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S. Hrg. 111–574 

NOMINATION OF ALEXANDER G. GARZA 

HEARING 

BEFORE THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

OF THE

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

NOMINATION OF ALEXANDER G. GARZA TO BE ASSISTANT SECRETARY 

AND CHIEF MEDICAL OFFICER, U.S. DEPARTMENT OF HOMELAND SECURITY 

JULY 28, 2009 

Available via http://www.gpoaccess.gov/congress/index.html 

Printed for the use of the 

Committee on Homeland Security and Governmental Affairs 

( 


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COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

JOSEPH I. LIEBERMAN, Connecticut, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

CLAIRE MCCASKILL, Missouri 

JON TESTER, Montana 

ROLAND W. BURRIS, Illinois 

MICHAEL F. BENNET, Colorado 

SUSAN M. COLLINS, Maine 

TOM COBURN, Oklahoma 

JOHN MCCAIN, Arizona 

GEORGE V. VOINOVICH, Ohio 

JOHN ENSIGN, Nevada 

LINDSEY GRAHAM, South Carolina 

MICHAEL L. ALEXANDER, Staff Director 

KRISTINE V. LAM, Professional Staff Member 

BRANDON L. MILHORN, Minority Staff Director and Chief Counsel 

JENNIFER L. TARR, Minority Counsel 

TRINA DRIESSNACK TYRER, Chief Clerk 

PATRICIA R. HOGAN, Publications Clerk and GPO Detailee 

LAURA W. KILBRIDE, Hearing Clerk 


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C O N T E N T S 

Opening statements: Page 

Senator Lieberman ........................................................................................... 1 

Senator McCaskill ............................................................................................ 1 

Senator Collins ................................................................................................. 4 

Senator Akaka .................................................................................................. 11 

Prepared statements: 

Senator Lieberman ........................................................................................... 19 

Senator Collins ................................................................................................. 20 

Senator McCaskill ............................................................................................ 21 

WITNESS 

TUESDAY, JULY 28, 2009 

Alexander G. Garza, M.D., to be Assistant Secretary and Chief Medical Officer, U.S. Department of Homeland Security: 

Testimony .......................................................................................................... 5 

Prepared statement .......................................................................................... 23 

Biographical and financial information .......................................................... 26 

Responses to pre-hearing questions ................................................................ 45 

Letter from the Office of Government Ethics ................................................. 79 

Letters of support ............................................................................................. 80 

Responses to post-hearing questions for the Record ..................................... 89 


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NOMINATION OF ALEXANDER G. GARZA 

TUESDAY, JULY 28, 2009 

U.S. SENATE, COMMITTEE ON HOMELAND SECURITY AND

GOVERNMENTAL AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:02 a.m., in room 

SD–342, Dirksen Senate Office Building, Hon. Joseph I. 

Lieberman, Chairman of the Committee, presiding. 

Present: Senators Lieberman, Akaka, McCaskill, and Collins. 

OPENING STATEMENT OF CHAIRMAN LIEBERMAN 

Chairman LIEBERMAN. Good morning and welcome to this hearing at which the Committee will consider the nomination of Dr. Alexander Garza to be Assistant Secretary and Chief Medical Officer 

of the Department of Homeland Security. 

Senator McCaskill, if you have other matters to go to, I think not 

only out of respect for you as a fellow Senator, but as a fellow honored Member of this Committee, we would welcome you to do your 

introduction first and then we can give our opening statements. 

OPENING STATEMENT OF SENATOR MCCASKILL 

Senator MCCASKILL. That is very kind. Thank you, Mr. Chairman and Senator Collins, not only for the hearing this morning, 

but for your really special leadership of this Committee. You are 

both role models of how this should be done, and I would say that 

even if I were not on the Committee. 

Chairman LIEBERMAN. Thank you. 

Senator MCCASKILL. You work together closely, and you get past 

some of the food fights that go on around here over turf and who 

gets credit and all of that stuff, and it is remarkable. I am honored 

to serve on the Committee because of your leadership. 

It is a special morning for me. People ask sometimes when you 

are having a rough week, because of the nature of our work and 

being in the public eye and being accountable for everything we say 

and do, why do you put up with it if you have to go through some 

of these things? Mornings like this morning are why you put up 

with it because you have the opportunity to meet and get to know 

people in your life who are the essence of public service and you 

have the opportunity to come into a room like this in the halls of 

the most deliberative body in the world and advocate for a man 

like Alex Garza. 

I am proud to be here to introduce him this morning. I have to 

give a confession before I read my formal introduction, and that is 


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that his family is very close to me. His wife has worked for me for 

a number of years in a number of different jobs over my public life, 

and I remember when they met. I remember when they fell in love. 

I remember their wedding, mostly because I was a lot younger and 

a lot thinner—— 

Chairman LIEBERMAN. You do not have to go too far with this 

confession. [Laughter.] 

Senator MCCASKILL. I remember the birth of all three children, 

who are here today. They are gorgeous boys. I remember the anxiousness and the anxiety that Melissa had when he was serving in 

Iraq. I remember all of it, and there is no man who is better 

equipped to step into these shoes today than Dr. Alex Garza. 

I have known him for over 15 years and I am confident in saying 

there could not be a more qualified person for this position. 

I first came to know Dr. Garza when he volunteered as a medical 

expert on the methamphetamine task force I directed as Jackson 

County Prosecuting Attorney. In recognition of his work, he was 

awarded the Presidential Citation by the Office of National Drug 

Control Policy. 

But his story of service and dedication to the medical community 

did not start here. Dr. Garza grew up as one of five brothers in a 

Maryland Heights, Missouri, middle-class suburb of St. Louis. 

Being one of five children, he learned the valuable art of negotiation at an early age. But more importantly, his mother, who 

worked the night shift as a nurse in the local emergency department, taught him the value of hard work and serving his community, skills that will serve him well as Assistant Secretary, if confirmed. 

While attending college, he decided he wanted not to just learn 

from the books, but to experience medicine from the ground up. He 

delayed attending medical school to work as a paramedic in Kansas 

City so he could learn from the front lines. He continued his work 

as a first respondent as a flight medic all through medical school, 

working weekends and holidays to put himself through school. 

