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[Senate Report 108-68]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 133
108th Congress                                                   Report
                                 SENATE
 1st Session                                                     108-68

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 POISON CONTROL CENTER ENHANCEMENT AND AWARENESS ACT AMENDMENTS OF 2003

                                _______
                                

                 June 11, 2003.--Ordered to be printed

                                _______
                                

    Mr. Gregg, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                         [To accompany S. 686]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 686) to provide assistance for 
poison prevention and to stabilize the funding of regional 
poison control centers, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and need for legislation.................................1
 II. Summary..........................................................2
III. History of legislation and votes in committee....................2
 IV. Explanation of bill and committee views..........................3
  V. Cost estimate....................................................3
 VI. Regulatory impact statement......................................4
VII. Application of law to the legislative branch.....................4
VIII.Section-by-section analysis......................................4

 IX. Changes in existing law..........................................5

                  I. Purpose and Need for Legislation

    Every year, approximately 122 children ages 14 and under 
die from unintentional poisoning. In 1992, more than 1.1 
million children under age 6 were poisoned. Of these 
poisonings, nearly a million were addressed by poison control 
centers over the phone.
    Currently, there are over 70 poison control centers 
nationwide. Since January 2002, these 70 poison control centers 
have fielded over 1 million phone calls. They commonly answer 
questions and concerns about what would typically be called 
poisonous products, such as cleaners and bleach. Children 
typically ingest household products, such as cosmetics and 
personal care products, cleaning substances, pain relievers, 
foreign bodies, and plants.
    Handling an average of one poison exposure every 15 
seconds, our Nation's poison control centers are critical to 
the communities that they serve. The specially trained staff of 
pharmacists and nurses at poison control centers regularly 
answer questions about poisonings, drug abuse, product 
contents, substance identification interactions, and adverse 
reactions.
    But poison control centers also can answer questions about 
products that people may not think are poisonous, including 
prescription or over-the-counter medications. Poison control 
centers can answer caller questions and direct the caller to 
seek medical attention if necessary.
    The 2001 Presidential Task Force on Citizen Preparedness in 
the War on Terrorism recommended that Poison Control Centers be 
used as a source of public information and public education 
regarding potential biological, chemical and nuclear domestic 
terrorism. This expanded role may increase demand for poison 
control centers during times of national crisis.
    The Poison Control Center Enhancement and Awareness Act 
Amendments of 2003 will provide the continued funding needed to 
ensure that the nationwide toll-free number stays up and 
running. The bill increases authorization--a total of $36 
million--for the Nation's poison control centers.

                              II. Summary

    The Poison Control Center Enhancement and Awareness Act 
Amendments of 2003 reauthorizes the activities of the Nation's 
poison control centers until 2009.
    Authorized activities include developing standardized 
poison prevention and poison control promotion programs; 
developing standard patient management guidelines for commonly 
encountered toxic exposures; improving national toxic exposure 
surveillance; expanding the toxicologic expertise within poison 
control centers; and improving the capacity of poison control 
centers to answer high volumes of calls during times of 
national crisis.
    In addition, the act maintains the national tool-free 
number, the nationwide media campaign to promote poison control 
center utilization, and allows for the implementation of a 
continuous toxicosurveillance of poison control center data.
    From its inception in 1983, the toxic exposure surveillance 
system has grown dramatically, with increases in the number of 
participating poison centers, populations saved by those 
centers and reported human exposures.
    These data collected by the system are used to identify 
hazards early, focus prevention education, guide clinical 
research, and direct training. The toxicosurveillance data have 
prompted product reformulations, repackaging, recalls and bans. 
The data are used to support regulatory actions and form the 
basis of post-marketing surveillance of newly released drugs 
and products.

           III. History of Legislation and Votes in Committee

    On March 21, 2003, Senator DeWine, for himself and Senators 
Murray, Landrieu, Breaux, Bingaman, Inouye, and Bunning, 
introduced S. 686, to reauthorize the Poison Control 
Enhancement and Awareness Act.
    On May 14, 2003, the committee held an executive session to 
consider S. 686. After agreeing to a single amendment, the 
committee approved S. 686 by unanimous voice vote.

