DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JOSE ́ E. SERRANO, New York 

TODD TIAHRT, Kansas 

DENNIS R. REHBERG, Montana 

RODNEY ALEXANDER, Louisiana 

JO BONNER, Alabama 

TOM COLE, Oklahoma 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

DAVID REICH, NICOLE KUNKO, STEPHEN STEIGLEDER, DONNA SHAHBAZ, 

JOHN BARTRUM, LISA MOLYNEUX, and MIKE FRIEDBERG, 

Subcommittee Staff 

PART 6 

STATEMENTS OF MEMBERS OF CONGRESS AND OTHER 

INTERESTED INDIVIDUALS AND ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 


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Part 6 


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DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, 

AND RELATED AGENCIES APPROPRIATIONS FOR 2011 


hsrobinson on DSK69SOYB1PROD with HEARING

hsrobinson on DSK69SOYB1PROD with HEARING
DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JOSE ́ E. SERRANO, New York 

TODD TIAHRT, Kansas 

DENNIS R. REHBERG, Montana 

RODNEY ALEXANDER, Louisiana 

JO BONNER, Alabama 

TOM COLE, Oklahoma 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

DAVID REICH, NICOLE KUNKO, STEPHEN STEIGLEDER, DONNA SHAHBAZ, 

JOHN BARTRUM, LISA MOLYNEUX, and MIKE FRIEDBERG, 

Subcommittee Staff 

PART 6 

STATEMENTS OF MEMBERS OF CONGRESS AND OTHER 

INTERESTED INDIVIDUALS AND ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 

U.S. GOVERNMENT PRINTING OFFICE 

58–144 WASHINGTON : 2010 


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COMMITTEE ON APPROPRIATIONS 

DAVID R. OBEY, Wisconsin, Chairman 

NORMAN D. DICKS, Washington 

ALAN B. MOLLOHAN, West Virginia 

MARCY KAPTUR, Ohio 

PETER J. VISCLOSKY, Indiana 

NITA M. LOWEY, New York 

JOSE ́ E. SERRANO, New York 

ROSA L. DELAURO, Connecticut 

JAMES P. MORAN, Virginia 

JOHN W. OLVER, Massachusetts 

ED PASTOR, Arizona 

DAVID E. PRICE, North Carolina 

CHET EDWARDS, Texas 

PATRICK J. KENNEDY, Rhode Island 

MAURICE D. HINCHEY, New York 

LUCILLE ROYBAL-ALLARD, California 

SAM FARR, California 

JESSE L. JACKSON, JR., Illinois 

CAROLYN C. KILPATRICK, Michigan 

ALLEN BOYD, Florida 

CHAKA FATTAH, Pennsylvania 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MARION BERRY, Arkansas 

BARBARA LEE, California 

ADAM SCHIFF, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

STEVE ISRAEL, New York 

TIM RYAN, Ohio 

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland 

BEN CHANDLER, Kentucky 

DEBBIE WASSERMAN SCHULTZ, Florida 

CIRO RODRIGUEZ, Texas 

LINCOLN DAVIS, Tennessee 

JOHN T. SALAZAR, Colorado 

PATRICK J. MURPHY, Pennsylvania 

JERRY LEWIS, California 

C. W. BILL YOUNG, Florida 

HAROLD ROGERS, Kentucky 

FRANK R. WOLF, Virginia 

JACK KINGSTON, Georgia 

RODNEY P. FRELINGHUYSEN, New 

Jersey 

TODD TIAHRT, Kansas 

ZACH WAMP, Tennessee 

TOM LATHAM, Iowa 

ROBERT B. ADERHOLT, Alabama 

JO ANN EMERSON, Missouri 

KAY GRANGER, Texas 

MICHAEL K. SIMPSON, Idaho 

JOHN ABNEY CULBERSON, Texas 

MARK STEVEN KIRK, Illinois 

ANDER CRENSHAW, Florida 

DENNIS R. REHBERG, Montana 

JOHN R. CARTER, Texas 

RODNEY ALEXANDER, Louisiana 

KEN CALVERT, California 

JO BONNER, Alabama 

STEVEN C. LATOURETTE, Ohio 

TOM COLE, Oklahoma 

BEVERLY PHETO, Clerk and Staff Director 

(II)


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DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

2011 

WEDNESDAY, MAY 12, 2010. 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

CHAIRMAN’S OPENING STATEMENT

Mr. OBEY. Well, good morning, everybody. Let me apologize for 

being late and to make just a couple comments about what we are 

going to be doing here today. 

I appreciate the fact that everyone who testifies today is going 

to be here in earnest support of programs that they think are vital. 

I spent a good deal of time last night looking over the statements 

of all of the witnesses for this morning and this afternoon, and I 

have to say that I agree with virtually all of them. 

But there is a problem. If you total up the cost of all of the items 

that are being requested in these statements, we wind up with requests that we increase the President’s budget by almost $14 billion and I think that, on the merits, is needed when it comes to 

health care research or when it comes to education. But when it 

comes to worker protection, I am a big spender and I make no apology for it. 

But we do have a problem because we have, even though the 

President asked for a budget freeze, we have the Republican leadership asking that we cut deeper than that; we have blue dog 

Democrats who are also asking that we cut deeper than that. 

In fact, if you take a look at the budget levels that we are going 

to be forced to operate under, we will not be able to increase this 

bill by $14 billion as a lot of you are going to be asking today; we 

are going to have to cut this bill by about $3.5 billion. And that 

means $3.5 billion below Obama’s budget. And the reason for that, 

frankly, is that the Country, and many members in the Congress, 

are apparently fixated only on one deficit, the Federal budget deficit. And I agree that is an important problem that must come 

down over time, once the economy starts to recover. 

But we have other deficits, as the testimony here today will certainly demonstrate. We have opportunity deficits, we have health 

care deficits, we have education deficits, we have science deficits; 

and those will not be responded to to any great degree unless there 


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is a significant mind-set in the Country and a significant mind-set 

in the Congress. 

That is one of the reasons why I am leaving Congress, because 

I am tired of producing bills that are inadequate to meet the needs 

of the Country, and yet the Congress and past presidents have not 

been at all bothered to increase the size of those deficits by providing very large tax cuts by financing, in my view, a misbegotten 

war. 

So I know some people will say, well, yeah, but you can fit my 

program in, you just have to cut some other fellow’s program. And 

it is because of that response that I have had hanging on my wall 

for the last eight years this sign. As you can see, it is elegant and 

beautiful. What it says is: What do you want me to do for somebody besides yourself that is more important than whatever it is 

you want me to do for you? Because that is the spirit that we have 

to move forward in if we are going to deal with budgets in a rational way. 

So I do not by any means want to discourage any of you from 

testifying today. What you will ask for is certainly needed; I recognize that. But I hope that you recognize that we need one hell of 

a lot of help to convince the public that we do the Country no favors when we short-sheet crucial long-term investments in health 

care, education, worker protection, environmental protection, and 

the like. 

We came out of the wilderness as a backward Country, and in 

the 19th century, because this Country made the right investments, by the beginning of the 20th century we became a worldwide powerhouse; and we did that by making the right kind of investments in the right things. 

So I apologize ahead of time to all of you for the limitations of 

the budget that we will be able to produce this year because of the 

factors that I have just described. And if you want to change that 

so that we do not have to, in the future, or so that people in the 

future, who are sitting in this chair, do not have to cut bills that 

they do not want to cut, then you have to go back home to your 

neighbors and make them understand that we are not going to be 

a great Country if we recognize the cost of everything and the 

value of nothing. 

So thank you for listening while I spout off. 

Mr. Tiahrt is not here. 

Denny, would you like to say anything in response before we 

begin? 

RANKING MEMBER’S OPENING STATEMENT

Mr. REHBERG. Well, let me just begin by saying, Mr. Chairman, 

thank you for your service on the Subcommittee. I do not get to be 

Acting Ranking very often, so I do not want to miss the opportunity 

to just say a few words to you, and that is I have appreciated everything you have done, both for this Subcommittee and the full 

Committee. 

I was sitting here reminiscing a bit while you were speaking. The 

last CODEL I took was with Mr. Murtha, Mr. Hobson, Mr. Walsh, 

and yourself, and I am the last man standing. That makes me a 

little nervous. 


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But it has been an educational experience, and serving on all the 

subcommittees that I do and have, this is the most meaningful exercise that any of the Subcommittees does, by bringing in a number 

of people to, in a rapid fashion, tell us their needs and give us a 

little glimpse of their organization and their desires of building a 

more secure future for the people that they represent. 

So I appreciate the process and I appreciate your leadership. We 

are going to miss you a lot. If you would be so kind, I would adopt 

Archie the Cockroach: ‘‘And if I have anything to say about it, we 

will get rid of the pencils; I do not think we need anything with 

an eraser on it.’’ But thanks for your kind service and an opportunity to thank you publicly, and why do we not begin? 

Mr. OBEY. Thank you. Thank you very much. 

All right, first we have Brigadier General Billy Cooper, representing the National Job Corps Association. 

And let me say that we are going to have to strictly enforce the 

four minute time limit, or the people at the back end of the schedule will not get a chance to testify. I am also concerned we are 

going to be interrupted by roll calls on the House Floor. The Congress would work just fine if we did not have to interrupt our work 

to go vote. [Laughter.] 

Mr. OBEY. Proceed. 

WEDNESDAY, MAY 12, 2010. 

JOB CORPS 

WITNESS 

BRIGADIER GENERAL (RET.) BILLY COOPER, CENTER DIRECTOR, 

EARLE C. CLEMENTS JOB CORPS CENTER, NATIONAL JOB CORPS 

ASSOCIATION, DEPARTMENT OF LABOR 

General COOPER. Mr. Chairman, members of the Subcommittee, 

thank you for this opportunity to talk about a passion of mine and 

thousands of other professionals around the Country, which is Job 

Corps. I am Billy Cooper. As you indicated, I am a retired Brigadier General from the United States Army, and currently I am the 

Center Director for the second largest Job Corps Center in the 

Country, in Morganfield, Kentucky, the Earle C. Clements Center. 

Before I get started, I would like to thank you for championing 

Job Corps throughout your illustrious service. As you know, in the 

very near future, we are going to open the new center in Wisconsin, 

and I look forward to meeting you there when we have an opportunity to open that one. 

My journey to Job Corps was not typical. While I do hold a Master’s Degree in Education, I did not start out as an educator; I am 

a Vietnam draftee who ascended to the rank of Brigadier General 

and had an opportunity to live the American dream by virtue of 

service in our armed forces. And my goal is to try to figure out how 

to help young men and women today to understand that the American dream is still possible; they can live it, but it is going to take 

some hard work, some education, some job training, and an opportunity that will only exist for them in America. 

I first learned about Job Corps when I was serving as the Deputy 

Commanding General of the U.S. Army Recruiting Command at 


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Fort Knox. There, I was introduced to the dozens of unique and holistic services that Job Corps has to offer to disadvantaged youth, 

and I became a believer in the program. I was responsible for starting a partnership between Job Corps and the Army which enhances the opportunity for young men and women who attend Job 

Corps to enlist in our armed forces today, and that agreement is 

still intact. 

Nine years ago, I could have gone into a very comfortable retirement, but I chose to serve my Country again through Job Corps. 

Like so many and you, we saw that the youth in America today 

might have had an opportunity to miss out on the American dream, 

and that is why Job Corps exists. 

I left the military, became a Center Director, and Job Corps, unlike many programs I encountered in the military, does in fact 

teach young men and women to be all that they can be through the 

comprehensive services that Job Corps provides. 

Job Corps is the only viable option for thousands of disadvantaged youth. They enroll voluntarily. It is difficult for a young man 

or woman to learn when they are hungry, when they are homeless, 

when they live in poverty and really cannot see a way out. The 

promising news is that, with a modest investment in fiscal year 

2011, Mr. Chairman, Job Corps can cost-effectively use its existing 

facilities to serve additional needy youth. 

Secondly, Job Corps offers comprehensive services, which include 

health care, dental care, education through college, job training, 

counseling; and we have Job Corps Centers in almost 50 States 

today. We have 123 and the Wisconsin Center will be number 124. 

On average, I welcome 40 new students to my Center every 

Tuesday. As I said, they are volunteers, and instead of dropping 

out of society in general, they come to Job Corps to get a second 

chance. We provide healthy meals, nutrition counseling, counseling, 

education, and job training again. And for members of the Subcommittee, I simply want to say it is the only program that provides these comprehensive services. 

Do not just take my word for it. Before I run out of time, I would 

like to introduce one of my students—— 

Mr. OBEY. [Remarks made off microphone.] 

General COOPER. Well, instead of having Mr. Brooks testify, I 

will tell you he dropped out of high school. He was from Oakland 

originally; he is from Florida now. He had an opportunity to hit the 

mean streets, but did in fact choose to help his family by coming 

to Job Corps, where he has earned his skill certification in electricity, will complete his high school diploma within the next couple 

of months. Instead of being a liability to society, he will in fact be 

an asset. Serves as a role model. He is probably going to go on to 

college when he leaves Job Corps; we believe we can get him a 

music scholarship at Kentucky State University. He is a great alto 

saxophonist and a super young man, and I regret that you did not 

have an opportunity to hear his entire story. 

Mr. OBEY. I do too, especially if he is a musician. I like bluegrass 

and play it myself. [Laughter.] 

But we are going to have to move on. 

And let me say, do not take the lack of comments or questions 

from people on the panel as disinterest. We get plenty of time to 


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talk to each other, but if we do not shut up today, we will never 

get through all of the witnesses that we have. 

Thank you much. 

General COOPER. Thank you, sir, for your service and my opportunity to testify before the Committee. 

[Written statement by Billy Cooper follows:] 


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Mr. OBEY. You too. Thank you much. 

Next, Joseph Sharpe from the American Legion. 

WEDNESDAY, MAY 12, 2010. 

VETS PROGRAMS 

WITNESS 

JOSEPH C. SHARPE, JR., DIRECTOR, NATIONAL ECONOMIC COMMISSION, AMERICAN LEGION, DEPARTMENT OF LABOR 

Mr. SHARPE. Mr. Chairman and members of the Subcommittee, 

the American Legion thanks you for this opportunity to present its 

views on fiscal year 2011 funding issues under your jurisdiction. 

The Department of Labor’s Veterans’ Employment and Training 

Service administers the following programs: Disabled Veterans’ 

Outreach Program, the Local Veterans’ Employment Representatives State grant programs; Transition Assistance Programs; Veterans’ Preference and Uniformed Services Employment and Reemployment Rights Act, USERRA; Homeless Veterans’ Reintegration 

Program; Veterans Workforce Investment Program; and the National Veterans’ Training Institute. VETS plays a vital role in promoting the economic security of America’s veterans by assisting 

them in finding meaningful employment. 

The American Legion believes staffing levels for DVOPs and 

LVERs should match the needs of the veteran’s community in each 

State and should not be based solely on the fiscal needs of the 

State government. Such services will continue to be crucial as today’s active duty service members, especially those returning from 

Iraq and Afghanistan, transition into the civilian workforce. Adequate funding will allow the programs to increase staffing to provide comprehensive case management job assistance to disabled 

and other eligible veterans. The American Legion recommends $267 million to the Department of Labor’s VETS State Administration Grants for fiscal year 

2011. And please note that the amount recommended for State 

grants include funds for the Transition Assistance Program. The American Legion also recommends $50 million for the Homeless Veterans Reintegration Program in fiscal year 2011. The program has successfully integrated homeless veterans into meaningful employment at a high percentage. In addition, the HVRP is the 

only nationwide program focused on assisting homeless veterans to 

reintegrate into the workforce. The American Legion also recommends $6 million for the National Veterans’ Employment and Training Service Institute in fiscal year 2011 so that VETS staff can receive comprehensive training that will ultimately turn into higher levels of proficiency for 

them and more employment opportunity for veterans and their 

families. 

The American Legion recommends $20 million for the Veterans 

Workforce Investment Program, VWIP, in fiscal year 2011. The increase in funding for VWIP would ensure continued efforts in lifelong learning and skills development programs that are designed 

to serve the most at-risk veterans, those with service-connected disabilities and those who recently separated. 


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The American Legion recommends $61 million for the Program 

Management that encompasses Uniformed Services Employment 

and Reemployment Rights Acts, USERRA, and Veterans’ Employment Opportunity Act, VEOA, in fiscal year 2011, to ensure service 

members who are deployed return to their jobs and Federal agencies are properly adhering to veterans’ preference rights. Finally, the American Legion is requesting a total of $404 million 

for the Department of Labor’s Votes Program. 

In conclusion, thank you for the opportunity to submit the American Legion’s recommendations on funding for the VETS program 

in the Department of Labor. 

[Written statement by Joseph C. Sharpe, Jr., follows:] 


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Mr. OBEY. Thank you for your testimony and for staying within 

the time limit. I appreciate it. 

Next, Robert Pleasure, from the Building and Construction 

Trades Department. How are you? 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY 

AND HEALTH 

WITNESS 

ROBERT PLEASURE, SPECIAL ASSISTANT TO THE PRESIDENT, BUILDING AND CONSTRUCTION TRADES DEPARTMENT, AFL–CIO 

Mr. PLEASURE. Good morning, Mr. Chairman, members of the 

Committee. As the Chairman just indicated, my name is Robert 

Pleasure. I am Assistant to the President of the Building and Construction Trades Department at AFL–CIO.The purpose of our testimony today is to request your support for increased funding for the 

National Institute for Occupational Safety and Health, NIOSH, and 

its Construction Research Program. 

Despite some improvements in workplace safety and health as a 

result of research and efforts of the Occupational Safety and 

Health Administration, still, nearly 15 American workers die each 

day from workplace injuries, and another 134 die from work-related diseases. 

Four out of those 15 that die on the job are employed in the construction industry. Indeed, the construction industry has the unfortunate distinction of being the single most hazardous industry from 

the perspective of the number of fatalities in the United States, accounting for some 1,200 construction workers killed on the job each 

year. 

While construction workers make up only 8 percent of the U.S. 

workforce, they account for more than 22 percent of all work-related deaths. In fact, due to exposures to an array of toxic and hazardous substances, construction workers have unacceptably high 

levels of occupational disease, including cancer, silicosis, asbestosis, 

and other heart, lung, and neurological diseases. 

I have to say that I also have had the dubious distinction of having worked on construction safety and health for a number of years 

as Director, in the past, of CPWR, the National Construction Center that has been supported over the years by NIOSH. But that 

program has been at $5 million for many, many years, from the 

early 1990s until the present, and I do not discount the important 

hazards that other workers are exposed to, having spent time, in 

my work life, with the Federal Mine Safety and Health Review 

Commission. 

I know that there are many other industries that face these challenges, but construction not only faces these very high rates of injury and illness, but we know now, as we move from research to 

practice, how to abate these hazards; and the research we are now 

focused on and leading a vanguard effort by NIOSH is this R2P, 

research to practice, program. 

So I speak as any person that might represent the mine workers, 

for example, or offshore workers, many of whom are part of the 


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construction industry, with a sense of urgency. This is not just a 

question of research, but it is a movement from surveillance to 

intervention, from research to practice. Except for a special $80 million for the World Trade Center Health Program and some $7 million for nanotechnology research, 

the President’s fiscal year 2011 NIOSH budget request remains at 

last year’s level; and, as I said, the Construction Research Center 

has remained at the same level going back to the mid-1990s. 

While we support both the WTC program and the nanotechnology program, we believe that a major increase in the NORA budget, the National Occupational Research Agenda budget, for NIOSH 

is essential. 

With respect to that funding, we recommend a $25 million in- crease over the President’s $124 million NORA request, which was 

a static request. And we ask particularly for support for the work 

that is done in the construction industry. 

I thank you very much for this opportunity to appear before you. 

We brought our data up to 2008 BLS data in what I submitted 

today, the 35 copies, and I ask your permission to include those 

changes in the record. 

Mr. OBEY. Sure. All right. 

Mr. PLEASURE. Thank you very much. 

[Written statement by Robert J. Pleasure follows:] 


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Mr. OBEY. Thank you much. 

Next, James Kohlmoos from Knowledge Alliance. 

WEDNESDAY, MAY 12, 2010. 

K–12 ED 

WITNESS 

JAMES W. KOHLMOOS, PRESIDENT, KNOWLEDGE ALLIANCE, DEPARTMENT OF ENERGY 

Mr. KOHLMOOS. My name is Jim Kohlmoos, this is Augustus 

Mays, and we are both from Knowledge Alliance, which is a coalition of 35 education organizations dedicated to promoting the expanded use of research-based knowledge in policy and practice. We 

greatly appreciate this opportunity to testify. 

And to you, Mr. Chairman, thank you so much for your skilled 

and dedicated leadership on so many critical issues of equity and 

excellence in education over so many years. We will greatly miss 

you, but your legacy will endure for a very, very long time. So 

thank you, sir. 

Mr. OBEY. Thank you. 

Mr. KOHLMOOS. We wish to offer three critical ideas as you grapple with this appropriations bill. 

Number one, the Nation is still at risk. If you were to read the 

Nations At Risk Report this afternoon, you would think that it was 

written just yesterday, not in 1983. The critical issues that we face 

today were pervasive more than 25, 30 years ago: the trend towards mediocrity, glaring achievement gaps, diminishing global 

competitiveness. 

Even though education reform has been a top priority for the last 

30 years, why have we made so little progress? A lack of political 

will? A fractured education system? The curriculum? Human capital? We think it is all of the above and more. And the more in this 

case is that we do not have in place an education and R&D infrastructure that can deliver the kind of research-based solutions in 

ways similar to other sectors like medicine, agriculture, energy, 

and defense. Education is not yet an evidence-based, knowledgedriven field. 

Second, education funding in R&D ranks near the bottom. While 

there are a number of structural flaws in the education’s R&D infrastructure, the root cause is the woefully meager Federal investment. Consider this: $78; $0.38. The difference between what you 

can buy with $78 versus $0.38 is obviously very significant. In 

similar proportions, it is the difference between the Federal investment in defense R&D, at $78 billion, and the Federal investment 

in education R&D, at just $170 million. For a $500 billion industry 

like K–12 education to invest less than one-one hundredth of a percent in R&D is a recipe for perpetual failure. 

Third, invest more in what is currently working. Despite the low 

investment in education R&D, there is reason for optimism in the 

pockets of excellence in the knowledge sector in education that can 

invigorate the R&D enterprise. Specifically, I am referring to three 

existing programs that lay a strong foundation from which to grow 

in the future: the Comprehensive Assistance Center Programs for 


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providing technical assistance to States; the Regional Education 

Laboratories that serve as an essential bridge between the research 

community and State and local agencies; and National R&D Centers for conducting research on issues of enduring national significance. 

As outlined in my written comments, we urge substantial increases in these three vital programs. And when combined with the 

resources for school improvement and innovation in the ARRA 

funds, these three programs can create a powerful launchpad from 

which to erect a world-class R&D system for education. 

Mr. Chairman, members of the Committee, the time has arrived 

to unleash America’s ingenuity, to solve our most pressing education problems, to deliver break-the-mold solutions to our schools, 

and to guide a new knowledge and innovation revolution in teaching and learning. You can begin doing that by taking on our recommendations for increased investment in Federal R&D. 

Thank you so much. 

[Written statement by James W. Kohlmoos follows:] 


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Mr. OBEY. Thank you very much. Appreciate your time. 

Next, Chris Francis, Afterschool Alliance. 

WEDNESDAY, MAY 12, 2010. 

AFTERSCHOOL PROGRAMS 

WITNESSES 

CHRIS FRANCIS, CEO, YMCA OF THE NORTHWOODS, RHINELANDER, 

WISCONSIN, AFTERSCHOOL ALLIANCE, DEPARTMENT OF EDUCATION 

JODI GRANT, EXECUTIVE DIRECTOR, AFTERSCHOOL ALLIANCE, DEPARTMENT OF ENERGY 

Ms. GRANT. Good morning, Chairman Obey, members of the Subcommittee. It is an honor to be here today. I am Jodi Grant, Executive Director of the Afterschool Alliance. Afterschool programs are 

critical to America’s next generation; keeping kids safe, inspiring 

them to learn, and providing a lifeline for working parents. 