He graduated from the University of Missouri School of Medicine 

and began the next stage of his emergency medical training at Truman Medical Center in Kansas City, Missouri. On top of all this, 

he also heeded his mother’s example to serve by joining the United 

States Army Reserves Medical Corps. 

He ultimately chose to make his career in medicine about public 

service when he accepted a position as a member of the faculty at 

the Truman Medical Center. He tenure was interrupted when he 

was called into active duty in service of Operation Iraqi Freedom, 

leaving behind his wife, who was in law school at the time, and his 

then two small children. 

Dr. Garza and his team were responsible for rebuilding health 

care in Iraq. What he found were medical schools with out-of-date 

textbooks and decades-old journals. True to his form, he orchestrated a textbook donation program that led to medical schools 

from across the United States sending texts to fill the library 

shelves of schools throughout Iraq. Because of Dr. Garza’s tireless 

work rebuilding hospitals and clinics, he became a trusted member 

of the Iraqi medical community and developed important strategic 

relationships. In addition, he also cared for an occasional Iraqi 


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sheik, the soldiers in his unit, took turns at his post, and cleared 

buildings when needed. 

When his tour was extended for an additional 6 months, I consoled Dr. Garza’s wife, Melissa, a longtime member of my staff, 

who came to me in tears after learning her husband would be 

spending Christmas in a bombed-out shell of a building where he 

had volunteered to assist the forward surgical team during a fullscale offensive operation in Samarra. He finally made it home to 

his family and was awarded the Bronze Star as well as the Combat 

Action Badge. 

His career in academics and public service immediately resumed 

when he returned to direct emergency medical services for the City 

of Kansas City and also returned to the faculty at Truman Medical 

Center. During this time, Dr. Garza recognized that outcomes for 

cardiac arrest patients could be improved, and he created a new 

cardiopulmonary resuscitation protocol that challenged conventional dogma. His ability to think outside the box led to a doubling 

of the survival time for cardiac arrest patients in Kansas City. For 

his work, he was awarded the Young Investigator Award by the 

American Heart Association. Because of his work, health care 

workers around the world are now changing the protocols and the 

way they resuscitate patients. 

Dr. Garza is one of those rare individuals who, through hard 

work and sacrifice, has improved the lives of those around him. He 

has saved the lives of his patients, working in the emergency room, 

taught compassion and clinical skills to medical students and residents, furthered medical science by publishing numerous articles in 

peer-reviewed scientific journals, served his country at war, and 

improved the way pre-hospital care is rendered across the globe. 

It is with great pleasure and it is an honor that I have the opportunity to introduce Dr. Alex Garza to the Committee. I have every 

confidence that under his leadership, the Office of Health Affairs 

will serve the Secretary and the President and the Department of 

Homeland Security in an effective and meaningful way. 

Thank you, Mr. Chairman. 

Chairman LIEBERMAN. Thank you, Senator McCaskill, for a very 

impressive and, I would say, obviously heartfelt, and for us moving, 

introduction. I would say that Dr. Garza deserves it all. I thank 

you for taking the time to come and deliver it. 

I don’t know when we have last had an introducing Senator kiss 

the nominee. [Laughter.] 

It is a good way to go. 

Senator MCCASKILL. It is progress. [Laughter.] 

Chairman LIEBERMAN. Thank you very much, Senator McCaskill. 

There is not much I can add to that really extraordinary and 

very compelling introduction. I will just say a few words about the 

position for which you have been nominated. 

The position of Chief Medical Officer at the Department of 

Homeland Security was created by the Post–Katrina Emergency 

Management Reform Act of 2006 that was authored, I am proud to 

say, by Senator Collins and me, following this Committee’s 8- 

month investigation into why the response of our Government to 

Hurricane Katrina was so poor. The Post–Katrina Reform Act 

reconfigured the Federal Emergency Management Agency (FEMA) 


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1The prepared statement of Chairman Lieberman appears in the Appendix on page 19. 

so that it could, for the first time in history, respond really in an 

excellent way to natural disasters and also beyond that to catastrophic disasters equivalent to the swamping of New Orleans in 

2005. 

Among the new positions created to achieve that end, which was 

better protection of the American people in crisis, was the position 

of Chief Medical Officer to be the chief and principal advisor to the 

Secretary of Homeland Security and to the Director of FEMA on 

both medical and public health issues. 

Among the responsibilities of the Chief Medical Officer is coordinating the Department’s response not just to natural disasters, but 

to terrorism, including particularly bioterrorism, which is a special 

focus of this Committee in this session, ensuring coordination of all 

medical preparedness and response activities at the Department, 

and coordinating the Department’s workforce health protection. In 

short, the Chief Medical Officer is responsible for ensuring that the 

Federal Government is ready, ready to carry out a quick, comprehensive, and effective medical response to disasters, both natural and unnatural. 

I would say that it is especially important, and I know the Secretary feels this, that we fill this position right away. 

As chief medical advisor, Dr. Garza, should you be confirmed, 

you will play a vital role in our Nation’s response to the H1N1 outbreak, which is continuing. Though many Americans and a lot of 

the news media have turned to other matters, this epidemic has 

continued to spread. Cases now number over 1 million in this country, and the flu has not subsided, as expected, this summer. It has 

not surged up in numbers, but it has continued at pretty much the 

same pace, which is not what most public health experts predicted. 

It continues to be most problematic for children and young adults, 

and unfortunately, there is every indication that it will spread 

more rapidly in the fall when the traditional flu season returns. 

Obviously, it is imperative that we be ready for that and we get 

the public ready for that, and I want to ask you about that during 

the question and answer period. 

The next section of my prepared statement was a recitation of 

your really quite extraordinary, patriotic biography,1 but Senator 

McCaskill did such a great job, I will just express in closing here 

my admiration and gratitude for your experience and your service 

to your country and how much I look forward to hearing your opening statement and then questioning you as you go forward on this 

nomination. Thank you. 

Senator Collins. 