              IV. Explanation of Bill and Committee Views

    The committee understands the importance of poison control 
centers and the bill reauthorizes the full scope of activities 
for the Nation's poison control centers as well as reauthorizes 
the nationwide toll free number and the media campaign.
    Publicizing the nationwide toll-free number (1-800-222-
1222) has increased awareness of poison control centers, 
resulting in a decreased number of unnecessary emergency room 
visits. With the toll-free number, parents can be confident 
knowing that no matter where they are with their children, the 
toll-free number will connect them with a poison control 
center.
    The committee authorizes the implementation of 
toxicosurveillance of poison control center data. 
Toxicosurveillance represents the collection of data relating 
to new and changing substances and commercial products that may 
be toxic. When a new product is developed, data on its 
potential toxicity will be collected by the toxicosurveillance 
program. As new products are constantly entering the market, it 
is critical that this data collection is up to date and widely 
disseminated to poison control centers nationwide.

                            V. Cost Estimate

S. 686--Poison Control Center Enhancement and Awareness Act Amendments 
        of 2003

    S. 686 would reauthorize the posion control program, which 
will expire in 2004, for the 2005-2009 period. That program, 
which is administered by the Health Resources and Services 
Administration, provides grants to regional poison control 
centers, maintains a toll-free poison information number, and 
conducts media campaigns to promote poison prevention. In 
addition to those activities, the bill would require the 
Secretary of Health and Human Services to help collect and 
analyze data from poison control centers.
    The bill would authorize the appropriations of $36 million 
in each of years 2005 through 2009 for the following purposes: 
$30 million per year for grants to poison control centers, $2 
million per year for the maintenance of the toll-free number, 
$1.5 million per year for the media campaign, and $2.5 million 
for data analysis. Based on past spending for this program, CBO 
estimates that implementing S. 686 would cost $11 million in 
2005 and $142 million over the 2005-2009 period, assuming the 
appropriation of the authorized amounts. Enacting S. 686 would 
have no effect on direct spending or receipts.
    This legislation contains no intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act. 
State, local, and tribal governments that operate poison 
control centers could benefit from some of the support 
activities authorized by the bill.
    The CBO staff contact for this estimate is Alexis Ahlstrom. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                    VI. Regulatory Impact Statement

    In accordance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the committee has determined that 
there will be minimal increases in the regulatory burden 
imposed by this bill.

           VII. Application of Law to the Legislative Branch

    The Committee has determined that there is no legislative 
impact.

                   VIII. Section-by-Section Analysis

Section 1. Short title

    Section 1 provides the short title of the bill, the Poison 
Control Center Enhancement and Awareness Act Amendments of 
2003.

Section 2. Findings

    Section 2 lists several Congressional findings to highlight 
the recent important role of poison control centers.

Section 3. Maintenance of a national toll free number

    Section 3 amends section 4 of the Poison Control 
Enhancement and Awareness Act to increase and extend the 
authorization for the toll free number. The amendment provides 
for $2,000,000 in funding for each of fiscal years 2005 through 
2009.

Section 4. Nationwide media campaign

    Section 4 amends section 5 of the Poison Control 
Enhancement and Awareness Act to increase and extend the 
authorization for the nationwide media campaign. The nationwide 
media campaign is designed to educate the public and health 
care providers about poison prevention and the availability of 
poison control resources in local communities. The change 
provides for $1,500,000 in funding for each of fiscal years 
2005 through 2009.

Section 5. Poison control center program

    Section 5 amends section 6 of the Poison Control 
Enhancement and Awareness Act to increase and extend the 
authorization for the regional poison control centers. The 
changes provides for $30,000,000 in funding for each of fiscal 
years 2005 through 2009.
    These grants are awarded to certified regional poison 
control centers for preventing and providing treatment 
recommendations for poisonings.
    In addition, the grants may be used for other improvements, 
including developing standardized poison prevention and poison 
control promotion programs; developing standard patient 
management guidelines for commonly encountered toxic exposures; 
improving national toxic exposure surveillance; expanding the 
toxicologic expertise within poison control centers; and 
improving the capacity of poison control centers to answer high 
volumes of calls during times of national crisis.
    Finally, the section authorizes the Secretary to waive 
certification requirements. Under this section, the Secretary 
may renew a waiver as long as the waiver and the renewal do not 
exceed 5 years.

