U.S. GOVERNMENT PUBLISHING OFFICE

32–462 PDF WASHINGTON : 2018

EXAMINING INITIATIVES TO ADVANCE PUBLIC 

HEALTH 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MAY 17, 2017 

Serial No. 115–32 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

GREG WALDEN, Oregon 

Chairman 

JOE BARTON, Texas 

Vice Chairman 

FRED UPTON, Michigan 

JOHN SHIMKUS, Illinois 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

TIM WALBERG, Michigan 

MIMI WALTERS, California 

RYAN A. COSTELLO, Pennsylvania 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

PETER WELCH, Vermont 

BEN RAY LUJA ́ N, New Mexico 

PAUL TONKO, New York 

YVETTE D. CLARKE, New York 

DAVID LOEBSACK, Iowa 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

RAUL RUIZ, California 

SCOTT H. PETERS, California 

DEBBIE DINGELL, Michigan 

SUBCOMMITTEE ON HEALTH

MICHAEL C. BURGESS, Texas 

Chairman 

BRETT GUTHRIE, Kentucky 

Vice Chairman 

JOE BARTON, Texas 

FRED UPTON, Michigan 

JOHN SHIMKUS, Illinois 

TIM MURPHY, Pennsylvania 

MARSHA BLACKBURN, Tennessee 

CATHY MCMORRIS RODGERS, Washington 

LEONARD LANCE, New Jersey 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILLY LONG, Missouri 

LARRY BUCSHON, Indiana 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GREG WALDEN, Oregon (ex officio) 

GENE GREEN, Texas 

Ranking Member 

ELIOT L. ENGEL, New York 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

BEN RAY LUJA ́ N, New Mexico 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

ANNA G. ESHOO, California 

DIANA DEGETTE, Colorado 

FRANK PALLONE, JR., New Jersey (ex 

officio) 

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(III) 

C O N T E N T S 

Page 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 1 

Prepared statement .......................................................................................... 3 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 4 

Hon. Greg Walden, a Representative in Congress from the State of Oregon, 

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 8 

Prepared statement .......................................................................................... 9 

WITNESSES

Kevin B. O’Connor, Assistant to the General President, International Association of Fire Fighters ............................................................................................. 11 

Prepared statement .......................................................................................... 13 

Cheryl Watson-Levy, D.D.S., Member, American Dental Association ................ 19 

Prepared statement .......................................................................................... 21 

Martin S. Levine, D.O., Intermin Clinical Dean, Touro College of Osteopathic 

Medicine ................................................................................................................ 36 

Prepared statement .......................................................................................... 38 

Jordan Greenbaum, M.D., Medical Director, Insitute for Healthcare and 

Human Trafficking, Children’s Healthcare of Atlanta, and Medical Director, 

Global Initiative for Child Health and Well Being, International Centre 

for Missing and Exploited Children .................................................................... 42 

Prepared statement .......................................................................................... 44 

SUBMITTED MATERIAL

H.R. 931, the Firefighter Cancer Registry Act of 2017, submitted by Mr. 

Burgess ................................................................................................................. 74 

H.R. 1876, the Good Samaritan Health Professionals Act of 2017, submitted 

by Mr. Burgess ..................................................................................................... 83 

H.R. 767, the SOAR to Health and Wellness Act of 2017, submitted by 

Mr. Burgess .......................................................................................................... 89 

H.R. lll, the Action for Dental Health Act of 2017, submitted by Mr. 

Burgess ................................................................................................................. 96 

Letter of May 17, 2017, from Fire Chief John D. Sinclair, President and 

Chairman of the Board, International Association of Fire Chiefs, to Mr. 

Burgess and Mr. Green, submitted by Mr. Collins ........................................... 102 

Statement of Michael K. Simpson, a Representative in Congress from the 

State of Idaho, May 17, 2017, submitted by Mr. Burgess ................................ 104 

Joint statement of the American Association of Neurological Surgeons and 

the Congress of Neurological Surgeons, May 17, 2017, submitted by Mr. 

Burgess ................................................................................................................. 106 

Statement of the American College of Surgeons, May 17, 2017, submitted 

by Mr. Burgess ..................................................................................................... 109 

Letter of May 17, 2017, from Thomas P. Nickels, Executive Vice President, 

American Hospital Association, to Mrs. Blackburn, submitted by Mr. Burgess ........................................................................................................................ 112 

Letter of May 17, 2017, from Brian K. Atchinson, President and Chief Executive Officer, PIAA, to Mr. Burgess and Mr. Green, submitted by Mr. Burgess ........................................................................................................................ 113 

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EXAMINING INITIATIVES TO ADVANCE 

PUBLIC HEALTH 

WEDNESDAY, MAY 17, 2017 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:17 a.m., in Room 

2322, Rayburn House Office Building, Hon. Michael C. Burgess 

(chairman of the subcommittee) presiding. 

Members present: Representatives Burgess, Guthrie, Upton, 

Shimkus, Murphy, Lance, Griffith, Bilirakis, Bucshon, Mullin, Collins, Carter, Walden (ex officio), Green, Schakowsky, Butterfield, 

Matsui, Castor, Sarbanes, Schrader, Kennedy, Ca ́ rdenas, Eshoo, 

and Pallone (ex officio). 

Staff present: Ray Baum, Staff Director; Paul Edattel, Chief 

Counsel, Health; Blair Ellis, Press Secretary/Digital Coordinator; 

Jay Gulshen, Legislative Clerk, Health; Katie McKeough, Press Assistant; Kristen Shatynski, Professional Staff Member, Health; 

Danielle Steele, Policy Coordinator, Health; Hamlin Wade, Special 

Advisor for External Affairs; Jacquelyn Bolen, Minority Professional Staff Member; Jeff Carroll, Minority Staff Director; Waverly 

Gordon, Minority Counsel, Health; Tiffany Guarascio, Minority 

Deputy Staff Director and Chief Health Advisor; Una Lee, Minority 

Senior Health Counsel; Samantha Satchell, Minority Policy Analyst; and C.J. Young, Minority Press Secretary. 

Mr. BURGESS. Please take your seats. The Subcommittee on 

Health will now come to order. 

The Chair will recognize himself for 5 minutes for the purpose 

of an opening statement. And Mr. Collins, I will be coming to you 

at the end of my opening statement to recognize you. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

This subcommittee has the responsibility of advancing legislation 

to improve and strengthen public health policy for all Americans. 

Today, we will examine four bipartisan bills intended to improve 

public health for some of our most at-risk populations. 

In 2015, a 5-year study of nearly 30,000 firefighters found that 

firefighters had a greater number of cancer diagnoses and cancerrelated deaths than the general population. While this built upon 

prior studies that have examined the link between firefighting and 

cancer, our understanding of this connection is still limited. 

2 

To improve upon our ability to alleviate the health risks that 

these public servants face, Representatives Collins and Pascrell introduced H.R. 931, the Firefighter Cancer Registry Act of 2017. 

This bill would authorize funding for the Centers of Disease Control and Prevention to create a national registry for the collection 

of data pertaining to cancer incidence among firefighters. 

We are anxious to hear more from our witnesses about how H.R. 

931 will fill the void in our understanding of the health risks that 

our Nation’s firefighters face. 

Another bill being considered today seeks to ensure that victims 

in federally declared disasters have access to medical care by establishing uniform good Samaritan standards for volunteer healthcare 

professionals. 

Federal and State laws have developed to encourage healthcare 

professionals to volunteer by providing limited liability protection 

and recent events have exposed gaps in those laws that led to 

delays in the ability of volunteers to provide care. To prevent this 

from happening in the future, Representatives Blackburn and Ruppersberger have introduced H.R. 1876, the Good Samaritan Health 

Professionals Act of 2017. 

This bill would provide limited civil liability protection to licensed healthcare providers during a declared disaster. 

I certainly want to hear from our witness today about the importance of H.R. 1876 to disaster victims. 

We will also discuss legislation to strengthen the ability of our 

healthcare workforce to recognize and care for victims of human 

trafficking. Identifying victims of trafficking is a crucial first step 

in getting them the support that they need but it is an incredibly 

challenging task. A reported 68 percent of trafficking victims end 

up at a healthcare setting at some point. And this can serve as an 

important chance for providers to step in and help. 

Having spent my time practicing medicine, I know that feeling 

prepared to handle difficult situations does require adequate training and protocols. However, the vast majority of providers do not 

have access to such resources. 

To address this gap, Representatives Cohen and Kinzinger have 

introduced H.R. 767, the SOAR to Health and Wellness Act of 

2017. 

This bill would build upon a pilot program underway at the Department of Health and Human Services that has enhanced the capacity of communities to identify victims and survivors. 

I certainly also want to hear from our witness today about how 

this bill will address an unmet need for trafficking victims and help 

healthcare providers throughout the United States of America. 

Finally, we will learn about the Action for Dental Health Act of 

2017 authored by Representative Kelly, who has joined us this 

morning. 

Welcome to you. 

This bill would take several steps to support and improve dental 

health for some of our most vulnerable populations, including children and the elderly. I look forward to learning more from our witness about the importance of the initiatives of this bill to the dental health of all Americans but especially those known to be underserved. 

3 

I thank all of our witnesses for being here. I look forward to 

hearing from each of you, and I will yield the balance of my time 

to the gentleman from New York, Mr. Collins. 

[The proposed legislation appears at the conclusion of the hearing. The statement of Mr. Burgess follows:] 

PREPARED STATEMENT OF HON. MICHAEL C. BURGESS

This subcommittee has the responsibility of advancing legislation to improve and 

strengthen public health policy for all Americans. Today, we will examine four bipartisan bills intended to improve public health for some of our most vulnerable, 

at-risk populations. 

In 2015, a 5-year study of nearly 30,000 fire fighters found that fire fighters had 

a greater number of cancer diagnoses and cancer-related deaths than the general 

population. While this built upon prior studies that have examined the link between 

firefighting and cancer, our understanding of this connection is still limited. 

To improve upon our ability to alleviate the health risks these public servants 

face, Representatives Collins and Pascrell introduced H.R. 931, the Firefighter Cancer Registry Act of 2017. This bill would authorize funding for the Centers for Disease Control and Prevention to create a national registry for the collection of data 

pertaining to cancer incidence among firefighters. I look forward to hearing more 

from our witness about how H.R. 931, will fill the void in our understanding of the 

health risks our Nation’s firefighters face. 

Another bill we will consider seeks to ensure that victims in federally declared 

disasters have access to medical care by establishing a uniform Good Samaritan 

standard for volunteer health care professionals. Federal and State laws have developed to encourage health care professionals to volunteer by providing limited liability protection-recent events have exposed gaps in in those laws that led to delays 

in the ability of volunteers to provide care. 

To prevent this from happening in the future, Representatives Blackburn and 

Ruppersberger introduced H.R. 1876, the Good Samaritan Health Professionals Act 

of 2017. This bill would provide limited civil liability protection to licensed 

healthcare providers during a declared disaster. I look forward to hearing from our 

witness about importance of H.R. 1876 to disaster victims. 

We will also discuss legislation to strengthen the ability of our healthcare workforce to recognize and care for victims of human trafficking. Identifying victims of 

trafficking is a crucial first step in getting them the support they need, but it is 

an incredibly challenging task. A reported 68 percent of trafficking victims end up 

in a health care setting at some point, and this can serve as an important chance 

for providers to step in and help. Having spent nearly three decades practicing medicine, I know that feeling prepared to handle such a difficult situation requires adequate training and protocols. However, the vast majority of providers do not have 

access to such resources. 

To address this gap, Representatives Cohen and Kinzinger introduced H.R. 767, 

the SOAR to Health and Wellness Act of 2017. This bill would build on a pilot program underway at the Department of Health and Human Services that has enhanced the capacity of communities to identify victims and survivors. I look forward 

to hearing from our witness about how this bill will address an unmet need for trafficking victims and health care providers throughout the US. 

Finally, we will learn about the Action for Dental Health Act of 2017, authored 

by Representative Kelly. This bill would take several steps to support and improve 

dental health for some of our most vulnerable populations, including children and 

the elderly. I look forward to learning more from our witness about the importance 

of the initiatives in this bill to the dental health of all Americans, but especially 

those known to be underserved. 

I thank all of our witnesses for being here, and I look forward to hearing from 

each of you. 

Mr. COLLINS. Thank you, Mr. Chairman, for holding this hearing 

today and thank you to all our witnesses and particularly Kevin 

O’Connor from the International Association of Fire Fighters for 

being here today. 

One bill up for discussion is legislation that I introduced, H.R. 

931, the Firefighter Cancer Registry Act of 2017. This thoroughly 

4 

bipartisan effort takes the first step towards addressing the detrimental health effects of fighting fires. 

While common sense tells us that firefighters frequently inhale 

smoke and other harmful substances, we must know more about 

the link between specific chemicals and diseases in order to reduce 

their prevalence. 

H.R. 931 requires the CDC to establish a voluntary cancer registry so we can better understand the correlation between serving 

as a firefighter and the incidence of cancer. The registry will allow 

the CDC to compile a large database of cancer incidence amongst 

firefighters and, through this research, we will hopefully be able to 

develop new protocols and safeguards for these brave men and 

women. 

Thank you again, Mr. Chairman, for holding this hearing, and I 

yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair recognizes the subcommittee ranking member, Mr. 

Green, for 5 minutes for an opening statement, please. 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman. And thank you to our 

witnesses for being here this morning. 

Today we are examining four pieces of legislation aimed at improving our Nation’s health, H.R. 767, the SOAR to Health and 

Wellness Act would help healthcare professionals identify and assist human trafficking victims. Far too many victims of trafficking 

have a contact with a healthcare professional while they are in captivity, yet go undetected. 

According to research, a large portion of healthcare professionals 

have not received specific training on human trafficking or are 

poorly equipped to recognize a sign or respond. This legislation 

builds on work initiated by the Administration of Children and 

Families in the Office of Women’s Health in 2014 known as the 

Stop, Observe, Ask, and Respond or SOAR to the health and 

wellness training programs that train providers to better recognize 

and respond to victims of human trafficking. 

H.R. 767 would authorize a program, as well as grants to train 

healthcare providers in diverse care settings. 

H.R. 931, the Firefighter Cancer Registry Act, would help advance scientific understanding and response to increased incidence 

of cancer among our Nation’s heroic firefighters and I am proud to 

be a co-sponsor. 

Several studies have identified that firefighters are at elevated 

risk of certain cancers, yet little beyond that is well-understood. 

H.R. 931 will direct the Centers for Disease Control and Prevention 

to develop and maintain a voluntary cancer registry for firefighters. 

This registration would collect relevant information to determine 

the risk of develop various cancers and inform efforts to advance 

interventions. 

The identified data from the registry would be made available to 

researchers so we can spur scientific study and, ultimately, better 

protect our Nation’s first responders. 

5 

The Action for Dental Health Act seeks to improve and promote 

oral health care. Millions of Americans, will never see a dentist, yet 

half of individuals over the age of 30 suffer from gum disease and 

a quarter of young children have cavities. The Action for Dental 

Health Act would reauthorize the CDC’s oral health promotion of 

disease prevention grants and allow volunteer dental programs 

that provide free care to underserved populations to apply directly 

for these grants. 

Finally, we are considering H.R. 1876, the Good Samaritan 

Health Professionals Act. The legislation would enable providers to 

better respond to disasters. Specifically, the legislation would limit 

the civil liability of healthcare professionals who volunteer to provide healthcare services during the response to a disaster. 

I have long-supported encouraging volunteerism through protections from civil liability for actions taken in good faith in the professional’s capacity but the solution should be covered by the Federal Tort Claims Act in these declared disaster areas. 

Houston has tragic experience with hurricanes, floods, and it is 

critical that our medical professionals who want to help are empowered to do so. I look forward to learning more about these worthy proposals and I want to thank the bills’ sponsors, and the 

chairman for this hearing, and our witnesses for their testimony. 

And I would like to yield the remainder of my time to Congressman Butterfield. 

Mr. BUTTERFIELD. I thank the gentleman for yielding and Mr. 

Chairman, thank you for holding this hearing today. 

This hearing is certainly an important first step in reviewing 

bills that are bipartisan, can benefit all of our constituents, and I 

certainly hope it will not be the last. 

There are many other important public health bills, Mr. Chairman, that we must consider, including my bills like the RACE for 

Children Act and the National Prostate Cancer Plan Act, and importantly, my colleague, Hakeem Jeffries’ bill called the Synthetic 

Drug Awareness Act. I hope these bills will be taken up very soon. 

The four bills that we are considering today all have significant 

potential to improve public health. I am grateful that the committee is considering the Action for Dental Health Act introduced 

by my friend and colleague, Robin Kelly from Illinois. As many of 

you certainly know, my father was a 50-year dentist in a rural 

community in Wilson, North Carolina, Meharry Medical College 

Class of 1927. So, I have always understood the need for good oral 

health care and the barriers that prevent people from accessing it. 

Many people do not know that tooth decay is the most common 

chronic disease among U.S. children, according to the Pew Charitable Trust. Adequate dental care is especially lacking for individuals in low-income, minority, and rural communities. The Pew 

Trust estimates that more than 18 million low-income children 

went without dental care in 2014. 

This bill, Mr. Chairman, would reauthorize important CDC oral 

health programs that provide grants to communities to expand 

health coverage. And I am glad. I am delighted that we are considering it today. 

And I thank the gentleman for yielding. I yield back. 

6 

Mr. BURGESS. The Chair thanks the gentleman. The gentleman 

yields back. 

The Chair now recognizes the chairman of the full committee, 

Mr. Walden of Oregon, 5 minutes for an opening statement. 

OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON 

Mr. WALDEN. Thank you, Dr. Burgess. I appreciate the good 

work you are putting into these bills and our colleagues on both 

sides of the aisle keeping up with our bipartisanship over the years 

on initiatives to advance solid public health in America. 

There are four bills before us today we have heard a bit about. 

I especially want to draw attention to H.R. 931, the Firefighter 

Cancer Registry Act of 2017, which requires Centers for Disease 

Control and Prevent to develop a voluntary registry of firefighter 

occupational information that can be linked to State cancer registries. 

Kevin, your testimony is especially pointed, given your own personal situation, and really speaks to the importance of the need for 

these types of registries, especially when it comes to our firefighters. As you point out, we have learned a lot over the years and 

what to do and not do in terms of best practices and we have got 

to get ahead of this one. 

Certainly in Oregon, we know the bravery our first responders 

not only for traditional firefighting, but also in the West, where the 

kind of fires we get in the summers in our forests, where they face 

intense smoke and flames and are frequently breathing in dangerous fumes and carcinogens on the job. 

So, this is really important legislation. And while we know somewhat about the cancer risk, we don’t know everything we need to 

know. And so I thank you for your support of this bill and Congressman Collins for introducing it, along with his colleagues. 

Legislation offered by Representative Robin Kelly, known as the 

Action for Dental Health Act of 2017 would help increase access to 

dental care in underserved communities, by allowing the CDC to 

award grants for volunteer oral health projects and free dental 

services to underserved populations. 

This bill would also improve outreach, prevention, and education 

in oral health. We have heard from colleagues on both sides of the 

aisle about the extraordinary importance of appropriate dental 

health, especially in underserved areas. 

We will also consider H.R. 1876, the Good Samaritan Health Professionals Act of 2017 authored by Chairman Marsha Blackburn, 

which would provide limited liability protections for health practitioners providing care to those in a natural disaster, terrorist attack, or other emergency. I think we have learned a lot over the 

years, as these disasters have struck our citizens, just the importance of breaking through some of the barriers when emergencies 

happen and to try and get ahead of them with legislation like this. 

Finally, we will examine H.R. 767, the SOAR to Health and 

Wellness Act of 2017 authored by Representative Steve Cohen. 

This bill would expand and codify the Stop, Observe, Ask, and Respond program at HHS, which provides health professionals training on how to identify and treat human trafficking victims. 

7 

Human trafficking is a crime. It is a violation of human rights. 

Health providers are uniquely positioned on the front lines to interact with suspected trafficking victims and get them the help that 

they need and deserve. 

So I want to thank my colleagues on both sides of the aisle for 

bipartisan work in these efforts and look forward to the testimony 

from our witnesses. 

I would say in advance I am being triple-teamed right now, in 

terms of this hearing, one downstairs, and some other meetings I 

have to attend to. But I appreciate your testimony, which I have 

read and look forward to our committee’s actions on these important pieces of legislation. 

I don’t know if there is anybody else on the other side that would 

like the remainder of my time but, if not, I would yield back to the 

chairman and look forward to the hearing. 