Thank you for your strong support of afterschool programs. This 

afternoon, more than 1.2 million children will be in afterschool programs supported by the 21st Century Community Learning Centers Fund. They are the lucky ones. They have access to a variety 

of exciting activities: CSI labs, robotics, theater, dance, art, music, 

and sports. Afterschool teachers make sure learning is fun and 

complements what the students are working on during the day. 

Children in 21st Century Centers have access to a snack or supper, homework help, tutoring, and caring adult mentors. More than 

15 million children remain unsupervised after the school bell rings. 

It is vital that this year’s budget provide the additional resources 

that afterschool programs so desperately need. 

I am delighted to introduce Chris Francis. Chris is the CEO of 

the YMCA of the Northwoods in Rhinelander, Wisconsin. Like 

many—— 

Mr. OBEY. Let me interrupt to say the staff listed it as 

Whinelander. It is Rhinelander. [Laughter.] 

Ms. GRANT. Like many YMCAs around the Nation, Chris operates an afterschool program serving the needs of youth and families in the community. 

Afterschool programs have been hit hard by this recession. Private funding sources have dried up and fees have gotten harder for 

families to pay. Federal funding has been essential in making 

afterschool available to many of the children that Chris serves and 

hundreds of thousands of them all across the Country. 

The Administration’s budget proposal for fiscal year 2011 carves 

out dollars from afterschool funding for other purposes, leaving 

some of our working parents and students behind. In addition, the 

blueprint for ESEA proposes to expand the priorities of the 21st 

Century Program in a way that would leave many more children 

without access to quality afterschool programs. 

On behalf of the more than 26,000 afterschool programs that the 

Afterschool Alliance works with, we urge the Committee to appropriate additional funds for 21st Century this year and to make certain that it remains a dedicated funding stream for afterschool and 

summer programs in the years to come. 


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Chris. 

Mr. FRANCIS. Good morning, Chairman Obey and Subcommittee 

members. I am Chris Francis and I am the CEO of the YMCA in 

Rhinelander, Wisconsin. 

Let me start by thanking my member of Congress, Chairman 

Obey, for his decades of public service. He has served the people 

of Wisconsin honorably and we are grateful for all he has done for 

our region. 

The YMCA provides the community and the school district of 

Rhinelander’s sole afterschool chance program. We are almost entirely reliant on the district’s 21st Century dollars. There are two 

multi-year grants at work, one for children grades 6 through 8 and 

one through grades 4 through 5. The district also applied for 21st 

Century dollars for K through 3, but was unfortunately not awarded a grant. 

The first point I want to promote is that we work very hard to 

make sure our program is coordinated with what is going on in the 

regular school day. We have regular school day teachers who serve 

as tutors, and they have specific knowledge of what is being taught 

when and what extra help children might need. 

At one of our centers, our site coordinator is also the school’s 

guidance counselor, and she is vigilant about making sure we know 

which students need help with a given issue. 

Over the course of the last year, students in our program have 

dramatically improved their grades. The average GPA of regular 

attendees has increased steadily from 2.5 in the first quarter to 3.2 

the first quarter this year. 

One of our afterschool students, whose name I will protect, came 

to us as a seventh grade student last year. He eventually had a 

run-in with law enforcement after school. That is the point at 

which a lot of kids can and do slip right through the cracks, labeled 

as troublemakers or low achievers. But the school district and the 

YMCA worked very hard with him to get his grades up and get 

him back on track, and this year he is on the honor roll and continues with our program because he enjoys it. 

I know the Committee is interested in the opportunity that afterschool programs offer for delivery of health care services and health 

literacy instruction, and I could tell you that afterschool provides 

an ideal platform. 

Now turning to a second to proposals going forward, I have some 

concerns. First, being a relatively small district, we do not have a 

professional grant writer on staff, so I am concerned about what it 

would mean if grants were nationalized. 

Mr. Chairman, afterschool programs are in short supply. More 

than 300,000 kids are left unattended after school. Children in our 

State and in our Country deserve and need more afterschool programs. 

[Written Statement by Chris Francis follows:] 


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Mr. OBEY. Thank you very much. Just one comment. You talk 

about kids who run into trouble with the law. When I was in the 

seventh grade, I skipped two days out of five regularly. I would get 

off the school bus—— 

[Laughter.] 

I would get off the school bus, I would walk three miles home, 

grab my dog, go out and sit in the woods. If I had not had the 

intervention by a couple of teachers in what was the equivalent of 

an afterschool program, I might be in an institution, but it would 

not be the United States Congress. [Laughter.] 

Mr. FRANCIS. Thank you, Mr. Chairman. We hear those stories 

a lot. 

Mr. OBEY. Next, Sharon Washington, National Writing Project. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL WRITING PROJECT 

WITNESSES 

SHARON J. WASHINGTON, EXECUTIVE DIRECTOR, NATIONAL WRITING 

PROJECT, DEPARTMENT OF ENERGY 

MARY TEDROW, ENGLISH TEACHER, JOHN HENLEY HIGH SCHOOL, 

WINCHESTER, VIRGINIA, DIRECTOR, SHENANDOAH VALLEY SUMMER INSTITUTE 

Ms. WASHINGTON. Good morning, Chairman Obey and other 

members of the Subcommittee. My name is Sharon Washington, 

Executive Director of the National Writing Project. I appreciate the 

opportunity to present this testimony requesting continued support. The National Writing Project is the only nationwide network 

of professional development centers dedicated to improving the 

teaching of writing. Since 1991, the National Writing Project has 

been an authorized program within the Elementary and Secondary 

Education Act. With consistent Federal funding, NWP has built a 

national infrastructure of more than 200 sites located in universities across the Country. NWP sites serve teachers at all grade 

levels and across disciplines; and teachers, schools, and districts 

across all 50 States, the District of Columbia, Puerto Rico, and the 

U.S. Virgin Islands. 

As you know, the Administration’s fiscal year 2011 budget proposal recommends a competitive grants program for States called 

Effective Teaching and Learning: Literacy. NWP is not eligible to 

compete for funds in this consolidated program and would receive 

no direct funding. As a result, this effective national infrastructure 

that Congress has invested in since 1991 would be lost. 

NWP professional development addresses two essential elements 

in educational improvement: the importance of quality teaching 

and the vital skill of writing. And today this means writing in all 

its forms—blog posts, tweets, persuasive essays, scientific and business writing, as well as digital stories, to name just a few. 

In fact, writing in its many forms is the signature means of communication in the 21st century. In a 2009 national public opinion 

poll, three-quarters of those surveyed believe good writing skills 

are more important today than they were 20 years ago. And those 


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of us who have children, grandchildren, nieces and nephews, do not 

need to be convinced on that score. 

Since 1974, the National Writing Project has expanded its capacity to work with teachers from one local site to more than 200 

today. NWP is truly a national, innovative, effective program with 

a significant portfolio of research and evaluation studies that show 

impact on student writing and performance. Here are three key 

facts: 

One hundred thousand teachers are served each year. Over the 

last decade, at least one million teachers have participated in our 

programs. 

Two, National Writing Project’s direct Federal support leverages 

a 1:1 match with university, local, State, and private dollars to improve classroom instruction in writing that reaches millions of students annually. 

Three, NWP develops new innovative programs to support the 

work of local sites. For example, NWP has been awarded a threeyear grant from the MacArthur Foundation to help support professional development programs using new digital tools for the teaching of writing. 

We know how important it is for the next new generation of students to be able to communicate effectively and how important that 

will be to their futures. I would like to introduce to you Mary 

Tedrow, an English teacher at John Henley High School in Winchester, Virginia, the Director of the Shenandoah Valley Summer 

Institute. 

Mary. 

Ms. TEDROW. Thank you. 

My initial contact with the NWP came in 1982, when I was a relatively new teacher and attended a professional development program featuring presentations by classroom teachers trained 

through the Northern Virginia Writing Project located at George 

Mason University. In an era when teachers worked in isolation, 

this was the first time teachers shared their best lessons and their 

student work with me. 

This contact resulted in immediate changes to my practice, such 

as adding daily writing and student sharing, all unheard of in traditional classrooms. 

In 1998, I was accepted into the five-week invitational summer 

institute. Since then, I have been able to extend the investment in 

my leadership to other teachers. Over 50 teachers in grades kindergarten through university have received training in the Shenandoah Valley since 2005 and returned to their respective districts 

to lead their peers in professional development, while continuing to 

learn new skills from the NWP network. 

I have been exposed to more than 21 years of professional development programs, and the Writing Project stands alone in its 

transformative nature. 

I thank you on behalf of Writing Project teachers from across the 

Country and the students that we teach each year. 

[Written statement by Sharon J. Washington follows:] 


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Mr. OBEY. Thank you both very much. 

Next, Sheriff Dean Roland, from Fight Crime: Invest in Kids. 

WEDNESDAY, MAY 12, 2010. 

CHILD CARE AND DEVELOPMENT BLOCK GRANT PROGRAM, HEAD START PROGRAM, AND 21ST CENTURY 

COMMUNITY LEARNING CENTERS PROGRAM 

WITNESS 

DEAN ROLAND, SHERIFF, BURNETT COUNTY, WISCONSIN, FIGHT 

CRIME: INVEST IN KIDS 

Mr. ROLAND. Thank you for the opportunity to testify before you 

today. My name is Dean Roland, and I am the Sheriff of Burnett 

County, Wisconsin. I am also a member of Fight Crime: Invest in 

Kids, a national organization of more than 5,000 law enforcement 

leaders who have come together to take a hard-nosed look at the 

research about what really works to keep kids from becoming 

criminals. Fight Crime: Invest in Kids takes no Federal, State, or 

local money, and does not run any of the programs we advocate for. 

I know from my experience and from research that access to highquality early care and education for at-risk kids cannot only help 

close the achievement gap, but prevent crime and make our communities safer as well. 

For example, a study found that at-risk kids left out of Chicago’s 

Child Parent Centers Early Education Program, similar to Head 

Start, were 70 percent more likely to be arrested for a violent crime 

by age 18. Another study found that at-risk kids left out of the 

high-quality Perry Preschool Program were five times more likely 

to be chronic offenders, with five or more arrested by age 27. By 

age 40, those who did not attend the Perry Preschool Program were 

more than twice as likely to become career offenders, with more 

than 10 arrests and twice as likely to be arrested for violent 

crimes. 

Head Start is the Nation’s premier school readiness program for 

children in poverty. Head Start incorporates most of the key features of high-quality, early education programs proven to cut crime, 

such as appropriate class size and teacher-student ratios, comprehensive and age-appropriate early learning standards, related 

services, including health referrals, and parent involvement and 

coaching. 

Research shows Head Start works for kids. For example, one national study found that Head Start increases high school graduation rates by 7 percent for children in the program compared to 

their siblings not in the program, but in other care, and decreased 

crime by 8.5 percent. 

Early Head Start provides comprehensive child development and 

family strengthening services for infants and toddlers from birth to 

age 3. Research shows that Early Head Start is effective. A study 

of over 3,000 families participating in 17 Early Head Start programs nationwide found that three-year-olds who had participated 

in Early Head Start had higher levels of cognitive and language development, better attention to play, and lower levels of aggressive 

behavior. 


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This finding on aggressive behavior relates directly to crime. Research shows that 60 percent of children with high levels of disruptive, aggressive behaviors in early childhood will manifest high levels of antisocial and delinquent behavior later in life. 

High-quality early care and education for at-risk kids not only reduces crimes, but saves the public money as well. For example, a 

cost-benefit analysis of the high scope Perry Preschool Program 

showed that it saved $16 for every $1 spent. And having been in 

this profession 35 years and 20 years as a professionist, I can tell 

you you cannot build enough jails. We need to focus on the education. Prevention works. 

Unfortunately, despite these proven benefits, these programs remain chronically underfunded. Nationally, Head Start is only able 

to serve about half of the eligible kids. Early Head Start serves less 

than 5 percent of eligible infants and toddlers. 

The Child Care and Development Block Grant is only able to 

help one in seven eligible low-income kids get high quality child 

care. In the current economic climate, more kids need these services, but are unable to access them, and States are cutting back 

their early care and education investments due to their budget 

shortfalls. 

To ensure at-risk kids get the high quality, early care and education they need, I strongly urge you to increase funding for investments that have been proven to reduce later crime and violence by 

helping kids get the right start in life. 

As you develop the fiscal year 2011 appropriations package for 

the Department of Labor, Health, and Human Services, I urge you 

to fund President Obama’s proposed increase of nearly $1 billion 

over fiscal year 2010 levels for Head Start and Early Head Start, 

and to increase funding for the Child Care and Development Block 

Grant by $1 billion over fiscal year 2010 levels. As a law enforcement officer who has watched too many kids grow up and become 

criminals, I know these investments will make our community 

safer. 

Thank you again for this opportunity. 

[Written statement by Dean Roland follows:] 


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Mr. OBEY. Thank you very much, and I appreciate the work you 

have done through the years. 

Mr. ROLAND. Thank you very much. 

Mr. OBEY. Thanks for coming. 

Mr. ROLAND. Same to you. 

Mr. OBEY. Next, Ford W. Bell, American Association of Museums. 

WEDNESDAY, MAY 12, 2010. 

AMERICAN ASSOCIATION OF MUSEUMS 

WITNESS 

FORD W. BELL, PRESIDENT, AMERICAN ASSOCIATION OF MUSEUMS, 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES 

Mr. BELL. Thank you, Chairman Obey and Ranking Member 

Tiahrt—who is not here—and other members of the Subcommittee. 

I appreciate the opportunity to testify today. I am here on behalf 

of the American Association of Museums to request your support 

for an increased investment in our Nation’s museums. The American Association of Museums is proud to represent the full spectrum of our Nation’s museums, from aquariums, botanical gardens, 

and historic sites, to planetariums, presidential libraries, science 

and technology centers, zoos, aquariums, and everything in between, along with professional staff and volunteers who work for 

and with museums. 

The Institute of Museum and Library Services is the primary 

Federal agency that supports the Nation’s 17,500-plus museums, 

and its Office of Museum Services awards grants to all types of 

museums to help museums care for their collections and to create 

innovative programs and exhibits. We urge your support for $50,000,000, a $15,000,000 increase for 

the Office of Museum Services at the Institute of Museum and Library Services. 

Museums are essential to our communities, schools, and economy 

for many reasons. Each dollar that supports museums is an important economic investment. In 2008 alone, museums contributed approximately $20 billion to the American economy. Museums also 

serve as economic engines, bolstering local infrastructure and encouraging tourism. There are 850 million museum visits in the 

United States every year. 

Museums create jobs. An estimated 500,000 people currently work for museums, but the more than $20 billion pumped into the 

American economy by museums creates millions more jobs. 

Museums are also key partners in education. Museums spend more than $2.2 billion annually on educational programming for K 

through 12 children and design educational programs in coordination with State and local curriculum standards in almost every 

subject. They also provide professional development for teachers in 

all subjects. 

Through the use of digitization and traveling exhibitions, museums are able to bring their collections to underserved regions 

across the Country. Unfortunately, like so many other nonprofits, 

museums are struggling in this economy. They have been forced to 


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cut back hours, programming, community services, and, therefore, 

jobs. Some have had to close their doors for good. 

It is for these reasons that increased funding for the Office of 

Museum Services, which has been essentially flat-funded for many 

years, is so critical. For example, Congressman Obey, in your district, IMLS grants support Lac Courte Oreilles Band of Lake Superior Chippewa Indians Malagasy Cultural Resources Center, allowing the Center to partner with the local schools to develop regional 

history curriculum. 

Congressman Rehberg, in your district, with IMLS support, the 

great Museum of the Rockies will host Dinosaurs Under the Big 

Sky through its new Mesozoic Media Center. This multi-partner 

project will bring science to entirely new audiences with live 

webcasts and other educational programming. 

It is important to note that zoos and aquariums are critical members of our museum family. They are leaders in environmental education; they are saving endangered species; and they too are economic engines creating thousands of jobs and spurring local tourism dollars. I raise the issue today because a year ago zoos and 

aquariums were excluded from competing for stimulus funds and 

are currently excluded from some proposed jobs bills. 

Museums are significant job creators, and zoos and aquariums, 

in particular, create green jobs. They are science education jobs, 

keep us competitive globally, and they are investments in community infrastructure that we cannot afford to ignore. I urge the Subcommittee to consider the vital role that zoos and aquariums play 

as any further stimulus bills or jobs bills or other appropriations 

bills are considered. 

Thank you for the opportunity. 

[Written statement by Ford W. Bell follows:] 


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Mr. OBEY. Thank you. Let me just make one point. Zoos were not 

excluded because there is anything wrong with zoos; they were excluded because it was necessary to find the votes to pass the stimulus bill. There are some people in this institution and out who 

have a habit of demagoging when they can find anything they can 

get a handle on, and they certainly have done so in the past with 

respect to those institutions, which is why, for the greater good, we 

regretfully had to recognize that the power of their outlandish rhetoric outweighed our ability to counter it, to be frank about it. 

Mr. BELL. I understand, Congressman. Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. 

Next, Vivian Schiller, National Public Radio. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL PUBLIC RADIO 

WITNESS 

VIVIAN SCHILLER, PRESIDENT AND CEO, NATIONAL PUBLIC RADIO, 

CORPORATION FOR PUBLIC BROADCASTING 

Ms. SCHILLER. Thank you, Mr. Chairman and members of this 

Subcommittee. I appreciate your giving me the opportunity to express support for funding for public broadcasting. As the President 

and CEO of NPR, I am testifying today on behalf of more than 850 

public radio station partners, producers, and programming allies, 

including American Public Media, Public Radio International, and 

Public Radio Exchange. 

The public radio system, all in public broadcasting, and the tens 

of millions of Americans who listen and watch every week are 

grateful for your decades of support. We are also grateful for the 

additional $25 million in funding provided by Congress last year to 

help stations offset the devastating financial impact of the Country’s economic crisis. 

The concept of public funds for public broadcasting is a cornerstone of the relative financial stability of our system. In the few 

minutes I have with you today, let me cover two closely related topics: the dramatic changes that have engulfed media, and particularly the world of journalism and news that are the strengths of 

public radio; and the state of public radio and steps we have taken. 

Last month, the Project for Excellence in Journalism from Pew 

released its annual State of the News Media Report. Every year it 

is a very hotly anticipated document and, at 700 pages, it is pretty 

closely analyzed for clues and nuances about the future of the business. Well, usually it is tea leaf reading, but not this year. This 

year, the report came like a blow to the head with a two-by-four. 

Here are a few phrases I pulled verbatim from the State of the 

Media Report: enormous losses; grim revenue numbers; continued 

declines in audience; continued declines in revenue; continued declines in staff; and this line, the losses suffered in traditional news 

gathering in the last year were so severe that, by any accounting, 

they overwhelmed the innovations in the world of news and journalism. 


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Here are these findings translated into numbers. Newspapers, including online, saw ad revenue fall 26 percent during the past year, 

bringing total losses over the last three years to 41 percent. Nearly 

one in every five journalists working for newspapers in 2001 is no 

longer doing so. Almost 6,000 full-time newsroom jobs were cut, or 

about 11 percent in 2008. Sixteen hundred jobs lost in local television the last two years. Over the past five years, newspaper audiences have declined by 29 percent. And on and on. 

This is coverage of the very issues that you referenced as so 

needing of support, a lot of things that are being talked about 

today. This is coverage about health care, about education, about 

worker protection, about children in need and children at risk. 

I add one more statistic that really begins to tell the story or, 

rather, leaves the story untold: overseas, all three television networks had, by the end of 2008, eliminated the posting of a full-time 

reporter in Iraq. The Pew report begins with two words: What 

now? 

First, you should know that we are NPR still have our Iraq bureau and a full-time bureau in Kabul, Islamabad, and 14 other 

international locations, plus 21 domestic bureaus. Yes, we were hit 

by the recession and suffered losses, mostly in underwriting revenue, but we have not hit in audience. We have just reached an 

all-time high: 34 million listeners every week to NPR member stations at six hours per week. Our audience continues to grow. 

So here is the what now for us. We are moving forward through 

innovation and partnership in three areas: more original reporting, 

foreign investigative breaking news, and particularly local reporting; reaching more diverse audiences to reflect changes in each 

race and ethnicity as the demographics of the Country change; and 

fully embracing new platforms and technologies—streaming, 

podcasting, use of the iPhone, iPad, BlackBerry; wherever our audience needs us. 

And unlike others in media seeking to turn a profit or charge 

fees for access to the news, we will always be free to our audience, 

the American people. NPR believes public radio and all of public 

broadcasting have an integral and primary role to present the future information needs of American communities, and we thank 

you for our support today. Thank you. 

[Written statement by Vivian Schiller follows:] 


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Mr. OBEY. Thank you. 

Next, Yasmina Vinci, from the National Head Start Association. 

WEDNESDAY, MAY 12, 2010. 

HEAD START 

WITNESS 

YASMINA VINCI, EXECUTIVE DIRECTOR, NATIONAL HEAD START ASSOCIATION 

Ms. VINCI. Chairman Obey and distinguished members of the 

Committee, thank you very much for the opportunity to testify. 

Chairman Obey, given your recent announcement of your pending retirement, I would like to take a very quick moment and 

thank you for all you have done as Chairman of the Committee, 

and I think early care in education is stronger as a result of your 

efforts. Thank you. 

I am testifying today on behalf of the National Head Start Association, which represents more than one million children, 200,000 

staff, and 2600 programs in the United States. 

Created in 1965, Head Start is the evidence of the Country’s 

longest commitment to early education and care. Head Start programs across the Country prepare young high-risk children and 

their families to succeed in school and in life. 

These investments in Head Starts have paid dividends to the 

children, to their families, and to the communities. Reliable research studies demonstrate that fewer Head Start children repeat 

grades; fewer need costly special education; more graduate from 

high school. 

Because of Head Start’s health services, 33 to 50 percent fewer 

children die of preventable diseases in their early school years. And 

as you heard from Sheriff Roland, Head Start benefits society at 

large by reducing crime and its cost to crime victims. 

More than 27 million children have benefitted from Head Start. 

But prior to the American Recovery and Reinvestment Act, Head 

Start was only able to serve about 40 percent of eligible children 

and Early Head Start served only 2 to 3 percent. Thanks to Congress, through the Recovery Act funding, Head Start and Early 

Head Start have been able to serve 14,000 more three- and fouryear-olds, and 50,000 more infants and toddlers across the Country. 

However, the increased numbers of children and families now assisted by Head Start still falls short of the need. According to the 

U.S. Bureau of Census, another 1.1 million children under the age 

of six slipped into poverty between 2001 and 2008, and those children are now on Head Start programs’ waiting lists. 

For instance, in Sedgwick County, Kansas, there were over 2,000 

applications for only 237 spaces. In five Minnesota communities, 

1,866 families are on waiting lists. And in just one program in California, Berkeley-Albany YMCA, 240 families are waiting anxiously 

every day for a space to open. 

For all of these reasons and more, NHSA strongly supports the 

President’s budget for fiscal year 2011. Specifically, the President’s 

budget provides an additional $989 million for Head Start and 


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Early Head Start to continue to serve the 64,000 additional children and families funded by the Recovery Act. 

The President’s proposal would allow Head Start programs to 

preserve the recent gains. After years of flat funding that did not 

keep up with the rate of inflation, we are moving towards paying 

Head Start staff wages consistent with their skills. 

Through the Recovery Act, an additional 24,000 jobs were created for the new Head Start staff. Thousands more jobs were created in building new Head Start classrooms and playgrounds, and 

many more children and families are being served. 

Accordingly, it would be devastating to every community across 

the Country if Head Start suddenly had to cut back and reduce the 

size of the program. Tens of thousands of early childhood professionals would have to be laid off; at-risk families would be dropped 

from the program with nowhere else to turn; buildings would sit 

empty; and the gains that have been made would be lost. This 

Country cannot afford for that to happen. 