OPENING STATEMENT OF SENATOR COLLINS 

Senator COLLINS. Thank you, Mr. Chairman. 

I join you in welcoming Dr. Garza to our Committee today. As 

is so often the case, the Chairman and I have written opening 

statements that are virtually identical. I, too, went through the history of the creation of the Chief Medical Officer in response to our 

investigation into the failed response to Hurricane Katrina. I, too, 

outlined the responsibilities and duties of the Chief Medical Officer. 


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1The prepared statement of Senator Collins appears in the Appendix on page 20. 

2The prepared statement of Dr. Garza appears in the Appendix on page 23. 

I, too, talked about the threat of H1N1 and the fear that experts 

have that it is going to return in the fall and winter with even 

higher rates of infection and increased severity. 

So rather than repeat what the Chairman has just said, let me 

just wrap up my comments by saying that I am particularly interested in hearing Dr. Garza’s thoughts on our ability to surge medical resources to respond to major medical events, whether caused 

by a pandemic flu, the intentional release of a deadly biological 

agent, or the detonation of a dirty bomb. 

Last year, our Committee held a series of hearings on our preparedness for the detonation of a nuclear device in a large urban 

area, and we found many troubling gaps in our medical surge capabilities. I contrasted that to what I saw in Israel, where there is 

such preparedness to surge medical resources. I think we have a 

long way to go. 

In that area, Dr. Garza, having served as an emergency doctor 

in both military and civilian settings, can help us improve. I look 

forward to hearing his testimony today. 

Thank you, Mr. Chairman, and I would ask that my full statement be inserted in the record.1

Chairman LIEBERMAN. Without objection, so ordered. Thank you, 

Senator Collins. 

That was actually a very good and different point that you made 

at the end. I was thinking as you were saying what you did that 

I remember saying when we switched roles and I became Chairman and you Ranking Member that nothing would change except 

our titles, and I realize that one thing has changed, which is that 

I get to give our speech first. 

Senator COLLINS. That is so true. [Laughter.] 

Chairman LIEBERMAN. Dr. Garza has filed responses to a biographical and financial questionnaire, answered pre-hearing questions submitted by the Committee, and had his financial statements reviewed by the Office of Government Ethics. Without objection, this information will be made part of the record, with the exception of the financial data, which are on file and available for 

public inspection in the Committee offices. 

Dr. Garza, our Committee rules require that all witnesses at 

nomination hearings give their testimony under oath, so I would 

ask you to please stand and raise your right hand. 

Do you swear that the testimony you are about to give to the 

Committee will be the truth, the whole truth, and nothing but the 

truth, so help you, God? 

Dr. GARZA. I do. 

Chairman LIEBERMAN. Thank you. Please be seated and please 

proceed with your statement and feel free to introduce your family. 

TESTIMONY OF ALEXANDER G. GARZA, M.D.,2 TO BE ASSISTANT SECRETARY AND CHIEF MEDICAL OFFICER, U.S. DEPARTMENT OF HOMELAND SECURITY 

Dr. GARZA. Thank you for those remarks. Good morning, Chairman Lieberman, Ranking Member Collins, and distinguished MemVerDate Nov 24 2008 13:10 Aug 18, 2010 Jkt 053116 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 P:\DOCS\53116.TXT SAFFAIRS PsN: PAT

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bers of the Committee. I am humbled and honored to be a nominee 

of President Obama and to seek your support today for my nomination to be Assistant Secretary for Health Affairs and Chief Medical 

Officer of the U.S. Department of Homeland Security (DHS). 

If I may, Mr. Chairman, I would like to thank my wife, Melissa, 

and my three sons. This is Alex—— 

Chairman LIEBERMAN. Good morning, Alex. 

Dr. GARZA [continuing]. Samuel, and young Danny. 

Chairman LIEBERMAN. Good morning. 

Dr. GARZA. They have supported me here today as well as 

throughout my career. 

I am grateful for the leadership of this Committee for ensuring 

the Nation is prepared to respond to all hazards and all threats. 

The position for which I am nominated was authorized by the 

Post–Katrina Emergency Management Reform Act of 2006. Therefore, it is because of the work of this Committee investigating the 

government’s response to Hurricane Katrina and the important legislation that all of you championed as a result that I stand before 

you today. I want to thank you again for your leadership. 

I believe the role of the Chief Medical Officer is one of the most 

challenging and rewarding roles for a physician in the Federal 

workforce. The position not only requires experience and knowledge 

in medical preparedness and response, but also demands an understanding and awareness of intelligence and security issues. My 

background as a local and State public health official, coupled with 

my military service, makes me uniquely qualified for this position. 

My career has been dedicated to public service. I appear before 

you today asking that you support my nomination so that I may 

continue serving our country. 

If confirmed, my priorities will be as follows. To continue to build 

and strengthen the relationships between the Office of Health Affairs (OHA) and its partners in DHS. The foundation established 

by these relationships will permit OHA to deliver the best possible 

advice and guidance to the Secretary, the Administrator of FEMA, 

and our other component services. 

Two, to continue building OHA’s capacity. OHA must continue to 

expand on its ability to respond to the various threats and challenges of the DHS. The Office must adopt an all-hazards and allthreats approach in order to prepare for a constantly changing 

landscape of natural and manmade disasters and catastrophic 

events. The office must be able to quickly assess and adapt to the 

circumstances and to deliver rapid, yet sound, response. 

Third, protecting the DHS workforce. Those protecting the homeland are absolutely vital to the mission of the Department. OHA 

must continue to offer appropriate guidance to the DHS’s components in order to protect those who protect us. 

If confirmed, I will pursue these three priorities. I would build 

and strengthen OHA’s relationships with all its component services, expand its capacity to respond to all hazards and all threats, 

and I will work with OHA’s efforts on protecting the health of the 

DHS workforce. 

In closing, I am honored by the President’s and Secretary 

Napolitano’s faith in my ability to effectively lead this office and 

would like to put my knowledge and experience to use in continued 


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service of my country. I look forward to working with this Committee, if confirmed, and I am glad to answer any questions that 

you may have. Thank you. 