[The statement of Mr. Walden follows:] 

PREPARED STATEMENT OF HON. GREG WALDEN

At today’s hearing, we will have the opportunity to dig into an area where this 

committee has a rich history of bipartisanship over the years—initiatives to advance 

public health. There are four bills before us today, each of which serve an important 

purpose in this collective effort. 

H.R. 931, the Firefighter Cancer Registry Act of 2017 requires the Centers for 

Disease Control and Prevention (CDC) to develop a voluntary registry of firefighter 

occupational information that can be linked to State cancer registries. Firefighters, 

in particular, often expose themselves to dangers that can impact their health well 

beyond their years of service. 

In Oregon, we know well the bravery of the men and women who protect our communities during fire season each year. These firefighters are not only battling the 

intense smoke and flames, but are also frequently breathing in dangerous fumes 

and carcinogens on the job. 

While we know there is a heightened risk of cancer among firefighters, there is 

very little accurate data available to understand the full impact. I thank my colleague, Rep. Chris Collins for sponsoring this important legislation. This bill will 

help us better understand how pervasive cancer is in this vulnerable population, 

which will lead to better treatment and prevention efforts. I believe this is an important opportunity to make sure our Nation’s firefighters know we have their backs 

when they put themselves in harm’s way. 

Legislation offered by Rep. Robin Kelly, known as the Action for Dental Health 

Act of 2017, would help increase access to dental care in underserved communities 

by allowing the CDC to award grants for volunteer oral health projects and free 

dental services to underserved populations. The bill would also improve outreach, 

prevention, and education in oral health. 

We’ll also consider H.R. 1876, the Good Samaritan Health Professionals Act of 

2017, authored by Chairman Marsha Blackburn, which would provide limited liability protections for health practitioners providing care to those in a natural disaster, 

terrorist attack or other emergency. Large-scale emergencies when rescue crews are 

overloaded treating victims require an all hands on deck effort. The willingness of 

qualified volunteers to offer their services to those in need should not be deterred 

by the fear of liability actions being brought against them. 

Finally, we will examine H.R. 767, the SOAR to Health and Wellness Act of 2017, 

authored by Rep. Steve Cohen. This bill would expand and codify the Stop, Observe, 

Ask, and Respond (SOAR) program at HHS, which provides health professionals 

training on how to identify and treat human trafficking victims. Human trafficking 

is a crime and a violation of human rights. Health providers are uniquely positioned 

on the front lines to interact with suspected trafficking victims and get them help. 

I’d like to thank our witnesses—experts and key stakeholders in these specific 

areas—for taking the time to weigh in on these important policies. We welcome your 

feedback. 

8 

Mr. BURGESS. The Chair notes the chairman’s attendance and is 

very appreciative because I know it is a busy morning for you, and 

I thank you for being here. 

The Chair now recognizes the gentleman from New Jersey, the 

ranking member of the full committee, Mr. Pallone, 5 minutes for 

an opening statement, please. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. Thank you Mr. Chairman. I believe that we can 

all agree on the importance of supporting our country’s public 

health system. A strong public health response is one of the first 

lines of defense when our Nation is faced with a health crisis. It 

is also an important tool when addressing longstanding healthcare 

issues, including the prevention of harmful and closely chronic conditions. And today we will hear from our witnesses on the four public health bills. 

Mr. Chairman, I am not going to repeat what is in the bills, but 

I do want to comment on them. 

With regard to H.R. 767, the SOAR to Health and Wellness Act, 

I wanted to say that a doctor’s visit or emergency department trip 

is a critical point of intervention for victims, as it may be a rare 

moment in which they can detach from traffickers. Teaching providers to recognize the signs of trafficking and providing them with 

the resources to assist victims can truly be the difference between 

life and death. So I want to thank Congressman Ca ́ rdenas for his 

work on this bill. 

With regard to H.R. 931, the Firefighter’s Cancer Registry Act is 

another bill which we will discuss that creates a voluntary cancer 

registry of firefighters to collect data related to their cancer risk 

and outcomes. And firefighters may be exposed to carcinogens and 

other hazardous chemicals that impact their health while they are 

on the job. The registry would help CDC collect and monitor information from firefighters over time to inform the best prevention 

and intervention practices. 

H.R. 1876, the Good Samaritan Health Professionals Act, again, 

our volunteer health professionals are a crucial resource in major 

disasters. I remember 9/11 and the bravery of medical volunteers 

from all over the Nation, especially from my home State of New 

Jersey, as they headed across the water to help the victims in New 

York City. I also think of the response to Hurricane Sandy and how 

many people survived the storm, due to the action of medical volunteers. 

While I am always concerned about preempting strong State 

laws, I look forward to learning more about this bill and understand what we can do as lawmakers to support medical volunteers 

at the Federal level. 

And finally, I want to thank Congresswoman Robin Kelly, who 

I see is here, for her work on H.R. 767, the Action for Dental 

Health Act of 2017. Oral health is often thought of as separate 

from a person’s medical care but the truth is that oral health is 

vital to overall health, ensuring access to affordable dental care 

would lower the number of emergency department visits for preVerDate Mar 15 2010 11:03 Oct 19, 2018 Jkt 037690 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 I:\115THCONGRESS\115X32PUBLICHEALTH\115X32PUBLICHEALTHPDFMADE WAYNE
9 

ventable oral conditions and reduce the risk of chronic disease. In 

short, it would lead to an improved quality of life. 

And again, I thank our witnesses. I look forward to the discussion. 

[The prepared statement of Mr. Pallone follows:] 

PREPARED STATEMENT OF HON. FRANK PALLONE, JR. 

Thank you Mr. Chairman. I believe that we can all agree on the importance of 

supporting our country’s public health system. A strong public health response is 

one of the first lines of defense when our Nation is faced with a health crisis. It 

is also an important tool when addressing longstanding healthcare issues, including 

the prevention of harmful and costly chronic conditions. Today we will hear from 

our witnesses on four public health bills: 

H.R. 767, the SOAR to Health and Wellness Act, establishes a pilot program to 

train health care providers to identify and care for potential human trafficking victims. A doctor’s visit or emergency department trip is a critical point of intervention 

for victims, as it may be a rare moment in which they can detach from traffickers. 

Teaching providers to recognize the signs of trafficking and providing them with the 

resources to assist victims can truly be the difference between life and death. Thank 

you to Congressman Ca ́ rdenas for his work on this bill. 

H.R. 931, the Firefighter Cancer Registry Act of 2017, introduced by Congressmen 

Collins and Pascrell, is another bill we will discuss that creates a voluntary cancer 

registry of firefighters to collect data related to their cancer risks and outcomes. 

Firefighters may be exposed to carcinogens and other hazardous chemicals that impact their health while they are on the job. The registry would help CDC collect and 

monitor information from firefighters over time to inform the best prevention and 

intervention practices. 

H.R. 1876, the Good Samaritan Health Professionals Act, would limit the civil liability of the volunteer health professionals that provide their services during disaster response. Our volunteer health professionals are a crucial resource in major 

disasters. I remember 9/11 and the bravery of medical volunteers from all over the 

Nation, especially from my home State of New Jersey, as they headed across the 

water to help the victims in New York City. I also think of the response to Hurricane Sandy and how many people survived the storm due to the action of medical 

volunteers. While I am always concerned about preempting strong State laws, I look 

forward to learning more about this bill and understanding what we can do as lawmakers to support medical volunteers at the Federal level. 

And finally, I would like to thank Congresswoman Robin Kelly, who is here today, 

for her work on H.R. 767, the Action for Dental Health Act of 2017. This bill would 

reauthorize the CDC oral health promotion and disease prevention grants, and 

would allow volunteer dental programs and other eligible entities to apply for these 

CDC grants. 

Oral health is often thought of as separate from a person’s medical care, but the 

truth is that oral health is vital to overall health. Ensuring access to affordable dental care would lower the number of emergency department visits for preventable 

oral conditions, and reduce the risk of chronic disease. In short, it would lead to an 

improved quality of life. 

I want to thank our witnesses for being here today to talk about these bills and 

their impact on our healthcare system. I look forward to our discussion. 

Mr. PALLONE. I would like to yield the remainder of my time to 

Mr. Ca ́ rdenas. 

Mr. CA ́ RDENAS. Thank you very much. I want to thank the chairman and also the ranking member for holding this hearing today. 

Human trafficking is an issue that really hits home for us in Los 

Angeles. Unfortunately, we are one of the largest trafficking cities 

in the world. I have been involved in combatting human trafficking 

efforts since my days on the city council. 

For example, while I was on the city council, the case occurred 

where 12 women were forced to work as prostitutes in South Los 

Angeles in a brothel to pay off debts to their smugglers. It was a 

10 

wake-up call for me and the entire city. We can and should be 

doing more to prevent human trafficking and we can. 

That is why I am proud to join Congressmen Cohen, Kinzinger, 

and Wagner in introducing H.R. 767, the SOAR to Health and 

Wellness Act—Stop, Observe, Ask, and Respond. This bipartisan 

bill creates a pilot program at the Department of Health and 

Human Services to ensure that more healthcare professionals are 

trained to identify and assist victims of human trafficking. 

Victims of forced sex and labor trafficking are often incredibly 

difficult to identify. Over 20 million human beings are victimized 

by traffickers worldwide every single year. And more than 85 percent of trafficking victims end up in a healthcare setting at some 

point. Despite this, fewer than 60 hospitals around the country 

have been identified as having a plan for treating patients who are 

victims of trafficking. Only five percent of emergency room personnel are trained to treat trafficking victims. 

This bill is part of the solution to the bigger issue of human trafficking. I urge my colleagues to join me in the fight against human 

trafficking by supporting this common sense legislation. 

And when we did identify that in Los Angeles, we actually did 

something at very, very little cost. All of the law enforcement agencies throughout L.A. city and county from the Federal level to the 

State level came together with the not-for-profit service providers 

and we created a human trafficking task force. And the identification of human traffic victims went up incredibly high and the identification rate didn’t have misses. They were all positive hits. So 

many lives were saved. 

And I thank you very much. I yield back. 

Mr. BURGESS. The Chair thanks the gentleman. The gentleman 

yields back. 

That concludes Member opening statements. The Chair would 

like to remind Members that, pursuant to committee rules, all 

Members’ opening statements will be part of the record. 

And we do want to thank all of our witnesses for being here this 

morning and taking time, their time to testify before the subcommittee. Each of our witnesses will have the opportunity to give 

a summary of their opening statement, which will be followed by 

a round of questions for Members. 

So today we have with us Mr. Kevin O’Connor, assistant to the 

general president of the International Association of Fire Fighters; 

Dr. Cheryl Watson-Lowry, the American Dental Association; Dr. 

Martin Levine, interim clinical dean, Touro College of Osteopathic 

Medicine; and Dr. Jordan Greenbaum, the director of the Global 

Child Health and Well Being Initiative from the International Center for Missing and Exploited Children. We appreciate all of you 

being here today. 

And Mr. O’Connor, you are now recognized for 5 minutes to summarize your opening statement. Thank you. 

11 

STATEMENTS OF KEVIN B. O’CONNOR, ASSISTANT TO THE 

GENERAL PRESIDENT, INTERNATIONAL ASSOCIATION OF 

FIRE FIGHTERS; CHERYL WATSON–LOWRY, D.D.S., MEMBER, 

AMERICAN DENTAL ASSOCIATION; MARTIN S. LEVINE, D.O., 

INTERIM CLINICAL DEAN, TOURO COLLEGE OF OSTEOPATHIC MEDICINE; AND JORDAN GREENBAUM, M.D., MEDICAL DIRECTOR, INSITUTE FOR HEALTHCARE AND HUMAN 

TRAFFICKING, CHILDREN’S HEALTHCARE OF ATLANTA, AND 

MEDICAL DIRECTOR, GLOBAL INITIATIVE FOR CHILD 

HEALTH AND WELL BEING, INTERNATIONAL CENTRE FOR 

MISSING AND EXPLOITED CHILDREN 

STATEMENT OF KEVIN B. O’CONNOR 

Mr. O’CONNOR. Thank you, Chairman Burgess, Ranking Member 

Green, full committee Chair Walden and Ranking Member Pallone, 

distinguished members. 

I am Kevin O’Connor, and I head the Governmental Affairs and 

Public Policy Division for the International Association of Fire 

Fighters. I am here today on behalf of over 305,000 members who 

provide fire, rescue, and emergency medical services to every congressional area in the country. 

Cancer is a scourge that plagues the fire service of people of all 

ages and in every region of the country. It is a disease that impacts 

both men and women, young and old. It is a sad truth that when 

people join the fire service, they knowingly recognize that they will 

incur a higher chance than the general public of contracting and 

dying from cancer. 

Firefighters respond to every conceivable disaster, emergency, or 

hazardous incident. The environments to which our members are 

exposed are laden with carcinogens, biohazards, and other chemical 

formulations and compounds. Under any circumstances, these 

products are hazardous but, under combustion, they emit byproducts that can be fatal, both at the emergency scene and years later 

through the accumulation of occupational diseases. 

Every year, the IAFF honors our fallen heroes at a memorial 

service in Colorado Springs. For the past generation, more firefighters have died of occupational cancers than those who are killed 

on the fire scene, at building collapses, and vehicular accidents, 

and all other incidents combined. In fact, over 60 percent of our 

deaths are cancer-related. 

There are three principle studies that track elevated incidence of 

cancer among firefighters. The first is a University of Cincinnati 

analysis which combine data from over two dozen other studies and 

classify the heighten risk of firefighters into several categories. 

Secondly, NIOSH tracked cancer data in over 30,000 firefighters 

over a 59-year period from large metropolitan regions and compiled 

data demonstrating increased risk of firefighters of dying from 

seven specific cancers. 

Lastly, a 40-year 16,000 firefighter cohort study in the Nordic 

countries largely mirror the results found by NIOSH. 

Here are some of those collective findings: Firefighters contract 

testicular cancer at a 102 percent greater rate than the general 

public; mesothelioma, 101 percent more; non-Hodgkin’s lymphoma, 

12 

51 percent; multiple melanomas 53 percent; rectum cancer, 45 percent; and sadly, the list continues. 

Cancer is an epidemic in our industry. To eliminate or reduce 

cancer risk, we need data. It is problematic but there is only three 

major studies that track these statistics. The IAFF and our members applaud Representative Chris Collins for introducing H.R. 931 

and those who have co-sponsored the legislation. The measure already has over 165 bipartisan co-sponsors and, as stated, would establish a voluntary cancer registry through the Center of Disease 

Control exclusively for firefighters, career, volunteer, part-time, 

wildland, all measures of firefighters. This information could be 

accessed by researchers, epidemiologists, and physicians to track 

cancer in our profession and use the findings for more advanced or 

targeted research. Simply put, it will be a centralized data collection point. 

The registry would be structured in a fashion that will track various demographic and employment information, including years of 

service, call volume, risk factors, and more but protect the confidentiality and privacy of the responders. The national registry 

would provide a trove of useful data and information. 

I have a personal interest in H.R. 931. I am a cancer survivor. 

Before assuming my current post, I served as a firefighter in Baltimore County for 16 years, a career much shorter than many other 

firefighters. I won’t embellish my service. I responded. I did my job 

just like everyone else. 

Last year, I developed prostate cancer. The statistics say that 

firefighters between 30 and 49 years of age have a 159 percent 

greater chance at contracting prostate cancer than other men. Was 

my cancer job-related? I don’t know the answer to that. But I do 

know that both my grandfathers lived past 80 and my father is still 

a very vibrant 85-year-old. I had the prostate removed last year 

and, as of today, I am cancer-free. 

Knowledge and information are very powerful tools. We need 

those tools to track, treat, and prevent cancer. The firefighter cancer registry does just that. 

I encourage this committee and the entire body to act favorably 

and expeditiously on this legislation. 

I thank you for the opportunity to testify today and am willing 

to answer any questions. Thank you very much. 

[The statement of Mr. O’Connor follows:] 

13 


INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS 

Statement of 

MR. KEVIN B. O'CONNOR 

ASSISTANT TO THE GENERAL PRESIDENT 

INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS 

Before the 

SUBCOMMITIEE ON HEALTH 

U.S. HOUSE OF REPRESENTATIVES 

On 

EXAMINING INITIATIVES to ADVANCE PUBLIC HEALTH 

MAY 17, 2017 
14 


Thank you, Chairman Burgess, Ranking Member Green and distinguished members of the 

Subcommittee. My name is Kevin O'Connor, and I am the Assistant to the General President for 

Governmental Affairs and Public Policy at the International Association of Fire Fighters. I appreciate the 

opportunity to appear before you today on behalf of the International Association of Fire Fighters and 

the over 305,000 professional fire fighters and emergency medical personnel that serve in each of the 

country's 435 Congressional districts. 

As our nation's front-line domestic responders, fire fighters regularly respond to a variety of incidents 

both natural and manmade. Whether it is a vehicle accident, residential fire, hazardous materials spill 

or countless other emergencies, fire fighters are always on the front lines, regardless of the size and 

complexity of an incident. 

In 2015, fire departments responded to nearly 35 million calls. Every day, fire fighters take calculated 

risks risks for which they have trained- but risks for which they know may cause injury or even death. 

It is a possibility no fire fighter wishes to meet, but all understand is part of the job. Over 100 fire 

fighters die in the line of duty every year, and thousands more suffer significant injuries. 

Every September we pay tribute to our fallen by etching their names on granite walls at the IAFF Fallen 

Fire Fighters Memorial located in Colorado Springs. But in recent years, we have noticed a new trend. 

Since 2002, nearly 60% of the names added are those of fire fighters who have died from occupational 

cancers. I am sad to say that cancer is now considered the leading cause of line of duty death among 

fire fighters. 

We appreciate that the Subcommittee has invested its significant resources into studying this matter 

and are pleased to be here today in support of H.R. 931, the Firefighter Cancer Registry Act, introduced 

by my friend and esteemed member of the Subcommittee, Representative Collins of New York. By 

establishing a national cancer registry specifically for fire fighters, we hope to help stem the tide of this 

disease in our ranks. 

The Risk for Cancer in Fire Fighters 

Our nation is served by approximately one million professional and volunteer fire fighters who respond 

to nearly 35 million calls for assistance each year. Statistics maintained by the National Fire Protection 

Association indicate that there are approximately two million fires or hazardous materials incidents 

annually, routinely placing fire fighters in environments where they will be exposed to carcinogens and 

toxic chemicals. 

In addition to heat and smoke, fire fighters are routinely exposed to known carcinogens including 

arsenic, benzene, diesel exhaust, formaldehyde, polychlorinated biphenyls and vinyl chloride. Fire 

fighters are also exposed to the now-ubiquitous halogenated and organophosphorus flame retardants 

which we know are toxic when on fire. 

These exposures are often chaotic and uncontrolled, and may last for significant periods of time. 

Furthermore, such exposures, while perhaps of little harm for one exposure, bio-accumulate, causing 

damage to a fire fighter over time. Despite modern advances in personal protective equipment and 
15 


clothing worn by fire fighters, such ensembles are often inadequate or only partially effective at 

providing physical protection for a fire fighter's skin and respiratory system. 

Research on Cancer in Fire Fighters 

We know definitively that fire fighters have elevated rates of many cancers in large part due to three 

significant studies, studies which also demonstrate a strong link between fire fighting and such cancers. 

The National Institute of Occupational Safety and Health (NIOSH) within the Centers for Disease Control 

examined 30,000 fire fighters from San Francisco, Philadelphia and Chicago. Examining statistics over 

fifty-nine years, this study found fire fighters have a statistically significant increased risk of dying from 

seven different types of cancer compared to the general population: 

i) Mesothelioma (100% increase) 

ii) Rectum (45% increase) 

iii) Buccal/pharynx (40% increase) 

iv) Esophagus (39% increase) 

v) Large intestine (31% increase) 

vi) Kidney (29% increase) 

vii) Lung ( 10% increase) 

This study also found excess bladder and prostate cancer incidence among fire fighters under age sixtyfive. 

