.]

Mr. MITCHELL.  Mr. Woodard?

STATEMENT OF STEVEN WOODARD

Mr. WOODARD.  Yes, good morning, sir.  Chairman Mitchell, and Ranking Member Roe, and other Members of the Subcommittee, I am Steve Woodard, Director of Response Operations within the Response Directorate at the Federal Emergency Management Agency.  And we would look forward to our continuing work with Congress to ensure that our Nation is prepared for all disasters.

As you all know, incidents begin and end locally.  And most are wholly managed at the local level.  Cognizant of this, we must manage these events at the lowest possible jurisdiction, supported by additional capabilities when needed.  State and local governments are closest to those impacted by incidents, and have always had to lead in response and recovery.  During response, States play a key role, coordinating resources and capabilities throughout the State, and in obtaining resources and capabilities from other States.  Many incidents require a unified a response from local agencies, nongovernmental organizations, and the private sector, and some require additional involvement from neighboring jurisdictions or the State itself. 

A small number require Federal support.  To be mos