Chairman LIEBERMAN. Thank you, Dr. Garza. 

I am going to start my questions with the three standard ones 

that we ask of all nominees. First, is there anything you are aware 

of in your background that might present a conflict of interest with 

the duties of the office to which you have been nominated? 

Dr. GARZA. No, sir. 

Chairman LIEBERMAN. Second, do you know of anything, personal or otherwise, that would in any way prevent you from fully 

and honorably discharging the responsibilities of the office to which 

you have been nominated? 

Dr. GARZA. No, sir. 

Chairman LIEBERMAN. And third, do you agree without reservation to respond to any reasonable summons to appear and testify 

before any duly constituted Committee of Congress if you are confirmed? 

Dr. GARZA. Yes, sir. 

Chairman LIEBERMAN. Thank you. 

We will start with a first round of questions of 7 minutes per 

Senator. 

As I indicated in my opening statement, in a relatively young Department of Homeland Security, the Office of Health Affairs is 

itself a relatively young office. The position of Chief Medical Officer 

was not formally authorized until 2006. Since then, the office, 

OHA, has grown to over 100 in staff and a budget of approximately 

$150 million, but in many respects, it is still young and still in its 

formative stages. 

I want to ask you, because you are coming in to manage at this 

point—you will be more than just a singular advisor to the Secretary, you have got an office there—to just develop a little bit 

more of what your priorities and vision is for the future of OHA. 

Dr. GARZA. I understand and I can fully appreciate the relative 

newness of the office and what challenges it brings with it. 

The priorities that I envision for the office, if confirmed, are as 

outlined in my opening statement. When I met with the staff over 

the last couple of weeks to try to get a better handle on what the 

office was doing, I asked each program manager at the end of our 

session, what was their biggest challenge. Without any hesitation 

and overwhelmingly, the program managers said the biggest challenge was integration and cooperation with other agencies. So I believe that should be at the very top of my list, trying to build relationships with our Federal agencies, Department of Health and 

Human Services (HHS) in particular, but as well as our other 

agencies since the Department of Homeland Security spans a 

greater breadth and depth than just medical issues. 

So we would do this, what I described as both vertically and horizontally. We would go across our components. The office would 

reach out to its other agencies and other partners. But the office 

should go up and down, as well, and by that I mean we should be 

able to cooperate and work with State, local, tribal, public health 

providers, first responders, law enforcement, emergency management, as well as critical infrastructure and key resources. 


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So that would be one of my priorities, and the second would be 

making sure that the workforce is protected. I know that there are 

challenges that have been identified by this Committee. I know it 

is the Secretary’s priority to make sure that the workforce is getting clear guidance, that they are operating with the best equipment, with the best training, with the best knowledge so that they 

can execute their duties. 

I have particular interest in this because of my military background as a battalion surgeon, where I fulfilled this role in making 

sure our soldiers were medically prepared to go to war, including 

vaccinations, and that included smallpox and anthrax, taking care 

of them while they were deployed, as well as doing post-deployment 

medical-related issues. So I fully understand, comprehend, and am 

passionate about that, as well. 

One of my other priorities is to build capacity within the office. 

I realize that the office spans a great many things. However, we 

must continue to build on a foundation of excellence, and that sort 

of fits in with building our relationships, as well. We have to build 

that capacity in order to get better information, in order to work 

collaboratively in building that capacity so that when we are advising the Secretary, the FEMA Administrator, and whoever else our 

customers are, be it the other Federal agencies, this Committee, 

State or local governments, that we are able to give them the very 

best product, the very best advice that we can. 

Chairman LIEBERMAN. Are there particular areas in which you 

want to build the capacity of the office, where you think it is short 

now? 

Dr. GARZA. Yes, sir. One of the areas that is of particular interest 

to me is in the area of biosurveillance. I do have some experience 

in this in the civilian world. I have worked with various emegency 

medical service (EMS) providers. During my time as a Medical Director in Kansas City, we made it a point to develop syndromic surveillance using emergency data. 

Chairman LIEBERMAN. And this biosurveillance is to set up a system where you would have as close to immediate notice as possible 

of a potential biological attack? 

Dr. GARZA. Absolutely, sir. And so with the syndromic surveillance, what we were doing is we were looking for any patterns that 

were out of the normal for the community. 

Chairman LIEBERMAN. Please say a little more about what 

syndromic is, as in syndrome. 

Dr. GARZA. Yes. And so what we tried to develop for the City of 

Kansas City was looking at all of the calls that came into 911. 

Now, the dispatch center for the EMS service uses computer algorithms to arrive at what we call presumptive conditions. So by interrogating the caller on a series of questions, we arrive at what 

we think is the most likely diagnosis or complaint. Those are all 

coded on computer. It is all in real time. 

One of the beauties of 911 data, which sets it apart from emergency department data, which I have written papers on, is all these 

calls are geocoded, and so we know exactly where the caller is calling from, so we know where the incidents will be coming from, as 

well. 


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So we collect this data, and we do a continuous sweep of the computer, and we plot it up against what we know our normals are for 

that time of day, for that time of year, things like this. 

Chairman LIEBERMAN. That is a very good idea. I was thinking 

you were going to talk about detection devices around areas, in 

other words, technological devices—— 

Dr. GARZA. Sure. 

Chairman LIEBERMAN [continuing]. But what you are really talking about is taking advantage of an existing flow of information 

and trying to draw from it quickly—— 

Dr. GARZA. Exactly. 

Chairman LIEBERMAN [continuing]. A warning sign that something is happening. 

Dr. GARZA. Exactly. And the way we reasoned it is that we can 

analyze this data much quicker than waiting for the emergency department to pull the data together from multiple different sources. 

One of the beauties of emergency dispatch data, as well, is that it 

is a single center. Everyone who calls 911 calls to the center. So 

you are not pulling data from different emergency departments to 

try to bring all that data together. You have a single source. You 

have a single algorithm. You have a single pattern that you can 

look at in order to decide if this is something that is out of the ordinary. 