A 2006 meta-analysis conducted by LeMasters at the University of Cincinnati examined data from thirtytwo smaller studies of fire fighters for twenty different cancer types. Their research identified ten 

cancers for which fire fighters were at an increased risk as compared to the general population: 

i) Testicular cancer (102% greater risk) 

ii) Multiple myelomas (53% greater risk) 

iii) Non-Hodgkin's lymphoma (51% greater risk) 

iv) Skin cancer (39% greater risk) 

v) Prostate cancer (28% .greater risk) 

vi) Malignant melanoma (32% greater risk) 

vii) Brain cancer (32% greater risk) 
16 


viii) Rectum (29% greater risk 

ix) Stomach (22% greater risk) 

x) Colon cancer (21% greater risk) 

A third study studied the likelihood of cancer risk in a cohort of 16,422 fire fighters from five Nordic 

countries. Cancer incidence was assessed by linking national cancer registries to census data on 

occupations from 1961- 2005. The study found an increased risk for all cancers combined in fire 

fighters similar to the previously mentioned NIOSH study. It also found a statistically significant 

increased risk for developing the following cancers: 

i) Prostate cancer (13% increase) 

The highest risk was found among fire fighters 30-49 years old: (159% increased risk) 

ii) Malignant melanoma (25% increase) 

iii) Non-melanoma skin cancer (33% increase) 

iv) Mesothelioma in fire fighters over 70 years of age (159% increase) 

v) Lung adenocarcinoma (29% increased risk) 

Despite the knowledge gained from these and other studies, we know that our understanding of the link 

between fire fighting and cancer is incomplete. Although the three studies referenced here are 

extraordinary in scope, many studies are limited by relatively small sample sizes and the absence of 

certain demographic groups within the cohort, including women and minorities. Studies have also been 

constrained by the lack of critical data such as the number of years on the job and the frequency, 

number and type of exposures. 

So, while we know there is a link between fire fighting and cancer, we still lack significant details about 

the relationship. We do not fully understand different routes of exposure, the effectiveness of personal 

protective equipment and decontamination procedures, the relationship between certain flame 

retardants and fire suppression foams and cancer development, as well as many other unstudied or 

understudied topics. Further, we have yet to fully understand the trend of unusual cancers in otherwise 

young and healthy fire fighters. 

A New Trend 

As I mentioned previously, every individual who signs up for the job understands that it comes with 

inherent risks. To be frank, the job attracts a certain type of person. A certain amount of bravado 

seems to be ingrained in every fire fighter, and we wear it on our sleeves, literally, as a badge of honor. 
17 


In the past, wearing soot-coated helmets and fire fighting ensembles silently signaled to the world that 

the wearer was a brave and experienced fire fighter. Traditionally, this display of boldness was 

commonplace throughout the fire service. However, we failed to grasp the silent dangers associated 

with this custom and often rebelled against some efforts to clean our gear of soot. Thankfully, through 

better education and a recognition of the growing presence of cancers in the fire service, this outdated 

tradition is slowly changing. 

Before I assumed my current position, I spent sixteen years as a frontline fire fighter in Baltimore County 

where I was also served as a Hazardous Materials Response Team member. I fought the everyday 

residential fires, but also responded to countless incidents involving hazardous materials and was on the 

first alarm assignment on fire and HAZMAT calls at Bethlehem Steel. And yes, I was young and reckless. 

I did not always wear my full protective ensemble or put a premium on safety and risk reduction. 

Today, I sit before you as a cancer survivor. Eighteen months ago, at 51 years of age, I learned that I had 

prostate cancer; a type of cancer that is more likely to occur in men older than I, unless you are a fire 

fighter. Studies suggest fire fighters are 159% more likely to develop prostate cancer than the general 

population during the prime of their life. 

I have suspicions that my cancer is the direct result of my years within the fire service. My father is 

healthy at 85 and has never experienced cancer. Similarly, my paternal grandfather lived 94 years, and 

my maternal grandfather lived 82 years before passing from non-cancer related illnesses. 

Today, I am happy to report that my prostate cancer was surgically removed and I am healthy. 

The Firefighter Cancer Registry Act 

So, Mr. Chairman, I think you can understand why this is an issue that is close to my heart. As you know, 

the Firefighter Cancer Registry Act will direct the Centers for Disease Control to establish and maintain a 

specialized cancer registry specifically for fire fighters in order to collect detailed data regarding fire 

fighters with cancer on a national scale, allowing researchers to more fully examine and understand the 

broader epidemiological cancer trends among fire fighters. In simple terms the Firefighter Cancer 

Registry Act will lead to a preeminent centralized data collection point that will aid in studies that we 

expect to result in better prevention and treatment measures for fire fighters. 

With this fire fighter cancer registry, researchers will have a centralized source to acquire an abundance 

of high-quality data for additional scientific studies. Fire fighters' basic demographical data will be 

collected and stripped of all personally identifiable characteristics. Additionally, the registry will collect 

several data points including, age, gender, ethnicity, the work history of the fire fighter, their status as a 

professional or volunteer fire fighter, the number of years of the job, an estimated number and type of 

fire incidents plus any known relevant risk factors. 

Collecting data on a national basis will permit scientists to conduct more comprehensive studies 

correcting the shortcomings of previous studies, and I am confident that this registry will be the catalyst 

to better cancer prevention measures in the future. And I am equally confident that the scientific 

knowledge that will originate from the registry's data collection will be responsible for improvements in 

cancer treatments for those that contract this terrible disease. 
18 


With more than one million fire fighters serving nationwide, the registry is intended to be inclusive of 

the entire fire service population. Therefore, data will be collected on professional fire fighters as well 

as volunteer fire fighters. Furthermore, this registry shall remain completely voluntary. 

Although the bill has yet to be scored, the Firefighter Cancer Registry Act is anticipated to be carried out 

at an extremely low cost. That said, we believe that the investment made will be recouped as the 

number of occupational cancers begins to decline, and fire fighters' healthcare expenses are moved 

from the liability column to the asset column of the balance sheet. 

Lastly, I am proud to say that I have yet to encounter any opposition to the Firefighter Cancer Registry 

Act. It is supported by the entire fire service community and has been endorsed by every major national 

fire service organization. 

Conclusion 

I'd like to conclude by thanking the Subcommittee for the opportunity to testify today. The 

International Association of Fire Fighters is committed to the fight against cancer in the fire service, and 

we appreciate your interest in ways the federal government can aid in this fight. We are happy to offer 

our cooperation and expertise as you continue to study the Firefighter Cancer Registry Act and look 

forward to, hopefully, its swift consideration by the full House. 

I am happy to answer any questions you may have. 
19 

Mr. BURGESS. The Chair thanks the gentleman for his testimony. 

Dr. Watson-Lowry, you are recognized for 5 minutes, please. 

STATEMENT OF CHERYL D. WATSON–LOWRY 

Dr. WATSON-LOWRY. Good morning. Mr. Chairman and members 

of the subcommittee, thank you for the opportunity to testify this 

morning in support of the Action for Dental Health Care Act 2017 

introduced by Representative Robin Kelly. Thank you very much. 

My name is Dr. Cheryl Watson-Lowry. I am a practicing dentist 

from Chicago, Illinois and a member of the American Dental Association. 

As you may have seen from my bio, I am a second generation 

dentist. My dad went to Meharry. I started working with my dad 

when I was 11 years old and I started working chair-side when I 

was 15 years old. 

My practice is in the inner city and my patients range in age 

from 6 months to 107 years old. My patients include professionals, 

politicians, teachers, police officers, students, fast food workers, 

and even one patient that sells incense on the train to pay his bills, 

including for his dental services. 

The Action for Dental Health Bill you are considering could positively affect every patient in my practice, which is why I am so passionate about it. 

This bill is important because healthy teeth and gums aren’t a 

luxury. They are an essential for good oral health and good overall 

health. As a practicing dentist, I know the causes of dental disease 

can be varied and complex. So the solutions for the dental health 

crisis facing America today needs to be wide-ranging. The American Dental Association is very proud to support H.R. 2422 because 

the legislation helps to address the numerous barriers to accessing 

care and oral healthcare services. The ADH bill does this by providing funding for organizations engaged in volunteer dental 

projects that provide free dental care directly to those in need but 

it also establishes a second grant program to promote oral health 

initiatives design to facilitate private-public partnerships collectively called Action for Dental Health Initiatives. 

A good example of a successful volunteer project, the ADA’s Give 

Kids A Smile program, which has provided free oral healthcare 

services for over 5.5 million children since 2003. While pro bono 

programs serve as an important safety net for individuals who cannot afford coverage, we all know that offering free oral health services is not a long-term solution. That is why in 2013, the ADA 

launched the Action for Dental Health Initiative. 

The ADA initiative is a nationwide community-based movement 

aimed at ending the dental crisis. It is composed of eight initiatives 

designed to address specific barriers to care. This morning, I would 

like to focus on just two of the ADH Initiatives: emergency room 

referrals and community dental health coordinators. 

A key initiative in the ADH program is reducing the number of 

people who visit the emergency room for dental conditions by referring them to dental practices. These emergency room visits for dental problems cost more than providing regular care by oral health 

professionals. It is estimated that the U.S. spent nearly $3 billion 

on E.R. dental visits between 2008 and 2010. Also, most E.R. visits 

20 

only provide patients with pain medication and antibiotics. They do 

not treat the underlying problem. 

While recent research indicates that hundreds of E.R. referral 

programs in virtually every State are working and the use of emergency room for dental conditions have been decreasing, we cannot 

let up now. More still needs to be done to expand E.R. referral programs and H.R. 2422 will help. 

The ADA also believes that the use of community dental health 

coordinators, also called CDHCs can continue this positive trend by 

connecting patients to dental homes and ensuring that the care is 

delivered in the most appropriate and cost-effective venue possible. 

The ADA’s commitment to improving America’s oral health has led 

us to invest more than $7 million in the CDHC program. This program trains individuals to provide patient navigation, oral health 

information, and preventative self-care for patients who typically 

do not receive dental services. 

The CDHCs work in inner cities, remote rural areas, and Native 

American lands. They help people who might otherwise through 

the cracks of what can be a complicated delivery system. Most 

CDHCs grew up in these communities, so they better understand 

the problems that affect the access to dental care. 

The CDHC model has been adapted to numerous community settings, including clinics, schools, Head Start programs, institutional 

settings, churches, and other venues. It is important to note that 

an evaluation based on 88 case studies of CDHC programs demonstrated the real-world value of the CDHC in making the dental 

team more efficient and effective. Before the end of this summer, 

the CDH program will have over 100 graduates working in 21 

States. With the help of H.R. 2422, we hope that the number will 

continue to grow and help our Nation’s vulnerable find dental 

homes. 

Mr. Chairman and subcommittee, thank you for the opportunity 

to share with you why the ADA believes the Action for Dental 

Health Act of 2017 will enhance ongoing efforts to reduce the barriers to oral health care facing Americans today. 

Thank you. 

[The statement of Dr. Watson-Lowry follows:] 

21 


American Dental Association® 

STATEMENT OF THE 

AMERICAN DENTAL ASSOCIATION 

TO THE 

SUBCOMMITTEE ON HEALTH 

COMMITTEE ON ENERGY AND COMMERCE 

U.S. HOUSE OF REPRESENTATIVES 

ON 

"EXAMINING INITIATIVES TO ADVANCE PUBLIC HEALTH" 

BY 

DR. CHERYL D. WATSON-LOWRY 

May 17,2017 

Washington Office: 1111 14th Street NW Washington DC 20005 (202) 898-2400 
22 


Executive Summary 

My name is Dr. Cheryl Watson-Lowry. I'm a general dentist with an inner-city practice in 

Chicago, Illinois. The "Action for Dental Health Act of2017" has the potential to positively 

affect every patient in my practice, which is why I am so passionate about it. 

The ADH bill supports grant programs that help: volunteer dental projects that provide free care 

directly to those in need; and Action for Dental Health (ADH) initiatives designed to address the 

many barriers to accessing oral health care services. 

Regarding volunteer projects, each year, approximately 450,000 children benefit from 1,500 

Give Kids A Smile (GKAS) events nationwide. Also, since 2003, the program has provided free 

oral health care services to over 5.5 million children. Since 2003, Missions of Mercy events have 

helped more than 243,000 patients and provided $159 million in free oral health care. 

There arc eight ADH initiatives but this testimony focuses on the need to grow the number of 

emergency room (ER) referral programs and to support the community dental health coordinator 

(CDHC) program. 

ER referral programs result in clear savings to the health care delivery system and, in particular, 

to government-funded programs, as the Medicare or Medicaid programs were the primary payer 

for almost half of ER dental visits in 2012 ( 43.2%). The bottom line is that in most cases an 

individual can receive an entire year's worth of dental services for the price of a single visit to 

the ER for a dental emergency. 

Page 11 
23 


The use ofCDHCs can connect patients to dental homes, ensuring that timely care is delivered in 

the most appropriate, cost-effective venue possible. 

The role of a CDHC is threefold: educating the community about the importance of dental health 

and healthy behaviors; providing limited preventive services, such as fluoride varnish and dental 

sealants; and connecting the community to oral health teams that can provide more complex 

care. CDHCs work in inner cities, remote rural areas and Native American lands. Most grew up 

in these communities, allowing them, through cultural competence, to better understand the 

problems that limit access to dental care. 

A September 2013 evaluation of 88 case studies of the CDHC program conducted by the ADA 

verified the real world value of the CDHC in making the dental team more efficient and 

effective. Screenings, dental education and certain preventive services were delivered by the 

CDHC and individuals needing additional care did not "fall through the cracks" of a complicated 

delivery system. Before the end of this summer, the CDHC program will have over I 00 

graduates working in 21 states. This includes 16 CDHCs working in tribal facilities. 

Page 12 
24 


Testimony 

On behalf of the American Dental Association (ADA) and our 161,000 members, thank you, Mr. 

Chairman, for the opportunity to testify today in support of the "Action for Dental Health Act of 

2017", introduced by Rep. Robin Kelly of Illinois. 

My name is Dr. Cheryl Watson-Lowry. I'm a practicing general dentist from Chicago, Illinois, 

and a member of the ADA. My practice is in the inner city and I see patients from I to 107 years 

of age. My patients range from professionals, politicians, teachers, and police officers to students 

and fast food workers. I even have one patient that sells incense on the train to pay his bills--

including paying for his dental services. Action for Dental Health (ADH) initiatives affect or 

have the potential to positively affect every patient in my practice, which is why I am so 

passionate about it. 

The bill will allow organizations to qualify for oral health grants to support activities that 

improve oral health education and dental disease prevention and develop and expand outreach 

programs that facilitate establishing dental homes for children and adults, including the elderly, 

blind and disabled. 

The ADH bill supports oral health initiatives that have the greatest impact on dental access 

disparities, including: 

Volunteer Dental Projects 

Programs like Give Kids A Smile and Missions of Mercv provide important platforms for 

dentists to deliver free dental care directly to those in need. 

Page i 3 
25 


Each year, approximately 450,000 children benefit from 1,500 Give Kids A Smile 

(GKAS) events nationwide. Since 2003, the program has provided free oral health care 

services to over 5.5 million children. 1

These are generally not single day events as the 

mantra for GKAS is "more than just a day," which points to the need to get these 

individuals into dental homes. 

Since 2003, Missions of Mercy events have helped more than 243,000 patients and 

provided $159 million in free oral health care. 2 

• These programs, along with the free and discounted care that individual dentists provide 

every day, add up to an estimated $2.6 billion per year. 3 

Action for Dental Health Initiatives 

Healthy teeth and gums aren't a luxury. They're essential. 

That's why the ADA in 2013 launched Action for Dental Health: Dentists Making a Difference, 

a nationwide, community-based movement aimed at ending the dental health crisis facing 

America today. 

All Americans deserve good oral health. 

The causes of dental disease are varied and complex, but we know that for each of us- and for 

the nation as a whole it's never too late to get on top of our dental health. Action for Dental 

1 http:/ /www.adafoundation .org/en/give-kids-a-smile. 2 http://www.adcfmom.org/. 

3 http://www .ad a. org/ en/ pub! i c-programs/ action-for -denta 1-hea lth/provide-care-now. 

Page 14 
26 


Health (ADH) aims to prevent dental disease before it starts and reduce the proportion of adults 

and children with untreated dental disease. Our goal is to help all Americans attain their best oral 

health. 

ADH initiatives are designed to deliver care now to people already suffering from dental disease, 

strengthen and expand the public/private safety net, and amplify dental health education and 

disease prevention into underserved communities. 

The ADH program is composed of eight initiatives4 designed to address specific barriers to care. 

Emergency Room Referral: Many people without dental coverage do not seek treatment until 

their dental pain grows so severe that it sends them to a hospital emergency room. But most 

hospitals cannot provide comprehensive dental care, so the problem often is not solved. Dentists 

and oral health clinics around the country are working with hospitals to get these patients out of 

the ER and into the dental chair, the right place for the right treatment. 

Community Dental Health Coordinators: Community Dental Health Coordinators (CDHCs) 

address barriers to oral health by providing patient navigation for people who typically do not 

receive care for a variety of reasons-among them poverty, geography, language, culture, and a 

lack of understanding of oral hygiene and the importance of regular dental visits. CDIICs 

typically work in inner cities, remote rural areas and Native American lands connecting patients 

in need to available but underutilized dental access points through case management and care 

coordination. 

Fluoridation: Studies prove community water fluoridation continues to be effective in reducing 

dental decay by at least 25 percent in children and adults. Even with the availability of secondary 

4 http://www .ada .org/ en/ pu bl i c-progra ms/ action -for -dental-health/action-for -den tal-health-initiatives. 

Page 5 
27 


sources of fluoride through toothpaste and varnishes, community water fluoridation remains one 

of the top 10 public health achievements of the 20'h century. 

Medicaid Reform: Most state Medicaid dental programs fall short of providing the amount and 

extent of care-both preventive and restorative-needed by their low-income beneficiaries. This 

is especially true for low-income adults, many of whom have virtually no access to dental care 

through Medicaid. The ADA advocates for increased dental health protections under Medicaid, 

especially in states that have yet to agree to a Medicaid expansion, and helps more dentists work 

with community health centers and clinics. The ADA works with states to reduce the 

administrative burdens often associated with being a Medicaid provider. 

Federally Qualified Health Centers: When private-practice dentists contract with Federally 

Qualified Health Centers, they are able to help these safety net facilities expand their capacity to 

provide care to underserved populations- primarily children on Medicaid without increasing 

the clinics' "bricks and mortar" expenses and staffing overhead. Patients benefit because quality 

care can be quickly and efficiently delivered, alleviating much of the backlog experienced by 

many health center dental programs. It truly becomes a community effort with both the public 

and private sectors contributing to this success. 

Nursing Home Programs: America's vulnerable elderly face the greatest barriers to accessing 

dental care of any population group. But delivering dental care to the nearly 1.3 million seniors 

in long-term care facilities remains problematic. Now, dentists and dental training programs 

across the country are adopting nursing homes in their communities with the cost of care offset 

by a provision in Medicaid currently used to supply eyewear and hearing aids to needy patients. 

Page i 6 
28 


Collaborations with other Health Professionals and Organizations: Better collaboration among 

dental and medical professionals can help more families understand that their dental health is a 

crucial part of their overall health. The dental health of a pregnant woman or a mother can affect 

the health of the baby. Diabetes and gum disease are interrelated. Physicians, nurses, and other 

medical providers can dramatically increase the number of patients and caregivers who receive 

basic dental health education through the ADA-endorsed online oral health curriculum entitled: 

Smiles for Life. These professionals also can be trained to recognize conditions needing 

diagnosis and possible treatment by a dentist. To date, over one million professionals have 

accessed this online educational series. 

Missions of Mercy/Give Kids A Smile: Missions of Mercy events arc temporary dental field 

hospitals that provide free dental care to the underserved. Give Kids A Smile programs allow 

dentists across the country to join with others in their communities to provide care to 

underserved children. An overarching goal of the programs is to provide each child with a dental 

home. At the events, dentists and other team members volunteer their time and services to 

provide screenings, treatments and education to children. 

In fact, there arc ADH initiatives in virtually every state as detailed in the state-by-state action 

maps found at the following site: http://www.ada.org/en/public-programs/action-for-dentalhealth/action-for-dcntal-hcalth-map. 

for the purposes of this hearing, however, I would like to focus on just two of the ADJ-1 

initiatives potentially most affected by the ADH bill -- emergency room/emergency department 

referrals and community dental health coordinators. 

Page i 7 
29 


Emergency Room/Emergency Department Referral Programs 

A key initiative in the ADII program is reducing the number of people who visit the emergency 

room for a dental condition by referring them to dental practices, where they can receive proper 

dental care. 5 

• Emergency department (ED) visits for dental problems cost nearly $3 billion during the 

period from 2008 through 20 I 0, according to a study in the Journal of the American 

Dental Association (April2014, Vol. 145:4, pp. 331-337). 

• The study noted that providing dental care in the ED costs more than providing regular 

care by oral health professionals. Also, most ED visits only provide patients with pain 

medication and antibiotics, while not treating the underlying problem. 

Many people without dental coverage postpone seeking treatment until their dental pain grows so 

severe that it sends them to a hospital emergency room. Many patients arc unaware of dental 

access locations and visit emergency rooms almost as a reflex action. But most hospitals cannot 

treat the underlying cause of the oral health emergency, so the problem often is not solved. 

