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Statement of

The Honorable Robert H. Roswell, M.D.

Under Secretary for Health

Department of Veterans Affairs

Before the

House of Representatives

Committee on Veterans’ Affairs

Subcommittee on Oversight and Investigations

on

VA’s Progress in Developing a Medical Education and Training Program

on the Medical Responses to the Consequences of Terrorist Activity

******

April 10, 2003 

            Mr. Chairman, I am pleased to be here to testify before the Subcommittee on the progress in the development of the medical education and training program mandated by section 3 of Public Law 107-287, the Department of Veterans Affairs Emergency Preparedness Act of 2002.  With me today is Dr. Susan Mather, VA’s Chief Officer for Public Health and Environmental Hazards.

            Implementation of section 3 of Public Law 107-287 has progressed more slowly than had been anticipated, due in large part to the uncertainty concerning language in VA’s FY 2003 appropriations bill.  Section 117 of H.R. 5605, as reported by the House, included language that would have prohibited the use of FY 2003 appropriations for implementation of all provisions of H.R. 3253, which was subsequently signed into law as Public Law 107-287.  However, the final language enacted on February 20, 2003, prohibited the use of funds provided for FY 2003 for implementation of only sections 2 and 5 of Public Law 107-287.  Accordingly, VA is now actively pursuing implementation of section 3, as well as the other, “non-prohibited” provisions.

Section 3 requires VA to carry out a program to develop and disseminate a series of model education and training programs on the medical responses to the consequences of terrorist activities.  That section further requires these programs to be modeled after programs established at DoD’s Uniformed Services University of the Health Sciences (USUHS).  At a minimum, these programs shall include emergency preparedness training for health care professionals.  They must also include, among other things, (1) training in the recognition of chemical, biological, radiological, incendiary, or other explosive agents, weapons, or devices that may be used in terrorist activities; and (2) identification of potential symptoms related to use of those agents, weapons, or devices.  The training would also be required to address short-term and long-term health consequences, including psychological effects that may result from exposure to such agents and the appropriate treatment of those health consequences.  The programs must be designed for a wide range of VA health care professionals in a variety of fields.

While the primary mission of the Veterans Health Administration (VHA) is to provide health care to our nation’s veterans, it also has a mission to provide education and training for health care professionals.  VHA conducts the largest coordinated education and training effort for health care professionals in the nation.  In this regard, VHA has affiliations with 107 medical schools and over 1,200 educational institutions.  In FY 2002, over 76,000 students received clinical training in VA facilities.  VHA provides educational services that are customer-based, accessible, performance measured, cost-effective and lead to the accomplishment of VA's organizational goals and objectives – providing high-quality health care and services to our nation's veterans.

Mr. Chairman, VA has committed to preparing its field administrators and health care providers to effectively respond and manage the challenges of terrorism, and we have made great strides to prepare VA employees for terrorism and emergency related crises.  We have provided several educational and training opportunities to educate employees in the event of another terrorist attack.  We have developed satellite broadcasts covering biological and chemical warfare issues and other educational tools and programs for those who may be charged to render care for victims of terrorist incidents.  We have collaborated with the Department of Defense on several joint educational initiatives.  We also have the capability, through our education infrastructure, to share the programs that we produce with others.  A listing of national initiatives that have been made available to VA employees is included on the Attachment to this statement.

As the Congress has recognized, it is critical that education and training programs be designed for a wide range of health care professionals.  To that end, the involvement of education and training experts and representatives of health care professions at all levels is essential in developing a comprehensive education response.  We have already had preliminary meetings with representatives from USUHS to explore collaborative endeavors.  VA has also developed an implementation plan, which we recently sent to the Subcommittee, and we will be meeting with USUHS representatives again to discuss the development of educational tools, materials, and programs that would be mutually beneficial to both parties.  We further intend to assemble a committee of experts to develop a plan to address priority educational needs through the use of multiple modalities consistent with section 3 of Public Law 107-287.

            Mr. Chairman, this concludes my statement.  Dr. Mather and I will be happy to respond to any questions that you or other members of the Subcommittee might have.

Attachment 

The following highlights a few of the programs and initiatives VA has developed since September 11, 2001, to provide emergency and terrorist related training to employees: 

1)                          VA’s Employee Education Service (EES) sponsored or co-sponsored 195 hours of instruction on biological, chemical and radiological agents that have a high probability of being used as weapons of mass destruction.  One hundred ninety-two hours of this instruction was targeted to clinical staff and three hours to administrative.

2)                          Eighty-five hours of instruction addressing response to use of Weapons of Mass Destruction (WMD) has been provided to an estimated 10,000 staff using distance-learning technology.

3)                          One hundred-ten hours of training have been provided to approximately 4,400 staff in face-to-face training sessions.  This includes two WMD conferences conducted in VISN 8 co-sponsored by the University of South Florida Division of Continuing Education in 2002 and 2003 with participants from federal, state, local and international groups.  This also includes participants in two National Disaster Medical System National Conferences involving VA, DoD, FEMA and HHS staff.

4)                          Eleven satellite broadcasts on chemical and biological agents have been provided.  Three of these utilized programming developed in whole or in part by the Department of Defense (DOD).  These programs are rebroadcast at different times of the day so that all employees have the opportunity to view them.  These programs are also taped and re-used in locally developed training programs.  An additional three broadcasts, scheduled for May, July and August, are being jointly developed by EES, the Department of Army Medical Research Institute of Infectious Diseases, and the VA Emergency Management Strategic Healthcare Group.

5)                          An inaugural VA Decontamination Training Course was held March 10- 14, 2003 in Reno, Nevada.  This weeklong session offered three days of basic emergency hospital decontamination operations, and two days of a train-the-trainer program that gives trainees important skills to take back to their facility.  Twenty-four staff from six VA medical centers completed the course.  Subsequent training courses will be held at the Little Rock, AK, and Bay Pines, FL, VA medical centers.

6)                          Last week, VA broadcast two satellite programs designed to address management of possible casualties of the current war with Iraq.  In addition, web-based materials will be made available to VA clinicians addressing both the physical and mental health aspects of war injuries.  Issues of biological attacks will be included, since the skills required to treat these types of injuries in combat casualties are, in most cases, identical to those needed to respond to a terrorist attack.

7)                          A number of products, web courses and training are in the VA Learning Catalog or currently under development.  This training resource is available to all VA facilities and VA employees in all locations.

8)                           VHA has developed laminated pocket cards to assist providers in managing patients with diseases possibly related to biological, chemical and radiological exposure in the context of terrorism.  The cards give providers proper information for better treatment of patients who have been exposed to these agents.  These are now available through the facility education contact and on the web.  Sixty thousand cards were produced at the first production and the requests for them have exceeded our supply.  Another order has been placed for immediate delivery to supplement the first one bringing the total of new requests to over 83,000.  These pocket cards have reached not only a VA audience, but DOD, other federal agencies as well as states and local agencies involved in the response to WMD

9)                           Last year EES began the development of continuing medical education programs which focus on the unique needs of those enlisted men and women who have served in areas of high risk (Veterans Health Initiative).  Currently there are 10 of these modules all of which also relate to caring for those who may be affected by weapons of mass destruction.  To keep abreast of current events in the Middle East, new VHI programs are under development which address Traumatic Brain Injury, and Post Deployment Health Care:  Biologic Warfare Agents.  Other programs will be developed as topics emerge from the battlefront and further potential uses of weapons of mass destruction are identified.