Section 6. Nationwide toxicosurveillance of poison center data to 
        promote hazard detection

    Section 6 creates a new section 7 in the Poison Control 
Enhancement and Awareness Act. This section requires the 
Secretary to implement and maintain a national 
toxicosurveillance of poison control center data to detect new 
hazards from households products. The section clarifies that 
any contract or grant awarded under this section must be 
competitive. The Committee expects that contracts or grants 
awarded under this section be competed among any qualified, 
eligible entities, including professional organizations, 
universities, private research entities, and others. The 
section authorizes $2,500,000 for each of fiscal years 2005 
through 2009.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no changes is proposed is shown in roman):

           *       *       *       *       *       *       *

POISON CONTROL CENTER ENHANCEMENT AND AWARENESS ACT

           *       *       *       *       *       *       *

[SEC. 2. FINDINGS.

    [Congress makes the following findings:
          [(1) Each year more than 2,000,000 poisonings are 
        reported to poison control centers throughout the 
        United States. More than 90 percent of these poisonings 
        happen in the home. Fifty-three percent of poisoning 
        victims are children younger than 6 years of age.
          [(2) Poison control centers are a valuable national 
        resource that provide life-saving and cost-effective 
        public health services. For every dollar spent on 
        poison control centers, $7 in medical costs are saved. 
        The average cost of a poisoning exposure call is $32, 
        while the average cost if other parts of the medical 
        system are involved is $932. Over the last 2 decades, 
        the instability and lack of funding has resulted in a 
        steady decline in the number of poison control centers 
        in the United States. Within just the last year, 2 
        poison control centers have been forced to close 
        because of funding problems. A third poison control 
        center is scheduled to close in April 1999. Currently, 
        there are 73 such centers.
          [(3) Stabilizing the funding structure and increasing 
        accessibility to poison control centers will increase 
        the number of United States residents who have access 
        to a certified poison control center, and reduce the 
        inappropriate use of emergency medical services and 
        other more costly healthcare services.]

SEC. 2. FINDINGS.

    Congress finds the following:
          (1) Poison control centers are our Nation's primary 
        defense against injury and deaths from poisoning. 
        Twenty-four hours a day, the general public as well as 
        health care practitioners contract their local poison 
        centers for help in diagnosing and treating victims of 
        poisoning and other toxic exposures.
          (2) Poisoning is the third most common form of 
        unintentional death in the United States. In any given 
        year, there will be between 2,000,000 and 4,000,000 
        poison exposures. More than 50 percent of these 
        exposures will involve children under the age of 6 who 
        are exposed to toxic substances in their home. 
        Poisoning accounts for 285,000 hospitalizations, 
        1,200,000 days of acute hospital care, and 13,000 
        fatalities annually.
          (3) Stabilizing the funding structure and increasing 
        accessibility to poison control centers will promote 
        the utilization of poison control centers, and reduce 
        the inappropriate use of emergency medical services and 
        other more costly health care services.
          (4) The tragic events of September 11, 2001, and the 
        anthrax cases of October 2001, have dramatically 
        changed our Nation. During this time period, poison 
        centers in many areas of the country were answering 
        thousands of additional calls from concerned residents. 
        Many poison centers were relied upon as a source for 
        accurate medical information about the disease and the 
        complications resulting from prophylactic antibiotic 
        therapy.
          (5) The 2001 Presidential Task Force on Citizen 
        Preparedness in the War on Terrorism recommended that 
        the Poison Control Centers be used as a source of 
        public information and public education regarding 
        potential biological, chemical, and nuclear domestic 
        terrorism.
          (6) The increased demand placed upon poison centers 
        to provide emergency information in the event of a 
        terrorist event involving a biological, chemical, or 
        nuclear toxin will dramatically increase call volume.