Dentists around the country arc working with hospitals to get these patients out of the ER and 

into the dental chair, the right place for the right treatment. 

5 According to the National Hospital Ambulatory Medical Care Survey, the number of dental ER visits in the U.S. 

increased from 1.1 million in 2000 to 2.1 million in 2010. A separate study shows that in 2009, dental caries (the 

disease that causes cavities) and abscesses alone- almost entirely preventable conditions- accounted for nearly 80 

percent of dental-related ER visits. 

Page i 8 
30 


ER referral programs result in clear savings to the health care delivery system and, in particular, 

to government-funded programs, as the Medicare or Medicaid programs were the primary payer 

for almost half of ER dental visits in 2012 (43.2%).6 In 2012, an ER visit for a dental condition 

happened every 15 seconds in the United States, costing taxpayers $1.6 billion. That came out to 

about $749 per visit? Adults with private dental benefits, ages 18-64, spent in a year (20 15 

dollars) on average between $323 and $523. If we look at the same age range (19-64) and same 

utilization of services, the range in average spending per year for people that pay strictly out of 

pocket (i.e. cash patients, or perhaps uninsured patients) is $492 to $785. 8 The bottom line is that 

in most cases an individual can receive an entire year's worth of dental services for the price of a 

single visit to the ER for a dental emergency. 

Currently, there are hundreds of ED referral programs in virtually every state in the United 

States.9 There are a variety of referral models, 10 as many of these programs arc the result of local 

interest in addressing an obvious need to reduce costs and provide comprehensive dental care. At 

least in part as a testament of how successful these programs have been is that more recent 

research indicates that the use of emergency rooms for dental conditions is decreasing. 11 Some 

programs arc reporting that use of the ED for dental pain patients has decreased 50-70 percent. 

6 Wall T, Vujicic M. Emergency department use for dental conditions continues to increase. Health Policy Institute 

Research Brief American Dental Association. April2015. Available from: 

http://www.ada.org/-lmedia/ ADA/Scicnce%20and%20Research/HPI!Files/HPIBrief_ 0415 _ 2.ashx 7 Wall T, Vujicic M. Emergency department use for dental conditions continues to increase. Health Policy Institute 

Research Brief. American Dental Association. April2015. Available from: 

http://www.ada.org/-lmedial ADA/Science%20and%20Research/HPl/FilesiHPIBrief. 0415 2.ashx. 8 Yarbrough C, Vujicic M, Aravamudhan K, Blatz A. An analysis of dental spending-~mong adults with private 

dental benefits. Health Policy Institute Research Brief. American Dental Association. May 2016. Available from: 

http://www.ada.orgHmedial ADAIScience%20and%20Research/HPl/Files/HPIBrief_ 05 16 __ l.pdf 9 http://www.ada.orglenipublic-programs/action-for-dental-health/action-for-dental-health-map. 

10 20 !7 ER Referral Program Models and Description, Action for Dental Health, ADA. 

11 Wall T, Vujicic M. Emergency department visits for dental conditions fell in 2013. Health Policy Institute 

Research Brief. American Dental Association. February 2016. Available from: 

http://www.ada.org/-lmedial ADAIScience%20and%20Research/HPI/FilesiHP!Brief_ 0216 _l.ashx. 

Page! 9 
31 


The ADA believes that the use of community dental health coordinators (CDHCs) can continue 

this trend, connecting patients to dental homes and ensuring that timely care is delivered in the 

most appropriate, cost-effective venue possible. 

Community Dental Health Coordinators 

The ADA's commitment to improving America's oral health has led us to invest more than $7 

million in the CDHC program. This program trains individuals to directly address the underlying 

social determinants of health by providing patient navigation, oral health information, and 

preventive self~care for people who typically do not receive dental services for a variety of 

complex reasons--- poverty, geography, language, culture, diet, and a lack of understanding of 

why it is important to achieve and maintain a healthy mouth. 

The role of a CDHC is threefold: educating the community about the importance of dental health 

and healthy behaviors; providing limited preventive services, such as fluoride varnish and dental 

sealants; and connecting the community to oral health teams that can provide more complex 

care. CDHCs work in inner cities, remote rural areas and Native American lands. Most grew up 

in these communities, allowing them, through cultural competence, to better understand the 

problems that limit access to dental care. 

A 2016 article by the ADA's Health Policy Institute 12 on the participation of dentists in the 

Medicaid program addresses the barriers preventing low-income individuals from accessing 

12 Is the number of Medicaid providers really that important? Health Policy Perspective (March 20 16), 

http://jada.ada.org/article/S0002-8 I 77(16)00023-4/pdf, p. 223. 

Page! 10 
32 


dental services for reasons beyond just the participation of dentists. The article points out the 

need for more policy interventions that target patient behavior. CDHCs are specifically trained to 

address patient behavior and other barriers to accessing care. 

The ADA and state dental societies are working with state governments, the higher education 

community, and the charitable and private sectors to create new CDHC programs. We believe 

that training CDHCs in greater numbers could dramatically improve oral health among people 

whose circumstances place them at greatest risk for untreated disease. 

While all CDIICs have basic core competencies, their job responsibilities vary depending on the 

goals of the clinics and communities they serve, including: 

Increasing awareness of the importance of oral health and how to become and stay 

healthy, through community outreach. 

Improving health outcomes by bringing at-risk patients, such as people with diabetes and 

the elderly, to their clinics. 

Providing preventive services, such as fluoride treatments and sealants, with dentists and 

dental team members performing restorative and other more complex procedures as 

appropriate. 

Improving access to care by providing assistance with establishing dental homes for 

people in the community and significantly reducing missed appointment rates at 

Page Ill 
33 


community health centers. 

The CDHC model has been adapted to both private practice and numerous community dental 

settings, including clinics, schools, Head Start centers, institutional settings, churches, social 

service agencies and others. 

A September 2013 evaluation of 88 case studies of the CDHC program conducted by the ADA 

verified: 

• There are increases in necessary services rendered at clinics that add a CDHC to the 

dental team. One clinic experienced over a I 00% increase in necessary procedures (from 

I ,066 to 2,307) in one year with the total value of care provided increasing from $91,399 

to $231,551. 

• Many children receive dental screenings and preventive services through elementary 

school, high school, juvenile detention center, and Head Start outreach programs. Over 

5,200 patients were treated through these programs with hundreds of thousands of 

additional needed procedures provided by dentists or others on the dental team. 

• Increased services were provided to patients with diabetes and HIV patients in 

community health centers. These three programs experienced fewer missed 

appointments, provided care to hundreds of patients, and provided over $100,000 in 

necessary services. 

Page! 12 
34 


• Dental screenings and preventive services are provided to senior citizens and to the very 

young through pediatric outreach programs, among other programs. Almost 1,600 

patients were seen in these programs with results similar to those cited above. 

The bottom line is that the data collected as part of the evaluation demonstrated the real world 

value of the CDHC in making the dental team more efficient and effective. Screenings, dental 

education and certain preventive services were delivered by the CDHC and individuals needing 

additional care did not "fall through the cracks" of a complicated delivery system. 

Community Dental Health Coordinators In Their Own Words 

"It's rewarding at the end of each day to know I 

guided someone and provided hope. Guiding 

someone to access to care is the first thing people 

need to start their journey to better health." 

-Angela Black, 20 ll CDHC graduate, University 

of Oklahoma-College of Dentistry 

"1 think the CDHC has the potential to make a real 

impact on so many patients' lives as a critical 

addition to the dental care team." 

-Calvin Hoops (right), 2011 CDHC graduate, 

Temple University 

Page 113 
35 


"I am working to improve my people's oral health." 

-Teresa Molina, 2012 CDHC graduate, Arizona 

School of Dentistry and Oral Hygiene 

Before the end of this summer, the CDHC program will have over 100 graduates working in 21 

states. This includes 16 CDHCs working in tribal facilities, including clinics serving the 

Chickasaw Nation Division of Health, Wewaka Indian Health, and the Muskogee Creek Nation 

in the Oklahoma City area. And more are being trained. For example, five Navajo trainees are 

currently part of the class at Central Community College in New Mexico. Presently, the 

Chickasaw Nation is working on a grant to begin a program with Pontotoc Technical College. 

Mr. Chairman, thank you for this opportunity to share with you and the subcommittee why the 

ADA believes the Action for Dental Health Act of 2017 is an important piece of legislation that 

will enhance ongoing efforts to reduce the barriers to oral health care facing many Americans 

today. 

The ADA looks forward to working with Representative Kelly and the committee in moving this 

bill through the legislative process. 

Page 114 
36 

Mr. BURGESS. Thank you and thank you for your testimony. 

Dr. Levine, you are recognized for 5 minutes for a summarization 

of your opening statement, please. 

STATEMENT OF MARTIN S. LEVINE 

Dr. LEVINE. Thank you, Chairman Burgess, Ranking Member 

Green, and—Chairman Burgess, thank you. Ranking Member 

Green and members of the subcommittee, on behalf of the American Osteopathic Association and the nearly 130,000 osteopathic 

physicians and osteopathic medical students we represent, than 

you for the opportunity to testify this morning on the Good Samaritan Health Professionals Act of 2017. 

My name is Martin Levine, D.O. I am a board-certified osteopathic family physician from New Jersey and I also have the distinct privilege of having served as the 115th President of the AOA 

in the 2011–2012 term. 

I have practiced osteopathic family medicine and osteopathic manipulation as well as sports medicine for 34 years. Throughout my 

career, I have always worked with students and I am now the Interim Clinical Dean at the Touro College of Osteopathic Medicine 

in Harlem. 

I have also served as a team physician at every level of sports, 

including local college, Olympic, and professional sports teams. In 

addition, I have been proud to serve as a volunteer physician at the 

New York City Marathon for over 20 years and also as the Elite 

Athlete Recovery Area physician at the Boston Marathon for the 

past 18 years. 

On April 15, 2013, after finishing my duties with the Elite Athletes, I was triaging runners in front of the main medical tent just 

after the finish line of the Boston Marathon when the first of two 

bombs exploded on Boylston Street. We heard the explosion and I 

saw the plume of smoke begin to rise. And the first thing I noticed 

with it, there were no people standing in that area anymore. 

I immediately told the staff inside the tent to make room and to 

clear out anyone that was able to leave, as it was clear we were 

going to have casualties. And then I turned and ran to the site of 

the explosion. 

As I arrived at the scene, the second bomb went off further up 

Boylston Street. As one of the first responders at the site of the 

first blast, I saw blood everywhere and dozens of victims on the 

ground with severe wounds, mostly below the waist. Many of the 

victims were missing lower limbs and bleeding profusely. So I and 

other responders improvised tourniquets with our belts and identification badge lanyards to staunch the bleeding. We transported 

victims to ambulances using stretchers, backboards, wheelchairs, 

whatever was possible. 

Thanks to the quick work of the EMS, other first responders, and 

the ambulances, the first casualty to arrive at the hospital was 

there in 14 minutes and they were in the operating room within 

22 minutes of the blast. In seconds, we had gone from helping runners recover from the race to treating spectators with severe trauma—horrific injuriesinflicted by a bomb. 

The medical team at the Boston Marathon is always prepared to 

treat mass casualties, just not the type of wounds we saw on that 

37 

day. As part of the medical responders, I didn’t feel the chaos of 

the moment; we were simply doing what we had to do in that situation and most important was that we were able to save lives. 

I am grateful that the committee is holding the hearing today to 

examine the Good Samaritan Health Professionals Act, legislation 

that will help provide professional healthcare volunteers with much 

needed certainty when serving as volunteers during federally declared disasters. The desire to help save lives drives many physicians and healthcare professionals from all over the country to volunteer when disaster strikes. 

While the scale of the disaster and the scope of needs will always 

vary, providing uniform Federal standards for professional liability 

will help ensure that a sufficient healthcare workforce can be mobilized without unnecessary delays or confusion. In our case of the 

marathon, the race’s liability coverage would have protected as volunteers for treating the runners. But we had to shift to treating 

spectators in a much different capacity which would not be covered 

under that policy. 

This legislation will help fill in the existing gaps in our liability 

protection laws. While many States have such protection in place, 

the current patchwork of laws does not provide healthcare professionals with the certainty they need and the inconsistency in understanding the application of these laws has resulted from physicians being turned away from disaster areas, when they attempt to 

volunteer their services. A uniform Federal standard narrowly focused to apply to federally declared disaster areas will ensure that 

qualified medical professionals can contribute their services to provide communities with the medical assistance they need. 

As an osteopathic physician, I am trained to treat the whole person, addressing not just the body but the mind and spirit. Disaster 

victims require the need for emotional support, comfort, and empathy, as they receive the care needed to address their physical 

wounds. In this case, it was an act of terrorism. In other instances, 

it might be a natural disaster or public health outbreak. Regardless, this legislation would provide healthcare professionals with 

the comfort and emotional well-being of knowing that they are not 

at financial risk when voluntarily treating victims of federally recognized disasters. 

Thank you once again for the opportunity to provide my testimony before the subcommittee today. On behalf of the nearly 

130,000 osteopathic physicians and students across the country, we 

appreciate your attention to the important issue and thank the 

committee members for taking steps to advance public health. 

Thank you. 

[The statement of Dr. Levine follows:] 

38 


Statement of Martin Levine, DO, MPH, FACOFP dist. 

Submitted on Behalf of the American Osteopathic Association 

Before the U.S. House of Representatives Committee on Energy and 

Commerce 

Subcommittee on Health 

Hearing on "Examining Initiatives to Advance Public Health" 

May 17,2017 

Chairman Burgess, Ranking Member Green, and members of the subcommitteeOn behalf of the American Osteopathic Association (AOA) and the nearly 130,000 osteopathic 

physicians and osteopathic medical students we represent, thank you for the opportunity to 

testify this morning on the Good Samaritan Health Professionals Act of2017. My name is 

Martin Levine, DO, and I am a board-certified osteopathic family physician from Bayonne, New 

Jersey. I also have the distinct privilege of having served as the !JS'h President of the AOA for 

the 20 ll-20 12 term. 

I have practiced osteopathic family medicine and osteopathic manipulative medicine for 34 

years. Throughout my career, I have seen patients in the office, and have helped guide new 

osteopathic medical students through their education at the Touro College of Osteopathic 

Medicine in Harlem, New York, where I currently serve as the Interim Clinical Dean. I have also 

been able to serve as a team physician for a variety of local, college, Olympic and professional 

sports teams. In addition, I have been proud to serve as a volunteer physician at the New York 

City Marathon for many years, as well as volunteer as the Elite Athlete Recovery Area physician 

for the Boston Marathon for the past 18 years. 
39 


On April 15, 2013, after finishing my duties with the elite athletes, I was triaging runners in front 

of the main medical tent just after the finish line of the Boston Marathon when the first of two 

bombs went off on Boylston Street. We heard the explosion and saw the plume of smoke begin 

to rise, and the first thing I noticed was that there were no people standing in that immediate area 

anymore. I immediately told the staff inside the tent to make room and to clear out anyone that 

was able to leave, as it was clear that we would have casualties- and then I turned and ran to the 

site of the explosion. As I arrived at the scene, the second bomb went off further up Boylston 

Street. 

As one of the first responders at the site of the first blast, I saw blood everywhere and dozens of 

victims on the ground with severe wounds, mostly below the waist. Many of the victims were 

missing lower limbs and bleeding profusely, so I and the other responders improvised 

tourniquets with our belts and identification badge lanyards to staunch the bleeding. We 

transported victims to ambulances using anything we could- stretchers, backboards, 

wheelchairs, whatever was available. Thanks to the quick work of EMS, other first responders, 

and the ambulances, the first casualty arrived at a hospital in 14 minutes, and was in the 

operating room within 22 minutes of the blast. 

In seconds, we had gone from helping runners recover from the race, to treating spectators with 

severe trauma -horrific injuries inflicted by a bomb. The medical team at the Boston Marathon is 

always prepared to treat mass casualties, just not with the type of wounds we saw on that day. As 

part of the medical responders, I didn't feel the chaos of the moment; we were simply doing what 

we had to do in that situation, and the most important thing is that we were able to save lives that 

day. 
40 


I am grateful that the Committee is holding this hearing today to examine the Good Samaritan 

Health Professionals Act, legislation that will help provide professional health care volunteers 

with much-needed certainty when serving as volunteers during federally-declared disasters. 

The desire to help, that desire to save lives, drives many physicians and health care professionals 

from all over the country to volunteer when disaster strikes. While the scale of the disaster and 

the scope of needs will always vary, providing uniform federal standards for professional 

liability will help ensure that a sufficient health care workforce can be mobilized without 

unnecessary delays or confusion. In our case at the marathon, the race's liability coverage would 

have protected us as volunteers for treating the runners, but we had to shift to treating spectators 

in a different capacity-- which would not be covered under that policy. 

This legislation will help fill in the existing gaps in our liability protection laws. While many 

states have some such protections in place, the current patchwork oflaws does not provide health 

care professionals with the certainty they need, and inconsistency in understanding and 

application of these laws has resulted in physicians being turned away from disaster areas when 

they attempt to volunteer their services. A uniform federal standard, narrowly-focused to apply 

to federally-declared disaster areas, will ensure that qualified medical professionals can 

contribute their services to provide communities with the medical assistance they need. 

As an osteopathic physician, I am trained to treat the whole person, addressing not just the body, 

but the mind and spirit. Disaster victims require the need for emotional support, comfort and 

empathy as they receive the care needed to address their physical wounds. In this case it was an 

act of terrorism, in other instances it might be a natural disaster or public health outbreak. 

Regardless, this legislation would provide health care professionals with the comfort and 
41 


emotional well-being of knowing that they are not at financial risk when voluntarily treating 

victims of federally recognized disasters. 

Thank you once again for the opportunity to provide my testimony before the subcommittee 

today. On behalf of nearly 130,000 osteopathic physicians and students across the country, we 

appreciate your attention to this important issue and thank the Committee members for taking 

steps to advance public health. 
42 

Mr. BURGESS. The Chair thanks the gentleman for his testimony. 

Dr. Greenbaum, you are recognized for 5 minutes for an opening 

statement, please. 

STATEMENT OF JORDAN GREENBAUM 

Dr. GREENBAUM. Thank you. Good morning Chairman Burgess, 

Ranking Member Green, and subcommittee members. I appreciate 

the opportunity to testify in front of you today. 

I am a child abuse physician and the Medical Director of the Institute for Human Trafficking at Children’s Healthcare of Atlanta. 

The purpose of the Institute is to improve the lives of children and 

families affected by human trafficking by enhancing mental health 

and medical care through research, training, and education. 

I am also the Medical Director of the Global Initiative for Child 

Health and Well Being at the International Center for Missing and 

Exploited Children and a HEAL Trafficking member, a national organization dedicated to ending human trafficking using a public 

health approach. 

A 15-year-old girl was admitted to Children’s Healthcare of Atlanta a few years ago for a suicide attempt. She had ingested alcohol and a narcotic. It was only after she woke up in the intensive 

care unit and was interviewed by one of our social workers that we 

learned her depression existed in the context of human trafficking. 

What if we had never asked her about her depression or the circumstances of her life? She probably would have been admitted 

briefly to a psychiatric institution and then, in all likelihood, discharged back to her life of exploitation. 

For the next 4 minutes, I would like to make three essential 

points: human trafficking is a healthcare issue; healthcare professionals need training in order to be able to recognize and respond 

to human trafficking; and the SOAR to Health and Wellness Act 

is a very effective strategy for addressing this widespread need for 

education and training. 

As you know, reliable estimates of the incidence and prevalence 

of human trafficking are lacking but the best estimates suggest 

that millions of adults and children around the world are impacted 

by human trafficking and the United States is a major destination 

country. Victims of trafficking may experience a plethora of physical and mental health adverse consequences ranging from physical 

assault injuries, sexual assault injuries, sexually transmitted diseases, HIV/AIDS, tuberculosis, major depression, and post-traumatic stress disorder. In a recent study of youth sex trafficking victims, 47 percent reported attempting suicide within the past year. 

Despite the criminal nature of human trafficking and the desire 

of traffickers to elude detection, research consistently shows that 

victims do have contact with medical professionals. In a study of 

female survivors, nearly 88 percent had been seen by a medical 

professional during their period of exploitation but we also know 

that victims rarely self-identify when they seek medical care. I believe that every day hundreds of victims across the United States 

are coming to our clinics and our emergency departments and presenting for symptoms, being treated for conditions, and discharged 

with no one ever asking about the possibility of exploitation. 