Chairman LIEBERMAN. So what are you thinking of, trying from 

the Chief Medical Officer’s position to advocate that at least the 

major urban areas in the country do similar ongoing screening of 

911 calls? 

Dr. GARZA. Sure. Presently, there are quite a number of communities that do this. That was in reaction to what we had done. 

Chairman LIEBERMAN. Right. 

Dr. GARZA. So currently, this monitoring is done in over 80 cities 

around the country, including Canada. So it does seem to be a fairly robust and equitable system. 

I think the point of me bringing that up, though, is to explain 

that we need to start thinking a little bit more globally on where 

we can look for syndromic surveillance and for other data bits in 

order to give us a complete picture of what is going on out in the 

community. 

Chairman LIEBERMAN. My time is up. I want to say I hope that, 

if you are confirmed, and I sense that you understand this already, 

you will not simply be there waiting for the Secretary to ask you 

for advice or the FEMA Director, but that in the areas of readiness, 

public health, medical, you will be a very aggressive advocate and 

initiator of policy. 

Dr. GARZA. Absolutely, sir. 

Chairman LIEBERMAN. Thank you. 

Dr. GARZA. Thank you. 

Chairman LIEBERMAN. Senator Collins. 

Senator COLLINS. Thank you, Mr. Chairman. 

Dr. Garza, I was very pleased to hear you say that workforce protection is a high priority for you. The Department is going to have 

to make a decision on whether or not Customs and Border Protection officials, for example, should receive priority for vaccination 

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tion, the Department needs to develop more complete protocols for 

the FEMA Emergency Response Teams that are deployed to disaster areas so that they are protected from hazards that they face. 

Your predecessor made it a priority that OHA would create a 

uniform set of policies for workforce protection. Yet in response to 

questions from the Committee, you seem to see your role more as 

advising the Chief Administrative Officer. I would tell you that is 

not what we envisioned. You are supposed to be the direct and 

principal advisor to the Secretary on a whole host of issues, including workforce protection. 

I am going to ask you again what role you think that your office 

should play when it comes to DHS workforce protection. 

Dr. GARZA. Yes, ma’am. I share in your concerns for workforce 

protection, and I know it is one of the top issues on the Secretary’s 

list, as well. So let me try to assuage your fears of us abdicating 

our role. 

OHA has a very strong presence with the Secretary. I view the 

role of the Chief Medical Officer and the Office of Health Affairs 

as being intimately involved in whatever posture that the border 

takes, that our workforce takes, and giving the Secretary the very 

best advice that we can, as well as assisting in developing policy. 

I do have some experience in this, I think as is evidenced by my 

biography, while working with the military. I was the chief advisor 

to the battalion as the battalion surgeon and as well as to the division staff on civil military operations. And so I do have some familiarity with that. 

Now, as the battalion surgeon, you assume a lot of roles, and so 

one of those is what sort of posture should your soldiers take while 

operating in a hostile environment, and that includes chemical protection, protection against known biological threats, and things like 

this. So I am completely comfortable with that role. 

As far as developing policy and procedures for our workforce, let 

me emphasize that our workforce is the most important asset of 

our organization, and there are no doubts that I, as well as my 

staff and the Secretary, take that role very seriously. 

Senator COLLINS. I just want to make very clear that we look to 

you to develop those protocols and provide that advice. It is not the 

job of the Chief Administrative Officer or the Under Secretary for 

Management. It is the job of your office, and I am confident from 

your response, in contrast to your response to the pre-hearing questions, that you do understand that. 

I want to go on to two other issues in the time that I have. Last 

year, the Commission on the Prevention of Weapons of Mass Destruction (WMD) Proliferation and Terrorism found that a biological attack was ‘‘more likely than not’’ to occur somewhere in the 

world by the year 2013. Seven years ago, we authorized the Select 

Agent Program in the wake of the anthrax attacks on our Capitol 

and on the Postal Service. I believe that DHS needs to play a 

stronger role in evaluating the security of labs that are working 

with the most dangerous pathogens. 

I, for one, was surprised and alarmed to realize how weak a regulatory structure we have and how dispersed these pathogens are 

in labs all over the country, many in academic or medical settings, 

with very low levels of security. 


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Do you believe that we need to reexamine and strengthen the 

regulation of labs that are housing these very dangerous pathogens? 

Dr. GARZA. Yes, Senator. I, as well, share your concern about biological agents with a potential to do harm to the community. As far 

as the biosafety level (BSL) labs and issues like that are concerned, 

I know that the Office of Health Affairs will work collaboratively 

with the Office of Science and Technology, which is, I believe, mostly charged with biosecurity instruction and things like that. 

So where I believe, as Chief Medical Officer—if confirmed—the 

Office of Health Affairs can be of assistance is, once again, getting 

all of the best science available to advise the Secretary on the 

threats that this would pose to the community as well as working 

with our component services and the Office of Science and Technology in developing plans to make sure that if there were such an 

event, we would have a robust response, as well as discussing any 

security issues and/or things of that nature. As a physician and as 

a community provider, I think it is important that we get the best 

available evidence for the Secretary to make those decisions. 

Senator COLLINS. I hope that you will also work with the Members of this Committee. 

Dr. GARZA. Absolutely, ma’am. 

Senator COLLINS. I personally think that we need to strengthen 

the law in this area and come up with a risk-based security scheme 

where greater level of scrutiny and regulation would be applied to 

labs with the most dangerous pathogens and that we come up with 

that kind of approach, similar to the approach that we took with 

chemical facilities security. 

Dr. GARZA. Yes, ma’am. 

Senator COLLINS. I see my time has expired, so I will wait for 

the next round. Thank you. 

Chairman LIEBERMAN. Thanks, Senator Collins. 

I just wanted to echo what Senator Collins has said. This will be 

one of our legislative priorities this year, which is to legislatively 

beef up the oversight and protection that we provide to the American people from bioterrorist attack. I mean, you are now moving 

into a position, if you are confirmed, which we live with. We are 

all about defense. We are all about defense of the homeland in the 

post-September 11, 2001, period, and in some ways we spend a lot 

of time imagining worst case scenarios. But after September 11, 

2001, that is what we have got to do. And this is one, particularly 

coming off of the Graham-Talent WMD Commission report, that I 

think we really want to focus on, and I will come back with one 

or two questions afterward. 