           *       *       *       *       *       *       *

[SEC. 4. ESTABLISHMENT OF A NATIONAL TOLL-FREE NUMBER.]

SEC. 4. MAINTENANCE OF A NATIONAL TOLL-FREE NUMBER.

    (a) In General.--* * *
    (b) * * *
    (c) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $2,000,000 for 
each of the fiscal years 2000 through 2004 and $2,000,000 for 
each of fiscal years 2005 through 2009. Funds appropriated 
under this subsection shall not be used to fund any toll-free 
phone number described in subsection (b).

           *       *       *       *       *       *       *

[SEC. 5. ESTABLISHMENT OF NATIONWIDE MEDIA CAMPAIGN.]

SEC. 5. NATIONWIDE MEDIA CAMPAIGN TO PROMOTE POISON CONTROL CENTER 
                    UTILIZATION.

    (a) In General.--* * *
    (b) * * *
    (c) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $600,000 for each 
of the fiscal years 2000 through 2004 and $1,500,000 for each 
of fiscal years 2005 through 2009.

           *       *       *       *       *       *       *

[SEC. 6. ESTABLISHMENT OF A GRANT PROGRAM.]

SEC. 6. MAINTENANCE OF THE POISON CONTROL CENTER GRANT PROGRAM.

    (a) Regional Poison Control Centers.--The Secretary shall 
award grants to certified regional poison control centers for 
the purposes of achieving the financial stability of such 
centers, and for preventing and providing treatment 
recommendations for poisonings.
    [(b) Other Improvements.--The Secretary shall also use 
amounts received under this section to--
          [(1) develop standard education programs;
          [(2) develop standard patient management protocols 
        for commonly encountered toxic exposures;
          [(3) improve and expand the poison control data 
        collection systems;
          [(4) improve national toxic exposure surveillance; 
        and
          [(5) expand the physician/medical toxicologist 
        supervision of poison control centers.]
    (b) Other Improvements.--The Secretary shall also use 
amounts received under this section to--
          (1) develop standardized poison prevention and poison 
        control promotion programs;
          (2) develop standard patient management guidelines 
        for commonly encountered toxic exposures;
          (3) improve and expand the poison control data 
        collection systems;
          (4) improve national toxic exposure surveillance;
          (5) expand the toxicologic expertise within poison 
        control centers; and
          (6) improve the capacity of poison control centers to 
        answer high volumes of calls during times of national 
        crisis.
    (c) Certification.--* * *

           *       *       *       *       *       *       *

    (d) Waiver of Certification Requirements.--
          (1) In general.--* * *
          [(2) Renewal.--The Secretary may only renew a waiver 
        under paragraph (1) for a period of 3 years.]
          (2) Renewal.--The Secretary may renew a waiver under 
        paragraph (1).
          (3) Limitation.--In no instance may the sum of the 
        number of years for a waiver under paragraph (1) and a 
        renewal under paragraph (2) exceed 5 years. The 
        preceding sentence shall take effect as if enacted on 
        February 25, 2000.
    (e) * * *
    (f) * * *
    (g) * * *
    (h) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $25,000,000 for 
each of the fiscal years 2000 through 2004 and $30,000,000 for 
each of fiscal years 2005 through 2009.

           *       *       *       *       *       *       *

SEC. 7. NATIONWIDE TOXICOSURVEILLANCE OF POISON CENTER DATA TO PROMOTE 
                    HAZARD DETECTION.

    (a) In General.--The Secretary shall assist in the 
implementation and maintenance of continuous national 
toxicosurveillance of poison control center data to detect new 
hazards from household products, pharmaceuticals, traditionally 
abused drugs, and other toxic substances.
    (b) Competitive Grant or Contract for Services.--The 
Secretary may enter into a competitive grant or contract with a 
university, academic center, or other appropriate professional 
organization for the collection and analysis of poison center 
data described in subsection (a) in real time.
    (c) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $2,500,000 for 
each of fiscal years 2005 through 2009.

           *       *       *       *       *       *       *

                                
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