43 

Consider a 14-year-old trafficked boy who comes to a clinic with 

symptoms of a sexually transmitted infection. He might easily be 

treated for his symptoms and sent on his way, without anyone ever 

asking about the possibility of exploitation or the circumstances of 

his life. Subsequently, that same unidentified victim may become 

HIV-positive or experience major traumatic injuries from a physical 

assault. 

This medical visit represents a critical missed opportunity. 

Health and services are within arm’s reach but go untouched. To 

prevent lost opportunities such as these, to offer exploited persons 

help in leaving their situation, it is imperative that healthcare professionals recognize signs of high-risk youth and adults, ask questions appropriately and provide trauma-sensitive care. 

The SOAR to Health and Wellness Act would address the critical 

need for training of healthcare providers. This training would be 

specific to the needs of varied professionals, ranging from medical 

and mental health practitioners, social workers, and public health 

professionals. And importantly, the training would be based on research, not emotion; on facts, not speculation. It would use well-established adult learning strategies to facilitate changes in practitioner attitude, knowledge, and behavior. And the training would 

be formally evaluated to make sure it is effective. 

Essential to facilitating lasting change in any medical practice is 

to support the newly trained practitioners and this can be facilitated through good protocols for providers to use whenever they 

suspect a patient has been trafficked. H.R. 767 addresses this need 

by including protocols in the program development—protocols for 

offices, clinics, and hospitals, and provision of technical assistance 

to those who want to implement the protocols. 

Training and technical support of healthcare professionals are 

critical components of the U.S. effort to curb the tide of human 

trafficking. Healthcare professionals have a unique role in preventing exploitation and identifying victims, as well as assisting 

them in escaping their plight. But without evidence-based, highquality, easily accessible training, and technical assistance, the 

very large, complex, and unwieldly healthcare sector may well lose 

track of the human trafficking issue and give up its role in fighting 

the battle against exploitation. We cannot allow that to happen. 

Thank you very much for allowing me to testify in front of you 

today. 

[The statement of Dr. Greenbaum follows:] 

44 


Testimony Before the House of Representatives Committee on Energy and Commerce 

Subcommittee on Health 

Hearing on "Examining Initiatives to Advance Public Health" 

May 17, 2017, 10:15 AM 

Rayburn House Office Building, Room 2123 

Written testimony by Jordan Greenbaum, MD, 

Medical director of the Institute for Healthcare and Human Trafficking at Children's Healthcare of Atlanta 

Medical director of the Global Initiative for Child Health and Well Being at the International Centre for Missing 

and Exploited Children 

Summary: 

Board member, HEAL Trafficking 

Human trafficking is a healthcare issue 

a. The physical and mental health effects of human trafficking may be severe, ranging from serious 

physical injuries to HIV/AIDS to post-traumatic stress disorder, to depression and suicidality. 

b. There is good evidence to show that human trafficking victims QQ. seek medical care, so 

healthcare professionals are ideally positioned to recognize victims and offer services. 

II. Healthcare professionals need training in order to be able to recognize and respond to human 

trafficking 

1 
45 


a. Research suggests that a large proportion of healthcare professionals have not received specific 

training on human trafficking and are ill-equipped to recognize victimization or to respond in a 

trauma-informed, cu~urally-appropriate manner. 

Ill. The SOAR to Health and Wellness Act of 2017 would be a very effective strategy for addressing this 

widespread need for education and technical support. 

a. This bill will provide the necessary infrastructure to train the vast health care community, and to 

provide technical support that will enable healthcare professionals to become effective 

advocates for victims. It helps to mobilize a critical sector of the work force in the U.S. drive to 

eliminate human trafficking. 

Good afternoon, Chairman Burgess, Vice Chairman Guthrie and distinguished Committee members. I am 

grateful for the opportunity to testify before you today. In addition to my oral testimony I would like to submit 

written testimony into the record. 

My name is Jordan Greenbaum. I am a child abuse physician and the medical director of the Institute for 

Healthcare and Human Trafficking at the Stephanie V. Blank Center for Safe and Healthy Children, of Children's 

Healthcare of Atlanta. The purpose of the Institute is to improve the lives of children and families affected by 

human trafficking by increasing and enhancing behavioral health and medical care through research, training 

and education. I am also the medical director of the Global Initiative for Child Health and Well Being for the 

International Center for Missing and Exploited Children. The International Centre is a non-governmental 

organization that works to combat child abduction and child sexual exploitation globally. Through its Global 

Health Initiative, the Centre seeks to apply a public health model to child sexual exploitation, to promote 

changes in medical education regarding exploitation, facilitate research on the health of victims, and to assess 

current treatment modalities for victims. Finally, I am a board member of HEAL trafficking, a national 

2 
46 


organization of multidisciplinary professionals dedicated to ending human trafficking and supporting its 

survivors using a public health perspective. 

A 15-year-old girl was admitted to Children's Healthcare of Atlanta a few years ago for a suicide attempt: she 

had ingested alcohol and a narcotic. It was only after she woke up in the intensive care unit and was 

interviewed by our social worker that we learned her depression existed in the context of human trafficking. 

What if we had never asked her about the circumstances of her life and the reasons for her depression? She 

would have been admitted briefly to a psychiatric institution and in all likelihood, discharged back into the life of 

exploitation. 

In this written testimony, I'd like to make 3 essential points: 1) Human trafficking is a healthcare issue, 2) 

Healthcare professionals need training in orderto be able to recognize and respond to human trafficking, and 3) 

the SOAR to Health and Wellness Act of 2017 would be a very effective strategy for addressing this widespread 

need for education and technical support. 

As you know, reliable estimates of the incidence and prevalence of human trafficking are lacking, but the best 

existing estimates suggest that millions of adults and children are involved worldwide(l) and the United States is 

a major destination country(2). Victims of human trafficking may experience a plethora of adverse physical and 

behavioral health sequelae, including traumatic injury from sexual and physical assault, work-related injury, 

sexually transmitted infections, non-sexually transmitted infections, chronic untreated medical conditions, 

pregnancy and related complications, chronic pain syndromes, complications of substance abuse, and 

malnutrition and exhaustion(3-5). Mental health consequences include depression with suicide attempts, 

flashbacks, nightmares, insomnia and other sleep problems, anxiety disorder, hypervigilance, self-blame, 

helplessness, anger and rage control problems, dissociative disorders, post-traumatic stress disorder, and other 

co-morbid conditions(6-8). In a recent study of youth survivors of sex trafficking 47% of the sample reported a 

suicide attempt within the past year( G). 

3 
47 


Despite the criminal nature of human trafficking and the desire oftraffickers to elude detection, research 

consistently shows that victims do have contact with medical professionals. In a study of adult and adolescent 

female sex trafficking survivors, nearly 88% had seen health care providers (HCP) during their period of 

exploitation(9). In another study of runaway and homeless youth involved in commercial sexual exploitation, 

over 75% had seen a provider within the past 6 months(10). But we also know that victims rarely self-identify 

when seeking medical care and may even deny victimization out of fear of the trafficker, lack of perception of 

their victim status, shame or humiliation(11). 

I believe that every day, hundreds of victims are visiting clinics and emergency departments all over the U.S., 

being treated for their conditions and discharged, with no one ever asking about the possibility of exploitation. 

Consider the 14-year-old trafficked boy who comes to a clinic with symptoms of a sexually transmitted infection. 

He might easily be treated for his symptoms and sent on his way, without anyone recognizing the possibility of 

commercial exploitation and taking the time to ask questions. Subsequently that same, unidentified victim may 

become HIV positive or sustain major traumatic injuries from a physical assault by a buyer. Consider the 35-

year-old Nigerian woman who comes to the emergency department with a head injury she claims occurred 

when she fell from a stepladder while cleaning. She is exhausted, passive, and clearly intimidated by the 'friend' 

who brought her. But none of the medical staff recognize these red flags and ask about possible labor 

trafficking. She returns to the home where she remains trapped as a domestic servant, working 16-hour days 

cleaning and cooking, without pay and without freedom. Each of these medical visits represents a critical missed 

opportunity. Help and services are within arm's reach, but go untouched. To prevent these lost opportunities, 

to offer exploited persons help in leaving their situation, it is imperative that the HCP recognize signs of at-risk 

youth and adults, ask questions appropriately and provide trauma-sensitive care to identified victims. 

Yet, research has demonstrated convincingly that many HCPs lack the knowledge and skills to identify and assess 

victims. In one study 63% of medical providers reported never having received training on how to identify 

4 
48 


human trafficking victims. Those who had training were significantly more likely to have confidence in their 

ability to do identify potential victims and to have encountered one in the past(12). Health care providers who 

participated in the study indicated that the greatest barriers to victim identification were a lack of training (34%) 

and lack of awareness of sex trafficking (22%). Further, a study of trafficking survivors demonstrated that the 

failure of HCPs to identify victims was often accompanied by behavior that hurt and humiliated victims, making 

it clear that a victim-centered, trauma-informed approach is not uniformly practiced(13). 

The H.R. 767, SOAR to Health and Wellness Act of 2017, would address the critical need for training of 

healthcare providers, enabling them to recognize victims and provide culturally appropriate, trauma-informed 

and victim-centered care. This training would be specific to the needs of varied professionals, including medical 

and mental health practitioners, public health professionals and social workers. And importantly, the training 

would be based on research, not emotion, on facts, not speculation It would use well-established adult learning 

strategies to facilitate changes in attitude, knowledge and behavior. The training would be formally evaluated, 

allowing for necessary changes to be made and effectiveness ensured. 

Essential to facilitating lasting change in any medical practice is support of the newly trained practitioners. This 

can be facilitated through implementation of specific protocols for providers to use when they suspect their 

patient is a trafficked person. H.R. 767 addresses this need by including in the pilot program the development of 

protocols for offices, clinics and hospitals, and the provision of technical assistance to organizations that 

implement a protocoL 

Training and technical support of healthcare professionals are critical components of U.S. efforts to curb the tide 

of human trafficking. Healthcare professionals have a unique role in preventing exploitation and identifying 

victims, as well as assisting them in obtaining services and escaping their plight Without evidence-based, highquality, easily available training and technical assistance, the very large, complex and unwieldy healthcare sector 

5 
49 


may lose track of the human trafficking issue and relinquish its role in fighting the battle against exploitation. 

We cannot allow this to happen. 

Thank you very much for allowing me to testify today. I appreciate the opportunity to explain that human 

trafficking is a healthcare issue, and that healthcare professionals need training in order to be able to recognize 

and respond to human trafficking. I strongly support H.R. 767, as I believe it would provide the infrastructure 

necessary to effect critical change. 

Submitted by 

Jordan Greenbaum, MD 

Stephanie V. Blank Center for Safe and Healthy Children 

Children's Healthcare of Atlanta 

975 Johnson Ferry Rd, NE, Suite 350 

Atlanta, GA 30042 

Jordan.greenbaum@choa.org 

404-785-3829 

References 

1. International Labor Organization. Global estimate of forced labour: Executive summary .. 2012;Available 

at: http:ljwww.ilo.org/wcmsp5/groups/public/---ed norm/---

declaration/documents/publication/wcms 181953.pdf Accessed Dec 23, 2014. 

2. United States Department of State. Trafficking in persons report. 2016;Accessed at 

http://www.state.gov/documents/organization/258876.pdf on July 26, 2016. 

3. Dank M, Yu L, Yahner J. Access to safety: Health outcomes, substance use and abuse, and service 

provision for LGBTQ youth, YMSM and YWSW who engage in survival sex. Urban Institute 2016. 

4. Greenbaum VJ, dodd M, McCracken C. A short screening tool to identify victims of child sex trafficking in 

the health care setting. Pediatr Emerg Care 2015;23(Epub ahead of print). 

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50 


5. Goldberg AP, Moore JL, Houck C, Kaplan OM, Barron CE. Domestic minor sex trafficking patients: A 

retrospective analysis of medical presentation. J Pediatr Adolesc Gynecol 2016;doi: 10.1016/j.jpag.2016.08/010 

[Epub ahead of print]. 

6. Edinburgh L, Pape-Biabolil J, Harpin SB, Saewyc E. Assessing exploitation experiences of girls and boys 

seen at a child advocacy center. Child Abuse Neglect 2015;46:47-59. 

7. Choi H, Klein C, Shin MS, Lee HJ. Posttraumatic stress disorder (PTSD) and disorders of extreme stress 

(DESNOS) symptoms following prostitution and child abuse. Vio Against Women 2009;15(8):933-951. 

8. Zimmerman C, Yun K, Shvab I, Watts C, Trappolin L, Treppete Mea. The health risks and consequences of 

trafficking in women and adolescents: Findings from a European study. London: London School of Hygiene and 

Tropical Medicine [LSHTM); 2003. 

9. Lederer L, Wetzel C. The health consequences of sex trafficking and their implications for identifying 

victims in healthcare facilities. Annals of Health Law 2014;23:61-91. 

10. Curtis R, Terry K, Dank M, Dombrowski K, Khan B. The commercial sexual exploitation of children in New 

York City: Volume 1: The CSEC population in New York City: Size, characteristics and needs. ln. National Institute 

of Justice, US Department of Justice; 2008. 

11. Greenbaum J, Crawford-Jakubiak J, Committee on Child Abuse and Neglect. Child sex trafficking and 

commercial sexual exploitation: Health care needs of victims. Pediatrics 2015;135(3):566-574. 

12. Beck ME, Lineer MM, Melzer-Lange M, et al. Medical providers' understanding of sex trafficking and 

their experiences with at-risk patients. Peds 2015;135(4):e895. 

13. Miller C. Child sex trafficking in the he lath care setting: Recommendations for practice. Paper presented 

at 25th International Nursing Research congress; July 27, 2014; Hong Kong. From Stoklosa H, Grace AM, 

Litten berg N. Medical education on human trafficking. Am Med Assoc J Ethics,2015;17;914-921. 2015. 

7 
51 

Mr. BURGESS. And thank you. We appreciate your testimony. 

And I thank all the witnesses for their testimony. 

We are now going to move into the question portion of the hearing. 

Just before we do that, I do want to recognize Dr. David Scott, 

who was a lead co-sponsor on the Good Samaritan Health Professionals Act. So, I certainly want to acknowledge his good work on 

that. 

I will get in trouble for doing this but I want to recognize the 

presence of Dr. Laura Sirott in the audience. She is a McCain Fellow from the American College of OB/GYN. She practices I think 

in Los Angeles, California and we are very grateful to have her attention this morning as the good folks at ACOG sponsor the 

McCain Fellowship to foster a greater understanding of public policy as it relates to health care. 

Dr. Levine, thank you so much for being here this morning. 

Thank you for your work. 

You know it was shortly after Hurricane Katrina struck on Labor 

Day weekend and I am sitting in my office a little bit north of Dallas, Texas, as a Member of Congress, but clearly there was a need. 

And I was somewhat startled to find out that if I made myself 

available down at Reunion Arena in Dallas, Texas, where I had a 

State license but I no longer carried liability insurance, I could be 

at risk. But if I traveled to Louisiana, where I didn’t have a medical license, I could volunteer all day long. 

Now, it turns out I was probably more useful as a triage individual, helping people get placement in nursing homes in the 

Metroplex who were in trouble in Louisiana but it struck me that 

day that there is kind of a patchwork that governs this. Is that correct? 

Dr. LEVINE. Yes, sir and it is hard for the physicians who may 

want to travel, for whatever reason, out of State but also within 

their own State. It is difficult when you are telling your insurer, 

liability insurer for your own practice, that if you are working outside of your practice spots, you may not be covered. So even if I 

am in the same State, some of the liability will not cover you within your own State. 

Mr. BURGESS. So just as a matter of course, a physician who 

wishes to volunteer in one of those types of situations, do they need 

to call their liability carrier first before they volunteer? 

Dr. LEVINE. Obviously, that would be very difficult and with the 

chaos of disasters, it is almost impossible to find out immediately 

what you would be covered by. 

Mr. BURGESS. Yes, in your situation in Boston, obviously, that 

would have been impossible in that chaotic moment. 

And I want to thank you for being there and responding. I will 

tell you, having watched that drama unfold on the television here 

on Capitol Hill, it was very, very difficult. And it really wasn’t until 

the medical professionals came out that night and gave the press 

conference that I had a sense that things were back under control. 

So, clearly, the people who respond in events like that provide, in 

addition to taking care of the people that are injured at the scene, 

it also provides care to those of us who are not on the scene, that 

52 

somebody competent is in charge and taking care of those who 

were injured. 

Mr. O’Connor, I want to thank you for your presence today. You 

have provided us information on something which I was unaware, 

was the dramatic increase, and if I understand your testimony correctly, that started around calendar year 2002, or is that just when 

we started keeping statistics? 

Mr. O’CONNOR. Well, the statistics have been kept longer than 

that. My testimony was germane to the IAFF’s fallen firefighter, 

when we started tracking statistics internally. That is just for 

those who actually have perished in our organization. That is not 

comprehensive of the entire fire service. 

Mr. BURGESS. I see. 

Mr. O’CONNOR. Statistics started being collected in 1950. The one 

study that I referenced began then and ended in 2009. The problem, unfortunately, has been the gathering of information has not 

been complete. There has been certain aspects in terms of risk factors, how long people served as firefighters, a lot of that other type 

of demographic data has not been collected. It has just basically 

been review of death certificates. 

Mr. BURGESS. Well, you certainly added good evidence to why the 

collection of data is important. 

Dr. Greenbaum, let me ask you. In your testimony you talked 

about a 14-year-old who came to an emergency room. When I practiced in Texas, if there was even any evidence of child abuse, I was 

required to call Child Protective Services. It wasn’t optional. It was 

an obligation in which case, I could perhaps incur legal liability if 

I didn’t do that. Would that not have been the case for this child 

that you referenced in your testimony? 

Dr. GREENBAUM. In many States, commercial sexual exploitation 

falls under the child abuse mandated reporting laws. It is not uniformly so. And I think all too often, people don’t ask the questions 

about the background and what led to that sexually transmitted infection. So, they don’t get the information that would tell them the 

child has been exploited, requiring a report. 

Mr. BURGESS. Well, I thank you for your testimony and for your 

work on this. 

It wasn’t in this committee, but, on the Helsinki Commission a 

year and a half ago, we had a very compelling hearing on this issue 

of human trafficking and both of the women who testified—it was 

very courageous for them to come forward—it was their interactions with the healthcare system, where the evidence and clues 

were missed. One of the things that just struck me during that 

hearing was each of those witnesses stated that their trafficking 

was done by a family member. So merely the fact that it is a family 

member who brought someone in for care does not mean you don’t 

have to worry about that. In these two cases, it was a direct result 

of their family member doing the trafficking that caused them to 

be in the emergency room or the clinical setting where they were 

that day. 

And the other thing that struck me is the length of time that it 

went on before there was actually recognition. So I suspect that is 

what you have brought to us today is extremely important and 

something the committee clearly needs to look at. 

53 

I am going to yield back my time and recognize the ranking 

member of the subcommittee, Mr. Green from Texas for 5 minutes 

for questions, please. 

Mr. GREEN. Thank you, Mr. Chairman. 

Mr. O’Connor, welcome to our committee and I want to thank 

you and your fellow firefighters across the country. If I hadn’t gotten into politics, I would probably have been a firefighter since my 

grandfather and my two uncles were. 

But cancer continues to be a devastating effect on individuals 

throughout our country. The American Cancer Society estimates 

that 692,000 Americans will die from this horrible disease. And 

these efforts—last Congress we passed the Beau Biden Cancer 

Moonshot, which was part of our 21st Century Cures in support in 

improving the lives of all Americans. 

The Firefighter Cancer Registry, though, is really important because there is an incidence of firefighters, even though nowadays 

they have a lot better equipment, when they go into a fire, they 

don’t know what they are breathing. It could be chemicals, particularly in an area like I come from because we have a chemical industry. 

What is currently known about the link between firefighter occupation and cancer? 

Mr. O’CONNOR. Well I mean that is a very good question and 

there is multiple answers for it. 

First, their industry has changed so much in the 31 years I became a firefighter. You are absolutely right. If this room itself 

caught on fire, there is carcinogens in just about everything, toxic 

flame retardants. For wildland firefighting, people just think that 

it is the trees and it is nature burning. In many cases, it becomes 

a conflagration, like what occurred in Colorado Springs, where 200 

houses went up. The World Trade Center, the collapse, the particulates. 

Firefighters are exposed to it from almost the minute they walk 

into a fire station. One of the problems we encounter is diesel exhaust just in the station from the equipment starting and shutting 

off. Obviously, when they get on the scene, they have exposure 

through inhalation, through breathing. Certainly, the technology of 

self-contained breathing apparatus has improved and lung cancer 

has actually diminished a little bit over the last generation because 

it was a known risk. 