Senator Akaka, good morning. Thanks for being here. 

OPENING STATEMENT OF SENATOR AKAKA 

Senator AKAKA. Thank you. Good morning. 

Let me congratulate you, Dr. Garza, for being the nominee and 

welcome you and your beautiful and handsome family. It is good 

to see Melissa here and also—is that Alexander Junior? 

Dr. GARZA. He has a different middle name, sir. I would not want 

to burden him with my name. 


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Senator AKAKA. I also welcome Samuel, Daniel, and the rest of 

your family here, and also friends and supporters, as well. Thank 

you for being here. 

Dr. GARZA. Thank you. 

Senator AKAKA. As you know, Dr. Garza, the Office of Health Affairs is tasked with protecting our country from bioterrorism as 

well as natural agents that threaten our health. Given the increasingly difficult challenge of protecting our Nation, I urge you to 

focus on working collaboratively and communicating effectively 

with partner agencies and other stakeholders. It was good to hear 

your priorities about strengthening relationships with other agencies. There are a lot of agencies and departments where the relationships have to be strengthened. 

Like you, I believe that our workforce is our most valuable asset, 

and I understand that one of your priorities is to protect and help 

build the morale of that workforce. I hope in particular that you 

will focus on the growing shortage of the Federal veterinarian 

workforce and how it will affect our public health and food safety. 

Dr. Garza, your wide-ranging experience in emergency medicine, 

academia, and the military gives me confidence that you will bring 

a valuable perspective to the office. Again, I congratulate you on 

your nomination and look forward to working with you and again 

commend you for your priorities. 

As I mentioned in my opening remarks, I am concerned about 

the Federal veterinarian workforce and its shortages. I requested 

that the Government Accountability Office (GAO) conduct a comprehensive review of the Federal veterinarian workforce and held 

a hearing in February of this year, which focused on the challenges 

facing this workforce. GAO found that within the next 3 years, 

more than one-fourth of the veterinarians at key agencies for public 

health, homeland security, and food safety will be eligible to retire. 

As you know, OHA veterinarian agro-defense personnel provide 

advice on zoonotic diseases and agricultural security related to food 

and water. Keeping in mind that most Federal veterinarians work 

outside DHS, what steps would you take to address this critical 

workforce challenge so that Federal veterinarians are able to help 

address the Nation’s vulnerabilities in these areas? 

Dr. GARZA. Senator, I share your concern about our veterinarians 

and their declining numbers in the workforce. 

If I may, I would like to discuss how the Office of Health Affairs 

intersects with veterinarian medicine. Now, as with almost the 

whole of DHS, it is multi-ingrained with many different aspects 

and partners and things like that, and the same is true of the Office of Health Affairs. The Office of Health Affairs does not necessarily just deal with human disease. We value the all-hazards, 

360-degree situational awareness, and that includes zoonotic disease as well as agricultural issues, as well. 

If we take a look at the big picture, we would understand how 

important the surveillance, the response, and the handling of 

zoonotic disease is to the importance of human health. So I share 

in your concerns that we must keep a robust, a very active and involved participation with our veterinarian colleagues, who, by the 

way, are some of the smartest people that I have ever met. 


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So as a role of the Chief Medical Officer and the Office of Health 

Affairs, I believe it is important that we support our veterinarians 

and that we enhance their capabilities, as well as interacting with 

partners in other agencies, such as the FDA and the Department 

of Agriculture, in order to leverage our abilities with them and also 

to showcase the importance and the value that they bring to the 

table, as well as push this down to the State and local agricultural 

partners and our veterinary partners. 

So I value their input. They are an important part of the Office 

of Health Affairs, and if confirmed, I would further continue to try 

to improve our relationship with them and improve their standing 

in the Federal workforce. 

Senator AKAKA. Dr. Garza, until recently, the Department of 

Health and Human Services operated immigrant health services 

while working with Immigration and Customs Enforcement (ICE) 

under a Memorandum of Understanding. Now, the Division of Immigration Health Services operates within ICE. In recent years, 

ICE’s medical services have come under great scrutiny due to the 

numerous reported deaths. 

What role do you expect OHA will play in guiding the decisions 

and policies to improve the oversight and quality of medical care 

for immigrant detainees? 

Dr. GARZA. Yes, Senator. Again, I think we share the concern for 

detainee health. I have read the same articles in the newspaper 

that you have. I know that this is a priority for the Secretary, so 

much so that she has a special advisor particularly on detainee 

health. 

I have spoken with her, and she has shared with me her assessment as well as some issues that she sees going forward. During 

the conversation, I implied to her that, if confirmed and if I assume 

this office, the Office of Health Affairs will be more than happy to 

assist her in whatever medical issues she would need guidance on 

as well as giving her the best science and policy advice available. 

Senator AKAKA. Thank you very much. 

Dr. GARZA. Thank you, Senator. 

Senator AKAKA. Mr. Chairman, my time has expired. 

Chairman LIEBERMAN. Thanks, Senator Akaka. Perhaps we will 

just do a few more questions if my colleagues have them. 

Dr. Garza, under Section 516 of the Homeland Security Act, as 

I read it, the Chief Medical Officer is actually responsible for coordinating all the biodefense activities of the Department. So you 

would play a very important role, and that is why, if you are confirmed, we will want to work with you—— 

Dr. GARZA. Yes, sir. 

Chairman LIEBERMAN [continuing]. On the legislation that we 

are going to introduce. 

The WMD Commission, Senators Graham and Talent, recommended that we do everything we could to ensure that we had 

a much more robust response capacity to a biological attack. And 

I understand you are just going into this, so these are preliminary 

thoughts, but beyond the upgrading of the biosurveillance that you 

talked about earlier, what thoughts do you have—this does tie into 

what Senator Collins mentioned in her opening statement—about 

our concern, which we share, about the relative lack of capacity to 


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surge our public health infrastructure in case of a biological or pandemic attack that takes off? 