For all these reasons and more, National Head Start Association 

hereby requests that this Committee support the President’s fiscal 

year 2011 budget proposal for Head Start and for the other early 

childhood programs as well. 

Thank you very much. 

[Written statement by Yasmina Vinci, follows:] 


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Mr. OBEY. Thank you. 

Next, is it Tunde Eboda? National Association for State Community Services Programs. 

WEDNESDAY, MAY 12, 2010. 

COMMUNITY SERVICES BLOCK GRANT PROGRAM 

WITNESS 

TUNDE EBODA, PH.D., CSBG STATE ADMINISTRATOR, DISTRICT OF COLUMBIA, NATIONAL ASSOCIATION FOR STATE COMMUNITY PROGRAMS 

Mr. EBODA. Yes, Mr. Chairman. Thank you very much. Chairman Obey, Acting Ranking Member Rehberg, good morning. Members of the Committee, we want to thank you for the opportunity 

this morning to provide testimony on behalf of the National Association for State Community Services Programs. 

We want to thank Congress for the support of the Community 

Services Block Grant and we look forward to the many opportunities in the future to demonstrate the successes and build upon the 

successes that we have accomplished in promoting economic stability and mobility for Americans everywhere. 

We especially want to thank Chairman Obey for the ardent work 

that he has done over the week and for being the champion of vulnerable populations. We very much appreciate your service and 

thank you for it. 

Mr. OBEY. Thank you. 

Mr. EBODA. I planned today to talk about CSBG outcomes, and 

we do have a lot of them, but first I want to talk about jobs. 

We are the recipient of economic recovery funds, and we are 

happy to report that this year, so far, we have created and retained 

or retained a minimum of 8,000 jobs, and have helped approximately 22 percent of Americans in poverty to stay employed and 

retain economic stability. 

The Federal recovery spending data ranks the Community Services Block Grant number 12 out of approximately 200 programs 

that were reviewed for jobs created and retained. Because of the 

Recovery Act funds, we have been able to accomplish this many 

successes. 

We stand the risk of losing the Recovery Act funds at the end of 2010. We will be asking and request that a minimum of $300 

million be added to the CSBG funds, which would be approximately 

33 percent of what we will be losing as a result of the Recovery Act 

funds expiring at the end of fiscal year 2010. 

What are some of the functions of the state in the Community 

Services Block Grant Program? We provide, of course, the assurance through the Federal Government and to all stakeholders that 

we hold community action agencies accountable for the use of Community Services Block Grant funds; we provide the partnerships 

that is critical to making Community Services Block Grant funds 

work. 

Many other Federal programs are already located within the 

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grams, all combine to make CSBG work through partnerships. We 

provide the monetary and evaluation that is necessary to assure 

our stakeholders that we are good stewards of Federal funds. 

Additionally, we have the responsibility for providing reports to 

Congress on an annual basis that demonstrate the successes and 

how we have overcome challenges that exist within the network. 

We are asking also that language in the CSBG statute be retained so that we have the flexibility to recapture funds and redistribute those funds within the CSBG network if agencies do not expend up to 20 percent of their grant going into the next fiscal year. 

We have many examples of successes within the CSBG program. 

We have provided details for the record in the testimony that we 

have submitted before the Committee today. 

We are happy to be here to report on the successes and we have 

many, many more, and we encourage members to please review the 

testimony, and we are happy to answer any questions that you may 

have. Thank you. 

[Written statement by Tunde Eboda follows:] 


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Mr. OBEY. Thank you again. 

Mr. EBODA. Thank you very much. 

Mr. OBEY. Next, Steven Berg, National Alliance to End Homelessness. 

WEDNESDAY, MAY 12, 2010. 

HOMELESSNESS 

WITNESS 

STEVEN R. BERG, VICE PRESIDENT FOR PROGRAMS AND POLICY, NATIONAL ALLIANCE TO END HOMELESSNESS 

Mr. BERG. Good morning, Mr. Chairman and members of the 

Subcommittee. The last time we had full national data was early 

in 2008, and at that point there were two-thirds of a million people 

homeless in the United States. Now, that is too many people. But 

that is also significantly fewer people than were homeless even a 

few years beforehand. We started to make progress on this issue 

thanks to what communities around the Country are doing to adopt 

new practices and better approaches. 

Homelessness is a problem with a solution, and an important 

part of that solution is in the jurisdiction of this Subcommittee. My 

written testimony identifies 11 different items that we believe are 

key and relevant to continuing to make progress. I want to spend 

a couple minutes just focusing on three of those that involve some 

new things. 

First of all, SAMHSA has a series of direct grants to nonprofits 

around the Country to provide services in supportive housing. Supportive housing is deeply subsidized housing, where the rents are 

subsidized, combined with intensive support services in health 

treatment that has proven to really work to get people who have 

been on the streets for many years, who have severe problems of 

mental health, substance abuse, other kinds of physical problems, 

to get them off the street, permanently housed, and end their 

homelessness. That is a model that has directly contributed to 

thousands of people who used to live on the streets now being 

housed. 

This year there is something in the President’s budget that people on this Committee and around the Country have been demanding for many years, which is for an initiative to get HHS and HUD 

to work more closely together to provide permanent supportive 

housing. So most of the funding for that is coming from HUD, but 

there is $15.8 million in the President’s budget to provide supportive services specifically matched up with HUD-funded rental 

vouchers to provide permanent supportive housing both for homeless people with disabilities and also for homeless families with 

children. This is a new initiative we think is going to go a long way 

toward getting those two agencies to work together and to get the 

people who get their money on the ground to work together. So 

that is an important item. 

Community Health Teams is a grant program that was in the 

health care reform bill that is ready to go as soon as money is appropriated for it. This would fund primary care providers to coordinate with other providers at the State and local level to provide 


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services to people in medical homes, which is a term of art, but 

which applies to permanent supportive housing. So it is another 

way into this permanent supportive housing problem. We believe 

an initial allocation of $20 million for that program, to get that program started and off the ground would be money well spent. 

Finally, the third piece has to do with youth homelessness. There 

are many unaccompanied youth who are homeless in our cities and 

our rural areas. We do not know as much about that part of the 

problem, but we do estimate that there is probably 50,000 who are 

long-term living on the streets, without anyplace to live, without 

any support from family. 

We are working very hard to up the visibility of this issue this 

year and to really look for better solutions, and we think the Runaway and Homeless Youth Act programs at the Administration for 

Children and Families are going to be a key part of those solutions. 

I would like to close just by saying we have made great progress 

on this issue over the last few years. The Appropriations Committee has been at the center of that progress by investing in 

things that work, so on behalf of myself, on behalf of literally hundreds of thousands of people who are going to bed tonight in a modest apartment, who would be sleeping in the back seats of their 

cars, I want to thank you for the work you have done over the 

years as a leader on this issue and assure you that we will continue to work on it while you are gone. 

[Written statement by Steve Berg follows:] 


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Mr. OBEY. Thank you much. 

Mr. BERG. Thank you. 

Mr. OBEY. Next, Kevin Martone, National Association of State 

Mental Health Program Directors. 

WEDNESDAY, MAY 12, 2010. 

MENTAL HEALTH BLOCK GRANT 

WITNESS 

KEVIN MARTONE, COMMISSIONER, NEW JERSEY DEPARTMENT OF 

HUMAN SERVICES, DIVISION OF MENTAL HEALTH SERVICES, NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS 

Mr. MARTONE. Mr. Chairman, members of the Subcommittee, I 

want to thank you for the opportunity to appear before you today. 

My full-time job, I am New Jersey’s Mental Health Commissioner. 

Today, I am here to reflect the views of the National Association 

of State Mental Health Program Directors, NASMHPD, which represent the public mental health authorities in the 50 States, as 

well as the District of Columbia and the territories.Permit me to 

briefly summarize the situation we confront. The larger State fiscal 

crisis is having a severe impact on public mental health systems 

across the United States and is certainly being felt in New Jersey. 

According to February 2010 data collected by NASMHPD’s Research Institute, between fiscal year 2009 and fiscal year 2011, 

States have been forced to cut mental health agency budgets by a 

combined total of $1.82 billion. That estimate reflects reporting 

from 45 States. 

Mr. Chairman, to put this in historical context, that number 

probably represents the largest total funding reduction to public 

center mental health services in nearly 50 years. The effect of these 

shortfalls on America’s mental health safety net, as well as the consumers it serves, can only be described as devastating. Some States 

have been forced to make cuts equaling 20 percent of their total 

mental health spending. In the worst hit States, reductions approaching 40 percent are being contemplated or have already been 

implemented. 

As an illustration, in Ohio, the combined State mental health cut 

over the last three fiscal years total over $191 million. The total 

percentage reduction equals 36 percent across the board. 

To date, the programs hardest hit are indigent care initiatives 

providing mental health services to low-income people and uninsured adults, many of whom recently lost health insurance coverage in this recession. Let me take a moment to give you some 

specific examples of what these cuts mean in our communities. 

In Illinois, Governor Quinn is being forced to contemplate a $90 

million funding cut to Illinois’ Division of Mental Health Community Services. Once Medicaid reimbursements reductions are included, the proposed State cut would result in a 40 percent reduction in community-based mental health services statewide. It is estimated that more than 70,000 low-income persons, including over 

4200 children, will lose access to mental health care. 


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In Kansas, 9 of the State’s 27 community mental health centers 

are in the red and may close. Most serve rural health professional 

shortage areas. Furthermore, it is astonishing to note that Kansas 

is actively contemplating a complete freeze on all new admissions 

to the State’s public psychiatric hospitals for up to a full year. 

In New Jersey, consistent with the United States Supreme 

Court’s Olmstead decision, and with Governor Christie’s support, 

we are reducing the number of State psychiatric hospitals and 

serving more people with severe mental illnesses in the community, 

closer to family and friends. In fiscal year 2011, our Division will 

close Hagedorn Psychiatric Hospital, producing a projected savings 

of $9 million. 

Yet, at the same time, the budget crisis has forced us to reduce 

community contracts and my division was required to make targeted cuts to partial care, case management, and jail diversion programs. This situation greatly contemplates our ability to close 

Hagedorn. Moreover, in all candor, what keeps me up at night is 

that fiscal year 2012 does not look much better than 2011. 

Let me end my testimony by making two larger points. First, 

State mental health agencies nationwide are caught in a policy 

vice. We are losing State and county revenues, while at the same 

time the recession is producing a huge spike in the number of people coming to us for mental health care. Twenty States are reporting increased demand for both outpatient services, as well as acute 

care hospital services. In Rhode Island, for instance, community 

mental health service centers served nearly 22,000 people with 

mental illnesses last year, one of the highest totals in its State history. 

Second, although Federal Medicaid FMAP increases approved in 

ARRA have helped temporarily avert even deeper cuts, they have 

not shielded the public mental health system from the worst funding reductions in nearly five decades. In addition, the new health 

care reform law will not begin providing health insurance to many 

indigent persons for several years, and many of the intensive rehabilitative services these individuals require will not be covered by 

the new insurance exchanges or Medicaid. 

In March 2010, Representatives Tonko and Napolitano, along 

with 35 other members of Congress, wrote to this Subcommittee requesting a $100 million increase for SAMHSA’s Community Mental 

Health Services Block Grant, resulting in a total funding level of 

$520 million. Both NASMHPD and the New Jersey Division of 

Mental Health Services strongly support this request. 

Yes, I acknowledge that the Tonko and Napolitano request is 

without precedent, but the scale of the fiscal crisis we confront is 

also unprecedented. The hard fact is that Mental Health Block 

Grant is the only program available to help public mental health 

authorities recover State and county service dollars lost during the 

current fiscal crisis. 

I welcome any questions you may have. 

[Written statement by Kevin Martone follows:] 


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Mr. OBEY. [Remarks made off microphone.] 

Next, Michael J. Fitzpatrick, National Alliance on Mental Illness. 

WEDNESDAY, MAY 12, 2010. 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 

ADMINISTRATION 

WITNESS 

MICHAEL J. FITZPATRICK, EXECUTIVE DIRECTOR, NATIONAL ALLIANCE ON MENTAL ILLNESS 

Mr. FITZPATRICK. Chairman Obey and members of the Subcommittee, I am Mike Fitzpatrick. I am the Executive Director of 

the National Alliance on Mental Illness. I am pleased today to offer 

NAMI’s views on the Subcommittee’s upcoming fiscal year 2011 

bill. NAMI is the Nation’s largest grassroots advocacy organization 

representing persons with serious mental illness and their families. 

I first want to thank the Subcommittee for a long bipartisan history of supporting funding for research and services for people with 

serious mental illness. As you know, the cost of mental illness to 

our Nation is enormous. 

I want to summarize NAMI’s statement to you by making three 

major points. 

The investments in research at the National Institute of Mental 

Health are critical for our Nation. NAMI joins the ad hoc group on 

medical research recommending $36 billion in overall funding for 

the National Institutes of Health, representing a 12 percent increase. 

NAMI also recommends a corresponding 12 percent increase of $1.7 billion for the National Institute of Mental Health. This increase will enable NIMH to continue supporting two critical initiatives that were started using stimulus monies. 

The first is RAISE, Recovery After an Initial Schizophrenia Episode. This is the first ever large-scale trial supporting early and aggressive treatment, integrating a variety of different therapies to 

reduce symptoms and prevent the gradual deterioration or functioning that is characteristic of schizophrenia. 

The second project is STARRS, which is the Study to Assess Risk 

and Resilience in Service Members, a joint Army and National Institute of Mental Health study of suicide and mental health among 

military personnel. 

Additionally, this 12 percent increase will allow the National Institute of Mental Health to continue supporting other important research initiatives to find better treatments and ultimately a cure 

for disabling illnesses. 

Our second point is this Subcommittee must address, as you just 

heard from the Commissioner of New Jersey and from NASMHPD, 

the current crisis in funding of the public mental health system. 

Mr. Chairman, as our Nation continues to struggle with this current economic downturn and States continue to struggle with diminished revenue, we see a crisis in America’s mental health system that we have not seen in our tenure at NAMI over the past 

31 years. The system is literally collapsing in front of us. We echo 

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ly $1.8 billion since 2009. We see cuts in States totaling as much 

as 20 percent and more. Looking at the budget numbers in State 

budgets for the next two or three years, we see this picture not 

changing through 2011, 2012. 

This has led to the elimination of State hospital beds, the closure 

of important, essential mental health services, and really has left 

the burden in communities falling on jails, homeless shelters, and 

emergency rooms as really the backbone of the mental health systems. This is tragic and really unacceptable. 

To help fill these gaps left by these ill-conceived cuts, NAMI strongly recommends a $100 million increase to the Mental Health 

Block Grant for fiscal year 2011. Funding for the Block Grant has 

been frozen at its current level of $420 million since fiscal year 

2000. An increase is long overdue. While this will not make up for 

the cuts to services on the State side, this is an important step that 

Congress must take to assist our most vulnerable citizens. 

NAMI also supports targeted increases in the President’s budget 

for the Center for Mental Health Services, including the PATH program, the Children’s Mental Health program, Suicide Prevention 

Programs under the Garrett Lee Smith Memorial Act, and homeless programs at SAMHSA. 

And third, and finally, for fiscal year 2011, the Subcommittee 

should continue the progress it has made in recent history in addressing the Social Security claims and appeals backlog. Mr. Chairman, people with mental illness and other severe disabilities have 

been bearing the brunt of the backlog crisis for disability claims at 

Social Security. Behind the numbers are individuals whose lives 

have unraveled because of this backlog. 

We applaud the work the Subcommittee has done in recent history to boost funding to the Social Security Administration. We 

would ask you just to please continue this progress by supporting 

the President’s funding recommendations regarding the Social Security Administration. 

Thank you for the opportunity to speak to you today. 

[Written statement by Michael J. Fitzpatrick follows:] 


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Mr. OBEY. [Remarks made off microphone.] 

Next, Julio Abreu, Coalition for Health Funding. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH, CENTERS FOR DISEASE CONTROL, HEALTH RESOURCES AND SERVICES 

ADMINISTRATION, SUBSTANCE ABUSE AND MENTAL 

HEALTH SERVICES ADMINISTRATION, AGENCY FOR 

HEALTHCARE RESEARCH AND QUALITY, FEDERAL 

DRUG ADMINISTRATION, AND INDIAN HEALTH 

WITNESS 

JULIO ABREU, SENIOR DIRECTOR, GOVERNMENT AFFAIRS, MENTAL 

HEALTH AMERICA, ALEXANDRIA, VIRGINIA, COALITION FOR 

HEALTH FUNDING 

Mr. ABREU. I have been called worse, Chairman. 

Mr. OBEY. [Comments made off microphone.] [Laughter.] 

Mr. ABREU. Good morning, Mr. Chairman and members of the 

Subcommittee. My name is Julio. I am President of the Coalition 

for Health Funding and Senior Director of Government Affairs at 

Mental Health America. I am pleased to offer this testimony on behalf of the Coalition regarding funding for agencies and programs 

of the U.S. Public Health Service, including NIH, CDC, HRSA, 

SAMHSA, and AHRQ. 

Since 1970, the Coalition has advocated for sufficient and sustained discretionary funding for the public health continuum to 

meet the mounting and evolving health challenges confronting the 

American people. We acknowledge and applaud the longstanding 

support of public health programs from the Subcommittee, particularly that of the Chairman. And I want to echo our deep gratitude 

for your tremendous leadership. 

Our diverse membership, representing the interest of over 50 

million patients, providers, researchers, and public health professionals, supports the belief that the public health agencies and programs are essential for improving health and health care through 

greater access, higher quality, lower costs, improved safety, faster 

cures, and ultimately healthier people. 

The Coalition’s pressing and immediate goals are to: one, build 

the capacity for our public health system; two, address America’s 

mounting health needs under the weight of an ongoing recession 

and aging population, a health workforce shortage, and rising rates 

of chronic disease; and, three to support the implementation of the 

Patient Protection and Affordable Care Act, a new health care reform legislation, PPACA. 

Given the current fiscal challenges, the Coalition appreciates the 

funding increases proposed in the President’s fiscal year 2011 

budget for public health programs. We are also grateful to you and 

your colleagues for the mandatory funding stream for public 

health, now provided through health reform, to augment discretionary funding for the existing public health infrastructure. 

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ments in the public health service, and making permanent capacity 

created by ARRA. 

We also hope Congress will resist the urge to look to the Mandatory Public Health and Prevention Fund provided in PPACA as a 

means to supplant current discretionary public health funding, as 

this mandatory investment was intended to make whole the existing public health infrastructure and support innovative cross-cutting programs to transform the ways in which public health services are delivered. 

These transformational investments will help lead the Nation toward a more community-oriented accountable approach to public 

health, which will in turn decrease our Nation’s health care costs 

and make America healthier. 

The public health infrastructure has experienced significant erosion over the past several years, despite its important role in keeping Americans healthy, productive, and secure. Federal spending 

for public health has been flat for nearly five years, and our States 

around the Country have cut more than $392 million for public 

health programs in just the past year. These shortfalls have left 

communities struggling. 

Federal discretionary investment in public health service represents only a fraction of our Nation’s total health care spending, 

just 2 percent in 2008 based on expenditure data from CMS, even 

though the public health continuum has the potential to slow sustainable growth in mandatory costs. Our Nation’s lost opportunity 

to save lives and money through investments in the public health 

continuum is possibly best represented by the Medicare program. 

A study published in Health Affairs finds that the causes of Medicare spending growth have changed dramatically in two decades, 

where Medicare’s skyrocketing costs are now mostly attributable to 

the treatment of preventable chronic conditions such as diabetes, 

conditions that could have been prevented with a more serious investment in public health. 

We listened to you, Mr. Chairman. We have been working with 

our other public health organizations and have 300 of them signed 

up with five former surgeon generals urging Congress to invest in 

public health. 

Let me close by saying that while I am not a musician, I bet I 

can get the public health community to join and perhaps create a 

band to go around the Country to make a compelling case for the 

need to invest in public health. Thank you for this opportunity, Mr. 

Chairman. 

[Written statement by Julio Abreu follows:] 


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Mr. OBEY. [Remarks made off microphone.] 

Next, James Sykes, AIDS Institute. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL, HEALTH RESOURCES 

AND SERVICES ADMINISTRATION, AND NATIONAL INSTITUTES OF HEALTH 

WITNESS 

JAMES SYKES, DIRECTOR OF GLOBAL PROGRAMS, POLICY AND ADVOCACY, AIDS INSTITUTE 

Mr. SYKES. Good morning, Mr. Chairman and Subcommittee 

members. The AIDS Institute is pleased to be here today to comment in support of funding domestic HIV/AIDS and hepatitis programs. We thank you for your support of these programs over the 

years and trust that you will do your best to adequately fund them 

in the future in order to provide for and protect the health of many 

Americans. 

HIV/AIDS remains one of the world’s worst health pandemics in 

history. To date, nearly 600,000 people have died of AIDS in the 

U.S. Over 1.1 million people in the U.S. are living with HIV/AIDS, 

and there is a new infection every nine and a half minutes. Persons 

of minority races and ethnicities are disproportionately affected, as 

well as the poor. About 70 percent of those infected rely on publicly 

funded health care. 

Despite the growing need, domestic HIV/AIDS programs have experienced only very minor increases in recent years. We hope you 

will support President Obama’s desire to increase funding for these 

important public health programs. Federal funding is particularly 

critical at this time, since State and local government budgets are 

being severely cut during this economic downturn, while demand 

for services are escalating due to the fact that people are living 

longer, people are losing their health insurance, and HIV testing 

programs are identifying more people who have HIV. 

Of immediate importance is our request of $126 million in emergency funding this year for the AIDS Drug Assistance Program. 

ADAPs provide lifesaving HIV drug treatment to over 150,000 people, the majority of whom are people of color and very poor. Currently, ADAPs are experiencing unprecedented growth. The monthly growth rate of nearly 1300 clients is an increase of 80 percent 

from fiscal year 2008. 

Due to the economic crisis, State contributions to the programs 

have dropped from $329 million to $214 million in just one year. 

Meanwhile, the Federal share of the ADAP program has dropped 

to only 49 percent, compared to 69 percent in 2000. 

Due to the lack of funding, States have instituted waiting lists 

and have reduced the number of drugs on their formularies, reduced eligibility, and capped enrollment. There are currently 1,056 

persons in 10 States on ADAP waiting lists as of today. In order 

to address the ADAP funding crisis, which will grow much worse 

in fiscal year 2011, we are requesting an increase of $370 million. 

To address the immediate situation, the AIDS Institute requests 


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$126 million of those funds in fiscal year 2010 as part of an emergency supplemental. 

We are very pleased that just last week 66 members of the 

House sent a letter to President Obama in support of this emergency funding for ADAP. 

For fiscal year 2011, the President requested an increase of only $39.5 million, or just 1.7 percent for the entire Ryan White Program, which includes ADAP; and no increase for Parts A and D of 

the program. 

The AIDS Institute urges the Subcommittee to consider the 

growing needs of all parts of the Program and provide the necessary resources it requires to meet the needs of people living with 

HIV/AIDS in the U.S. 

Nearly two years ago, the CDC increased its estimate of new infections per year by 40 percent. In order to reverse that trend, the 

CDC is going to need additional resources so that it can scale up 

HIV prevention. But currently we only allocate about 3 percent of 

our total HIV/AIDS spending on domestic prevention. Unfortunately, the requested $31 million increase by the President is far from what is needed to reduce the number of new HIV 

infections. We would, however, like to commend the President for 

focusing much of this increase on gay men, who represent a majority of HIV cases in the U.S. and is the only group in which HIV 

incidence is increasing. 

Investing in prevention today will save money tomorrow. Every case of HIV that is prevented saves, on average, $355,000 of lifetime treatment costs. That translates into nearly $20 billion in annual future medical costs for the 56,300 new infections that occur 

every year. 