But what we are finding now is that people are getting exposed 

through, essentially, their sweat, basically through their clothing 

absorbing into the skin, through so many different sources. It isn’t 

just the inhalation risk. It is almost every aspect of it. 

The other aspect is the type of fires have changed so much and 

the responsibilities of firefighters. Many years ago, it was simple 

construction. People understood the risk. But today it is hazardous 

materials response, it is EMS. There are so many different things, 

every measure of disaster. It was referenced the situations down on 

the Gulf Coast, the same thing with Super Storm Sandy. 

We are exposed and what this registry does differently than any 

other study is it takes almost every factor into account, not just 

people contracting and dying, but it will actually take how long 

somebody is a firefighter, what type of firefighter. Are they large 

54 

city firefighters, where they may have more responses and more 

varied responses? Are they volunteer, paid on call, wildland? All 

those demographics are going to be taken into account. So, hopefully, over a period of time, we will actually be able to assimilate 

the information and digest it and make it useable to prevent cancers in the future. 

Mr. GREEN. Thank you. Thank you all for bringing the bill before 

us. 

Dr. Levine, because our chair coming from Houston, I remember 

very well Hurricane Katrina. And at the Astrodome in Houston we 

received a quarter of a million folks from Louisiana. They brought 

us good gumbo, too, and we sent them back with good barbecue. 

My concern about the bill that would just give protection from 

lawsuits and we have a patchwork of laws with States. Louisiana 

is different from Texas, for example, maybe. But on the Federal 

level, if we could give these tort claims protections under a Federal 

act, would that solve the same problem? 

Dr. LEVINE. I believe it might and I am saying might. I mean 

there are still State laws that are fairly strong in this area so, they 

would still be there for protection. But I would think that having 

one overarching one is what we are after here, one overarching 

Federal law that would tell the first responders it is OK to be there 

and do what you need to do. 

If you are relying on State law, you may or may not know what 

is going on at the moment and that time is really the key to any 

act and any treatment of an individual. 

I mentioned that 14 minutes, and 22 minutes, and minutes to get 

somebody to the OR, when we are talking about a large loss of 

blood, either you do it or you don’t. There is no questions. There 

is no—you know you don’t have time anything except to respond. 

Mr. GREEN. An example is we worked for years for the Federally 

Qualified Health Clinics to have volunteer doctors so they could 

provide for the underserved in giving them Federal tort claims protection by volunteering in those clinics. So that was just an example. 

Mr. Chairman, I would like to yield my last 2 seconds to my colleague, Congressman Sarbanes from Maryland. 

Mr. SARBANES. I thank the gentleman for yielding. I don’t know 

that I am going to be here when it comes time. 

I just wanted to thank you, Kevin. You mentioned your 16 years 

of service to the residents of Baltimore County. I represent those 

folks and, on their behalf, I want to thank you and for your extraordinary advocacy on all of these issues. 

And I yield back. 

Mr. BURGESS. The Chair notes the gentleman’s time had expired 

when he yielded time that didn’t exist. 

Mr. GREEN. Well, I had 5 seconds. 

Mr. BURGESS. So, it comes off future time. 

I do now want to recognize the gentleman from Virginia, Mr. 

Griffith, for 5 minutes for your questions, please. 

Mr. GRIFFITH. Thank you very much. I do appreciate it. I appreciate all of you all being here. These are all important topics. I was 

talking earlier, I had carried legislation related that also dealt with 

hypertension but also cancer, when I was in the State legislature. 

55 

The dental program, let me start there, although I have got lots 

of questions and I tend to be somebody that reads, looks at things, 

and tries to sort things out. One of the things that it said is that 

among the groups that can get some assistance from this bill would 

be ones that are affiliated with an academic institution and that 

are exempt under the taxes and offer free dental service programs 

to underserved populations. 

We have, in my district, a group that sets up weekend medical 

clinics at a large field and they have a dental component with a 

number of dentists who come in and give their entire weekend, and 

they bring all the equipment, and they have a mobile unit, and so 

forth but they are not affiliated, as far as I know, with any academic institution. Is that something that is critical, you think, to 

the bill or can we maybe carve out an exemption if they are longstanding providers of free medical, or in this case, dental care to 

an underserved area? 

Dr. WATSON-LOWRY. This bill does not say that you have to be 

associated with an institution. It is basically providing local solutions to local problems. 

So if that particular group wanted to be able to apply for funding, they could apply for funding also. 

Mr. GRIFFITH. All right, I do appreciate that. 

I have got an issue on the Good Samaritan Section 2, if I might 

ask a couple of questions on that. And I guess the first one is 

that—I don’t think there would be any problem with it—I think the 

language might need to be tightened up just a little bit because it 

appears that it might actually say that, if they are on their way 

to the scene and they are driving 85, 90 miles an hour and they 

run over a pedestrian, they might be covered. You wouldn’t have 

any problem—you are trying to get to the folks who are providing 

medical care, once they get there, as I understand it. It think that 

is the intent of the bill. Would you not agree that is the intent of 

the bill? Just to make sure we are not getting folks in trouble who 

are trying to be good guys. 

Dr. LEVINE. Yes, I would agree. Thank you. 

Mr. GRIFFITH. All right and I do want to work on that. 

Likewise, and it may need to be tweaked a little bit, it might be 

in there, would you have any problem if we made it clear that the 

medical care they were providing was at least within the scope of 

their license, so that—I mean I know, obviously, the health—you 

mentioned mental health, which I think is important and a lot of 

folks can do that, but I am not sure I want my chiropractor trying 

to reattach my fingers. 

Dr. LEVINE. I would agree always with the scope of practice within their license, yes. 

Mr. GRIFFITH. All right and I do appreciate that. 

And one thing that I think because of your background, Dr. 

Greenbaum, that might have been misunderstood but my reading 

of the bill does not say it is just for minors who are sexually trafficked, it is looking for adults who you know they might be 18 or 

19 who are being sexually trafficked, too. Is that your understanding as well? 

Dr. GREENBAUM. Absolutely, the bill includes both adults and 

minor sex and labor trafficking, yes. 

56 

Mr. GRIFFITH. And obviously, theoretically, minors are probably 

more vulnerable but if you had somebody that has been in the system as a person who has been trafficked or enslaved in that industry, they could be an adult but have been in for a while or it could 

be somebody with diminished—some forms of diminished capacity. 

Dr. GREENBAUM. Absolutely. You make a very good point. A lot 

of the children that we see age out and so they are 19, 20, 21 but 

they started when they were 15. So a lot of adults were kids when 

they started. And then a lot of adults are very vulnerable because 

of disabilities, mental health issues, other reasons. And so yes, but 

this bill will cover everything. 

Mr. GRIFFITH. This bill will cover everything. 

Well, I appreciate it and these are all, I think, bills that are trying to do good things for the American people and I appreciate you 

all’s testimony here today. 

And Mr. Chairman, I yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair recognizes the gentlelady from Florida, Ms. Castor, 5 

minutes for questions, please. 

Ms. CASTOR. Well, thank you, Mr. Chairman for organizing this 

hearing and thanks to all of our witnesses who are here today. 

These are all very positive ideas and bills. 

And Mr. O’Connor, thank you for your long-term service. 

And Dr. Levine, thank you. I am so grateful that you were in the 

right place at the Boston Marathon and that is quite a story. So, 

thank you for being there. 

I wanted to focus on Congresswoman Kelly’s bill. I think it is 

such an important reauthorization. And I want to thank her and 

Congressman Simpson and ask Dr. Watson-Lowry a few questions 

because I have seen dentists in Florida, the Florida Dental Association, they really do a wonderful job of providing free care. In fact, 

I have a few statistics here that kind of blew me away. 

The Florida Dental Association’s Mission of Mercy Event, just 

over the past couple of years in Pensacola, that is a pretty small 

town in the Panhandle, their events saw more than 1,800 patients 

and provided more than $1.4 million in donated care just in March. 

Similar, in Jacksonville, saw 2,800 patients, where they provided 

$2.75 million in donated care and there were almost 2,500 volunteers. 

In my hometown of Tampa, there are some outstanding dentists 

with the public service interest, along more with more health. 

Their event saw more than 1,600 patients; 8,000 treatment procedures worth over $1 million; more than 350 dentists, registered 

dental hygienists who volunteered; and there were 1,000 support 

volunteers. 

So there are very serious gaps in dental care in America. And I 

wanted to ask you to talk about that, this troubling lack of access 

to dental services and how we have to rely on these volunteer initiatives and describe your experience with providing free dental 

care in your community. 

And as we talk to our colleagues about the importance of making 

this investment through the CDC to local communities, what are 

the long-term benefits? Isn’t there a return on investment here? 

57 

Dr. WATSON-LOWRY. Well, thank you for your question. I just 

want to say last year I went to the Florida Dental Association 

meeting, and it was wonderful, in Orlando. I met some new friends 

down there. 

But yes, it is a wonderful question. In Illinois we have a MOM’s 

Event approximately every 2 years because it takes so much to set 

it up and it costs so much. We have to get sponsors and that type 

of thing. Our last event we had about 2,000 patients visits and did 

more than $1 million worth of service. So, that is something that 

is going on across the country. 

What this bill does is bring the CDHCs online a little bit more 

and increasing their numbers. What we have is it kind of bridges 

that gap. There are a lot of patients that don’t know where to get 

care. There has been an increase in Medicaid funding but if a patient has a problem but they don’t know where to go, then the first 

place they go is to the emergency room. 

And so we are trying to—this bill helps to cut down on those 

emergency room visits so that patients can receive care at a dental 

office, or in a practices, an FQHC. That care may cost $70 versus 

an emergency room visit that is $700 or more. And when they go 

to the emergency room, as I mentioned in my testimony, they just 

get a prescription for an antibiotic and a pain medication and then 

they are back in the emergency room in a couple of months or a 

month or so and they haven’t gotten that care. 

So, this addresses that situation. It puts the CDHC in place so 

that they can help those patients find the proper place to receive 

care, make sure they have transportation for that, and also talk to 

them about maybe if they have some anxieties about going to the 

dentist and help them through those issues, and teach them about 

prevention. 

That is one of the key things that I see in my practice. One of 

the first visits I talk to them about well, you have this cavity; it 

is not just about treating that cavity. How did that cavity get 

there? And a lot of my patients are one peppermint on Sunday in 

church every Sunday and that is causing them to lose all of their 

back teeth. And it is costing them, especially seniors, it is costing 

them a lot of money. 

So, everything that we have in here is going to help bridge that 

gap. 

Ms. CASTOR. And there is an important education element that 

comes with all of this—— 

Dr. WATSON-LOWRY. Huge. Huge. 

Ms. CASTOR [continuing]. So that they are not returning patients. 

Dr. WATSON-LOWRY. Exactly. Exactly. I don’t know if I have the 

time but I have a friend that was in Alaska and saw the Native 

Americans. And he went to the grocery store and three of the four 

rooms were stacked from floor to ceiling with pop. The children 

were drinking pop all day. They weren’t drinking milk because that 

was $7 for a half a gallon of milk. And so all of their cavities—they 

were losing their front teeth because they had cavities in their 

front teeth from drinking the pop. 

And so just the education, letting them know this is what is 

causing the problem and helping them find a solution to that and 

58 

teaching the parents, teaching the kids what to do and what not 

to do. That is a huge component. 

Ms. CASTOR. Thank you very much. I yield back my time. 

Dr. WATSON-LOWRY. Thank you. 

Mr. BURGESS. The Chair thanks the gentlelady. The gentlelady 

yields back. 

The Chair recognizes the gentleman from Kentucky, Mr. Guthrie, 

the vice chairman of the subcommittee, 5 minutes for questions. 

Mr. GUTHRIE. Thank you, Mr. Chairman. I appreciate the recognition. 

And first to Mr. O’Connor. Should this legislation be enacted, the 

CDC will be tasked with collecting data from all over the United 

States. Can you please share how the publicity for firefighter’s data 

solicitation will take place and how do you foresee the data collection taking place? 

Mr. O’CONNOR. Well, the bill addresses that. The CDC, along 

with NIOSH, will get with stakeholders from the fire service. I 

would imagine that would include organizations representing professional firefighters, a managerial component of the fire service, 

the International Association of Fire Chiefs, the National Volunteer 

Fire Council. Collectively, we have about 1.1 million firefighters 

across the country. I imagine that they will be sitting down with 

the CDC, based on the direction articulated in the bill and try and 

come up with a process whereby the data can be aggregated, probably department by department, in terms of if a department chooses to participate, they would be able to essentially provide the data 

from their employees, their retirees, because that is a huge component of it as well, to make sure that you have got length of service 

of all the people involved and do it in a fashion that essentially 

people are de-identified; that you are able to basically get the data, 

the information on people but protecting their confidentiality. 

I could envision that you know if there needs to be a deeper dive 

in terms of direct information, that there may be a process in place 

whereby the researchers at CDC or the people keeping the database would be able to contact these people but it would be on a voluntary basis. 

Mr. GUTHRIE. OK, thanks. 

Let me go to Dr. Watson-Lowry. You mentioned in your testimony that most Medicaid dental programs fall short of providing 

the amount and extent of care needed by low-income patients. According to Kaiser Family Foundation, even States with extensive 

adult dental benefits, patients have a difficult time finding a dentist. 

I know a lot of dentists don’t accept private insurance and some 

accept private but not Medicaid. And could you kind of walk 

through why it is hard to find a dentist that does Medicaid? 

In Kentucky, I have visited some. We do pediatrics and, although 

they are not celebrating their reimbursements, don’t get me wrong, 

but the biggest issue that they talk about is booking chair time and 

having no-shows. That is one of their biggest issues. 

Dr. WATSON-LOWRY. Thank you for that question. 

Yes, this bill addresses that with the community health coordinators. They help them navigate those situations so they help them 

find someplace that takes—in Illinois we have like three different 

59 

kinds of coverage for Medicaid, which makes it very complicated in 

the paperwork with the doctors. So but when they can find one, 

they have to be able to find transportation. So the CDHC helps so 

that that chair time doesn’t go empty and so that improves the utilization of the participators that are functioning there. It helps that 

whole situation and improves care and it also cuts the cost because 

you can see more patients in less time. 

Mr. GUTHRIE. Good. Thank you. Because the issue is that we 

have to overbook, therefore, it is not good for our patients who 

come in and have to wait—— 

Dr. WATSON-LOWRY. Exactly. 

Mr. GUTHRIE [continuing]. Because they don’t distribute themselves, the no-shows, and sometimes there is just no one there and 

they are not using their chair. So, it is a thing they are trying to 

thread the needle on. 

Dr. WATSON-LOWRY. There are some studies that have shown 

that they have reduced the no-show rate by 18 percent, the 

CDHCs. 

Mr. GUTHRIE. Perfect. Perfect. 

I am going to get a couple more questions in. So, Dr. Levine, why 

is it not sufficient to require medical volunteers to present their 

medical license on site? 

Dr. LEVINE. Well, I assume this is a combination of two things. 

One is your medical license—— 

Mr. GUTHRIE. I mean, if it is a large disaster, not just general. 

Go ahead, I am sorry. Go ahead, please. 

Dr. LEVINE. Your license is one thing but liability coverage is a 

separate issue. Here, we are just dealing with the liability issue as 

to whether or not the physician is there to respond only if he or 

she is covered potentially. It has nothing to do with presenting 

their license only. What does that mean and who is going to verify 

that license, at the time of the disaster? That is very difficult and 

it is so chaotic that it is hard to do. And sometimes that will even 

take a few days in a normal situation. 

Mr. GUTHRIE. Right. 

Dr. LEVINE. That is the difficulty. 

Mr. GUTHRIE. OK, thanks for that. 

And then Dr. Greenbaum, in your testimony you say that research consistently shows that victims of trafficking do have contact with medical professionals. Are there certain health providers 

and certain health settings who are more commonly in contact with 

suspected trafficking victims? 

Dr. GREENBAUM. There has been a limited amount of research 

but probably the most relevant research shows that about twothirds show up to emergency departments in hospitals but a quarter of them also go to public health clinics, Planned Parenthood, 

sexually transmitted infection clinics, and some to their own doctors like their gynecologists or their pediatricians. So it really runs 

the gamut, but I would say that probably emergency departments 

and public health clinics are the biggest. 

Mr. GUTHRIE. OK, thank you. I appreciate that. 

My time has expired, and I yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

60 

And the Chair recognizes the gentleman from Maryland, Mr. 

Sarbanes, for 5 minutes for questions, please. 

Mr. SARBANES. Thank you, Mr. Chairman. I want to thank the 

panel for being here today on these very important proposals that 

I think you see broad agreement of support for. 

I wanted to ask you, Kevin, and again, thank you for not just 

your service in Baltimore County but your advocacy on these issues 

and being a terrific resource for so many of here on the Hill when 

it comes to issues that affect firefighters of all categories across the 

country. 

I think I have a pretty decent understanding of what the registry 

offers and, obviously, we support it. I was wondering if you could 

speak a little bit to what kinds of advances, in terms of technology, 

and equipment, and other things are available to firefighters when 

they are going into these situations that can help to reduce some 

of the risks for cancer and other diseases. Because I imagine, as 

you become more and more aware of the heightened risk for these 

things, that you are thinking about that as you come on to the 

scene and that there has probably been some advances with respect 

to that. 

Mr. O’CONNOR. The best way to answer that question is through 

example. When I came to the fire service in 1985, I was issued a 

helmet, a turnout clip coat, and three-quarter rubber boots. So 

what that meant is every time I went into a fire, large portions of 

my body were exposed. If something happened below the waist, essentially, any type of water, wash off contamination, could go down 

into those boots. 

Over the years, we made a determination that because of some 

of the diseases, cancer and other diseases, were being caused by 

those type of exposures, that it made sense to more fully encapsulate a firefighter. 

So, we came up with hoods that protect the neck and the ears. 

But unfortunately, technology hasn’t advanced to the point that it 

is a complete coverage, a complete shield. You still, as I said in my 

testimony, you can absorb materials, toxic soups, if you will, in 

your sweat, things of that nature going into your pores. That serves 

as a single example. 

A successful story is with respect to lung cancer. Many years before I came to fire service, people went into buildings without selfcontained breathing apparatus. They were inhaling everything. 

Over the years, the advancement in that technology has been 

marked in terms of the duration with which people can stay in that 

type of an environment. But even that has—it is not drawbacks but 

its limitations. For years, people thought that once the fire was 

done, you took your breathing mask off and you walked around. 

But the residual smoke and toxicity that was there continued to 

cause diseases. 

Within the fire station itself, the diesel exhaust, which I referenced, now we have what is called a Nederman exhaust system 

that actually attached to the exhaust. 

So as things manifest and we are able to make determinations, 

the technology ultimately catches up to it. The problem is, the way 

that people are being exposed to these toxins now is very different 

than it was even 15 years go. So, essentially what we need, we 

61 

need the information and data on these different types of cancers. 

It is not just a simple cancer. It is like a prostate cancer or a colon 

cancer. We are having clusters of cancer of firefighters that are exposed to benzene, for example, and they develop a very specific 

type of liver cancer which occurred, actually, in Baltimore many 

years ago. 

So this information really allows us to take a deep dive and look 

at it and essentially work with our partners that manufacture 

clothing, the researchers to come up with things to better protect 

firefighters and, essentially, try to de-risk it as much as possible. 

Mr. SARBANES. Well, thank you for that answer, and I think 

what it shows is the attention, through this registry, to the issue 

can heighten the awareness so that we can have more technologies 

developed but also points to the need for investing the resources 

that can allow for better protection and better protective equipment 

and so forth. And actually even potentially extends to—I know 

there is issues around sort of flame retardant and other kinds of 

things that are put onto furniture. And in theory, that is supposed 

to help the situation when a fire breaks out. But to extend its generating smoke and other things that can be inhaled that are even 

more toxic than if you didn’t have those retardants in place. 

So it gets a conversation going. I don’t know if you want to respond to that. 

Mr. O’CONNOR. Yes, very quickly. Our organization has been in 

the forefront of trying to expose some of the problems with flame 

retardants and the potential health hazards they pose not just to 

firefighters but to ordinary citizens, as well. I think, at the last 

count, 26 States have enacted some type of law, either regulating, 

forcing disclosure on flame retardants. Legislation was just passed 

in Maryland with respect to its impact on children. So, it is something that we are very involved in. 

But you are absolutely right. That is a hazard not just to firefighters but to the general public. 

Mr. SARBANES. Thank you. I yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair recognizes the gentleman from New York, Mr. Collins, 

5 minutes for questions, please. 

Mr. COLLINS. Thank you, Mr. Chairman. I ask unanimous consent to enter into the record letters of support for H.R. 931 from 

the International Association of Fire Chiefs, the Congressional Fire 

Services Institute, the National Volunteer Fire Council, International Association of Fire Fighters, and the National Fallen Firefighters Foundation. 