Dr. GARZA. Yes, sir. The Office of Health Affairs is the primary 

biodefense office within the Department of Homeland Security and 

so the way that I envision in response to a biodefense or a biological event is, I think, in my priority with building capacity. And so 

in building capacity, I do not feel that the office should purely focus 

on surveillance activities and data acquisition and things like this. 

I believe that the office must take an almost holistic view for all 

threats, all hazards, as well as working with our component services, such as the Centers for Disease Control and Prevention (CDC) 

and the Office of the Assistant Secretary for Preparedness and Response (ASPR), in the response capabilities, as well. 

One part where we are particularly effective is in working with 

our first responders, with our emergency managers, and with law 

enforcement. Should I be confirmed, I would put emphasis on this 

office, as well, to get information and guidance, policy directive, 

down to these individuals, as well, who are going to, frankly, be 

where the rubber hits the road and the first folks on the scene. 

They deserve this sort of support from our office. 

So I am trying to take more of a systematic approach to our biodefense capabilities with building the structure so that no matter 

what the threat, whether it is manmade or natural, whether it is 

a weather-related event or infectious disease or other issues, we 

would be able to appropriately detect, appropriately respond, and 

appropriately recover from that event. 

Chairman LIEBERMAN. Let me focus finally on H1N1, which we 

talked about. I think that Secretary Napolitano along with Secretary Sebelius have done an admirable job in both responding and, 

as importantly—maybe more importantly—keeping the focus on 

preparing for the flu season to come in the fall. But everybody 

agrees, we have a lot of work to do, and there are very critical 

questions about whether, for instance, vaccines will be ready in 

time. 

So I wanted to ask you, assuming you are confirmed, what do 

you see are the major challenges that we face as a Nation or the 

Department faces over the next couple of months as we head into 

the fall and the more traditional flu season to get ready for a possible rapid spread of H1N1? 

Dr. GARZA. Yes. I believe everyone on the Committee as well as 

Secretary Napolitano and myself and the office shares your concerns with H1N1. I know it is a priority of hers. I am familiar with 

her meeting with Secretary Sebelius and the Department of Education. 

So the issues that need to be coordinated before our presumed 

second surge of the virus are multi-faceted and multi-pronged. And 

so the issue that we have with OHA, which sort of separates us 

from the rest of the field, is we have to have better interaction with 

our partners over at HHS. 

I have met with Dr. Lurie at ASPR, talked with the CDC, and 

sat down and had discussions with Craig Fugate at FEMA, as well, 

and this seems to be on the top of their list, as well. 

So the issue for the Office of Health Affairs would be coordinating with these folks to strengthen our relationships. I know that 


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we have a physician in our office who is particularly involved with 

vaccine as well as distribution of vaccine, prioritizing, protecting 

our workforce, which is on the top of our list, as well as disseminating information down to our critical infrastructure and key resources, as well as our emergency responders, first responders 

down at the front level, as well as providing guidance to the American people. So all of these issues, I think, put together are issues 

that the Office of Health Affairs really needs to focus on to get us 

prepared for the presumed second wave of H1N1. 

Chairman LIEBERMAN. Would you say that in the meetings you 

have had with people at DHS and HHS, for instance, the presumption is that we will have a serious problem with H1N1 this fall and 

winter, obviously hoping that is not so, but people are going forward acting as if this is going to be a genuine public health crisis? 

Dr. GARZA. Thank you, sir. In my meetings with these individuals, they did express to me their concern for the coming fall. 

Chairman LIEBERMAN. Right. 

Dr. GARZA. They did not expressly say whether they felt it was 

going to be worse than our spring. Of course, the big fear is that 

the virus will mutate and assume some sort of different form and 

then we will be in a lot of trouble. But they did not express with 

any confidence whether they felt it was going to be worse. So when 

I was discussing these issues with them, we mostly discussed our 

needs to better collaborate and work together on H1N1 issues. 

Chairman LIEBERMAN. Thank you. 

Dr. GARZA. Thank you. 

Chairman LIEBERMAN. Senator Collins. 

Senator COLLINS. Thank you, Mr. Chairman. 

Dr. Garza, earlier this year when we held a hearing with the 

Secretary to look at the Federal response to the flu pandemic, we 

found that there was a great debate over whether our border with 

Mexico should have been closed and also whether there should 

have been more rigorous screening at the border. Now, I, for one, 

accept the medical advice we heard that closing the border was not 

the answer. For one thing, the virus was already in our country. 

Dr. GARZA. Yes. 

Senator COLLINS. However, I am concerned that the Department 

seems to be very hesitant to use technology more fully to try to 

identify travelers who may be carrying H1N1 or some other new 

communicable disease. Other countries have successfully used technology that is able to scan travelers to identify fever. This was used 

back when the severe acute respiratory syndrome (SARS) epidemic 

was in full force, and some countries, including Japan and Singapore, have been using it during the flu pandemic. 

What are your views on the use of technology to better screen 

travelers at the border? After all, I think we have to remember 

that while our Customs and Border Protection officials and our immigration agents are highly trained, they are not physicians. They 

are not nurses. They are not health officials. 

Dr. GARZA. Yes, Senator. I understand your concerns, and I appreciate them, and I would like to work further with the Committee in order to help with this issue. I know the Secretary keeps 

this on the top of her list, as well. 


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So in regard to the border protection, this is of prime importance 

to the Secretary. It is her responsibility for the protection of the 

border. I know that she values good, active, actionable intelligence 

and information in order to decide what actions and what posture 

she is going to take at the border. 

With that being said, I also appreciate the tremendous strain 

that our Customs and Border Protection agents were under during 

this event. You are correct, they are not medically trained personnel, and so quite frankly, I think it makes them a little uneasy 

to be performing duties such as these since they are not medically 

trained. 

So as far as the technology is concerned, I am somewhat familiar 

with the technology. I cannot say that I am an expert at the technology. But from what I have understood is that it still is not 

where it needs to be. 