As detailed in our written statement, the AIDS Institute supports additional funding for AIDS research at NIH, the Minority 

AIDS Initiative, the CDC’s Viral Hepatitis Division. We also appreciate the Committee’s support for funding of syringe exchange and 

comprehensive sex education programs, two proven HIV prevention 

programs. 

Again, the AIDS Institute appreciates the opportunity to appear 

before you today, and thank you for your continued support. Thank 

you, sir. 

[Written statement by James Sykes follows:] 


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Mr. OBEY. [Remarks made off microphone.] [continuing]. Have 

written the Committee asking for increased funding. I am sure 

most of them are consistent, but there are more than a few members in Congress who will sign every blessed letter that comes 

along asking for more money, and then they will vote against the 

bill that contains the money when it comes to the Floor and kick 

the hell out of us for saying it contains too much money. 

Mr. SYKES. I understand. 

Mr. OBEY. So if you can help us to avoid giving hypocrisy a bad 

name, it would be appreciated. [Laughter.] 

Mr. SYKES. Give me the names of those members, sir, and we 

would gladly call on them. 

Mr. OBEY. Next, Dr. Heidi Chumley, Health Professions and 

Nursing Education Coalition. 

WEDNESDAY, MAY 12, 2010. 

TITLE VII AND VIII 

WITNESS 

DR. HEIDI CHUMLEY, SENIOR ASSOCIATE DEAN OF MEDICAL EDUCATION, UNIVERSITY OF KANSAS MEDICAL CENTER, HEALTH PROFESSIONS AND NURSING EDUCATION COALITION 

Dr. CHUMLEY. Good morning. My name is Dr. Heidi Chumley, 

and I am a family physician and the Senior Associate Dean for 

Medical Education at the University of Kansas School of Medicine. 

Like most academic family physicians, I have a firsthand appreciation for HRSA’s health profession programs, as they have supported my work throughout the various stages of my career. So it 

is a pleasure to testify today on behalf of the Health Professions 

and Nursing Education Coalition, or HPNEC, an alliance of more 

than 60 national organizations representing schools, programs, 

health professionals, and students dedicated to ensuring the health 

care workforce is trained to meet the needs of the diverse population. 

I am here to speak with you about the Title VII health professions and Title VIII nursing programs, which enhance the supply 

of the diversity and the distribution of health care workforce by 

supporting the education of health professionals. 

In particular, these programs emphasize primary care and training in interdisciplinary settings. With the recent enactment of 

health reform legislation, the Nation will need a robust, diverse 

health care workforce to meet the increased demands for care. 

HPNEC recommends $600 million to sustain and strengthen the 

existing Title VII and Title VIII programs in fiscal year 2011. As 

you know, PPACA updated and restructured the existing health 

professions programs to improve their efficiency, effectiveness, and 

accountability. The legislation also authorized several new programs and initiatives designed to help mitigate health workforce 

challenges. 

Many HPNEC members are enthusiastic about the opportunities 

afforded through these newly authorized workforce programs. As a 

coalition, HPNEC encourages an investment in these new proVerDate Mar 15 2010 23:27 Oct 01, 2010 Jkt 058144 PO 00000 Frm 00142 Fmt 6633 Sfmt 6602 E:\HR\OC\A144P2.XXX A144P2

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grams that supplements, but does not replace, support for the existing Title VII and Title VIII programs. 

We are grateful to the Chairman and this Subcommittee for the 

increases provided for many of the health professions programs in 

recent years, and for the Subcommittee’s longstanding support. 

These investments are crucial to addressing existing and looming 

provider shortages throughout the Country. According to HRSA, 

over 30,000 health practitioners are needed today to allay existing 

shortages. Further, within the next 10 to 20 years, the Nation faces 

shortages of 200,000 physicians, including at least 46,000 primary 

care professionals, a million nurses, 38,000 pharmacists, 250,000 

public health professionals, and 40,000 geriatricians and geriatric 

social workers, as well as shortages among dental, allied health, 

mental health, and other providers. 

These shortages, combined with faculty shortages, racial and ethnic disparities, and shortages of health professionals in rural and 

other underserved areas will take time to reverse. We must make 

appropriate investments in the education and training of health 

professionals today to truly extend health care access to all segments of the population. 

At KMC, where I am from, Title VII and Title VIII grants work 

to alleviate these strains on the system. Primary care loans 

incentivize financially needy students to choose primary care; nursing loans help students pursue a diploma, associate, baccalaureate, 

or graduate degree in nursing; and scholarships help disadvantaged students pursue a health professions degree. 

In the last five years along, KU has given out over 400 Title VII 

and Title VIII funded scholarships and loans to help students pursue a career in the health professions. 

Faculty and staff have also benefitted from grants, helping boost 

faculty development in primary care, as well as supporting the 

Central Plains Geriatric Education Center Consortium. Additionally, thanks to ARRA, our Minority Centers of Excellence Program 

and our Health Careers Opportunity Program can still operate 

today, providing mentorship and guidance to aspiring health professions from diverse backgrounds. With this support, over 5,000 

students have been able to participate in KU’s health professions 

pipeline programs. 

In closing, HPNEC’s $600 million recommendation for the existing health professions programs will not only help sustain the expansion of the health workforce supported in recent years, but will 

also help to ensure the programs are able to fulfill their mission 

of improving the supply distribution and diversity of health professionals nationwide. 

Thank you. 

[Written statement by Heidi Chumley follows:] 


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Mr. OBEY. Thank you. Appreciate it. 

Lori J. Heim, American Academy of Family Physicians. 

WEDNESDAY, MAY 12, 2010. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION 

WITNESS 

LORI J. HEIM, MD, PRESIDENT, AMERICAN ACADEMY OF FAMILY PHYSICIANS 

Dr. HEIM. Good morning, Chairman Obey and members of the 

Subcommittee. I am Dr. Lori Heim, family physician from Vass, 

North Carolina. As the President of the American Academy of 

Family Physicians, representing 94,700 family doctors, residents, 

and medical students, I congratulate the Congress on the enactment of the Patient Protection and Affordable Care Act. 

In order for a successful implementation of that health care reform, I urge you, despite what you said, Chairman, to increase the 

Federal investment in primary care workforce. Despite the consensus that good primary care is essential for genuine health care 

reform, 65 million Americans—that is about one in five—live in 

primary care shortage areas. 

Not only do we have shortages in primary care physicians in 

practice, but the medical education pipeline is now only producing 

22.6 primary care physicians, down from 33 percent a decade ago. 

As a result, we have fewer primary care physicians being trained 

to care for the newly insured. 

Health reforms include a number of provisions to increase the 

workforce, including the vital Primary Care Medicine Grants authorized through Title VII. We believe a minimum of $600 million 

for all of Title VII programs is needed. We also urge the Committee 

to provide $170 million for Title VII Section 747 primary care 

training and enhancement programs. 

Physician shortages are particularly hard on rural Americans, as 

they face more barriers to care than their urban or suburban areas. 

Family physicians provide the majority of the care for America’s 

underserved and rural populations, so we were very pleased with 

the new Rural Physician Training Grants authorized by health reform. We request that you fully fund the Title VII Rural Physician 

Training Grants. 

The AAFP supported the authorization of the innovative Teaching Health Centers Program to train primary care residents in nonhospital settings, which is where the care is delivered. However, if 

this program is going to be effective, there must be grants for planning. We recommend the Committee appropriate the full authorized amounts for the Teaching Health Centers Developmental 

Grants of $50 million for fiscal year 2011. 

Another significant barrier to the production of primary care 

physicians is the huge student debt that they have. The National 

Health Service Corps has long provided debt relief to primary care 

physicians and has helped to reduce the health disparities. We 

urge that the Corps receive $414.1 million in fiscal year 2011. 

The AAFP commends Congress for authorizing the Primary Care 

Extension Program within the Agency for Health Care Research 


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and Quality, as small primary care practices need the kind of support that was offered by the Federal Cooperation Extension Services to implement innovative and best practices. This new program 

will assist primary care providers to transform their practices 

using effective evidence-based therapies and techniques in their 

practices. The AAFP recommends the Committee provide $731 million for AHRQ to provide the funding requested in the President’s 

budget, as well as the important new Primary Care Extension Program authorized by the health reform law at $120 million. 

Thank you very much for the opportunity, sir. 

[Written statement by Lori Heim follows:] 


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Mr. OBEY. Thank you. Again, let me simply say that I agree with 

everything you said. The problem is there is no way I can get there 

because, in negotiations over the budget resolution right now, for 

instance, one of the offers on the table, in order to get people who 

are reluctant to vote for it to actually do so, one of the offers was 

to reduce domestic appropriations by $110 billion over the next five 

years. That is not deep enough for some of our brethren. 

So I would love to provide the dollars you are talking about. We 

do not have the votes for it because we have to live under budget 

ceilings and, as I said earlier, there are a whole lot of people who 

are very comfortable at reducing the deficit by cutting this portion 

of the budget, but not in cutting the portions of the budget that 

have been treated much more gingerly the last ten years. 

But thank you for coming. 

Dr. HEIM. Thank you. And we will help take that message forward because, otherwise, without the workforce, we will not be able 

to take care of the people. 

Mr. OBEY. You are absolutely right. 

Next, Wayne Riley, Association of Minority Health Professions 

Schools. 

WEDNESDAY, MAY 12, 2010. 

HEALTH RESOURCES AND SERVICES 

ADMINISTRATION—TITLE VII 

WITNESS 

WAYNE J. RILEY, MD, MPH, CHAIRMAN, BOARD OF DIRECTORS, ASSOCIATION OF MINORITY HEALTH PROFESSIONS SCHOOLS, INC. 

Dr. RILEY. Good morning, Mr. Chairman, members of the Subcommittee. It is my pleasure to be here today. My name is Wayne 

Riley, President and Chief Executive Officer of Meharry Medical 

College, Nashville, Tennessee. I am here today in my role as Chair 

of the Association of Minority Health Professions Schools. AMHPS, 

as it is called, represents 12 of the Nation’s superb HBCU academic health science centers. We train graduates in dentistry, 

pharmacy, medicine, and veterinary medicine. Mr. Chairman, these 

institutions are indeed national treasures. 

We applaud the passage of health care reform, as some of my colleagues have already mentioned, but we do want to alert the Committee that, with the passage of health care reform, there are looming shortages of health professionals to take care of Americans. We 

are particularly concerned about the shortage among minority 

groups. For example, although African-Americans represent 13 percent of the Nation’s population, only 3 percent of health care professionals are African-American. The similar statistics are evident 

in Latino and Native American and Asian Pacific Islanders as well. 

Now, sometimes I get the question: Why are you guys always up 

here asking for help? Well, it is simple. Minority-serving institutions do not have the big endowments; we do not have big fat donors that give us millions of dollars to do our work. But we are private institutions with a very public mission, and we take that mission very seriously. So much so that our institutions are among the 

leaders in producing primary care physicians. 


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Next week, I will graduate a class of Meharry physicians, of 

which over 50 percent are going into primary care fields, the kinds 

of doctors our Nation needs. 

So the programs that this Subcommittee has jurisdiction over are 

very important to us. The first being Title VII Health Profession 

Training. As you know, there were some cuts between 2006 and 

here, cuts anywhere from 45 to 90 percent in COE and HCOP. 

Those cuts have partially been restored, and we appreciate your 

leadership, Mr. Obey, on restoring some of this. However, we do request a consideration of the Subcommittee and the Committee and 

the Congress to restore the program to about the $300 million 

level, which would add an incremental increase of $33 million to 

$35 million respectively, in Title VII. 

The other program particularly germane to our mission is the 

National Center for Research Resources. That is the Extramural 

Facilities Program which helps to beef up our laboratories and clinical facilities on our campuses. We are recommending $50 million 

for extramural facilities construction and we remind the Subcommittee that the first 25 percent of such appropriations are earmarked or set aside, rather, for institutions of emerging excellence 

like the 12 I represent. 

Also want to highlight the work of the Research Careers and Minority Institutions Program, again, that allows us to focus our work 

there. 

One of the great byproducts of health care reform, Mr. Chairman, is the fact that we now have a new institute, the National 

Institute of Minority Health and Health Disparities, which was elevated through the landmark legislation. This is outstanding news, 

but we urge the Committee to fund it at an institute level of approximately $500 million given the fact that it has been given significantly enhanced authority and power over Minority and Health 

Disparities work. 

Mr. Chairman, we also ask consideration to increase the HBGI 

program, which trains doctoral students at our institutions. 

We appreciate the work of this Committee. Mr. Chairman, we salute you for your distinguished service to Congress and our Nation 

in the 7th Congressional District of Wisconsin. You have been a 

champion of these programs and we salute you. Thank you, Mr. 

Chairman. 

[Written statement by Wayne J. Riley follows:] 


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Mr. OBEY. Thank you much. 

Next, Debbie Hatmaker, American Nurses Association. 

WEDNESDAY, MAY 12, 2010. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION 

NURSING PROGRAMS 

WITNESS 

DEBBIE HATMAKER, PHD, RN–BC, SANE–A, FIRST VICE PRESIDENT, 

BOARD OF DIRECTORS, AMERICAN NURSES ASSOCIATION 

Ms. HATMAKER. Good morning, Mr. Chairman, distinguished 

members of the Subcommittee and congressional staff. I am Debbie 

Dawson Hatmaker. I am here as First Vice President of the American Nurses Association, the largest nursing organization in the 

Country that represents the interest of the Nation’s 3.1 million registered nurses. I have been an RN for 31 years, practicing in a variety of settings, and it is an honor to be with you today to talk about 

funding for the Title VIII programs. 

ANA appreciates the continued support of the Subcommittee, but 

we remain concerned that Title VIII funding levels have been insufficient to address the growing nursing shortage. In preparation 

for the implementation of health reform initiatives which ANA 

strongly supported, we believe there will be even greater demand 

for nurses, deeming funding even more essential. ANA asks you to 

meet today’s shortage with a relatively modest investment of 

$267.3 million in Title VIII programs. 

Registered nurses are fundamental to the critical shift that will 

occur in health services delivery. Title VIII programs recruit new 

nurses into the profession, promote career advancement, and improve patient care delivery. These programs also direct RNs into 

areas with the greatest need, including public health, community 

health centers, and disproportionate share hospitals. 

Today, the nursing shortage continues to impact patient care. 

HRSA released projections that the Nation’s nursing shortage 

would grow more than one million nurses by the year 2020, and 

that all 50 States would experience a shortage of nurses to varying 

degrees by the year 2015. The U.S. must graduate approximately 

90 percent more nurses to meet this demand. 

This growing shortage is already having a real impact on the 

ability to provide quality care. A study in the Journal Medical Care 

provides new evidence of the economic value of appropriate RN 

staffing. The findings demonstrate that as nursing staffing levels 

increase, patient risk of complications and hospitalization stays decrease, resulting in medical cost savings, improved national productivity, and lives saved. The study suggests that adding 133,000 

RNs to the acute care hospital workforce would save 5,900 lives per 

year. These are not just numbers; these are real avoidable deaths. 

In order to meet our Nation’s health care needs, an integrated 

national health care workforce must be put into action. The ability 

of advanced practice registered nurses to provide high quality, costeffective care has been widely recognized. Title VIII funds more 

than 60 percent of U.S. nurse practitioner education programs and 

assists 83 percent of nurse midwifery programs. Over 45 percent of 


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the nurse anesthesia graduates supported by this program go on to 

practice in medically underserved communities. 

A study published in the Journal of Rural Health showed that 

80 percent of the nurse practitioners who attended a program supported by Title VIII chose to work in a medically underserved or 

health profession shortage area after graduation. 

As an administrator of a clinical nursing program, I experience 

the difficulty in finding clinical sites for nursing students. One way 

to combat this problem is to support nurse managed health clinics. 

With more than 250 clinics reporting over 2.5 million annual client 

encounters, these clinics also serve as sites for nursing education. 

Led by advanced practice nurses, the nurse managed care model is 

especially effective in disease prevention, early detection, and management of chronic conditions. 

ANA thanks you for the opportunity, Mr. Chairman, to testify 

and appreciates your commitment to nursing. We urge you to fund 

the fiscal year 2011 Title VIII nursing programs at $267.3 million. 

Thank you so much. 

[Written statement by Debbie Hatmaker follows:] 


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Mr. OBEY. Thank you. 

Next, Cheryl Phillips, American Geriatrics Society. 

WEDNESDAY, MAY 12, 2010. 

AMERICAN GERIATRICS SOCIETY 

WITNESS 

CHERYL PHILLIPS, MD, AGSF, PRESIDENT, AMERICAN GERIATRICS 

SOCIETY 

Dr. PHILLIPS. Again, thank you, Chairman Obey and members of 

this special Subcommittee. This is a remarkable opportunity and I 

wish to take advantage to talk about funding for fiscal year 2011 

to improve care for America’s older adults. 

My name is Cheryl Phillips, and I am a fellowship-trained geriatrician, a rare breed these days and becoming rarer. I am also 

President of the American Geriatrics Society, the Nation’s largest 

professional organization which represents the interdisciplinary 

health care professionals serving America’s older adults, particularly those with complex chronic needs, medical conditions, frailty, 

and the risk for functional decline. 

The 2008 Institute on Medicine Report that I know you are all 

familiar with, Retooling for an Aging America, noted the severe 

shortage of geriatric health professionals and called for initiatives 

to increase recruitment into geriatrics and ensure all health care 

professionals are adequately trained to serve America’s older 

adults. 

If we are going to fulfill our promises of health care reform that 

have been articulated in the Act, we need sufficient and sustained 

Federal investment to educate and train geriatric health professionals across all disciplines, which includes physicians, nurses, social workers, mental health professionals, pharmacists, therapists, 

all of which make up this geriatric team—it is indeed a team 

sport—which has demonstrated both the improvement in quality 

and cost-reduction and cost-effectiveness for this very vulnerable 

and fragile group of individuals that we serve. 

The Patient Protection and Affordable Care Act authorizes geriatric health professions programs under Titles VII and VIII, as we 

have been talking about with the previous speakers. Specifically, 

AGS requests funding for the fiscal year 2011 in the following 

areas: $49.7 million for Title VII Geriatrics Health Professions Programs. 

There are three key Federal initiatives under this Title VII appropriations area. One is called the Geriatric Academic and Career 

Awards, also known as GACAs; second are the Geriatric Education 

Centers, one of which is in Marquette University in Milwaukee 

that has served over 50,000 individuals in the 15 years of its operation in reducing thousands and thousands of dollars of medical 

costs for the population served; and then also the Geriatric Health 

Faculty Fellowships. 

All of these are required and essential to create the next generation of health care professionals in order to serve the increasing 

numbers of seniors. These programs have been underfunded and, 


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in fact, as has been mentioned earlier, there was no funding in 

2006. 

We are also asking for a relatively small $3.34 million—although 

in these days every penny counts, I know. But this is specific funding for direct care workforce training. This is the silent army of 

workers that is often unrecognized in training programs. These are 

those individuals who do the direct care, the bedside care, often unlicensed, but need training for recruitment, for skills enhancement, 

and for sustenance to maintain this growing body of need for our 

elder Americans. 

We are asking for $15.7 million for Title VIII, as was just previously mentioned, specifically for the geriatric nursing workforce. 

We recognize that the nursing personnel must receive adequate 

education and training to serve all of our frail Americans; and specifically 200 traineeships for advanced practice nurses. 

Lastly, briefly mentioning the National Institute on Aging. It is 

the NIA funding that is essential to make advances today that lead 

to higher quality and cost-efficient care for tomorrow. We request 

that funding be restored to 2003 fiscal year funding levels, taking 

in account medical inflation. 

In closing, geriatrics is at a critical juncture. Our Nation is facing 

an unprecedented increase in the number of older patients with 

complex health needs. We acknowledge the work that you have 

done. We appreciate your past commitment, your continued commitment, and on behalf of the American Geriatrics Society, we 

thank you for your continued support for the health and quality of 

life for older Americans. 

Thank you very much. 

[Written statement by Cheryl Phillips follows:] 


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Mr. OBEY. Thank you. 

Next, Peggy Troy, National Association of Children’s Hospitals. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL ASSOCIATION OF CHILDREN’S HOSPITALS 

WITNESS 

PEGGY TROY, RN, MSN, PRESIDENT AND CEO, CHILDREN’S HOSPITAL 

AND HEALTH SYSTEM, WISCONSIN, NATIONAL ASSOCIATION OF 

CHILDREN’S HOSPITALS 

Ms. TROY. Chairman Obey and members of the Subcommittee, 

thank you for the opportunity to testify today in support of Children’s Hospitals Graduate Medical Education, CHGME. I am 

Peggy Troy, President and Chief Executive Officer of Children’s 

Hospital and Health System of Wisconsin. I am here today on behalf of the National Association of Children’s Hospitals and the 60 

independent children’s teaching hospitals that qualify for CHGME 

funding. 

Congress established the CHGME program in 1999 to address a 

disparity in Federal graduate medical education support that existed between adult teaching hospitals and independent children’s 

hospitals. Because our hospitals treat kids, and not the elderly, 

they are largely excluded from the predominant payer of graduate 

medical education, Medicare. 

Prior to CHGME, children’s teaching hospitals received less than 

.5 percent of the Federal GME support that adult teaching hospitals received. Thanks to the Subcommittee’s leadership and the 

broad bipartisan congressional support, the CHGME program currently provides about 80 percent of the GME that Medicare provides to trained adult physicians. 

CHGME funding is critical to the future of pediatric medicine 

and access to care. This funding has allowed children’s hospitals to 

address a large gap that exists between a child’s need for pediatric 

subspecialty care and the supply of pediatricians who are trained 

for their unique needs. 

CHGME has shown remarkable success in erasing the decline of 

the number of pediatric residencies that existed prior to its enactment. It has enabled children’s hospitals to sustain and expand our 

residency programs at a time of national specialist workforce shortages in pediatrics. In fact, freestanding children’s hospitals that receive this funding have accounted for 65 percent of the growth in 

pediatric specialty programs. 

To give you an idea of the impact, since 1999, prior to the enactment of the CHGME, Children’s Hospital of Wisconsin had 65 pediatric residents rotating through our program. This past year we 

trained 113 pediatric medical and dental residents. 

You may be interested to know that the leading cause of absenteeism for children from schools today is dental pain. So it is important we also consider the dentists in this. 

Because we now have dedicated CHGME funding for our training 

programs, we can target other resources to better serve all children 

in our regions. These funds provide vital primary care training for 

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waukee. The Center serves as a medical home for 5400 low-income 

vulnerable children every year. Because of this experience, half of 

our graduating residents go into primary care and about a quarter 

of them serve in urban and rural underserved areas. 

CHGME funding is critical. It ensures that the safety net children’s hospitals, like us, can continue to care for all children, irrespective of their parents’ ability to pay. Nearly 50 percent of all of 

our services at Children’s in Milwaukee is supported by Medicaid. 

Similar figures exist for the freestanding children’s hospitals across 

our Nation. 

In 2006, Congress reauthorized the CHGME program with over- whelming bipartisan support, providing $330 million in authorized 

funding. Last year, the House approved an appropriation of $320 

million for the program, $10 million above the 2009 funding level. The final funding level for CHGME in 2010 was $317.5 million, 

and President Obama maintained this funding level in his fiscal 

year 2011 budget request. We deeply appreciate the support of this 

program and what it has received by the members of this Subcommittee, and, Chairman Obey, we personally really appreciate 

all the support that you have given for the health care and education needs of the citizens across the Country. 

We are grateful for the leadership of you and Ranking Member 

Tiahrt for supporting this program. 

CHGME is a targeted, fiscally responsible, slow growth program 

that operates under extensive data reporting requirements. 

CHGME is important to the Nation’s children’s hospitals and is absolutely critical to children’s health and the future of pediatric 

medicine. Our training program represents less than 1 percent of 

all hospitals, but trains 35 percent of all pediatricians, 50 percent 

of all pediatric specialists, and a great majority of the researchers. 