Mr. BURGESS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. COLLINS. Thank you. 

So, Mr. O’Connor, I mean, we touched on this briefly, but I know 

we have, just in my one county alone, 99 volunteer fire companies. 

And when we look back at what was the standard procedures 20, 

30 years ago versus today, I always think back when firefighters 

would tell me they would keep their turnout gear in their car, in 

the trunk. So they would be fighting a fire today and God knows 

what chemicals they could be associated with. And we certainly 

62 

had a lot of chemical fires in the Niagara Falls area. You know 

they would finish the fire and just throw the turnout gear into the 

trunk of the car and drive their kids to baseball games and the 

like, having no clue that there could be an association of what was 

on that turnout gear then exposing their families to where we are 

today with a lot of protocols. Some stations follow these protocols 

better than others. 

But if you could comment just a little bit. And I have got a sign 

in my office that says in God we trust; all others, bring data. And 

where this data will be taking us, especially with the manufacturers of some of this gear, as we are learning and, certainly, with the 

data, we will continue to learn more to produce safer equipment 

and better apparatus. 

If you could maybe just where we have gone just in the last 10 

years and where this might take us. 

Mr. O’CONNOR. Well, first, I again really want to thank you for 

your stalwartship on this issue. It is very important. And as you 

have indicated, data is what really matters with respect to being 

able to do this tracking and making these determinations. 

And you are absolutely right. I mean part of it you can’t get 

around of it, is resources as well. You know I mentioned my ensemble when I first went to the fire department. You are 100 percent 

right. We did not adequately clean our turnout clothing. We were 

afforded one set of turnout clothing. If you were busy, you went 

from one fire immediately to the next fire and the aggregation occurred. 

You were consistently wearing it, whether it was a fire call—if 

you were going out on a cold evening for an EMS call, what did 

you put on? You put on your turnout coat. Your previous calls 

might have been at a chemical plant. It might have been at a fire 

where you were exposed to different things. So people were consistently re-exposed to the carcinogens and the toxins that they encounter on their calls. 

Beyond that, you are also correct in the volunteer fire service but 

also in a career fire service. If you were detailed from one station 

to another, you took your turnout clothing, you threw them in the 

car, and you were continuing re-breathing in all of that. It is a real 

hazard. 

The sad aspect, though, unfortunately, is we have not been able 

to quantify that. We have not been able to really make any direct 

determination. We know it is hazardous but, in the absence of good 

data, we haven’t been able to do that. 

All the studies that I have mentioned are very comprehensive 

studies in terms of just one simple analysis. They looked at the 

death certificates and they made their determinations. What your 

bill, hopefully, will be able to do is provide enough data, enough demographics in terms of work and risk, what people actually do that 

we can factor that into the equation and try to make these determinations. 

I do believe that a lot of the companies that do manufacture this 

type of equipment are partners with the fire service. Certainly, we 

do have some issues at times but, at the end of the day, they can 

only design equipment that is safe and healthy if they have the 

data to recognize how we can better avoid these hazards. 

63 

Mr. COLLINS. So another question is we have seen the cancer, the 

prevalence of cancer. Are we seeing it while a firefighter is currently serving or after they have left the service? 

Mr. O’CONNOR. Both. Some of it manifests early. The one statistic that I put out was a 159 percent increase of men firefighters 

between 30 and 49 years of age. Most of those people are still in 

the service but a lot of these diseases are manifesting afterwards. 

A good example is in your home State, the aftermath of 9/11. We 

lost 343 people that day. Unfortunately, in the days since 9/11, 

1,590 firefighters have contracted some form of cancer. Many of 

those people have retired from the service and the symptoms are 

just coming now. And that is one example. It is a very graphic example but the same thing is applicable throughout the country in 

departments large and small, where you will see the aggregation 

and accumulation of people, the hazards that they have encountered over the years, manifest in terms of developing some type of 

cancer years after retirement. 

Mr. COLLINS. Thank you for your testimony. My time has run 

out, and I yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair recognizes the gentlelady from California, Ms. Eshoo, 

5 minutes for questions, please. 

Ms. ESHOO. Thank you, Mr. Chairman, and thank you to the witnesses, not only for being here today but the work that you have 

done over your entire adult life in key areas; great contributions to 

the country. 

I also want to compliment my colleagues that are sponsoring the 

four bills today for their work because I think that they are offering a good legislation. 

I want to start with Dr. Watson-Lowry first. You are aware that 

the House recently passed legislation that would allow States to 

pick and choose which essential benefits, health benefits they require insurance plans to cover. Pediatric oral care is currently one 

of the ten essential health benefits covered in the Affordable Care 

Act. The House-passed bill also makes cuts to Medicaid, which currently requires coverage of early and periodic screening, diagnostic 

treatment, the EPSDT—we have abbreviations for everything 

here—including dental screening. 

So what I would like to ask you to at least touch on is the continuing need for programs like these to be funded by the CDC’s 

oral health promotion and disease prevention grants for people who 

are currently served by these programs. 

And, also, touch on the benefits that people will be—you know 

on what people are going to be forced to make changes to Medicaid 

that could result in the elimination of these benefits. I think that 

we have Members here that may not even realize that that is in 

the bill that passed the House. But nonetheless, it is one of the essential health benefits. 

So, would you comment on that please? 

Dr. WATSON-LOWRY. Thank you for your question. 

Just one point is the children being covered in the essential 

health benefits that almost slipped out. And the ADA noticed that 

64 

and it was like the 11th hour and we were able to get that back 

in. 

That is critical for children to receive care. When children lose 

their teeth at an early age, that can affect their self-esteem in 

school. Another thing is that that is the highest reason that children missed school and a lot of people don’t realize that. That is 

the most common chronic disease is dental cavities. And so when 

children are missing school, the other problem is now, at least in 

Illinois, the schools don’t get the funding for that child for that day. 

So, it has repercussions that—— 

Ms. ESHOO. There are repercussions. 

Dr. WATSON-LOWRY. Exactly—that follow behind those things. 

As far as funding for adults, patients that have diabetes, there 

is a clear connection between diabetes and periodontal diseases. 

Ms. ESHOO. There is. 

Dr. WATSON-LOWRY. So even some of the insurance companies 

have started covering the adults that have diabetes for them to 

come in three times a year instead of twice a year because they 

found the savings in that. You can save thousands of dollars a year 

with patients that have chronic conditions like diabetes. And when 

we reduce their chronic dental conditions, it helps to improve their 

overall health. 

So, it is critical that patients receive care and also these preventative care issues that we have. And we are hoping that those 

things will help the whole population of the United States, along 

with, as I mentioned before, the educational piece, helping prevent—— 

Ms. ESHOO. Thank you very, very much. 

To Dr. Martin Levine, first, I want to thank you for your service 

as a first responder during the Boston Marathon bombing in 2013. 

What I want to ask you is: Does current liability law, in your 

view, actually discourage health professionals from volunteering 

during times of emergency? I mean, is that even on their mind or 

do they know and not go, or know and be hesitant, or just go? 

Dr. LEVINE. Thank you for the question. 

Unfortunately, I think it is on their mind. I think they do react 

to it. There were several articles in the New England Journal of 

Medicine following the Boston event. One of them was from an individual who texted his mother. He was working in the medical 

tent as a volunteer for the first time as a physician. And his mother texted him back: Get out of there as quickly as possible. And as 

he was leaving, it was only because the individual who was on the 

microphone in the tent, who is not a physician, said please don’t 

leave your patients at a time of crisis that he turned around and 

said maybe I shouldn’t leave. 

But one of the things that was on their minds was my responsibility is in the medical tent, where the runners are, not anywhere 

else. So, I am not leaving the tent to see what happened outside. 

So there were physicians in the tent who did not go elsewhere. 

By the time I got back into the medical tent, most of the triage 

was finished on the site but a lot of the physicians were no longer 

there. So, yes, it is absolutely on their minds. 

Ms. ESHOO. There is the answer. I am going to submit further 

questions to the witnesses, as Members are allowed. 

65 

And with that, I want to thank you again for what you do. 

I yield back. 

Mr. BURGESS. The Chair thanks the gentlelady. The gentlelady 

yields back. 

The Chair recognizes the gentleman from New Jersey, Mr. 

Lance, 5 minutes for questions, please. 

Mr. LANCE. Thank you, Mr. Chairman, and good morning to the 

distinguished panel. And I will ask several questions and if they 

have already been answered, I apologize. We are between two subcommittee hearings this morning. 

To Mr. O’Connor, I understand that there has already been an 

in-depth study of cancer in over 30,000 participants in three major 

U.S. cities. Mr. O’Connor, can you tell me which cities have been 

studies and are additional studies necessary? 

Mr. O’CONNOR. Let me answer your second question first. 

Mr. LANCE. Yes. 

Mr. O’CONNOR. Yes, additional study is definitely needed. 

Mr. LANCE. That is Mr. Collins’ bill. 

Mr. O’CONNOR. Absolutely. 

Mr. LANCE. Yes. 

Mr. O’CONNOR. The three cities that were utilized were San 

Francisco, California; Chicago, Illinois; and Philadelphia, Pennsylvania. 

Mr. LANCE. I see. 

Mr. O’CONNOR. They were chosen, I imagine, by the researchers 

at that point in time because they represented different parts of 

the country—— 

Mr. LANCE. I see. 

Mr. O’CONNOR [continuing]. And the call volumes there were 

substantial. 

But what I would note and one of the reasons why additional 

study is needed, they are three relatively similar type fire departments, large metropolitan areas. Certainly, there is different hazards between cities but very, very extensive call volume during the 

time of the study. 

Park of what we are trying to—what Mr. Collins’ bill is trying 

to accomplish is looking at the broad fire service, where people 

work in smaller communities; where people have a higher number 

of call volumes, where perhaps they have a greater incidence of 

hazardous materials response; whether they are responding to 

wildland fire; the whole aspect of it. Those three cities, essentially 

are relatively homogenous in terms of their call load. 

The other aspect that I had mentioned a little bit earlier is that 

a lot of the employment demographics weren’t taken into account 

in terms of how long people remained a firefighter, where they 

were assigned, what their specific duties were, ages when they 

were employed, et cetera, and that is what we are hoping to accomplish in the cancer registry. 

Mr. LANCE. In the part of New Jersey I represent, not exclusively 

but predominately, firefighters are volunteers. 

Mr. O’CONNOR. Correct. 

Mr. LANCE. I represent 75 municipalities. If we each represent 

three-quarters of a million people, that is roughly 10,000 in each 

66 

of the municipalities. And so it is different from large metropolitan 

areas. 

Should any study include the effect on volunteer firefighters? 

Mr. O’CONNOR. That is included in this, volunteer as well as paid 

on-call. 

Mr. LANCE. Yes. 

Mr. O’CONNOR. So, absolutely. And in fact, your colleague read 

into the record a letter from the National Volunteer Fire Council, 

which represents volunteer firefighters supporting legislation for 

that reason. 

Mr. LANCE. Thank you. 

To Dr. Levine, I understand your practice is in Bayonne in Jersey City. Is that right? 

Dr. LEVINE. That is correct, sir. 

Mr. LANCE. You ought to move to Westfield or Somerville in the 

district I serve. 

Dr. LEVINE. I live in your district. 

Mr. LANCE. Where do you live? 

Dr. LEVINE. Short Hills. 

Mr. LANCE. Short Hills. Do you want me to wash your car or 

mow your lawn? 

Dr. LEVINE. That won’t be necessary, sir. 

Mr. LANCE. That won’t be necessary. I am pleased to hear that 

since the last time I mowed a lawn was sometime in the middle 

of the last century. 

Many States have reciprocity agreements with their neighboring 

States, Dr. Levine. Perhaps wouldn’t it be easier for States experiencing a large-scale disaster to ask their neighboring States to send 

medical volunteers? And I am interested in your expertise, based 

upon what you have done, including at the Boston Marathon. 

Dr. LEVINE. The bill explicitly recognizes the State laws that provide a stronger protection to the volunteer health professionals but, 

as you know, some of those States are not as strong. 

And as an example, we spoke about 9/11 in another context but 

having, unfortunately, been involved, I guess in some ways in that 

disaster as well—— 

Mr. LANCE. Yes, of course. 

Dr. LEVINE [continuing]. I was at Liberty State Park after being 

at Bayonne Hospital that had some of the first wounded. 

Mr. LANCE. Yes. 

Dr. LEVINE. But there was a group of surgeons who were taking 

a course, a CME course to pass their recertification boards at the 

Meadowlands. They took a bus over to Liberty State Park and set 

up a triage unit that would have been very valuable, had there 

been more injured personnel because they were coming over by 

boat to Liberty State Park to evacuate lower Manhattan. They 

were from all over the country. 

And the problem, potentially, with neighboring States is that the 

reciprocity is usually one neighboring State to another like New 

York and New Jersey. 

Mr. LANCE. Yes. 

Dr. LEVINE. They were from Oklahoma, et cetera. 

Mr. LANCE. Yes, of course. Very good. Thank you. 

67 

I won’t have time to ask questions of Dr. Watson-Lowry or of Dr. 

Greenbaum but I admire your fine work in your areas of expertise, 

the dental health of this country and also, of course, identifying 

missing and exploited children. Thank you for your public service 

in what you do, as well as the rest of the panel. 

Thank you, Mr. Chairman. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair recognized the gentleman from Georgia, Mr. Carter, 5 

minutes for questions, please. 

Mr. CARTER. Thank you Mr. Chairman and thank all of you for 

being here. These are very important pieces of legislation and I appreciate your interest in them. 

I want to start with Dr. Greenbaum. Dr. Greenbaum, I am from 

Georgia as well and served in Georgia State Legislature and certainly, human trafficking a problem in a lot of urban areas but particularly in Atlanta. 

When I served in the Georgia State Senate, we addressed this 

and it is something that we passed legislation on. In fact, a great 

champion of this has been State Senator Renee Unterman, who has 

passed Rachel’s Law and the Safe Harbor Law and those are very 

important. 

And you know human trafficking is horrific and it is widespread 

and it is in our urban areas. We think it is not there but it is there. 

And oftentimes, the only people that these victims will see will be 

healthcare professionals, while the victims are in captivity. And I 

say captivity and I mean they are in captivity. I think you all understand that. But how can nurses and doctors; how can they identify? Are we doing any training to help them to identify victims? 

I know it is very difficult but are we doing anything? Are there 

any telltale signs that we can point toward? 

Dr. GREENBAUM. We are doing a lot of training for healthcare 

providers in looking for possible indicators and red flags and there 

are some well-known ones. We are also doing some research to actually come up with a screening tool that can be used in a very 

busy healthcare setting to identify children who are at risk and we 

are validating that in a multi-site study out of Children’s 

Healthcare of Atlanta. 

But we do try very hard to make healthcare providers, nurses, 

and doctors, and physician assistants aware of the red flag indicators that might suggest that person is high-risk. 

Mr. CARTER. Do you concentrate on emergency rooms or just—— 

Dr. GREENBAUM. We do a lot of work with emergency rooms but 

also with general internists, and pediatricians, and just about any 

specialist, especially gynecologists also will see a fair number of 

victims as well. So really, we try to educate everybody in the 

healthcare system. 

Mr. CARTER. What about the Children’s Hospital of Atlanta; have 

they done anything that you are aware of? Have they got any programs like this? 

Dr. GREENBAUM. Yes, I think the Institute for Human Trafficking was just funded this year and we are doing the research I 

talked about earlier, as well as doing a lot of training of healthcare 

providers and people who work in the healthcare sector. We do a 

68 

lot of webinars and on-site trainings, as well as the research into 

a screening tool for children. 

Mr. CARTER. And results, have you seen positive results as a result of this education and efforts? 

Dr. GREENBAUM. Yes, we have tracked the results of our 

webinars and there were large improvements in knowledge and 

skills, as well as the use of the materials that we trained people 

on in their practice. So people began screening. People began talking to other healthcare providers about human trafficking, which 

is exactly what we wanted. 

Mr. CARTER. Well, I want to thank you for your work because— 

and I want to make sure my colleagues all understand what a big 

problem this is. It is a serious problem, particularly in international cities, if you will, like Atlanta, where you have so many 

people coming in like that. It is something we have really struggled 

with and I think we have made progress and I am very proud of 

that. 

Dr. GREENBAUM. Yes, I think that Georgia has done a whole lot 

with the issue of human trafficking, partly because Atlanta is such 

a major hub. 

Mr. CARTER. Exactly. Exactly. 

Dr. Watson-Lowry, I wanted to ask you about the dental bill. I 

know that CDC works with a lot of the local communities, and they 

have State partners in local communities, and they do a lot to help 

with water fluoridation and making sure that they have monitoring 

systems to help the communities monitor their water systems and 

all. And they also send funds to health departments for oral education and for different things. 

So if they are doing this, explain to me the purpose of the partnerships or the contracts that are outlined in this legislation. I 

mean are we duplicating things here? Is this necessary or how is 

this going to complement that? 

Dr. WATSON-LOWRY. Thank you for your question. 

It is necessary because this is more grassroots. It is local solutions to local problems. Sometimes the CDC is flying up here. We 

need things on the ground. We need to be able to address the 

issues that are local in those particular areas and be able to take 

care of those problems efficiently. 

The CDHCs are able to—a lot of those CDHCs are from those 

particular areas so they know exactly what the situations are, what 

the problems are. They can get the patients to those locations, 

make sure they receive the services, make sure they receive the 

care that they need. Sometimes it is just difficult finding the exact 

location to get the particular service that you need. 

Mr. CARTER. Great. Well, thank you for your work. Thank all of 

you for being here today. This is most important legislation that we 

are talking about. 

And Mr. Chairman, I yield back. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

The Chair would like to recognize the ranking member of the 

subcommittee, Mr. Green, 5 minutes for redirect questioning. 

Mr. GREEN. Well, thank you, Mr. Chairman for letting me go 

first. 

69 

Dr. Watson-Lowry, in your testimony you talk about the elderly 

face the greatest barriers in accessing dental care for any group 

population. I know in our district our seniors, we have a lot of dual 

eligibles, so Medicaid does cover it but Medicare doesn’t. 

How are the Action for Dental Health Programs currently increasing access to dental care for the vulnerable elderly? 

Dr. WATSON-LOWRY. Thank you for that question. 

One of the tenets of the plan trains dentists to treat patients in 

the nursing homes. It is very difficult for patients in the nursing 

home to get out and get access to dental care and get to dental offices. Some of them don’t have mobility. I have a patient, in particular. She is able to get transportation to our practice but now 

she has had surgery, she can’t get back to get her services. 

I have done some care in nursing homes and gone out but there 

are certain procedures I have to have equipment to go to those 

areas. So we are trying to train dentists to do procedures in those 

nursing homes and maybe have the availability to have equipment 

so that they can take it with them and go take care of those patients. 

But they are a very vulnerable population and they have served 

us very well. We don’t want to see them be neglected. 

Mr. GREEN. I am also interested in the Medicare. Do you know 

of any Medicare Advantage programs that offer dental? Because so 

many of them, we have a lot of competition between plans. 

Dr. WATSON-LOWRY. There are. It depends. Some situations depend on the State. We can get more information to you from the 

ADA. But some of those plans get to be complicated so it makes 

it very difficult for the dentists to be able to navigate what they 

can do, what they can’t do, what is covered, and what is not covered. And some of those crossovers cause paperwork barriers. 

So some of this helps with some of that paperwork but we can 

get more information to you in writing from the ADA. 

Mr. GREEN. OK. And today we are hearing more and more evidence that chronic conditions, such as diabetes and heart disease 

have impact from bad oral health. Would you discuss the evidence 

and educate us on how the oral health and general health are 

linked? 

Dr. WATSON-LOWRY. Well, I am going to give you a situation. I 

had a particular patient that was coming in and he was doing fine 

for a while and then all of sudden he was losing a tooth every year. 

I looked in his mouth and I told him you know I am looking at 

some things and it looks like you have diabetes. And he went to 

his physician and he said well, no, you don’t have diabetes. 

And I kept telling him something is not right and his doctor 

looked again. But he was borderline. He was just flying under the 

radar. Over a 10-year period, he lost 12 teeth. 

He retired from the police force. He went to another physician 

and then they told him, yes, you do have diabetes. He came in to 

me and he said you were right, Doc, all along. But by this time, 

he was having problems with his eyes. He was having a lot of other 

problems, threatening losing a foot, a lot of other things that were 

going on. 

So, it is really important that we address these issues with patients. Periodontal disease is a silent killer. A lot of patients don’t 

70 

even realize they have it and they just notice their teeth loosening. 

