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Witness Testimony of Alan M. Miller, Ph.D., M.D., Tulane University, Interim Senior Vice President for Health Sciences, New Orleans, LA

Mr. Chairman and members of the Committee: Thank you for the opportunity to speak to you  about the importance of fully restoring accessible health care and benefits services to our region’s veterans and about Tulane’s historic and present role in the provision of that care. Almost 23 months have passed since Hurricane Katrina devastated our city and our healthcare system. While we’ve seen enormous progress in some areas, in other areas progress has come at a distressingly slow pace. At this juncture, our primary focus should be the timely re-establishment of the highest quality care possible for the men and women who have served our country.

The VA has been a valued Tulane partner for nearly 40 years and during that time our faculty, residents, and medical students have worked side by side with the VA in providing outpatient and inpatient care for the 23-parish region, the education of our future physician workforce, and cutting edge medical research.

Today, I’d like to focus my comments on four key areas:

  1. Provision of care at the VA pre-Katrina;
  2. The VA's and Tulane's roles in re-establishing medical care post-Katrina;
  3. The importance of the VA in medical research;
  4. Looking ahead to the biosciences
  1. Tulane and the VA – Before the Storm

Prior to Hurricane Katrina, Tulane University provided approximately 70 percent of the patient care at the VA, with more than 75 Tulane faculty physicians serving joint appointments with the VA in many medical, surgical, and psychiatric sub-specialties and advanced clinical services. These included geriatrics care, coronary intensive care and post-traumatic stress disorders.

Well-educated and trained physicians are essential elements in assuring access to quality healthcare services not only in New Orleans but throughout our country. Tulane’s mission of health care, medical education and research is intimately intertwined with that of the VA, and each institution depends upon the other for success.

Before August 2005, the VA Medical Center and Hospital in New Orleans provided training for approximately 140 residents, 120 of whom were from Tulane.

The VA's integration with the health sciences centers at Tulane and LSU provided a critical synergy that was a key strength both for the New Orleans VA and the region's overall health care standing. It also provided a vibrant environment in which groundbreaking research took place. For example, Dr. Andrew V. Schally of the VA and the Tulane School of Medicine achieved international recognition as a Nobel Laureate for Medicine or Physiology for research that opened the door to new research in contraception, diabetes and mental retardation, as well as depression and other human mental disorders.

In short, the VA, in tandem with the medical education programs at Tulane and LSU, had by August 2005 become a vital fixture in the healthcare landscape of New Orleans and the surrounding region, not only providing critical medical care but also playing a crucial role in graduate medical education and medical research.

  1. Re-establishing Medical Care, Post-Katrina

The actions of a number of local, state and federal agencies have been questioned in the aftermath of Katrina, but the VA is not among them. The VA’s swift response allowed the agency to successfully and safely evacuate hundreds of patients and employees as well as thousands of critical patient records. The presence of a significant number of Tulane faculty physicians, residents and staff was integral to the evacuation and crucial in re-establishing a presence in the community immediately following the storm.

Today, the VA’s outpatient clinics have reopened and visits are up to 75% of the pre-storm numbers. In addition, through its partnership with Tulane, the VA is now providing much-needed inpatient care at Tulane Hospital and Clinic as it strives to keep up with the rapidly expanding population. Currently, the VA is supporting an average of 26 Tulane residents per month who are involved in outpatient care. If more VA beds were available, Tulane would increase the number of residents there to 70.

Historically, Tulane Health Sciences Center faculty and staff have provided from 70 - 80% of the healthcare services at the area’s VA locations. In addition to our residents, more than 40 Tulane physicians are currently providing services and training at various VA locations in the area, representing more than $2.2 million in physician compensation alone. In addition, numerous other Tulane faculty physicians are frequently available for service at VA locations as needed. The Tulane’s Health Sciences Center is now actively recruiting new physicians to accommodate the increasing need in the area and has open searches for five faculty positions specifically to support the clinical mission at the VA.

Tulane physicians at the VA represent numerous specialties and subspecialties, including cardiology, clinical immunology, endocrinology, family medicine, gastroenterology, general internal medicine, hematology/oncology, internal medicine, nephrology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, psychiatry, pulmonology, radiation oncology, urology, and surgery.