As our workforce prepares for the increased volume as a result 

of health care reform, this is going to play a very, very important 

role. We thank you and the members of this Committee for your 

support. 

You have heard today from many of the children’s programs, the 

safety net programs. Health and education are inextricably linked. 

We appreciate your support for this and we would hope that you 

would guarantee the success of the future of the CHGME program 

by appropriating the fully authorized level of $330 million in fiscal 

year 2011. 

Thank you very much for your support. 

[Written statement by Peggy Troy follows:] 


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Mr. OBEY. Thank you. The Committee will recess until 2:00. 

AFTERNOON SESSION

WEDNESDAY, MAY 12, 2010. 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

Mr. OBEY. Good afternoon, everybody. The Committee will resume its sitting. 

Mr. Rehberg, did you have anything you wanted to say? 

Mr. REHBERG. No, let’s get on. 

Mr. OBEY. Okay. I am for that. 

Our first witness this afternoon will be Eric Rose from the Alliance for Biosecurity. And as I said this morning, I am going to 

have to be very strict with the four-minute rule because otherwise 

people at the end will not get to testify, because we have another 

meeting a 4:00 p.m. and somebody is going to call a roll call on the 

House Floor, too, you can bet. So please proceed. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL AND PREVENTION, 

NATIONAL INSTITUTES OF HEALTH 

WITNESS 

ERIC A. ROSE, M.D., CO-CHAIR, ALLIANCE FOR BIOSECURITY 

Dr. ROSE. Mr. Chairman and Members of the Subcommittee, I 

am Eric Rose, the CEO of Siga Technologies and Co-Chair of the 

Alliance for Biosecurity. It is a pleasure to be with you today to 

provide you with my impression of how the United States Government and specifically BARDA is handling a critical national security mission. 

We at Siga develop novel biodefense countermeasures to treat 

and prevent serious infectious diseases. While many have criticized 

the perceived slow pace of development of critically needed novel 

defense countermeasures, our experience has been that the substantial Federal investment in biodefense is beginning to bear fruit 

less than seven years after BioShield enactment and less than four 

years after the creation of BARDA. 

We at Siga have pursued the development of a treatment that 

has been sought for hundreds of years, namely an oral drug to cure 

smallpox. The United States has stockpiled enough smallpox vaccine for the entire Nation, but the vaccine cannot treat the potentially large number of symptomatic disease victims in the event of 

a surprise attack whose expected mortality rate would be 30 percent. 

We are now producing commercial scale validation batches of our 

drug candidate which we hope will soon be added to the Strategic 

National Stockpile. 


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The Alliance for Biosecurity is a collaboration among pharmaceutical and biotechnology companies that is working in the public 

interest to improve prevention and treatment of biological threats. 

The H1N1 pandemic has given us all a better sense of how quickly 

biological threats can spread. Fortunately in that case, the consequences of mortality and morbidity were minimal. 

Most large pharmaceutical companies have chosen not to develop 

biological countermeasures, while small biotechnology companies 

have become heavily engaged. These financially fragile enterprises 

must survive the so-called valley of death, the significant product 

development hurdles between basic research and procurement, in 

order to bring safe and effective medical countermeasures to the 

government for purchase. Congress appropriated $5,600,000,000 in 2003 to Project BioShield to fund potential countermeasure procurements, while three 

years later it created BARDA with a separate advance development 

budget to ensure a pipeline of novel, safe, effective and procurable 

countermeasures. 

Our experience with BARDA leadership has been overwhelmingly positive. I have interacted with Dr. Lurie and Dr. Robinson 

and many others about the state of play for emerging biotech companies like ours and how their decisions affect the marketplace. 

They have been responsive and interested and are gaining traction 

in the organization to deliver on its critical mission. 

We note that the December, 2008 report of the Congressionally 

established Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism found that ‘‘it is more likely 

than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013,’’ most 

likely a bio-weapon. 

With respect to appropriations, we encourage that even in this 

challenging budget environment, the need to sustain and even 

strengthen BARDA’s advanced development funding is understood 

well. 

However, the transfer of BioShield resources to shore up this 

funding is counterproductive to the Nation’s overall biodefense effort. This is because diversion of funds for acquisitions from BioShield clearly disincentivizes private investment in this sector at a 

time when increased private sector effort and funding is clearly 

critical. 

We at the Alliance urge the Committee not to transfer additional 

dollars out of the BioShield reserve fund, and instead to maintain 

the fund balances as guarantees that future procurements will 

have sufficient resources available. 

Let me stop there and invite your questions. 

[Written statement by Eric A. Rose, M.D. follows:] 


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Mr. OBEY. Let me say that I think you will find me asking virtually no questions because if we take any time at all, people are 

not going to get done. 

I thank you for coming. 

Dr. ROSE. Sure. Thank you. 

Mr. OBEY. Let me suggest that since we have a vote on that 

Members go vote and let’s just keep the Committee running and 

that way I will go vote after you hurry back so we can avoid stiffing somebody. Okay? 

Mr. MORAN. I think it is a series of votes, though. There are four 

votes, that is the problem. 

Mr. OBEY. Oh, wonderful. Well, all right. In that case, we will 

go until we are dangerously near missing the vote. [Laughter.] 

Next, Ronald Tankersley, American Dental Association. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH 

WITNESS 

RONALD L. TANKERSLEY, DDS, PRESIDENT, AMERICAN DENTAL ASSOCIATION 

Dr. TANKERSLEY. Good afternoon. I am Ron Tankersley, a practicing oral surgeon and President of the American Dental Association. On behalf of the ADA’s 157,000 member dentists, thank you, 

Mr. Chairman and Members of the Subcommittee for the opportunity to comment on the 2011 appropriations for Federal dental 

programs. 

The ADA last testified before the Committee in 2006. Since that 

time, many oral health programs have made great advances, but 

much remains to be done to help reduce oral disease and increase 

access to dental care for those with untreated disease. 

Since 2005, the National Institute of Dental and Craniofacial Research has established research networks to answer the questions 

that private dentists face every day in their practices. These networks allow for the rapid translation of scientific advances to clinical practice. 

The NIDCR is also leading the investigation into salivary 

diagnostics. This research indicates that there is a strong possibility that saliva can one day be used to screen for breast, prostate, 

oral and pancreatic cancer, as well as detect cardiovascular disease, 

drug usage and exposure to diseases like anthrax. As a diagnostic 

tool, this could dramatically reduce cost and invasive procedures. 

However, the most common of the oral diseases, dental caries or 

tooth decay, remains the most prolific communicable disease in the 

world. Even though it is preventable, it is still a major problem. 

Childhood caries are epidemic among the under-served populations, 

especially Native Americans. The ADA urges the Committee to 

fund NIDCR at $463,000,000 to continue its critical research. 

The Committee’s past support has allowed general dentists and 

pediatric dental residency programs to remain stable and strong. 

The new healthcare reform law adds funding for public health dental residencies. This could not have happened at a more opportune 

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atric dentists and there are only 180 certified public health dentists 

in America. 

The ADA recommends that training in pediatric and public 

health dentistry programs be funded at the authorized amount of 

$30,000,000. 

The ADA has said for many years that the Nation cannot drill 

and fill its way out of the epidemic of untreated dental disease. 

Mr. OBEY. I thought you were getting into another subject there. 

[Laughter.] 

Dr. TANKERSLEY. We think it is catchy. 

But there are viable solutions for preventing disease through 

community water fluoridation, early applications of dental sealants 

and varnishes, and establishing dental homes for children, and last 

but not least, oral health literacy programs. These proven cost-effective measures can dramatically reduce oral disease. 

The new healthcare law includes several provisions for prevention and research programs in the CDC’s Division of Oral Health. 

The ADA recommends $33,000,000 to fully fund the Division’s 

State Infrastructure Grant Program, and also help communities establish or rebuild their community fluoridation systems for their 

water supplies. 

Mr. Chairman, I would be remiss if I did not note the personal 

interest that you have taken to improve oral health in your State 

and in this Country. We appreciate your recognition of how funding 

for small clinics, local dental sealant projects, where Federal dental 

programs can improve oral health outcomes in the dental workforce. 

You have been a wonderful champion for oral health in this 

Country and we will greatly miss you, and thank you for the opportunity to testify. 

[Written statement by Ronald L. Tankersley, D.D.S. follows:] 


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Mr. OBEY. Thank you very much. I appreciate your coming. 

Next, Daniel Church, Hepatitis Appropriations Partnership. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

WITNESS 

DANIEL CHURCH, ADULT VIRAL HEPATITIS PREVENTION COORDINATOR, MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 

Mr. CHURCH. Good afternoon, Chairman Obey and Members of 

the Subcommittee. I am Dan Church, the Adult Viral Hepatitis 

Prevention Coordinator for the Massachusetts Department of Public Health. I am here representing the Hepatitis Appropriations 

Partnership and the National Alliance of State and Territorial 

AIDS Directors. 

Thank you for allowing me to address you today. I am here to 

speak to you about viral hepatitis. Viral hepatitis is a group of contagious liver diseases that can lead to life-long infection. There are 

over 5 million Americans chronically infected. It is the leading 

cause of liver disease, liver cancer and liver transplantation. It is 

also the most common cause of death in persons infected with HIV. 

Unfortunately, two thirds of those infected do not know it because symptoms often don’t occur until irreversible and potentially 

fatal liver damage has occurred. Chronic hepatitis B and C infections cost the United States approximately $16,000,000,000 each 

year. Experts estimate that baby boomers account for two out of 

every three cases of chronic hepatitis C. If we do nothing to increase screening, the cost of these diseases will skyrocket and the 

American taxpayer will foot the bill as this cohort ages into Medicare in the next decade. 

In Massachusetts, it is estimated that over 100,000 people are 

living with hepatitis C virus alone, most of whom are not aware 

of their infection. Since 2002, we have had 8,000 to 10,000 newly 

diagnosed cases of hepatitis C and 2,000 cases of hepatitis B reported to the Department of Public Health each year. 

Since 2005, there has been an alarming increase in the numbers 

of people under the age of 25 being reported with chronic hepatitis 

C infection, indicating a new epidemic of disease largely due to heroin use among youth. 

Despite this remarkably high disease burden both in Massachusetts and nationally, the only dedicated Federal funding for viral 

hepatitis is $19,000,000 to CDC’s Division of Viral Hepatitis. State 

health departments receive a total of $5,000,000 that averages to 

$90,000 per jurisdiction. This provides for only one staff person and 

no money for core prevention services such as hepatitis education, 

testing, vaccination for hepatitis A and B, surveillance and referral 

into medical management and care. I am that staff person in the 

Massachusetts Department of Public Health. 

It is important to note that because of such minimal funding, 

CDC cannot implement a comprehensive prevention approach such 

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grams accordingly. We must rely on estimates from a national 

household survey from 2002 that did not include two highly impacted populations: homeless and incarcerated people. 

The President’s fiscal year 2011 budget proposes an almost $2,000,000 increase for a total of $21,000,000. While we laud this 

increase in a time of decreasing resources, it is insufficient to address the chronic diseases of this magnitude. We are asking for an 

increase of $30,700,000 for total of $50,000,000 for the Division of 

Viral Hepatitis. We are not asking for creation of a separate infrastructure, but rather to integrate into existing infectious disease 

programs such as HIV, STDs, and tuberculosis. Unfortunately, 

funding to support this integration is largely not available. 

If we had the resources to test those at risk, the good news is 

that there are effective treatments to manage, and in the case of 

hepatitis C, to clear the virus. There are also new therapies for 

both hepatitis B and C in the pipeline. The Institute of Medicine 

recently issued a report, Hepatitis and Liver Cancer: A National 

Strategy for Prevention and Control of Hepatitis B and C. 

I was a member of the panel that authored the report. The report 

attributes the lack of knowledge and awareness among the American public and healthcare providers, and large health disparities, 

to the lack of dedicated resources and high mortality rates. Without 

concerted efforts to respond, Americans will continue to be infected 

and fail to be identified, diminishing their quality of life and life 

expectancy. I urge you to invest in the prevention of these diseases 

so that we may one day control these burgeoning epidemics. 

Thank you again for allowing me to speak with you today. 

[Written statement by Daniel Church follows:] 


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Mr. OBEY. Thank you. 

Let’s keep going. Janel Wright, American Diabetes Association. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL AND PREVENTION, 

NATIONAL INSTITUTES OF HEALTH, NATIONAL INSTITUTE OF DIABETES, DIGESTIVE AND KIDNEY DISEASE 

WITNESS 

JANEL WRIGHT, NATIONAL ADVOCACY COMMITTEE CHAIR, AMERICAN DIABETES ASSOCIATION 

Ms. WRIGHT. Mr. Chairman, distinguished Members of the Subcommittee, thank you for the opportunity to testify today. 

As someone who has lived with diabetes for nearly 35 years, I 

am proud to represent the American Diabetes Association, nearly 

24 million Americans with diabetes, and 57 million with pre-diabetes. 

The Centers for Disease Control and Prevention have identified 

diabetes as a disabling, deadly epidemic on the rise. Between 1980 

and 2007, its prevalence increased by 300 percent. Its total cost is 

over $218,000,000,000 a year. During the four minutes I will be 

speaking to you, 12 Americans will be diagnosed with diabetes. 

Today, 55 Americans will go blind, 120 will enter end-stage kidney 

disease programs, and 230 will undergo an amputation because of 

diabetes. 

If we do not take action to stop diabetes, one out of three of our 

children will face a future with diabetes. And for children in minority communities, it is close to one in two. 

Despite these numbers, there is hope. Thank you for consistently 

funding vital HHS programs, including the National Institute of 

Diabetes, Digestive and Kidney Disease at the NIH and the CDC’s 

Division of Diabetes Translation to help reduce the overwhelming 

burden of diabetes. 

Because of this investment, our knowledge of the disease has 

been expanded and the critical work towards ending this epidemic 

can continue. As you consider fiscal year 2011 appropriations, we 

urge you to make diabetes a priority by increasing funding for 

these essential research and prevention programs proportionate to 

the magnitude of diabetes in our Country. And by doing so, changing the future and destiny of diabetes in America. 

NIDDK continues to make major discoveries, including the ability to predict type 1 diabetes and new drug therapies for type 2. 

Because of advances in treatment, my hemoglobin A1c, which provides a snapshot of how well my disease is managed, went from 

12.9 to 5.9. Each point I lower my A1c translates to a 40 percent 

better chance to avoid the devastating complications of diabetes. 

There is still so much work to do. Scientists stand ready, willing 

and able to take diabetes research to the next level. The 

$2,200,000,000 we are requesting for 2011 will allow the NIDDK 

to act on promising research opportunities and ultimately move us 

closer to the cure. 

Stopping diabetes also means transforming new discoveries into 

new ways to prevent the disease. CDC’s DDT works to eliminate 


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the preventable burden of diabetes. DDT has a proven record of 

success through community-based prevention programs, national 

diabetes surveillance, and translational research. But DDT is woefully under-funded. The Association is requesting $86,000,000 in 2011 funding for 

the DDT so these vital programs can reach more Americans at risk 

for the disease and its complications. DDT works to speed effective 

interventions to local communities. For example, NIDDK’s Diabetes 

Prevention Program found modest weight loss prevented type 2 diabetes by 58 percent in patients at high risk. DDT moved this program into community settings and improved upon the trial, achieving the same astounding results for less than $300 a year. 

Congress recognized the importance of this program by authorizing the National Diabetes Prevention Program in the recently 

passed health reform law which, when funded, will expand this 

successful program. We acknowledge the Subcommittee’s leadership in the implementation of the newly created Prevention in Public Health Fund, and respectfully request your support of 

$80,000,000 in 2011 for implementation of the NDPP through the 

fund. 

As you consider the 2011 appropriations for NIDDK and the 

DDT, we ask you to consider diabetes as an epidemic, growing at 

an astonishing rate, which will overwhelm our healthcare system 

with tragic consequences. To change this future, we must increase 

our commitment to research and prevention to reflect the burden 

diabetes poses both for us and for our children. 

Thank you. 

[Written statement by Janel Wright follows:] 


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Mr. OBEY. Thank you very much. 

And I hate to do this, but I have to go vote and we will be back 

as soon as the votes are over. 

[Recess.] 

Next, we have Scott Kneser from the American Heart Association. He is from a place called Wausau, Wisconsin. [Laughter.] 

WEDNESDAY, MAY 12, 2010. 

NATIONAL HEART, LUNG AND BLOOD INSTITUTE, NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS 

AND STROKE 

WITNESS 

SCOTT KNESER, VOLUNTEER, AMERICAN HEART ASSOCIATION 

Mr. KNESER. Mr. Chairman and Members of the Subcommittee, 

I thank you for this opportunity to share my story and to advocate 

for increased funding for heart disease and stroke research, prevention and treatment. 

As the Chairman has mentioned, my name is Scott Kneser. I am 

from Wausau, Wisconsin. I am a proud constituent of the Seventh 

Congressional District of Wisconsin, which is Chairman Obey’s District. I am an accountant for the hospital, but more importantly, 

thanks to NIH-supported research, I am a heart disease survivor. 

I am also a volunteer for the American Heart Association, where 

I try to help other people like myself. 

Chairman Obey, when you announced your retirement last week, 

you expressed your hope that you had made a difference during 

your 41 years in the House of Representatives. I am here to tell 

you that you have made a difference through your continued support of heart disease research and prevention programs. I am living 

proof of how your investment in NIH can lead to longer, more productive lives. 

My battle with heart disease began in 1982 when I was diagnosed with hypertrophic obstructive cardiomyopathy, a genetic defect with a mitral valve prolapse and a heart murmur. In layman’s 

terms, the main pumping chamber of my heart was enlarged and 

I had a valve that did not close properly. This condition caused 

blood to leak from my mitral valve and diminish my blood flow, 

creating a decrease in my activity level. In 2005, I became more 

symptomatic and experienced increased fatigue during normal activity like climbing stairs. 

My doctors determined that I needed a type of surgery called 

septal myectomy. During this procedure, my surgeon went through 

my aortic valve and carved out the enlarged section of muscle on 

my septum which separates my heart’s chambers to improve my 

blood flow. 

Also at this time, I had an implanted cardio defibrillator placed 

in my chest to regulate my irregular heartbeats that were discovered during an EKG. This amazing device, a result of your investment in the NIH, keeps me alive by regulating my heartbeat. If I 

have more than five consecutive irregular heartbeats, the ICD 

shocks my heart back into a normal rhythm. I can even hold a 


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magnet over my ICD, which uploads the data on my heart. This 

data is then transferred to my cardiologist via the telephone lines. 

Not long ago, the only solution to my condition was a heart 

transplant, but thanks to advances in medical research, I am recovered from my surgery and today I enjoy a 30 percent increase in 

my blood flow and my energy level has improved substantially. I 

can still run up and down the basketball court refereeing high 

school basketball games. 

As a heart disease survivor, I have also benefitted from other advances such as color flow Doppler echocardiograms, which improve 

the non-invasive images of the heart and blood flow. And the gold 

standard for diagnosing heart problems, a heart catheterization, no 

longer requires an overnight hospital stay. 

Despite these advances, there is no cure for heart disease and 

stroke. Heart disease remains our Nation’s number one killer and 

stroke is still the number three cause of death. Thanks to NIH research, there are survivors like me. But to bring us closer to a cure, 

it is critical for Congress to increase funding for NIH heart research, now at only 4 percent of the budget, and stroke research, 

still at just 1 percent of the budget. 

Also, Congress must increase funding for CDC’s Heart Disease 

and Stroke Prevention Programs. Although heart disease and 

stroke can often be prevented, Americans need access to prevention 

programs, but that is not happening. 

CDC spends just 16 cents per person on heart disease and stroke 

prevention. Moreover, more rural areas like my hometown of 

Wausau need increased access to automated external defibrillators 

to improve chances of sudden cardiac arrest victims surviving this 

particularly deadly form of heart disease. 

Americans deserve better. Thank you for your time. 

[Written statement by Scott Kneser follows:] 


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Mr. OBEY. Thank you very much. I appreciate your coming. Glad 

you are doing so well. 

Mr. KNESER. Thank you. 

Mr. OBEY. I hope you have better luck with airplanes getting 

back. I usually do. [Laughter.] 

Next, Landon King, American Thoracic Society. 

WEDNESDAY, MAY 12, 2010. 

AMERICAN THORACIC SOCIETY 

WITNESS 

LANDON KING, M.D., DIRECTOR, PULMONARY AND CRITICAL CARE 

MEDICINE, JOHNS HOPKINS SCHOOL OF MEDICINE 

Dr. KING. Good afternoon. My name is Landon King. I am Director of Pulmonary and Critical Care Medicine at Johns Hopkins. I 

am here today representing the American Thoracic Society, whose 

18,000 members are dedicated to preventing and fighting respiratory disease around the globe through research, education, patient care and advocacy. 

I would like to particularly thank you, Mr. Chairman, for your 

leadership role in providing the historic biomedical research investment made through the American Recovery and Reinvestment Act. 

This investment is accelerating lifesaving research into respiratory 

diseases affecting millions of people. 

I would like to illustrate how NIH-funded research turns medical 

advances that save people’s lives by telling you about one patient 

that I treated in the medical intensive care unit in November. This 

19 year old girl arrived in our ICU after becoming progressively ill 

at home for the preceding week. She developed worsening shortness of breath and required mechanical ventilation to stay alive. 

In the ICU, she was diagnosed with H1N1 influenza. She required intravenous medication to support her blood pressure, as 

well as intravenous antibiotics to fight infection. She was on a ventilator in the ICU for several weeks and required additional weeks 

of hospitalization once she left the ICU. 

Her care was managed throughout by dedicated teams of nurses, 

therapists and physicians. What ultimately improved this young 

girl’s chances of survival was a new mechanical ventilation strategy that was less stressful on her lungs. 

Several elements of her story are relevant to my testimony today. 

First, this young girl had H1N1 influenza, emphasizing the continued importance of a strong public health system. Second, respiratory failure of the type she experienced, called acute lung injury, can be caused by many things, including infection, drowning 

and traumatic injury, for example in traffic accidents. Threats from 

infectious disease or other exposures frequently cause illness or 

death because of the effect on the lungs. 

Third, she’s alive today as a result of the mechanical ventilation 

strategy developed through a National Heart, Lung and Blood Institute-funded clinical trial. In this study, pulmonary and critical 

care investigators identified that mechanical ventilation itself can 

damage the lung and through a multi-center clinical trial published 

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vival was improved by 25 percent using a ventilator strategy distinct from traditional approaches. 

Finally, despite the advances in ventilator management that 

saved this young girl’s life and thousands of other patients each 

year, many more people are not so fortunate. Of the nearly 200,000 

people per year who develop acute lung injury, approximately 

75,000 people still die each year. By 2030, as a result of the aging 

population, it is estimated that the number of acute lung injury 

cases per year will increase to 335,000 and the number of deaths 

per year will increase to 147,000. 

Despite groundbreaking research by NHLBI, NIGMS and other 

institutes, we do not have specific therapies other than mechanical 

ventilation to treat this type of respiratory failure. More investigation is essential to generate new approaches to therapy. 

These examples are emblematic of respiratory disease in general. 

Chronic obstructive pulmonary disease, such as emphysema or 

chronic bronchitis, affects more than 12 million Americans and is 

the fourth leading cause of death in the U.S., the only one of the 

top four that has actually increased. 

More than 22 million children and adults have asthma, with per- sonal and public health costs of $20,500,000,000 billion per year. It 

is estimated that more than 50 million Americans have breathing 

disturbances associated with sleep disorders, shown through NIHfunded investigation to increase strokes and death. 

Beyond these, significant numbers of Americans have other lung 

diseases that cause illness and deaths every day. 

Mr. Chairman, thanks in no small measure to the generous support of this Committee, the research and public health community 

continues to make advances against lung diseases. We urge this 

Committee to build on the biomedical research investment made 

through the ARRA to speed the discovery of more lifesaving treatments and cures. 