Given that, though, I believe the OHA mission should be taking 

all available resources in order to screen or identify or protect the 

country from infectious agents and other things coming into the 

country, and that, of course, includes new technology such as what 

you were talking about with the thermal scanners. I believe the Office of Health Affairs as well as Science and Technology, we do 

have a duty to look at, evaluate, and understand all these technologies. It is on the forefront of our agenda every day to protect 

the people, and it is a priority of the office to make sure that we 

are using all available resources. 

With that being said, I think we should also rely on best science, 

as well, to dictate what our priorities should be and what equipment we should use and what sort of posture we should take at the 

border. 

Senator COLLINS. The thermal scanners are not perfect, that is 

certainly true, but they are a tool—— 

Dr. GARZA. Absolutely. 

Senator COLLINS [continuing]. That can be used to screen. It does 

not mean that you allow that tool to make the decision, and there 

are, I believe, five developed nations, industrialized nations, using 

them—— 

Dr. GARZA. Yes. 

Senator COLLINS [continuing]. So clearly there is some value. If 

they were so inaccurate or unproven—— 

Dr. GARZA. Right. 

Senator COLLINS [continuing]. I doubt very much Japan would be 

using them. So I really urge you to take a look at this. We need 

to be willing to use all the tools that we have. Technology should 

not be used to make the decision, but it can be helpful in assisting 

individuals who do not have medical training in making the first 

cut, if you will, in making the preliminary screening more effective. 

Similarly, last year, there was a case where a Mexican citizen 

with a contagious form of resistant tuberculosis was able to cross 

the border, back and forth, 21 times despite the fact that the Department of Homeland Security had his name and his date of birth. 

This was an example where the left hand of government did not 

talk to the right hand of government. The CDC had identified the 

individual as having this kind of contagious tuberculosis. It was 

known to the government that, for business reasons, he frequently 


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crossed the border. And yet there was a failure of communication 

between the CDC and DHS. 

First of all, are you familiar with this case? 

Dr. GARZA. I am somewhat familiar. I cannot say I know the intimate details, but yes. 

Senator COLLINS. What will you do to make sure that we do not 

have these egregious gaps in communication? Here, we have an individual who has specifically been identified by the CDC, and there 

is just poor communication. 

Dr. GARZA. Yes. I understand the concern of the Committee with 

this, and I believe it would be on OHA’s priority list to do, as well. 

But I think what you have brilliantly illustrated is what I was trying to put forth in my opening statement and answers to other 

questions, and that is capacity and systems building as well as developing relationships with our component services. 

So, if confirmed, one of the priorities in my office would be to 

make sure that those relationships and those systems are robust 

enough to not let this issue happen again. And if confirmed, I look 

forward to working with the Border Patrol, CDC, and DHS as a 

whole so that these sorts of issues would not occur again. 

Senator COLLINS. Finally, our Committee held 24 hearings looking at the failed response to Hurricane Katrina. Of all those hearings, the one that stands out most in my mind because it was so 

tragic and so preventable was the hearing that looked at the number of homebound individuals and elderly, sick individuals in nursing homes who died because of a failure to evacuate them. It was 

so tragic and so outrageous that it happened. 

After that hearing, I had a number of home health care groups 

with whom I have worked closely come to me and say, we know 

where the homebound elderly are because we serve them. We visit 

their homes. But we have never been asked to be involved in evacuation planning. 

What will you do to ensure that all resources are brought to bear 

by States, by local governments, and by the Federal Government 

to ensure that we never again see homebound elderly individuals 

who are incapable of evacuating themselves, or people who are in 

a nursing home who, again, cannot evacuate themselves, become 

victims of a disaster due to a failure of planning and a failure to 

mobilize all possible resources? 

Dr. GARZA. Yes, Senator. I think that question absolutely goes 

back to my previous answers of capacity building. And so for us to 

effectively deal with the entire population, we must make sure that 

we are cooperating and connected with the entire population, and 

so that includes populations that you mentioned. 

Now, I am not sure if you had a meeting with the FEMA Director right before I did, but that was on the top of his list, as well, 

when I met with him. And so I do want to assure you that it is 

on a lot of people’s minds. And in particular, Mr. Fugate’s direct 

question to me was, we need better planning on at-risk populations, and I consider the homebound and nursing home population an at-risk population. 

I believe that also speaks to the Office of Health Affairs having 

to think outside the box. We cannot just simply accept the normal 

response to an event which is very well contained, such as a small 


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event. We have to be prepared for all hazards, all threats, and all 

people in response to a catastrophic event. 

Senator COLLINS. Thank you. I look forward to working with you. 

Dr. GARZA. Thank you. 

Senator COLLINS. Thank you, Mr. Chairman. 

Chairman LIEBERMAN. Thank you very much, Senator Collins. 

I thank you, Dr. Garza. I do not have any further questions, and 

I think we have reached the limits of the impressive patience of 

your sons. They have really been very well behaved today. I do not 

think we should ask more than this of them. [Laughter.] 

Dr. GARZA. He almost made it. 

Senator COLLINS. A good period on that. 

Chairman LIEBERMAN. He expressed a sentiment often felt by 

people who sit in this room but rarely expressed. [Laughter.] 

Without objection, the record will be kept open until noon tomorrow for the submission of any written questions or statements for 

the record. 

It would be the intention of our Committee to have, as we call 

it, an off-the-floor markup sometime soon of your nomination and 

hopefully get you confirmed before we break for August recess on 

August 7. 

But I thank you for your willingness to serve. I thank your family for their willingness to back you up as you serve. As Senator 

Collins said, we really look forward to working with you on these 

urgent matters of homeland defense. Thanks very much. 

Dr. GARZA. Thank you. 

Chairman LIEBERMAN. The hearing is adjourned. 

[Whereupon, at 11:04 a.m., the Committee was adjourned.] 


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88 


ph44585 on D330-44585-7600 with DISTILLER53116.073
89 


ph44585 on D330-44585-7600 with DISTILLER53116.069
90 


ph44585 on D330-44585-7600 with DISTILLER53116.070
91 

Æ 


ph44585 on D330-44585-7600 with DISTILLER53116.071