  1. The VA, Medical Education and Research: Vital Partnerships

The VA Medical Center relies heavily on Tulane faculty to conduct important basic, clinical and translational research studies. In the year prior to Katrina, $1.2 million in VA-funded research projects were awarded, most of which were under the direction of Tulane faculty researchers. Tulane faculty had numerous clinical trials open at the VA prior to the storm in areas including cancer, diabetes and lung disease. Clinical research studies conducted at the VA Medical Center help ensure that our country’s veterans, and ultimately its citizens at large, reap the benefits of this nation’s substantial investment in cutting-edge treatments, technologies and pharmaceutical development.

  1. Looking Ahead: A Synergy of Innovation, Education and Health Care

As we look down the road five, 10, 20 years and longer, it’s clear that the VA will be a cornerstone in the future of health care and the biosciences industry in the region. These industries already represent a significant share of New Orleans’ regional economy. More than 8,000 people are employed in the bioscience and health related fields, with the metro area ranking 67th in the country. Although New Orleans is still behind bioscience giants such as the San Francisco Bay area, Boston, and Research Triangle in North Carolina, the metro area currently outranks other up-and-coming centers including Nashville, Birmingham, Louisville and Greenville, South Carolina.

Pre- and post-Katrina, the area’s bioscience institutions have been conducting cutting-edge research in areas such as gene therapy, cancer biology, peptide pharmaceutical design, and infectious diseases. Federal and private grant funding in New Orleans exceeded $180 million in 2003 and is growing substantially as New Orleans-based institutions capitalize upon their core strengths. In FY 2005, the New Orleans area accounted for $131.4 million in awards from the National Institutes of Health (NIH), representing 71% of the total amount awarded within the entire state of Louisiana and 82% of all NIH funding in the Gulf Coast region including New Orleans, the Mississippi and Alabama Gulf Coasts, and the Florida Panhandle. NIH investment in the area continues to grow.  Tulane University itself accounted for 46% of all NIH awards in the region from New Orleans through the Florida panhandle.

Prior to Hurricane Katrina, the New Orleans Bioscience District was actively building a framework for entrepreneurial success. As a crucial component of that framework, the Louisiana State University Health Sciences Center (LSUHSC), Tulane University (TU) and the State of Louisiana formed both the Louisiana Gene Therapy Research Consortium and the Louisiana Cancer Research Consortium (LCRC). These partnerships are focused on leveraging the universities’ research and education strengths to position the region as a leading center for clinical, biomedical and translational research, and to increase the area’s competitiveness for large-scale research projects funded by the National Institutes of Health. In support of the region’s efforts to expand its bioscience and biomedical infrastructure, the State of Louisiana also provided support for the creation of a 60,000-square-foot New Orleans BioInnovation Center (NOBIC). This center is designed to support the area’s growing bioscience community, to attract additional biotechnology investment, and to foster the commercialization of new technologies and pharmaceuticals developed in the vibrant New Orleans Bioscience District. With additional funding provided this year by the state legislature, construction will begin this fall in the downtown bioscience district on an $86 million cancer research facility, and the $60 million BioInnovation Center.

The synergy generated by Tulane, LSU, the construction of the BioInnovation Center and the LCRC building, each within a few city blocks of the other, will create a rich, dynamic teaching and research environment that will rival any in the country. A strong VA Medical Center is a crucial component of this burgeoning bioscience hub that will maximize the potential of both the district and of the VA. It is hard to imagine the district without the VA, and the VA being built anywhere but the district.

I want to thank each of you and your colleagues in Congress for demonstrating your strong commitment to re-establishing a permanent base of care for the region’s veterans in New Orleans by appropriating more than $600 million for a new state-of-the-art VA Medical Center. Although it may have taken longer than many of us would have hoped, the state too has done its part in providing funding for a public hospital to be built in tandem with the VA. This leverages the federal government investment, providing substantial cost savings and demonstrating good stewardship of taxpayer dollars. In addition, the investments by the state, city, and our own institutions in the emerging bioscience district provide a unique opportunity to create a vibrant inter-reliant collaboration among key healthcare, education and research entities, all of which are crucial to the VA’s mission. It is the hope of Tulane University, as well as that of the many local and regional stakeholders in the biosciences, that the VA and the City of New Orleans move quickly to begin the process of land acquisition, planning and construction so that we may re-establish the full spectrum of care for our rapidly growing veteran population.

Once again, I thank you for allowing me to speak to members of this Committee today. With your help, we will continue to bring health care in our city and region not just back to where it was, but into an even better future.