Similarly, our Nation’s public health and chronic and infectious 

disease prevention programs must be equipped to effectively translate NIH research into programs in chronic disease prevention, infectious disease control, and occupational safety and health research and training. 

Thank you. 

[Written statement by Landon King, M.D. follows:] 


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Mr. OBEY. Thank you very much. 

Next, Neil Bressler, American Academy of Ophthalmology. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH, NATIONAL EYE 

INSTITUTE 

WITNESS 

DR. NEIL BRESSLER, WILMER EYE INSTITUTE, JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE; AMERICAN ACADEMY OF OPHTHALMOLOGY 

Dr. BRESSLER. Mr. Chairman, Subcommittee Members, thank 

you for the opportunity to appear before you today in support of appropriations for the National Institutes of Health and the National 

Eye Institute. 

My name is Neil Bressler and I am the James P. Gills Professor 

of Ophthalmology at Johns Hopkins University. I currently serve 

as Chief of the Wilmer Eye Institute’s Retina Division, but I also 

chair the FDA Ophthalmic Devices Panel and chair the Data and 

Safety Monitoring Committee, which oversees all intramural clinical trials by the National Eye Institute. 

And I have been the recipient of many NIH grants to chair large 

scale multi-center clinical trials, most recently, a comparative effectiveness study conducted at more than 50 clinical centers by the 

Diabetic Retinopathy Clinical Research Network. 

This network confirmed just two weeks ago a treatment breakthrough for saving the vision of tens of thousands of people in the 

United States each year with a common diabetic eye disease. And 

I am pleased to be here testifying on behalf of the American Academy of Ophthalmology, the world’s largest organization of eye physicians and surgeons. 

It is particularly appropriate, Mr. Chairman, to discuss vision 

and preventing blindness today since May is Healthy Vision 

Month, a designation to elevate vision as a health priority for the 

Nation. We need our vision to work, to read, to drive, to distinguish 

the faces in this room. 

The Academy and the vision community commends Congress for $10,400,000,000 in NIH funding in the ARRA, as well as fiscal year 

2009 and 2010 funding increases that enabled the NIH to keep 

pace with biomedical inflation after six previous years of flat funding that resulted in a 14 percent loss of purchasing power. 

The Academy supports a fiscal year 2011 NIH funding level of $35,000,000,000, which would result in NEI funding at almost 

$800,000,000. This funding level would increase the level of grants 

available to researchers, maintain the momentum of the research 

I am describing, and leverage the investment that Congress has already made in the NIH and the NEI through ARRA funding to 

allow us to continue to make breakthroughs which reduce blindness throughout the world. 

The recent treatment breakthroughs which are having a huge 

impact on reducing vision impairment and blindness from these 

common eye diseases suggests that this is not the time for a lessthan-inflationary increase that nets a loss in NEI’s purchasing 


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power, which was previously eroded by 18 percent in fiscal years 

2003 through 2008. 

The baseline funding in fiscal years 2009 and 2010 has also enabled the NEI to fund key research networks that are studying 

such issues as the genetic basis of glaucoma, the second leading 

cause of blindness. And as I mentioned, the NIH just issued a press 

release only two weeks ago announcing the publication of this comparative effectiveness study which confirmed that a new treatment 

for swelling of the retina from diabetes, the main cause of central 

vision loss in people with diabetes, which can affect as many as 30 

percent of people who have had diabetes for more than 20 years, 

and affects their ability to read or drive, the study showed that 

these eye injections of a new medication, combined with laser, 

nearly 50 percent of the people who received this treatment had 

substantial vision improvement, and fewer than 5 percent lost vision. 

The unprecedented level of fiscal year 2009 to 2010 vision research funding is moving our Nation that much closer to preventing blindness and to restoration of vision. With an overall NIH 

funding level of $35,000,000,000 and an NEI funding level of almost $800,000,000, the vision community can accelerate these efforts and reduce healthcare costs, maintaining productivity, causing independence, and ensuring quality of life. 

In closing, I would just like to summarize and encourage the 

Subcommittee to increase the funding level of the NIH to 

$35,000,000,000 or at a minimum increase the NEI funding by at 

least 3.2 percent in fiscal year 2011 in order to continue the momentum of vision-saving research in the United States. Not working today to stave off debilitating eye disease will have a huge and 

grave economic and social repercussion for America’s future. 

Thank you very much. 

[Written statement by Neil Bressler, M.D. follows:] 


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Mr. OBEY. Thank you. 

Next, Wanda Burns, American Cancer Society Cancer Action 

Network. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER 

INSTITUTE 

WITNESS 

WANDA BURNS, RN, AMERICAN CANCER SOCIETY CANCER ACTION 

NETWORK 

Ms. BURNS. Chairman Obey and Members of the Subcommittee, 

thank you for the opportunity to appear before you this afternoon 

to testify in support of the National Institutes of Health and National Cancer Institute. My name is Wanda Burns and I am from 

Niles, Ohio, a town just outside of Youngstown. 

I am here today on behalf of the American Cancer Society Action 

Network, and my late sister-in-law Cindy. Cindy died from ovarian 

cancer in 2008 and I appear here today to honor her fight against 

cancer. I have been a registered nurse for 30 years, and in that 

time have seen first-hand the results of the tremendous progress 

we have made thanks to research in preventing, detecting and 

treating cancer, and better managing symptoms and side effects to 

improve patient quality of life. 

Part of my nursing career has been in the hospice study, so I am 

also keenly aware that far too many people facing the disease, our 

cancer-fighting tools for early detection, treatment, and care remain limited. Ovarian cancer lacks a screening test to aid in the 

early diagnosis and treatment that is essential to survive. The majority of cases are diagnosed at a distant stage when the cancer has 

spread and the five-year survival rate in those cases drops to only 

31 percent. 

Cindy, sadly, was one of those cases. She discovered a protrusion 

on her abdominal wall in early January, 2004 and was diagnosed 

with cancer a few weeks later. By that time, Cindy’s cancer had 

metastasized to her colon and diaphragm. According to statistics, 

Cindy’s life expectancy was 19 months. 

We were fortunate that Cindy’s oncologist was able to help her 

find and enroll her in a clinical trial sponsored by the National 

Cancer Institute which took place at the Cleveland Clinic. While 

conventional chemotherapy failed and offered Cindy little help and 

hope, the clinical trial offered an additional course of treatment 

and an additional 45 months of life. Her participation in these clinical trials gave all of us hope. More importantly, it gave us precious 

additional time together as a family. 

I am so pleased to tell you that Cindy beat the odds and enjoyed 

nearly five rewarding years of life after her late stage diagnosis, 

which included being there to see her only son get married. This 

meant the world to Cindy and to the entire family. 

But research progress does not happen overnight, though we 

would wish it could. Cindy enrolled in one particular clinical trial 

at Cleveland Clinic in 2005, a trial that had actually initiated in 

2001 and just concluded earlier this year. This trial, which took 


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just under 10 years to complete, evaluated a combined therapy regimen for treating ovarian cancer. 

After being invited to testify, I checked in with Cindy’s gynecological oncologist and learned that the results from the clinical trial 

are very promising. It is clinical trials such as this that give 

healthcare providers, patients, family and friends hope. Clinical 

trials are important to all of us, for no one knows what our personal futures hold. 

Cindy’s story and the countless stories of other cancer patients 

make clear that sustained funding for cancer research is critical to 

maintain and build on the progress we are making every day. The 

clinical trials that gave us treasured years with Cindy and gave 

Cindy countless special moments like being at her son’s wedding, 

would not have happened absent support from the National Institutes of Health National Cancer Institute. 

The NIH and NCI support life-saving research at the Cleveland 

Clinic, 64 NCI Cancer Centers and multiple other institutions in 

oncology practice settings across the country. Knowing that funding 

for this research is secure gives us all hope. 

For this reason, I am requesting on behalf of the American Cancer Action Network that the National Institutes of Health receive 

a budget of $35,000,000,000 in fiscal year 2011, including 

$5,800,000,000 for the National Cancer Institute. 

Thank you, Mr. Chairman, for the opportunity to testify. 

[Written statement by Wanda Burns, R.N. follows:] 


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Mr. OBEY. Thank you. 

Mr. RYAN. Mr. Chairman, I would just like to say hello because 

Wanda is not only from my District, she is from my home town, 

and I want to thank her for coming up. 

So thank you for your work. 

Mr. OBEY. She told me a lot about you. [Laughter.] 

Mr. RYAN. Let’s keep that off the record, will you, Mr. Chairman? 

[Laughter.] 

Ms. BURNS. Thank you. 

Mr. OBEY. Thank you. 

Next, I understand, Congressman Shimkus would like to introduce someone. 

Mr. SHIMKUS. Thank you, Mr. Chairman. 

It is an honor to be here, especially as I have never been in this 

hearing room and it is good to be here in your last years of serving, 

and I appreciate your service. 

Thank you, Ranking Leader Rehberg also for this time. 

I am here to introduce Kristin. Kristin is the widow now, wife 

of my former Legislative Director Ray Fitzgerald, who passed away 

from gastric cancer. Kristin has testified before, now I am Ranking 

on the Subcommittee on Health, to talk about the funding aspects 

of the National Cancer Institute and the issues related there. 

She is a former Hill staffer, was on Education and Labor with 

now our Leader Boehner’s staff, so she is very capable and understanding of the ways of how we work out here. She came out here 

on the train. 

Mr. OBEY. I’m glad that somebody is. [Laughter.] 

Mr. SHIMKUS. She came out on the train with Nora, Maggie and 

Lucy. 

About half the deaths from cancer come from a deadly cancer disease, and only 17 percent of the funding goes there. And so I think 

in part what we had in our hearing raised that issue and talked 

about the proportion of where our money should go and how it 

should be spent. She does a much better job than I do. I am just 

pleased to have her still working on behalf of healthcare for all 

Americans, and in a legacy of my former employee and her husband, Ray Fitzgerald, who we miss dearly. 

Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. Glad to have you. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER 

INSTITUTE 

WITNESS 

KRISTIN W. FITZGERALD 

Ms. FITZGERALD. Thank you, Congressman Shimkus, for your 

tireless commitment and support. 

Mr. Chairman and Members of the Subcommittee, thank you for 

the opportunity to testify at today’s hearing on the need for fiscal 

year 2011 funding to research gastric or stomach cancer and other 

gastrointestinal or GI cancers in young people. 


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Chairman Obey, I was also sorry to hear of your retirement, with 

your longstanding commitment to medical research. 

I am here today not only on my own behalf, but that of my husband, Ray Fitzgerald, who died last year of gastric or stomach cancer. As you have heard, Ray was Legislative Director for Congressman John Shimkus. 

Until his diagnosis in May of 2008, Ray was a healthy 36 year 

old man. He had no risk factors for cancer. He had never smoked, 

drank infrequently, and lived a healthy lifestyle. With no family 

history of cancer, nothing would ever have put him at a high risk 

of a cancer diagnosis. 

Ray’s cancer symptom was burping, which appeared for a period 

of two months before his cancer was diagnosed. When he was diagnosed, his cancer was an advanced stage four. His gastric tumor 

had spread throughout the lining of his stomach and progressed to 

his esophagus and liver. 

We were told that there was no hope of a cure, but that chemotherapy could reduce the cancer for a time. That time was eight 

months. Let me be clear. The time between diagnosis and Ray’s 

death was only eight months. This is not an abnormal scenario for 

gastric cancer. It is the second deadliest cancer worldwide. It very 

often presents in stage four and is always incurable at that point. 

Ray, however, at 36, was 40 years younger than the average gastric cancer patient, and thus the grim prognosis impacted not just 

Ray, but myself and our three young daughters, Nora, Maggie and 

Lucy. 

Members of the Subcommittee, it is my belief that Ray’s diagnosis and prognosis is our worst cancer nightmare: diagnosis of a 

deadly cancer with very few warning symptoms at an advanced 

stage where cure is impossible. It is a death sentence. 

After Ray died, I spent time researching how this kind of scenario can be prevented. As a former Congressional health staffer, 

I assumed that gastric cancer research was ongoing. However, far 

too little is being done to research gastric cancer and other GI cancers that have a similar deadly prognosis. 

CBS News analyzed the disparity in research dollars in May of 

2009. For every cancer death, the most Federal research dollars are 

spent on cancers of the cervix and breast. The very least funded is 

gastric cancer, at about $1,100 a person. 

GI cancers are some of the deadliest cancers in the United 

States. Four out of the five lowest five-year cancer survival rates 

for metastatic cancer are GI, including stomach cancer with a survival rate of only 3.4 percent. 

And GI cancers are rising, particularly in young people. Last 

week, NCI released a study showing that a young person’s likelihood of being diagnosed with gastric cancer has increased by almost 70 percent since 1977. Likewise, a recent NCI article documented a 190 percent increase in a sub-type of cancers of the stomach and esophagus in young white males like Ray. 

And the situation for young people with GI cancers is particularly grim. Because of their lack of symptoms, the disease is usually in a late stage by the time a diagnosis is established. And their 

very age works against them as the strength and relative health 

of their bodies is passed on to their cancers, making them even 


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more aggressive than in older patients. As a result, GI cancers in 

young people tend to be fatal. 

In my view, this is intolerable. Congress and NCI can and should 

do more to ensure that researchers can have access to the tools 

they need to prevent and diagnose these cancers before it is too 

late. Research is essential in order to understand the unique characteristics of the disease in younger people and develop a screening 

test based on molecular markers to allow for earlier detection. 

In order to accomplish this research, NCI must develop a coordinated national GI cancer tissue biorepository and a research 

project to focus research in this area and make tumor tissue available for research purposes. 

A specific research project is critical in order to obtain IRB approval to go beyond the standard of care in obtaining tumor tissue 

and elicit the participation of our Nation’s top cancer centers. 

Last year, the Labor, HHS, and Education Appropriations Report 

included language asking the NCI to develop a research project and 

biorepository to study these cancers in young people, and language 

for fiscal year 2011 asking NCI to report on its progress has been 

submitted by Congressman Jackson. 

After my testimony to the Energy and Commerce Committee, 

work with NCI has commenced to potentially include gastric cancer 

in the Cancer Genome Atlas, but we need Congressional support 

and NCI support to ensure that these cancers can be cured. 

[Written statement by Kristin W. Fitzgerald follows:] 


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Mr. OBEY. Thank you very much. We are sorry for your loss. 

Next, E. Clarke Ross, Friends of NCBDDD. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL, NATIONAL CENTER 

FOR BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES 

WITNESS 

E. CLARKE ROSS, CHAIR, FRIENDS OF THE NATIONAL CENTER FOR 

BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES 

Mr. ROSS. Thank you, Mr. Chairman. I am representing the 

Friends of the National Center on Birth Defects and Developmental 

Disabilities at CDC. According to the National Council on Disability, there are 54 million Americans with disabilities, and 

NCBDDD is the disabilities center at CDC. 

I have had the privilege of working for 40 years with five different national disability organizations and I brought a photo of 

you that I was at with the leadership of United Cerebral Palsy of 

Wisconsin from the late 1970s or the early 1980s. 

Mr. OBEY. That guy is an imposter. [Laughter.] 

Mr. ROSS. People recognize you. People recognize you. We are asking for a $20,000,000 increase in the appropriation for NCBDDD. That is a 14-percent increase over the $143,000,000 

level of the current level and NCBDDD would do five things with 

this $20,000,000. One is to enhance wellness and prevention initiatives for people with disabilities. This is a big priority of the First 

Lady, obesity. The new CDC Administrator’s big priority is antismoking, obesity, infectious diseases. 

I am the father of a 19-year-old son with high-functioning autism 

and non-attentive ADHD, significant anxiety and learning disabilities. He is 19. He is right out of high school. And what does he 

do left to his own druthers? He sits in his apartment and watches 

TV and does Game Boy kinds of things. 

So this population is very socially isolated. And unless we have 

aggressive NCBDDD programs that deal with things like social isolation in this population, what are guys like my son going to do? 

They are going to eat. Fortunately, he does not drink or smoke or 

do drugs, but what he is going to do when he is socially isolated 

by himself is use behaviors that are not very positive and helpful. So we would use some of this $20,000,000 to deal with health 

and wellness programs like the First Lady and the CDC Administrator desire. 

We also need to do a lot in the health disparity area. The disability population itself is highly under-served compared to the 

population at large. Many of the witnesses are consumers and family members. A high priority of NCBDDD is to educate family 

members and consumers about all of these disabilities, how to deal 

with the disabilities, how to plan your life around the disabilities. 

That is a third area. 

The fourth area is a big need. We have a good special education 

law in this Country. We have 6.5 million kids in special education. 

They come out of high school. We as a society are not really dealing 


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with the transition from high school to employment or college, and 

we need a lot of planned supportive activities to help young adults. 

And this is very consistent with the whole employment initiative. 

We need to help people get employed. We need to support them in 

employment, and NCBDDD can do that with an increase in appropriations. 

And last, NCBDDD does do global health work like folic acid distribution around the Country to prevent birth defects. So $20,000,000, these are the five things the Friends would like 

to see money used for. 

[Written statement by E. Clarke Ross, D.P.A., follows:] 


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Mr. OBEY. All right. Thanks again. 

Next, Vicki Modell, Jeffrey Modell Foundation. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH, OFFICE OF PUBLIC 

HEALTH GENOMICS 

WITNESS 

VICKI MODELL, CO-FOUNDER, JEFFREY MODELL FOUNDATION 

Ms. MODELL. Mr. Chairman and Members of the Committee, 

thank you so much for this extraordinary opportunity to testify 

today. 

My husband and I created the Jeffrey Modell Foundation in 

memory of our son Jeffrey, who died at the age of 15 after a lifelong battle with primary immunodeficiency. PI diseases afflict more 

than 1 million Americans, but most of them go undiagnosed. 

Over the past 12 years that we are coming to Washington, you 

have given us the opportunity to build a strong partnership with 

Congress, CDC, NIH, as well as industry and private donors. Now, 

I would like to tell you where we are, where we are going with your 

continued support, and some changes that are needed in the President’s budget request that will allow us to continue to help our patients and save lives. 

This Committee provided the funding for physician education 

and public awareness programs. Working with CDC, we started the 

campaign five years ago and our public service ads have generated 

more than $130,000,000 in donated media. It has enabled us to 

generate additional funding from the private sector, and we are 

very proud to report that every $1 of Federal funds provided has 

been leveraged into more than $10 for our program. 

I am delighted to report that this initiative is having exactly the 

impact that we all had hoped for. Physicians at our 79 Jeffrey 

Modell Centers in the U.S. report a doubling every year in the 

number of patients diagnosed and treated. And severe infections, 

hospitalizations, school and workdays missed were reduced by an 

average of 70 percent. This generates a savings to the healthcare 

system of more than $80,000 per patient per year. 

Since the NIH reports that there are 500,000 Americans with PI 

who are undiagnosed, the wasted cost to our healthcare system is 

$40,000,000,000 annually. All of this has been published in a peerreviewed journal. 

This program is successful, but here is the problem. The President’s budget for fiscal year 2011 reduces funding for the Office of 

Public Health Genomics and eliminates the line items created by 

this Committee to fund the education and awareness programs. 

While CDC has indicated its support, the only guarantee that it 

will go forward is if this Committee supports that and acts. 

For this reason, we are requesting that when you assemble the 

Chairman’s mark for the bill, you return this account to the current status, as was found in the fiscal year 2010 bill. The program 

is working and it has earned your continued support. 


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An additional success story for this Committee and by this Committee, I may say, is the newborn screening program that was 

funded and piloted in Wisconsin and Massachusetts by CDC and 

our Foundation. Today, every baby born in those two States is 

being screened for this life-threatening condition, and potentially 

cured. The cost of the screening is less than $5 per baby. Now, that 

is priceless. 

That is why this past January the Secretary’s Advisory Committee voted unanimously to add SCID testing to the national core 

panel. 

I received a note from a mother in Edgar, Wisconsin, not far 

from you, whose baby was screened, transplanted, and has been 

completely cured. The impact of this Committee is extremely well 

expressed in her note: ‘‘We are so blessed to have our beautiful 

baby Dawson. Every day I feel we are the luckiest family in the 

world. I always think about the time we testified in D.C. and we 

sat next to the parents from Oregon who lost their baby Liam to 

SCID. That could have been us. This September will be Dawson’s 

two-year anniversary of his transplant. We cannot imagine life 

without him.’’ 

Well, tomorrow 11,000 babies will be born in this Country, but 

only 300 to 400 of them will be born in States that currently screen 

for SCID. They will be the lucky ones. They will have a chance of 

life. If every State would screen for SCID, we could actually wipe 

out this deadly disease. What a great legacy for this Committee. 

So Fred and I accept the reality that science and discovery did 

not come in time to save Jeffrey, but we are dedicated and committed to work with you so that all the Jeffreys in the future will 

have a healthy life. This is our hope. It is our dream. Let’s go forward on this journey together starting today. 

Thank you and thank you for your service for so many years. 

[Written statement by Vicki Modell follows:] 


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Mr. OBEY. Thank you. 

Next, Madeleine Will, National Down Syndrome Society. 

WEDNESDAY, MAY 12, 2010. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

WITNESS 

MADELEINE WILL, VICE PRESIDENT, NATIONAL DOWN SYNDROME SOCIETY 

Ms. WILL. Good afternoon, Mr. Chairman and Members of the 

Subcommittee. I am Madeleine Will, Vice President of Public Policy 

for the National Down Syndrome Society. I want to thank you for 

the opportunity to testify today and to thank you for your leadership role that you and the Subcommittee have played over the 

years in supporting and creating greater public awareness of Down 

Syndrome. 

There are more than 400,000 people living with Down Syndrome 

in the U.S. and about 5,000 babies are born each year or one in 

733. Down Syndrome occurs in people of all races and economic levels, and is the most frequently occurring chromosomal condition. 

Mr. Chairman, recognizing the challenges the Subcommittee 

faces in prioritizing requests, the National Down Syndrome Society 

respectfully recommends that you appropriate $5,000,000 in fiscal 

year 2011 to the Centers for Disease Control and Prevention to implement the requirements of the Prenatally and Postnatally Diagnosed Conditions Awareness Act which was enacted in 2008. 

This law will ensure that pregnant women who receive a diagnosis of Down Syndrome and other genetic disorders prenatally or 

postnatally receive up to date scientific information about such 

things as life expectancy, functional development, clinical course, 

prenatal and postnatal treatment options, educational and psychosocial outcomes. This information is to be provided through the development of materials, the creation of hot lines, Web sites and informational clearinghouses. With $5,000,000, the Department of Health and Human Services 

will be able to fund, to collect and distribute information related to 

prenatally and postnatally diagnosed conditions. 

There are several points I would like to underscore in my testimony. First, it is important to note that the organizations supporting the legislation went to great lengths to ensure bipartisan 

support for it, seeking out and achieving the championships of Senator Brownback and former Senator Kennedy. 

We also went to considerable lengths to speak to both right to 

life and pro-choice groups to convey that this legislation should be 

characterized for what it is, a piece of legislation about accurate 

evidence-based information that needs to be delivered to pregnant 

women. 

It is also important to underscore that the legislation was not designed to focus only on women who receive information about Down 

Syndrome. Rather, the legislation seeks to develop and to have distributed information about many disabilities and genetic disorders, 

to name a few: Trisomy 13 and 18, Williams Syndrome, spina 

bifida. 


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More than 1,000 prenatal tests are available or in development 

and a best practice bulletin has been issued by the American College of Obstetricians and Gynecologists. It is recommended that all 

pregnant women be offered prenatal testing, all 4 million pregnant 

women annually. 

This means that these women need to receive information that 

is complex and challenging and changing with new data, advances 

and findings that need to be conveyed, particularly after Francis 

Collins’ mapping of the human genome. Hank Greely, the Director 

of Stanford University’s Center for Law and Biosciences, said recently, ‘‘Information is powerful, but misunderstood information 

can be powerfully bad.’’ 

Another point I would like to emphasize is that we do know how 

obstetricians feel about the issues of screening and the delivery of 

a diagnosis of Down Syndrome and other chromosomal disorders. 

In an article published by ACOG, 36 percent of obstetricians feel 

well qualified to counsel patients who screen positive for Down 

Syndrome; 51 percent thought the training they received was adequate, but 40 percent thought it was less than adequate; and only 

29 percent of physicians surveyed provided printed educational materials to a woman when her fetus was diagnosed with Down Syndrome. 

Lastly, we have information about how the diagnosis should be 

delivered. A 29-member research team surveyed women who had 

received a diagnosis to determine the best way of delivering the 

news, and some of the most important findings were that all 

women wanted to discuss all options available to them, including 

continuing the pregnancy, adoption and termination. 

They also wanted screening results explained as a risk assessment and not as a positive or a negative result. They wanted sensitive language used in the delivery of a diagnosis and they wanted 

consistency in the messages conveyed by the variety of professionals with whom they interact. 

NDSS is working collaboratively with ACOG, the National Society of Genetic Counselors, and the American College of Medical Genetics since the passage of the law. We have developed a consensus 

document which explored myths and realities about prenatal testing. We have pledged to review materials together, but frankly, we 

are stuck even if we had materials developed, we would not be able 

to move forward to publish and distribute this information to physicians and women without a Federal partner and additional funding. 

Mr. OBEY. I will have to ask you to wrap it up. 

Ms. WILL. Yes, Mr. Chairman, thank you for your time and attention. We are thrilled beyond measure that Congress enacted this 

legislation and hope that the funding of this law will lead to better 

information and better decision making. 

Thank you. 

[Written statement by Madeleine Will follows:] 


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Mr. OBEY. Thank you. 

I understand the situation. My nephew was a Down Syndrome 

child. 

Next, Michael Goldberg, Society for Neuroscience. 

Oh, I am sorry. I mucked up. Okay. 

Gail Smith, Dr. Anthony R. Horton, International Rett Syndrome 

Foundation. 

WEDNESDAY, MAY 12, 2010. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

WITNESS 

GAIL SMITH, INTERNATIONAL RETT SYNDROME FOUNDATION 

Ms. SMITH. Mr. Chairman and Committee Members, thank you 

for this opportunity to speak. I had a daughter with Rett Syndrome, and this is my story. 

My name is Gail Smith and I reside in Maryland. My husband 

and I dreamed of raising a normal healthy family. Seems like yesterday when our first child was born. She was a perfect baby. She 

babbled and cooed her way through the first year, a bouncing 

happy baby. She played patty-cake and waved bye-bye and began 

to feed herself and walk. 

Suddenly after one year old, Kristi became aloof and began to 

lose skills rapidly. At two and a half, she literally overnight lost 

her ability to walk independently. We were terrified. We pursued 

countless doctors and many, many medical tests, but still no answers. By five years of age, her mind was trapped within a body 

that would not allow her to communicate or physically respond. 

We mourned the death of our normal child and began to grapple 

with our changing life. We experienced fear, anger and a deep 

sense of sadness. I used to lie in bed trembling and praying that 

I could just learn to cope and that she wouldn’t die. 

I searched fervently in medical journals and papers for any remote likeness to the symptoms that Kristi exhibited. Then one day 

a friend who had a daughter in some ways similar to mine shared 

with me a paper on Rett Syndrome. That was the first article on 

the condition ever published in English. I knew I had found Kristi’s 

diagnosis. 

At 13 years of age, Kristi was one of the first girls in the United 

States officially diagnosed with Rett Syndrome at Johns Hopkins 

by Dr. Andreas Rett himself. Rett Syndrome is a neurologic disorder that occurs almost exclusively in girls who develop normally 

until between six and 18 months of age, when the child begins a 

regression that severely challenges her mentally and physically. 

At that time, there was no known cause, treatment or cure. 

Kristi spoke volumes with her eyes. She spread love with her sweet 

smile. She and I became symbiotic, joined at the hip. The last word 

she could speak was ‘‘Mama,’’ usually when she was in stress. I became sensitive to her every need and I couldn’t help her frustration 

or take her place from her. 

She endured so many operations for scoliosis, tendon releases, 

and the placement of a feeding tube. As her lungs deteriorated, she 


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was hospitalized many times for aspiration pneumonia. I have 

never experienced anything as painful as watching her suffer. 

On September 9, 2006, as I lay holding her in the intensive care 

unit at Children’s National Medical Center, she slipped away. And 

part of me slipped away, too. She was 34 years old. 

Despite the struggle, we have been so blessed to have her in our 

life. She has taught me more about life and relationships than any 

teacher I have ever had. I cry every day since she has been gone. 

There is a hole in my heart. 

However, I am somewhat comforted knowing that she is smiling 

down knowing there is hope for other girls with Rett Syndrome. It 

is my everlasting love for Kristi and the hope for those children 

with Rett Syndrome, the hope that children with Rett Syndrome 

can be reversed for those who have the disease, and the families 

caring for them that brings me here today. 

Research is the only way to help us find a cure for the many 

thousands of girls who are today suffering as Kristi did for 34 

years. Through research, we have now found the cause of Rett Syndrome. Through research, we now know it can be reversed. Researchers tell us that we are at the point of testing treatments to 

reverse the symptoms of this disease. 

With your support, we can take the next steps on the path and 

begin testing the therapies that will help these girls live better 

lives. With your support, we could reverse this disease once and for 

all. 

I loved Kristi so much and it would mean so much to see funding 

appropriated to help avenge the devastating impact of this horrible 

disease. 

Please help us. Thank you for your time and consideration. 

Congressman Steny Hoyer has worked tirelessly with us on funding for Rett Syndrome. Our families met at church. He and Kristi 

have had a long and lasting relationship over the years. He has 

worked with us and has been so helpful and I want to thank him. 

I know he is not here. 

Thank you for your time. God bless all. 

[Written statements by Gail Smith and Dr. Antony R. Horton follow:] 


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Mr. OBEY. Thank you. I know it is tough to bring that story here. 

Next, Michael Goldberg, Society for Neuroscience. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL INSTITUTES OF HEALTH 

WITNESS 

MICHAEL E. GOLDBERG, M.D., PRESIDENT, SOCIETY FOR NEUROSCIENCE 

Dr. GOLDBERG. Mr. Chairman and Members of the Committee, it 

is an honor to testify today on the fiscal year 2011 budget. 

On behalf of the 40,000 scientists and clinicians who are members of the Society for Neuroscience, I thank the Subcommittee for 

its past support of research at the NIH and in particular I thank 

Chairman Obey for his unflagging support for biomedical science. 

I am Michael Goldberg, President of the Society for Neuroscience, 

and the David Mahoney Professor of Brain and Behavior at Columbia University in New York. Because I am both a basic 

neuroscientist and an active clinical neurologist, I know how basic 

research translates to new and better treatments for human disease often in unexpected ways. 

On behalf of the Society, I respectfully request a 2011 NIH ap- propriation of $35,000,000,000. This level will sustain the burst of 

scientific productivity funded by the American Recovery and Reinvestment Act for which the scientific community thanks this Congress and the Obama Administration, and which was especially 

welcome after six years of below inflationary increases for NIH. 

ARRA funding was an unqualified success. Areas of research that 

need to be sustained include the application of genetic knowledge 

to clinical treatment, immunological treatments for addiction, and 

the understanding of memory loss in Alzheimer’s and in normal 

aging. 

While we applaud President Obama’s strong commitment to 

science, the Administration’s fiscal year 2011 budget does not fully 

take into account the tremendous scientific momentum from ARRA. 

With continued funding at the ARRA-adjusted base of 

$35,000,000,000, this research will form the foundation for new 

medical applications. Without it, NIH will see the wasteful termination of promising research programs just begun under ARRA 

funding and the firing of thousands of technicians and research fellows. Young investigators, the future of American science, will be 

especially devastated. Ultimately, scientific progress on diseases 

that cost society trillions will be delayed or derailed. 

In addition, strong NIH funding is vital to ensure that the 

United States remains the world leader in biomedical research. 

Today, that role is being threatened. For instance, China’s government is using financial resources to draw scientists home. In my 

own lab, a post-doctoral fellow with a green card received an offer 

from the Chinese government that could not be matched in America, given the current funding climate, and he went back to China. 

SFN supports a robust international scientific community, yet we 

understand that strong American leadership is vital both to catalyze global research and to protect our Nation’s future. 


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Finally, as an NIH-funded scientist, funded by the National Eye 

Institute, I not only conduct research relevant to autism and attention deficit disorder, I support a community of workers. More than 

three-quarters of my funding goes to hire fellows, machinists, computer scientists, biological technicians and animal caretakers, as 

well as administrative staff. 

Nationwide, robust NIH funding generates hundreds of thousands of high wage jobs in every American State. According to a 

recent report, every $1 in NIH funding adds $2.11 to our economy. 

In closing, I stress that today, we live on the forefront of an era 

of breathtaking potential to advance biological knowledge and 

human health. And we are all fortunate to have the NIH, the 

world’s finest biomedical research enterprise and a strong economic 

engine for America. As the Nation considers difficult decisions in 

the face of economic strain, prioritizing strong NIH funding remains a wise investment precisely because it contributes to our 

health and our economic strength. 

As the Nation emerges from recession, ARRA’s infusion in infrastructure, labs, people and discoveries should be made permanent 

to serve the American people, their health and our economy. 

On behalf of the Society for Neuroscience, I again thank this 

Subcommittee, its Chair, and the Nation for America’s commitment 

to research. I urge you to sustain the momentum with a fiscal year 

appropriation of $35,000,000,000. 

Thank you, Mr. Chairman. 

[Written statement by Michael E. Goldberg, M.D., follows:] 


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Mr. OBEY. Thank you. 

Next, Cynthia Bearer, Children’s Environmental Health Network. 

WEDNESDAY, MAY 12, 2010. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES, 

CLEAN GREEN AND HEALTHY SCHOOL INITIATIVE 

WITNESS 

CYNTHIA BEARER, M.D., BOARD CHAIR, CHILDREN’S ENVIRONMENTAL 

HEALTH NETWORK 

Dr. BEARER. Good afternoon. Thank you for the opportunity to 

testify before you today. 

I am the Mary Gray Cobey Professor of Neonatology and Division 

Chief of Neonatology at the University of Maryland. However, I am 

not here today in that role, but in my role as Board Chair for the 

Children’s Environmental Health Network. 

The Network is a nonprofit organization that has been working 

for almost 20 years to promote a healthy environment and to protect all children from environmental health hazards. 

The world in which today’s children live has changed tremendously from that of previous generations. This includes a phenomenal increase in the number of new substances to which children are exposed. For example, my 13-year-old son Matt has already been exposed to many more chemicals than I was at his age. 

Most of these chemicals are untested in their effects on developing 

organ systems such as the brain. 

Children have unique vulnerabilities and susceptibilities to toxic 

chemicals. As we have learned from lead, mercury and alcohol, an 

exposure which may cause little or no harm to an adult may cause 

permanent harm to a child. The Network appreciates the wide 

range of needs that you must consider here for funding. We urge 

you to give priority to those programs that directly protect and promote children’s environmental health. In so doing, you improve not 

only our children’s health, but also their educational outcomes and 

their future. 

My written testimony provides information on the funding needs 

of a variety of agencies and collaborative programs that are key in 

protecting children’s environmental health, such as the Children’s 

Environmental Health Research Centers of Excellence; the National Environmental Public Health Tracking Program; and the 

National Children’s Study. 

The Network urges the Committee to provide full funding for the 

Administration’s Clean Green and Healthy School Initiative. As 

you know, school children and their parents do not have an OSHA. 

No agency is authorized to intervene to protect children from environmental hazards in schools. We require our children to spend 

hours in an environment where they and their parents have no recourse if that environment is not healthy. 

Unfortunately, studies have shown that many of our school buildings are unhealthy. Similarly, although millions of preschool children spend hours in day care, most State licensing programs include few environmental health standards. Thus, we urge the ComVerDate Mar 15 2010 06:04 Oct 01, 2010 Jkt 058144 PO 00000 Frm 00319 Fmt 6633 Sfmt 6602 E:\HR\OC\A144P2.XXX A144P2

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mittee to expand the Clean Green and Healthy Schools Initiative 

to include child care. 

I will close by mentioning an area that has been of great concern 

to the Network, but which has received little attention by policymakers. I am referring to global climate change. Of course, climate 

change has been a hot topic. However, the health impacts of climate change, especially the health impact on children, have received almost no attention. Yet children as a vulnerable sub-population will be the first and worst hit by climate change. 

The World Health Organization estimates that more than 

150,000 deaths per year due to climate changes are already occurring in the world’s low-income nations. Of these deaths, almost 85 

percent are young children. Thus, the Network urges the Committee to provide $50,000,000 in fiscal year 2011 for the Department of Health and Human Services to prepare for the potential 

health effects of global climate change. 

In conclusion, investments in programs that protect and promote 

children’s health will be repaid by healthier children with brighter 

futures, an outcome we can all support. That is why the Network 

asks you to give priority to these programs. 

Thank you. 

[Written statement by Cynthia Bearer, M.D., follows:] 


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Mr. OBEY. Thank you. We appreciate your comments. 

Next, Leonardo Trasande, Children’s Environmental Health Center. 

WEDNESDAY, MAY 12, 2010. 

NATIONAL CHILDREN’S STUDY 

WITNESS 

LEONARDO TRASANDE, M.D., CO-DIRECTOR, CHILDREN’S ENVIRONMENTAL HEALTH CENTER, MT. SINAI MEDICAL CENTER 

Dr. TRASANDE. Chairman Obey, Members of the Subcommittee, 

thank you for the opportunity to update you on ongoing progress 

at the National Children’s Study, our Nation’s opportunity to address the preventable and environmental causes of the epidemic of 

chronic conditions that affect children today. 

I co-direct the Children’s Environmental Health Center at the 

Mt. Sinai School of Medicine, the Nation’s first academic policy center devoted to the protection of children against environmental 

threats to health, and serve as the location principal investigator 

for Queens, New York, one of seven locations where the National 

Children’s Study launched in early 2009. 

The National Children’s Study is a prospective study that will 

follow 100,000 American children, a nationally representative sample of all children born in the United States, from conception to age 

21, and was mandated by Congress through the Children’s Health 

Act of 2000. The study will gather an unprecedented volume of 

high quality data on how environmental factors acting either alone 

or in combination with genetics affect the health of infants and 

children, examining a wide range of environmental factors from air, 

water and dust, to what children eat and how often they see a doctor. 

The study will help develop prevention strategies and cures for 

a wide range of childhood diseases. The National Children’s study 

will employ the latest tools in molecular epidemiology and will incorporate state of the art analyses of gene-environment interactions. 

Congress has already laid a firm foundation for the National 

Children’s Study. Between 2000 and 2009, Congress invested more 

than $580,000,000 to design the study and begin building the nationwide network for its implementation. Seven vanguard centers 

and a coordinating center were designed in 2005 to test the necessary research guidelines with plans to expand the program to 41 

States and 105 communities nationwide. 

Findings in these study centers have suggested that further refinements are necessary to ensure the most cost-effective investment in implementing the study, and generating policy-relevant 

findings for decades to come. The study has recently been expanded 

to 30 additional locations where approaches to recruitment can be 

more fully optimized. 

A formative research program will generate new knowledge that 

will inform redesign of key questionnaires and other data collection 

approaches in response to important concerns that were raised by 


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the National Academy of Sciences regarding the original vanguard 

protocol. 

The tough job of designing and organizing is nearly complete. 

Funding for the study this year will permit researchers to begin 

achieving the results that will make fundamental improvements in 

the health of America’s children. To abandon the study at this 

point would mean foregoing all of that dedication, all of that incredible effort, and all of that logistical preparation. 

The National Children’s Study will yield benefits that far outweigh its cost. Six of the diseases that are the focus of the study 

cost America over $642 billion each year. If the study were to 

produce even a 1 percent reduction in the cost of these diseases, 

it would receive $6,400,000,000 annually, 50 times the average 

yearly cost of the study itself. 

The Framingham Heart Study upon which the National Children’s Study is modeled, is the prototype for longitudinal medical 

studies and contributed powerfully to the 42 percent reduction in 

mortality rates from cardiovascular disease that were achieved in 

our Country over the past five decades. 

Funding for the study will require a commitment of $194,000,000. These funds will be used to begin enrolling children 

in to the study. They will enable the NIH to continue establishing 

the 105 study sites around the Country. We do not need to wait 

21 years for benefits to materialize from the study. Valuable information will become available in a few years time, as soon as the 

first babies in the study are born. 

The National Children’s Study will provide a blueprint for the 

prevention of disease and for the enhancement of health of America’s children today and in the future. It will be our legacy to the 

generations yet unborn. 

Thank you for the opportunity to speak before you today. 

[Written statement by Leonardo Trasande, M.D. follows:] 


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Mr. OBEY. Thank you. 

Mr. REHBERG. May I ask how old you are? You look really young. 

Dr. TRASANDE. That is kind. I am 36. [Laughter.] 

Mr. RYAN. Hey, Rehberg, quit picking on young people, okay? We 

don’t appreciate that. We have a caucus going over here. [Laughter.] 

Mr. REHBERG. Don’t you wish you had that resume. [Laughter.] 

Mr. OBEY. Next, David Meltzer, American Red Cross. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL AND PREVENTION, 

GLOBAL IMMUNIZATION 

WITNESS 

DAVID MELTZER, SENIOR VICE PRESIDENT FOR INTERNATIONAL 

SERVICES, AMERICAN RED CROSS 

Mr. MELTZER. Thank you, Chairman Obey and Members of the 

Subcommittee. The American Red Cross appreciates the opportunity to submit testimony in support of the measles control activities of the U.S. Centers for Disease Control and Prevention. 

We recognize the leadership that Congress has shown in funding 

CDC for these essential activities and we sincerely hope that the 

Congress will continue to support the CDC during this critical period in measles control. 

In 2001, CDC, along with the American Red Cross, the United 

Nations Foundation, the World Health Organization, and UNICEF 

founded the Measles Initiative, a partnership committed to reducing measles deaths globally. 

The current UN goal is to reduce measles deaths by 90 percent 

by 2010 compared to 2000 estimates. Working towards this goal, 

the Measles Initiative has achieved spectacular results by supporting the vaccination of more than 700 million children around 

the world. Largely due to the Measles Initiative, global measles 

mortality dropped by 78 percent from an estimated 733,000 deaths 

in the year 2000 to 164,000 deaths in 2008. During this same period in Africa, measles deaths fell by 92 percent, from 371,000 to 

just 28,000. 

Working closely with host governments, the Measles Initiative 

has been the main international supporter of mass measles immunization campaigns since 2001. The Initiative mobilized more than 

$720,000,000 and provided technical support in more than 60 developing countries on vaccination campaigns, surveillance, and improving routine immunization services. 

From 2000 to 2008, an estimated 4.3 million deaths were averted 

as a result of these accelerated measles control activities at a donor 

cost of $184 per death averted. This makes measles mortality reduction one of the most cost-effective public health interventions. 

Nearly all the measles vaccination campaigns have been able to 

reach more than 90 percent of their target populations. By the end 

of 2008, all WHO regions, with the exception of Southeast Asia, 

achieved the 2010 goal two years ahead of target. The extraordinary reduction in global measles deaths contributed an estimated 


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25 percent of the progress to date toward Millennium Development 

Goal Number 4, which is reducing under age 5 child mortality. 

However, at the height of global achievements in measles control, 

a sharp decline in commitment threatens to erase the gains of the 

last decade and permit a global measles resurgence. The Measles 

Initiative presently faces a funding shortfall of an estimated 

$47,000,000 for 2011. The American Red Cross, which has to date 

contributed $141,000,000 to the Initiative, currently faces financial 

challenges that reduce my organization’s foreseeable funding capacity. 

Current funding gaps have led to delays in mass campaigns, 

which have resulted in outbreaks and regrettably deaths. Sufficient 

funding must be secured for measles control activities in order to 

achieve the 2010 goal and to avoid a measles resurgence. Since fiscal year 2001, Congress has provided $43,600,000 annually in funding to CDC for global measles control activities. These 

funds were used towards the purchase of 415 million doses of measles vaccine for use in large scale measles vaccination campaigns 

in more than 60 countries in Africa and Asia, and for the provision 

of technical support to the Ministries of Health in those countries. 

Your commitment has brought us unprecedented success in reducing measles mortality around the world. The CDC support 

made possible by the Congressional funding was essential to 

achievement of the sharp reduction in measles deaths in just eight 

years. In fiscal year 2010, Congress has appropriated $51,900,000 

to fund CDC for global measles control activities. The American 

Red Cross thanks Congress for the increase in financial support 

from past years. We respectfully request level funding for fiscal 

year 2011 for CDC’s measles control activities to prevent a global 

resurgence of measles and a loss of progress toward Millennium 

Development Goal Number 4. 

Thank you for the opportunity to submit testimony. 

[Written statement by David Meltzer follows:] 


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Mr. OBEY. Thank you. 

Next, James Lacy, Rotary International. 

WEDNESDAY, MAY 12, 2010. 

CENTERS FOR DISEASE CONTROL 

WITNESS 

PAST PRESIDENT AND CHAIR JAMES LACY, POLIO ERADICATION ADVOCACY TASK FORCE, ROTARY INTERNATIONAL 

Mr. LACY. Thank you very much, Chairman Obey and Members 

of the Subcommittee. On behalf of 1.2 million Rotarians in more 

than 170 countries around the world, we thank you for your tremendous commitment to polio eradication globally. 

Thanks to your leadership in appropriating funds, progress toward a polio-free world continues on a positive course. Only four 

countries have never stopped polio transmission: Afghanistan, 

Pakistan, India and Nigeria. 

The number of polio cases has fallen more than 99 percent from 

an estimated 350,000 cases in 1988 to only 1,606 cases in 2009. 

This year to date, the number of polio cases globally is 84 compared to 383 at the same point in 2009. India went seven weeks 

without reporting any case of the wild polio virus. This is the first 

such lull in polio transmission since records have been kept. Transmission of polio in India is now focused in only 107 blocks in two 

states, a geographic area representing only 2 percent of that country. 

Due to increased ownership from national and state governments 

and religious and traditional leaders in Nigeria, the only polio endemic country in Africa, has reported only two cases of polio for 

2010. By this point in 2009, polio had paralyzed 236 children. 

Twelve of the 20 reinfected countries in 2009 and 2010 have not 

reported a case of polio in the last six months. 

In March and April, 2010, countries throughout West and Central Africa took part in a preplanned synchronized immunization 

campaign. Political interest in the campaigns were extensive. Six 

heads of state and one First Lady launched the campaigns. This included the critical new involvement of the President of Chad, who 

declared war against polio. 

In sum, the prospects for polio eradication are better than ever 

in terms of the low level of polio incidence and the commitment to 

polio eradication in the polio endemic and outbreak countries. 

Lack of funds to conduct necessary activities may now pose the 

biggest threat. We have yet to identify sources of support for approximately half the U.S. $2,600,000,000 needed between now and 

the end of 2012 to achieve the goal of stopping all outbreaks and 

interrupting transmission of the wild polio virus. 

Rotary is committed to doing whatever it takes to ensure we 

seize the opportunity to conquer polio once and for all. Rotarians 

have already contributed more than $900,000,000 in this effort, 

plus thousands of man hours and are more than halfway to our 

current fundraising goal of $200,000,000. 

The leadership of the United States remains essential and Rotary International urges you continued support toward the shared 


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goal of a polio-free world. For fiscal year 2011, we respectfully request that you include $102,000,000 of level funding for the targeted polio eradication efforts of the Centers for Disease Control 

and Prevention. 

The funds we are seeking will allow CDC to continue intense 

supplementary immunization activities in Asia and improve the 

quantity and quality of immunization campaigns in Africa to ensure we meet the goal of interrupting transmission of wild polio in 

these regions as quickly as possible. 

These funds will also help maintain certification standard disease surveillance, which is essential to protecting against and responding to outbreaks. Failure to achieve success would have significant humanitarian and economic consequences. 

Within the next decade, hundreds of thousands of children would 

again be paralyzed for life by this disease. Billions of dollars would 

have to be spent on outbreak response activities, rehabilitation, 

and treatment costs, and the associated loss to economic productivity. 

Success, on the other hand, will ensure that the significant investment made by the United States, Rotary International and 

many other countries and entities is protected in perpetuity. 

Thank you very much for your continued support, and we thank 

you especially, Mr. Chairman, for your support through the years, 

and thank you also for you also for the opportunity to give this testimony. 

Thank you. 

[Written statement by James Lacy follows:] 


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Mr. OBEY. Thank you very much. 

Thank you all for testifying. That is it for the day, just in time. 

The Committee stands adjourned. 


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pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 797 here 58144B.289
524 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 798 here 58144B.290
525 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 799 here 58144B.291
526 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 800 here 58144B.292
527 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 801 here 58144B.293
528 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 802 here 58144B.294
529 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 803 here 58144B.295
530 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 804 here 58144B.296
531 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 805 here 58144B.297
532 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 806 here 58144B.298
533 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 807 here 58144B.299
534 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 808 here 58144B.300
535 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 809 here 58144B.301
536 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 810 here 58144B.302
537 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 811 here 58144B.303
538 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 812 here 58144B.304
539 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 813 here 58144B.305
540 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 814 here 58144B.306
541 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 815 here 58144B.307
542 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 816 here 58144B.308
543 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 817 here 58144B.309
544 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 818 here 58144B.310
545 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 819 here 58144B.311
546 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 820 here 58144B.312
547 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 821 here 58144B.313
548 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 822 here 58144B.314
549 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 823 here 58144B.315
550 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 824 here 58144B.316
551 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 825 here 58144B.317
552 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 826 here 58144B.318
553 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 827 here 58144B.319
554 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 828 here 58144B.320
555 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 829 here 58144B.321
556 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 830 here 58144B.322
557 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 831 here 58144B.323
558 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 832 here 58144B.324
559 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 833 here 58144B.325
560 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 834 here 58144B.326
561 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 835 here 58144B.327
562 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 836 here 58144B.328
563 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 837 here 58144B.329
564 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 838 here 58144B.330
565 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 839 here 58144B.331
566 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 840 here 58144B.332
567 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 841 here 58144B.333
568 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 842 here 58144B.334
569 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 843 here 58144B.335
570 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 844 here 58144B.336
571 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 845 here 58144B.337
572 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 846 here 58144B.338
573 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 847 here 58144B.339
574 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 848 here 58144B.340
575 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 849 here 58144B.341
576 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 850 here 58144B.342
577 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 851 here 58144B.343
578 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 852 here 58144B.344
579 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 853 here 58144B.345
580 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 854 here 58144B.346
581 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 855 here 58144B.347
582 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 856 here 58144B.348
583 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 857 here 58144B.349
584 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 858 here 58144B.350
585 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 859 here 58144B.351
586 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 860 here 58144B.352
587 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 861 here 58144B.353
588 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 862 here 58144B.354
589 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 863 here 58144B.355
590 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 864 here 58144B.356
591 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 865 here 58144B.357
592 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 866 here 58144B.358
593 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 867 here 58144B.359
594 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 868 here 58144B.360
595 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 869 here 58144B.361
596 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 870 here 58144B.362
597 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 871 here 58144B.363
598 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 872 here 58144B.364
599 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 873 here 58144B.365
600 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 874 here 58144B.366
601 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 875 here 58144B.367
602 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 876 here 58144B.368
603 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 877 here 58144B.369
604 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 878 here 58144B.370
605 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 879 here 58144B.371
606 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 880 here 58144B.372
607 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 881 here 58144B.373
608 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 882 here 58144B.374
609 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 883 here 58144B.375
610 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 884 here 58144B.376
611 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 885 here 58144B.377
612 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 886 here 58144B.378
613 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 887 here 58144B.379
614 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 888 here 58144B.380
615 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 889 here 58144B.381
616 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 890 here 58144B.382
617 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 891 here 58144B.383
618 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 892 here 58144B.384
619 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 893 here 58144B.385
620 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 894 here 58144B.386
621 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 895 here 58144B.387
622 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 896 here 58144B.388
623 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 897 here 58144B.389
624 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 898 here 58144B.390
625 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 899 here 58144B.391
626 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 900 here 58144B.392
627 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 901 here 58144B.393
628 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 902 here 58144B.394
629 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 903 here 58144B.395
630 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 904 here 58144B.396
631 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 905 here 58144B.397
632 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 906 here 58144B.398
633 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 907 here 58144B.399
634 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 908 here 58144B.400
635 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 909 here 58144B.401
636 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 910 here 58144B.402
637 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 911 here 58144B.403
638 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 912 here 58144B.404
639 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 913 here 58144B.405
640 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 914 here 58144B.406
641 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 915 here 58144B.407
642 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 916 here 58144B.408
643 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 917 here 58144B.409
644 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 918 here 58144B.410
645 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 919 here 58144B.411
646 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 920 here 58144B.412
647 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 921 here 58144B.413
648 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 922 here 58144B.414
649 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 923 here 58144B.415
650 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 924 here 58144B.416
651 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 925 here 58144B.417
652 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 926 here 58144B.418
653 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 927 here 58144B.419
654 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 928 here 58144B.420
655 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 929 here 58144B.421
656 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 930 here 58144B.422
657 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 931 here 58144B.423
658 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 932 here 58144B.424
659 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 933 here 58144B.425
660 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 934 here 58144B.426
661 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 935 here 58144B.427
662 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 936 here 58144B.428
663 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 937 here 58144B.429
664 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 938 here 58144B.430
665 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 939 here 58144B.431
666 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 940 here 58144B.432
667 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 941 here 58144B.433
668 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 942 here 58144B.434
669 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 943 here 58144B.435
670 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 944 here 58144B.436
671 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 945 here 58144B.437
672 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 946 here 58144B.438
673 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 947 here 58144B.439
674 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 948 here 58144B.440
675 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 949 here 58144B.441
676 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 950 here 58144B.442
677 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 951 here 58144B.443
678 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 952 here 58144B.444
679 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 953 here 58144B.445
680 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 954 here 58144B.446
681 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 955 here 58144B.447
682 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 956 here 58144B.448
683 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 957 here 58144B.449
684 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 958 here 58144B.450
685 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 959 here 58144B.451
686 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 960 here 58144B.452
687 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 961 here 58144B.453
688 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 962 here 58144B.454
689 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 963 here 58144B.455
690 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 964 here 58144B.456
691 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 965 here 58144B.457
692 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 966 here 58144B.458
693 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 967 here 58144B.459
694 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 968 here 58144B.460
695 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 969 here 58144B.461
696 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 970 here 58144B.462
697 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 971 here 58144B.463
698 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 972 here 58144B.464
699 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 973 here 58144B.465
700 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 974 here 58144B.466
701 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 975 here 58144B.467
702 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 976 here 58144B.468
703 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 977 here 58144B.469
704 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 978 here 58144B.470
705 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 979 here 58144B.471
706 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 980 here 58144B.472
707 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 981 here 58144B.473
708 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 982 here 58144B.474
709 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 983 here 58144B.475
710 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 984 here 58144B.476
711 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 985 here 58144B.477
712 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 986 here 58144B.478
713 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 987 here 58144B.479
714 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 988 here 58144B.480
715 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 989 here 58144B.481
716 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 990 here 58144B.482
717 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 991 here 58144B.483
718 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 992 here 58144B.484
719 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 993 here 58144B.485
720 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 994 here 58144B.486
721 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 995 here 58144B.487
722 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 996 here 58144B.488
723 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 997 here 58144B.489
724 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 998 here 58144B.490
725 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 999 here 58144B.491
726 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1000 here 58144B.492
727 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1001 here 58144B.493
728 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1002 here 58144B.494
729 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1003 here 58144B.495
730 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1004 here 58144B.496
731 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1005 here 58144B.497
732 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1006 here 58144B.498
733 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1007 here 58144B.499
734 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1008 here 58144B.500
735 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1009 here 58144B.501
736 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1010 here 58144B.502
737 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1011 here 58144B.503
738 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1012 here 58144B.504
739 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1013 here 58144B.505
740 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1014 here 58144B.506
741 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1015 here 58144B.507
742 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1016 here 58144B.508
743 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1017 here 58144B.509
744 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1018 here 58144B.510
745 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1019 here 58144B.511
746 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1020 here 58144B.512
747 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1021 here 58144B.513
748 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1022 here 58144B.514
749 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1023 here 58144B.515
750 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1024 here 58144B.516
751 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1025 here 58144B.517
752 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1026 here 58144B.518
753 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1027 here 58144B.519
754 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1028 here 58144B.520
755 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1029 here 58144B.521
756 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1030 here 58144B.522
757 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1031 here 58144B.523
758 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1032 here 58144B.524
759 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1033 here 58144B.525
760 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1034 here 58144B.526
761 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1035 here 58144B.527
762 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1036 here 58144B.528
763 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1037 here 58144B.529
764 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1038 here 58144B.530
765 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1039 here 58144B.531
766 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1040 here 58144B.532
767 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1041 here 58144B.533
768 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1042 here 58144B.534
769 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1043 here 58144B.535
770 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1044 here 58144B.536
771 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1045 here 58144B.537
772 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1046 here 58144B.538
773 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1047 here 58144B.539
774 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1048 here 58144B.540
775 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1049 here 58144B.541
776 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1050 here 58144B.542
777 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1051 here 58144B.543
778 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1052 here 58144B.544
779 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1053 here 58144B.545
780 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1054 here 58144B.546
781 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1055 here 58144B.547
782 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1056 here 58144B.548
783 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1057 here 58144B.549
784 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1058 here 58144B.550
785 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1059 here 58144B.551
786 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1060 here 58144B.552
787 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1061 here 58144B.553
788 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1062 here 58144B.554
789 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1063 here 58144B.555
790 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1064 here 58144B.556
791 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1065 here 58144B.557
792 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1066 here 58144B.558
793 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1067 here 58144B.559
794 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1068 here 58144B.560
795 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1069 here 58144B.561
796 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1070 here 58144B.562
797 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1071 here 58144B.563
798 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1072 here 58144B.564
799 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1073 here 58144B.565
800 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1074 here 58144B.566
801 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1075 here 58144B.567
802 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1076 here 58144B.568
803 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1077 here 58144B.569
804 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1078 here 58144B.570
805 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1079 here 58144B.571
806 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1080 here 58144B.572
807 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1081 here 58144B.573
808 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1082 here 58144B.574
809 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1083 here 58144B.575
810 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1084 here 58144B.576
811 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1085 here 58144B.577
812 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1086 here 58144B.578
813 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1087 here 58144B.579
814 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1088 here 58144B.580
815 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1089 here 58144B.581
816 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1090 here 58144B.582
817 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1091 here 58144B.583
818 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1092 here 58144B.584
819 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1093 here 58144B.585
820 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1094 here 58144B.586
821 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1095 here 58144B.587
822 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1096 here 58144B.588
823 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1097 here 58144B.589
824 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1098 here 58144B.590
825 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1099 here 58144B.591
826 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1100 here 58144B.592
827 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1101 here 58144B.593
828 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1102 here 58144B.594
829 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1103 here 58144B.595
830 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1104 here 58144B.596
831 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1105 here 58144B.597
832 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1106 here 58144B.598
833 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1107 here 58144B.599
834 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1108 here 58144B.600
835 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1109 here 58144B.601
836 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1110 here 58144B.602
837 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1111 here 58144B.603
838 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1112 here 58144B.604
839 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1113 here 58144B.605
840 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1114 here 58144B.606
841 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1115 here 58144B.607
842 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1116 here 58144B.608
843 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1117 here 58144B.609
844 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1118 here 58144B.610
845 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1119 here 58144B.611
846 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1120 here 58144B.612
847 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1121 here 58144B.613
848 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1122 here 58144B.614
849 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1123 here 58144B.615
850 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1124 here 58144B.616
851 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1125 here 58144B.617
852 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1126 here 58144B.618
853 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1127 here 58144B.619
854 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1128 here 58144B.620
855 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1129 here 58144B.621
856 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1130 here 58144B.622
857 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1131 here 58144B.623
858 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1132 here 58144B.624
859 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1133 here 58144B.625
860 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1134 here 58144B.626
861 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1135 here 58144B.627
862 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1136 here 58144B.628
863 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1137 here 58144B.629
864 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1138 here 58144B.630
865 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1139 here 58144B.631
866 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1140 here 58144B.632
867 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1141 here 58144B.633
868 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1142 here 58144B.634
869 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1143 here 58144B.635
870 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1144 here 58144B.636
871 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1145 here 58144B.637
872 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1146 here 58144B.638
873 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1147 here 58144B.639
874 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1148 here 58144B.640
875 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1149 here 58144B.641
876 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1150 here 58144B.642
877 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1151 here 58144B.643
878 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1152 here 58144B.644
879 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1153 here 58144B.645
880 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1154 here 58144B.646
881 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1155 here 58144B.647
882 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1156 here 58144B.648
883 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1157 here 58144B.649
884 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1158 here 58144B.650
885 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1159 here 58144B.651
886 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1160 here 58144B.652
887 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1161 here 58144B.653
888 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1162 here 58144B.654
889 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1163 here 58144B.655
890 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1164 here 58144B.656
891 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1165 here 58144B.657
892 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1166 here 58144B.658
893 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1167 here 58144B.659
894 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1168 here 58144B.660
895 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1169 here 58144B.661
896 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1170 here 58144B.662
897 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1171 here 58144B.663
898 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1172 here 58144B.664
899 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1173 here 58144B.665
900 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1174 here 58144B.666
901 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1175 here 58144B.667
902 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1176 here 58144B.668
903 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1177 here 58144B.669
904 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1178 here 58144B.670
905 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1179 here 58144B.671
906 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1180 here 58144B.672
907 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1181 here 58144B.673
908 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1182 here 58144B.674
909 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1183 here 58144B.675
910 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1184 here 58144B.676
911 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1185 here 58144B.677
912 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1186 here 58144B.678
913 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1187 here 58144B.679
914 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1188 here 58144B.680
915 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1189 here 58144B.681
916 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1190 here 58144B.682
917 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1191 here 58144B.683
918 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1192 here 58144B.684
919 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1193 here 58144B.685
920 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1194 here 58144B.686
921 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1195 here 58144B.687
922 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1196 here 58144B.688
923 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1197 here 58144B.689
924 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1198 here 58144B.690
925 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1199 here 58144B.691
926 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1200 here 58144B.692
927 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1201 here 58144B.693
928 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1202 here 58144B.694
929 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1203 here 58144B.695
930 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1204 here 58144B.696
931 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1205 here 58144B.697
932 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1206 here 58144B.698
933 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1207 here 58144B.699
934 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1208 here 58144B.700
935 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1209 here 58144B.701
936 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1210 here 58144B.702
937 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1211 here 58144B.703
938 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1212 here 58144B.704
939 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1213 here 58144B.705
940 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1214 here 58144B.706
941 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1215 here 58144B.707
942 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1216 here 58144B.708
943 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1217 here 58144B.709
944 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1218 here 58144B.710
945 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1219 here 58144B.711
946 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1220 here 58144B.712
947 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1221 here 58144B.713
948 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1222 here 58144B.714
949 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1223 here 58144B.715
950 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1224 here 58144B.716
951 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1225 here 58144B.717
952 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1226 here 58144B.718
953 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1227 here 58144B.719
954 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1228 here 58144B.720
955 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1229 here 58144B.721
956 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1230 here 58144B.722
957 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1231 here 58144B.723
958 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1232 here 58144B.724
959 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1233 here 58144B.725
960 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1234 here 58144B.726
961 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1235 here 58144B.727
962 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1236 here 58144B.728
963 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1237 here 58144B.729
964 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1238 here 58144B.730
965 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1239 here 58144B.731
966 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1240 here 58144B.732
967 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1241 here 58144B.733
968 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1242 here 58144B.734
969 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1243 here 58144B.735
970 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1244 here 58144B.736
971 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1245 here 58144B.737
972 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1246 here 58144B.738
973 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1247 here 58144B.739
974 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1248 here 58144B.740
975 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1249 here 58144B.741
976 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1250 here 58144B.742
977 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1251 here 58144B.743
978 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1252 here 58144B.744
979 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1253 here 58144B.745
980 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1254 here 58144B.746
981 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1255 here 58144B.747
982 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1256 here 58144B.748
983 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1257 here 58144B.749
984 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1258 here 58144B.750
985 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1259 here 58144B.751
986 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1260 here 58144B.752
987 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1261 here 58144B.753
988 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1262 here 58144B.754
989 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1263 here 58144B.755
990 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1264 here 58144B.756
991 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1265 here 58144B.757
992 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1266 here 58144B.758
993 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1267 here 58144B.759
994 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1268 here 58144B.760
995 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1269 here 58144B.761
996 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1270 here 58144B.762
997 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1271 here 58144B.763
998 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1272 here 58144B.764
999 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1273 here 58144B.765
1000 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1274 here 58144B.766
1001 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1275 here 58144B.767
1002 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1276 here 58144B.768
1003 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1277 here 58144B.769
1004 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1278 here 58144B.770
1005 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1279 here 58144B.771
1006 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1280 here 58144B.772
1007 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1281 here 58144B.773
1008 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1282 here 58144B.774
1009 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1283 here 58144B.775
1010 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1284 here 58144B.776
1011 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1285 here 58144B.777
1012 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1286 here 58144B.778
1013 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1287 here 58144B.779
1014 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1288 here 58144B.780
1015 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1289 here 58144B.781
1016 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1290 here 58144B.782
1017 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1291 here 58144B.783
1018 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1292 here 58144B.784
1019 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1293 here 58144B.785
1020 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1294 here 58144B.786
1021 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1295 here 58144B.787
1022 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1296 here 58144B.788
1023 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1297 here 58144B.789
1024 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1298 here 58144B.790
1025 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1299 here 58144B.791
1026 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1300 here 58144B.792
1027 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1301 here 58144B.793
1028 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1302 here 58144B.794
1029 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1303 here 58144B.795
1030 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1304 here 58144B.796
1031 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1305 here 58144B.797
1032 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1306 here 58144B.798
1033 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1307 here 58144B.799
1034 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1308 here 58144B.800
1035 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1309 here 58144B.801
1036 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1310 here 58144B.802
1037 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1311 here 58144B.803
1038 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1312 here 58144B.804
1039 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1313 here 58144B.805
1040 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1314 here 58144B.806
1041 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1315 here 58144B.807
1042 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1316 here 58144B.808
1043 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1317 here 58144B.809
1044 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1318 here 58144B.810
1045 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1319 here 58144B.811
1046 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1320 here 58144B.812
1047 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1321 here 58144B.813
1048 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1322 here 58144B.814
1049 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1323 here 58144B.815
1050 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1324 here 58144B.816
1051 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1325 here 58144B.817
1052 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1326 here 58144B.818
1053 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1327 here 58144B.819
1054 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1328 here 58144B.820
1055 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1329 here 58144B.821
1056 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1330 here 58144B.822
1057 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1331 here 58144B.823
1058 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1332 here 58144B.824
1059 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1333 here 58144B.825
1060 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1334 here 58144B.826
1061 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1335 here 58144B.827
1062 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1336 here 58144B.828
1063 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1337 here 58144B.829
1064 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1338 here 58144B.830
1065 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1339 here 58144B.831
1066 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1340 here 58144B.832
1067 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1341 here 58144B.833
1068 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1342 here 58144B.834
1069 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1343 here 58144B.835
1070 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1344 here 58144B.836
1071 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1345 here 58144B.837
1072 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1346 here 58144B.838
1073 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1347 here 58144B.839
1074 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1348 here 58144B.840
1075 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1349 here 58144B.841
1076 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1350 here 58144B.842
1077 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1351 here 58144B.843
1078 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1352 here 58144B.844
1079 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1353 here 58144B.845
1080 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1354 here 58144B.846
1081 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1355 here 58144B.847
1082 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1356 here 58144B.848
1083 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1357 here 58144B.849
1084 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1358 here 58144B.850
1085 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1359 here 58144B.851
1086 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1360 here 58144B.852
1087 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1361 here 58144B.853
1088 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1362 here 58144B.854
1089 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1363 here 58144B.855
1090 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1364 here 58144B.856
1091 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1365 here 58144B.857
1092 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1366 here 58144B.858
1093 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1367 here 58144B.859
1094 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1368 here 58144B.860
1095 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1369 here 58144B.861
1096 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1370 here 58144B.862
1097 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1371 here 58144B.863
1098 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1372 here 58144B.864
1099 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1373 here 58144B.865
1100 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1374 here 58144B.866
1101 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1375 here 58144B.867
1102 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1376 here 58144B.868
1103 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1377 here 58144B.869
1104 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1378 here 58144B.870
1105 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1379 here 58144B.871
1106 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1380 here 58144B.872
1107 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1381 here 58144B.873
1108 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1382 here 58144B.874
1109 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1383 here 58144B.875
1110 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1384 here 58144B.876
1111 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1385 here 58144B.877
1112 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1386 here 58144B.878
1113 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1387 here 58144B.879
1114 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1388 here 58144B.880
1115 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1389 here 58144B.881
1116 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1390 here 58144B.882
1117 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1391 here 58144B.883
1118 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1392 here 58144B.884
1119 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1393 here 58144B.885
1120 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1394 here 58144B.886
1121 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1395 here 58144B.887
1122 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1396 here 58144B.888
1123 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1397 here 58144B.889
1124 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1398 here 58144B.890
1125 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1399 here 58144B.891
1126 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1400 here 58144B.892
1127 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1401 here 58144B.893
1128 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1402 here 58144B.894
1129 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1403 here 58144B.895
1130 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1404 here 58144B.896
1131 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1405 here 58144B.897
1132 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1406 here 58144B.898
1133 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1407 here 58144B.899
1134 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1408 here 58144B.900
1135 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1409 here 58144B.901
1136 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1410 here 58144B.902
1137 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1411 here 58144B.903
1138 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1412 here 58144B.904
1139 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1413 here 58144B.905
1140 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1414 here 58144B.906
1141 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1415 here 58144B.907
1142 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1416 here 58144B.908
1143 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1417 here 58144B.909
1144 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1418 here 58144B.910
1145 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1419 here 58144B.911
1146 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1420 here 58144B.912
1147 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1421 here 58144B.913
1148 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1422 here 58144B.914
1149 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1423 here 58144B.915
1150 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1424 here 58144B.916
1151 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1425 here 58144B.917
1152 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1426 here 58144B.918
1153 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1427 here 58144B.919
1154 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1428 here 58144B.920
1155 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1429 here 58144B.921
1156 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1430 here 58144B.922
1157 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1431 here 58144B.923
1158 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1432 here 58144B.924
1159 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1433 here 58144B.925
1160 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1434 here 58144B.926
1161 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1435 here 58144B.927
1162 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1436 here 58144B.928
1163 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1437 here 58144B.929
1164 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1438 here 58144B.930
1165 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1439 here 58144B.931
1166 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1440 here 58144B.932
1167 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1441 here 58144B.933
1168 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1442 here 58144B.934
1169 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1443 here 58144B.935
1170 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1444 here 58144B.936
1171 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1445 here 58144B.937
1172 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1446 here 58144B.938
1173 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1447 here 58144B.939
1174 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1448 here 58144B.940
1175 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1449 here 58144B.941
1176 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1450 here 58144B.942
1177 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1451 here 58144B.943
1178 


pwalker on DSKD5P82C1PROD with HEARINGInsert offset folio 1452/1800 here 58144B.944
(i) 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 1 here 58144.001
ii 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 2 here 58144.002
iii 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 3 here 58144.003
iv 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 4 here 58144.004
v 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 5 here 58144.005
vi 


tjames on DSK5CLS3C1PROD with HEARINGInsert graphic folio 6 here 58144.006