So it is really important that we talk to the patients, educate them, 

and get these things under control so that they can, their overall 

health can be improved. 

Mr. GREEN. Do you have any information regarding cost savings 

of dental case management for patients who have chronic medical 

diseases such as diabetes or special conditions that we can say 

show the before and after that you actually have? 

Dr. WATSON-LOWRY. Well, one study shows that there was a re- duction of $1,300 per patient that had diabetes. Also, these patients, we can reduce them going to the emergency rooms when 

they are having other medical problems when we keep their dental 

conditions under control. So, there are cost savings there, as far as 

emergency room situations are concerned and all their other 

healthcare issues, keeping that blood sugar under control when 

their periodontal disease is under control. 

Mr. GREEN. OK, thank you. 

Dr. Greenbaum, I want to thank you for your work. Coming from 

the Houston area international airports like L.A. and Miami, and 

New York, we have terrible situations. 

You discussed in your testimony the need to focus on trauma, 

and form, and culture in appropriate care. Can you explain some 

of the evidence-based techniques that should be used when caring 

for human trafficking victims that are trauma-sensitive and culturally appropriate? 

Dr. GREENBAUM. Yes, thank you. We all know that human trafficking victims have experienced complex trauma before they were 

trafficked and, certainly, during their period of trafficking. And so 

that likely impacts the way they see the world, the way they see 

us, as healthcare providers, and the things they say and do, and 

the way they interpret what do. 

So we have to, as healthcare providers, be able to stand back and 

say OK, that person may be acting belligerent, or may be acting 

aggressive, or may be very socially withdrawn. That is not reflecting on me. That is their trauma talking, and it is really important 

that I don’t rise to that and that I sit and be very nonjudgmental 

because that is going to build the rapport that allows them to find 

out more information and provide services. 

So until you can really get beyond that, that trauma exterior, it 

is very hard to get to the real issues and provide care. 

Mr. GREEN. To get through that ice. 

Thank you, Mr. Chairman. 

Mr. BURGESS. The gentleman yields back. The Chair thanks the 

gentleman. 

I will now recognize myself for 5 minutes for redirect. I won’t use 

all of the time. 

But Dr. Greenbaum, I think Ranking Member Pallone, in his 

opening statement, talked about the interaction with the 

healthcare system, giving an opportunity for the victim to detach 

from their trafficker. And in that other hearing that I referenced 

in the Helsinki Commission, the chairman, Chairman Smith from 

New Jersey ran, one of the things that impressed me was how not 

only was the trafficker a family member but they would never 

leave the patient. And he even detailed multiple E.R. physician visVerDate Mar 15 2010 11:03 Oct 19, 2018 Jkt 037690 PO 00000 Frm 00074 Fmt 6633 Sfmt 6633 I:\115THCONGRESS\115X32PUBLICHEALTH\115X32PUBLICHEALTHPDFMADE WAYNE
71 

its. At least one time through labor and delivery, the naming of the 

child was done by the trafficker. I mean these were clearly clues 

that fall outside the norm. So, I recognize that what you are talking about doing can be very important, and very impactful, and 

clearly, it is an area where we need to make a difference. 

And understanding that people coming in in that situation are 

not always going to be truthful about their situation but there can 

be other clues that lead to the correct assignment of what is actually happening. 

So I am grateful that you are here today. And again, although 

that hearing was in a different committee in the Helsinki Commission, that has bothered me since that hearing occurred. So I am 

grateful to see that we are taking some tangible, measurable steps 

towards solving that problem and I believe next week is the week 

that we focus on human trafficking. So it is appropriate that we 

are doing the hearing this week to do that. 

And to every other member of our witness panel today, I can’t 

thank you enough. Dr. Levine, again, you provided, whether you 

knew it or not, reassurance to the country that night and I was 

grateful for the participation of all of the medical professionals in 

Boston that day. I think it was an important part of the healing 

of our country. 

Dr. Watson-Lowry, thank you for what you do in helping provide 

services to people who need them so desperately. 

And Mr. O’Connor, my patron saint back home in Louisville, 

Texas was Chief Latzky of my fire department. He has now gone 

on to a different department, a trophy club. But certainly before I 

ever ran for public office, it was his example of giving back in public service that has always—it has been a North Star for me, something to help guide me through my time in public service. So, I 

thank you for being here today and what you brought to the committee. 

I see that we have been joined by Mr. Bilirakis, who I would be 

happy to recognize 5 minutes for questions. 

Mr. BILIRAKIS. Thank you very much. I appreciate it. I had the 

V.A. full committee meeting and TELCOM. So, I apologize for 

being late. 

Dr. Levine, Florida is bracing for the next big one each hurricane 

season and its implications, especially for a State with a significant 

population growth over the last few years, a sizeable portion age 

55 and older. A huge concern, and God forbid we get it, but we 

have got to be prepared. 

Can you walk us through the Volunteer Protection Act and why 

it is so—I mean what is your opinion and why is it not sufficient? 

Yes, please. 

Dr. LEVINE. I believe it goes to a certain point but, unfortunately, 

a healthcare professional providing medical care specifically. There 

is a difference between just doing first aid, doing triage, but actually providing medical care goes to another level that I don’t believe would be covered for that physician from a liability perspective. 

At the Boston Marathon, we deal with mass casualties every 

year. It could be hyponatremia. Approximately 20 to 30 people have 

that. It is life threatening. 

72 

We deal with cardiac disease. Again, it could be two to five a 

year. With 38,000 runners, typically we are going to get one cardiac 

event per 100,000, also life threatening. 

We also deal with hyperthermia, in which people have body temperatures, core temperatures of 104 to 109 every year. This past 

year was not as bad as 2012, in which we had 24 people who had 

to be in the dunk tank for almost 30 minutes. Those are life-threatening conditions that you must have medical care and get their 

temperatures down within 30 minutes. 

In a disaster situation, you don’t have time to understand whether, at the moment, you are going to have the capability of evacuating someone to a hospital immediately. You may have to actually 

render the care immediately. 

One of the things at the Boston Marathon was, when I got to the 

site, there were a lot of people with their shirts off, who were trying to staunch the bleeding by putting a cotton shirt up against, 

unfortunately, a limb stump. What that did was, it actually increased the amount of flow into the shirt. Now, these were people 

that were volunteers but they were not medically trained. So they 

didn’t know that they probably should have torn the shirt, tied it 

around and used tourniquets. 

So, if a medical personnel is not going to be on the site because 

they are not covered by the Volunteer Act, this is why this act I 

think is necessary. 

Mr. BILIRAKIS. Thank you very much. 

Dr. Watson-Lowry, in preparation for this hearing, I reached out 

to the dental community to get a sense of the cost impact of dental 

issues in my district. I know it is significant. 

In 2014, there were at least 163,906 E.R. visits in Florida for 

dental problems, almost none of which were cured in the E.R., obviously, and the hospital bills exceeded $243 million. 

In Pasco County, and I represent all of Pasco County, but in 

Pasco County alone, it accounted for approximately $10.9 million in 

E.R. expenses—$10.9 million in E.R. expenses. 

Can you explain how the E.R. referral works and how does it 

provide cost savings? 

Dr. WATSON-LOWRY. Thank you for your question. 

Mr. BILIRAKIS. Sure. 

Dr. WATSON-LOWRY. There are approximately 200 E.R. diversion 

programs that we have going right now. There are approximately 

six different models, so they work differently in different situations. 

So, we can get information to you specifically on that. 

But suffice it to say, when you have someone going to the emergency room, that can cost over $700 for that one emergency visit 

and, as we mentioned before, it doesn’t cure the problem. We can 

take care of that issue in a dental practice or a dental clinic for 

one-tenth of that cost. 

So there is one particular program that the patients go in, they 

receive the service, and to pay for that service, they actually volunteer in different areas. So there have been situations where they 

have decreased the E.R. visits by 50 percent and increased the volunteer hours in other settings by like 9,000 different volunteer setting visits. 

73 

So there are a lot of different programs that are there and we 

can get more information to you about those different ones. 

Mr. BILIRAKIS. Yes, please do. Please do. I am very interested. 

One more question, Mr. Chairman or—can I go to one more? 

What do you think? 

Mr. BURGESS. The gentleman is testing the patience of the Chair. 

Mr. BILIRAKIS. OK. All right, I will yield back and submit. Thank 

you very much, Mr. Chairman. 

Mr. BURGESS. The Chair thanks the gentleman for yielding. 

Mr. BILIRAKIS. I want my bills passed. 

Mr. BURGESS. The Chair thanks the gentleman for yielding back 

his time. 

Seeing that there are no further Members wishing to ask questions, I do want to thank all of our witnesses for being here today. 

We have received outside feedback from a number of organizations on these bills and I would like to submit statements from the 

following for the record: Representative Simpson of Idaho, a cosponsor of H.R. 2442, the American Association of Neurological 

Surgeons and the Congress of Neurological Surgeons, the American 

College of Surgeons, and the American Hospital Association, PIAA, 

and the International Association of Fire Chiefs. 

Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. BURGESS. Those will be added to the record. 

Pursuant to committee rules, I remind Members they have 10 

business days to submit additional questions for the record. I ask 

that the witnesses submit their response within 10 business days 

upon receipt of the questions. 

Without objection, the subcommittee stands adjourned. 

[Whereupon, at 12:07 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

74 


115Tn COXGRESS 

l8T SESSION H. R. 931 

'l'o require the Secretary of Health and Human Serdces to develop a 

voluntary registry to eolleet data on eaneer ineidenee amo11g firefighters. 

IX THE HOUSE OF, REPRESENTATIVES 

F'EHRt:AI!Y 7, 2017 

:VIr. COLLI:\S of Xew York (for himself, Mr. PASCRELL, :VIr. A:IIODEI, :Hr. 

lhRLE'I"r"'' Mr. R\lm, :VIr. Bu::~rENAnm, :VIs. BONAI\IICI, :VIr. BosT, 

Mrs. BROOKS of Iudiana, :\Is. BRO\Y:>.:u<.:Y of Califomia, :\Irs. B1:STOS, 

:\Irs. CmrsTOCK, :.\Ir. Co:-.:NOU,Y, :VIr. J)gF"\ZIO, Ms. Dl<JGJ<JTTE, l\lr. 

D0:\0\'AN, :VIr. EJ,J,ISON, l\IY. ENG!;;L, 1\Is. EsTY, Mr. F'OSTJm, :VIr. F,\SO, 

l\Ir. GAIU:IIE:>.:lll, Mr. GRJ.J.\IXA, l\lr. HECK, l\Ir. ,JoYCE of Ohio, :VIs. 

KAI''ITH, :VIr. KNI'KO, Mr. KlLmm, :VIr. KIND, lVIl·. KING of New York, 

:VIr. K:-.:rmrr, Ms. Kt:STER of 1\ew Hmnpshire, Mr. IJEVIN, :VIr. Lil'l:\SKI, 

l\Ir. !JOBIONDO, l\Ir. LOF.:nS,\CK, :.\Irs. CAROJ/{N B. l\L\LONEY of Xew 

York, Ms. :VIcCOLLU~I, :VIr. :.\IcGovER:-.1, :VIr. l\Il~EHA.'\, :VIr. :.\Iot:uroN, 

:VIr . .\",\DLEI!, l\Ir. KOLA:\, l\Ir. NORCROSS, l\Is. :"J'ORTO:\, :Vir. PAY:-.JE, l\Ir. 

PlmDH'TTim, l\Ir. PP~TERSOJ\', :VIs. Pr:>.:GREE, l\lr. POLIQCI:-.1, :VIr. 

RENACCI, :\Iiss RICE of .\"ew York, :VIr. HOGERS of Kentucky, Mr. RY,\N 

of Ohio, l\Ir. S~<.:HH.A:\0, l\Ts. Sm~A-PORTicl{, l\I1·. Sm•STER, :VIs. SIT':E1Li, 

l\Ir. Sums, l\Is. S!.u\l'GIITEH, l\Ir S~IITII of 1\t>w Jersey, l\Ir. SWALWI%L 

of California, l\Is. TEXNWi, :VIr. TOi'\1<0, :VIs. 'l'SO:\GAS, l\lr. VAiu\DMl, 

:\Irs. \V,\LORSKI, l\Ir. \Y.u.r., l\Is. \VASSI<JRl\L\.:\ Scm:urz, Mrs. WATS0:'-1 

CoLJ·:~L\.", l\Ir. Y,unwTJI, l\Ir. Yoc."<; of 1\lnska, l\Ir. !i':ELDIX, l\'Ir. 

LAXCE, l\Ir. S:\IITII of \Yashington, l\fr. SEA:\ PATJUCK l\L\LONEY of l'\ew 

York, l\Ir. Qt:IGJ,EY, l\Ir. GOTTIIEL\IER, and l\Is. STEFANIK) introduced 

the following bill; whieh was referred to the Committee 011 Energy and 

Commerce 

A BILL 

To reqmre the Secretary of Health and Human Services 

to develop a voluntary registry to collect data on cancer 

incidence among firefighters. 
75 


2 

1 Be it enacted by the Senate amd House of Representa2 tives ql the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Aet may be cited as the "Firefighter Cancer 

5 Hegistry Act of 2017". 

6 SEC. 2. PATIENT REGISTRY FOR FIREFIGHTER CANCER IN7 CIDENCE. 

8 (a) Ix GEXEHAL-rl'he Secretary of Health and 

9 Human Services, acting through the Director of the Cen1 0 ters for Disease Control and Prevention, shall develop and 

11 maintain, directly or through a grant or cooperative agree12 ment, a voluntary registry of firefighters (referred to in 

13 this section as the "Firefighter Hegistry") to collect rcl14 evant history and occupational information of such fire15 fighters that can be linked to ava.ilable cancer registry 

16 data collected by existing State cancer registries. 

17 (b) USE OF FnmFIGIITEH HEGISTRY.-The Fire18 fighter Registry shall be used for the following purposes: 

19 ( 1) To establish and improve collection infra20 structure and activities related to the nationwide 

21 monitoring of the incidence of cancer among fire22 fighters. 

23 (2) rro collect, consolidate, store, and make 

24 publicly available epidemiological information related 

25 to cancer incidence and trends among firefighters. 

•HR 931 IH 
76 


3 

(c) RELEVA?\T DATA.-

2 (1) Ix OE:\'ERAL-In carrying out the vol3 untary data collection for purposes of inclusion 

4 under the Firefighter Hegistry, the Secretary should 

5 seek to include the following information: 

6 (A) Identifiable information from a rep7 resentativc sample size, as determined by the 

8 Secretary under subsection (d)(2)(A), of volun9 tcer, paid-on-call, and career firefighters, inde10 pendent of cancer status or diagnosis. 

11 (B) With respect to individual risk factors 

12 and work history of firefighters, available infor13 mation on14 (i) basic demogTaphic information, in15 eluding the age of the firefighter involved; 

16 (ii) a listing of status of the firc17 fig·hter as either volunteer, paid-on-call, or 

18 career firefighter; 

19 (iii) the number of years on the job 

20 and a detailing of additional employment 

21 experienee that vvas either performed eon22 eurrcntly alongside firefighting service, be23 fore, or anytime thereafter; 

24 (iv)(I) a measure of the number of 

25 fire incidents attended as well as the type 

•HR 931 m 
77 


4 

of fire incidents (such as residential house 

2 fire or commercial fire); or 

3 (II) in the case of a firefighter who is 

4 unable to provide information on such 

5 number and t:n)e, an estimate of such 

6 number and type based on the method de7 veloped under subsection (d)(2); 

8 (v) a list of additional risk factors, in9 eluding smoking or drug use, as cleter10 mined relevant by the Secretary; and 

11 (vi) other physical examination and 

12 medical history information relevant to a 

13 cancer incidence study or general health of 

14 firefighters not available in existing cancer 

15 registries. 

16 (C) Any additional information that 1s 

17 deemed necessary by the Secretary. 

18 (2) DIAG:\IOSRS AXD TRRATl\IE.'JT.-ln carrying 

19 out the data collection for purposes of inclusion 

20 under the Firefighter Registry, with respect to diag21 noses and treatment of firefighters diagnosed \'lith 

22 cancer, the Secretary shall enable the Firefighter 

23 Registry to link to State-based cancer registries, for 

24 a purpose described by clause (vi) or (vii) of section 

•HR 931 ill 
78 


5 

1 399B(c)(2)(D) of the Public Health Service Act (42 

2 U.S.C. 280c(c)(2)(D)), to obtain information on3 (A) administrative information, ineluding 

4 date of diagnoses and source of information; 

5 and 

6 (B) pathological data characterizing the 

7 cancer, ineluding cancer site, state of disease 

8 (pursuant to Staging Guide), incidence, and 

9 type of treatment. 

10 (d) :YIETHODS.-

11 (1) I:\ ClK'\EltAL.-For the purposes described 

12 in subsection (b), the Secretary is authorized to in13 corporate questions into public health surveys, ques14 tionnaires, and other databases. 

15 (2) REQL'IHED STI{ATEGY.-'l'he Secretary shall 

16 develop a strategy, working in consultation \'v1th the 

17 stakeholders identified in subsection (e), to maximize 

18 participation in the lj'irefighter Registry established 

19 under this Act. At minimum, the strate6'Y shall in20 elude the follmving: 

21 (A) Identified mnnmum participation tar22 gets for volunteer, paid-on-call, and career fire23 fighters. 

24 (B) A strategy for increasing awareness of 

25 the Firefig·hter Registry and maxumzmg par-

•HR 931 IH 
79 


6 

ticipation among volunteer, paid-on-call, and ca2 reer firefighters to meet minimum participation 

3 targets. 

4 (C) Additional steps that may be required 

5 to ensure the equitable representation of groups 

6 identified in paragraph ( 5). 

7 (D) Information on hO\v the Secretary will 

8 store data described in subsection (c)(l) and 

9 provide links to relevant health information cle10 scribed in subsection (c)(2). 

11 (E) "Working in consultation \vith the cx12 pcrts described in subsection (c), a reliable and 

13 standardized method for estimating the number 

14 of fire incidents attended by a firefighter as 

15 well as the type of fire incident so attended in 

16 the case such firefighter is unable to provide 

17 such information. 

18 (3) REPORT TO COKGRESS.-Thc Secretary 

19 shall submit the strategy described in paragraph (2) 

20 to the Committee on Energy and Commerce of the 

21 House of Representatives and the Committee on 

22 Health, Education, r~abor, ancl Pensions of the Sen23 ate not later than 30 days after the date of the com24 pletion of the strategy. 

•fiR 931 III 
80 


7 

( 4) GCIDA!\CE POH 1!\CLUSIO:\ AXD l\IAJXTE2 :\AXCE OF DATA OX FIHIWIGHTEHS.-The Secretary 

3 shall develop, in consultation >>-ith the stakeholders 

4 identified in subsection (e), and disseminate guicl5 ance to State health agencies, State departments of 

6 homeland security, and volunteer, paid-on-call, com7 bination, and career firefighting agencies that out8 lines the follmving: 

9 (A) How new information about fire1 0 fighters will be submitted to the Firefighter 

11 Registry for inelusiou. 

12 (B) How information about firefighters will 

13 be maintained and updated in the Firefighter 

14 Registry over time. 

15 (C) A method for estimating the number of 

16 fire incidents attended by a firefighter as well 

17 as the type of fire ineident so attended in the 

18 ease sueh firefighter is unable to provide sueh 

19 information. 

20 (D) Further information, as deemed nec21 essary by the Seeretary. 

22 (5) EXSURING REPHESEXTATIO:\ OF UXDEH23 HEPHESE:KTED GHOUPS IX HEGISTHY.-In can'}-ing 

24 out this section, the Secretary shall take such mcas25 ures as the Seeretary deems appropriate to encour-

•HR 931 IH 
81 


8 

age the inclusion of data on minority, female, and 

2 volunteer firefighters in the Firefighter Registry es3 tablished under this section. 

4 (e) CoxsuLTATIO".-The Secretary shall, on a reg5 nlar basis, seck feedha(~k regarding the utility of the Fire6 fighter Registry established under this section and ways 

7 the Pirefighter Reg·istry can be improved from non-Fed8 cral c:>.:pcrts in the following areas: 

9 (1) Public health experts with experience in del 0 vel oping and maintaining cancer registries. 

11 (2) Epidemiologists with experience in studying 

12 cancer incidence. 

13 (3) Clinicians with experience in diagnosing and 

14 treating cancer incidence. 

15 ( 4) ActiYe and retired volunteer, paid-on-call, 

16 and career firefighters as ·well as relevant national 

17 fire awl emergency response organizations. 

18 (f) RESEAHCII AVAILABILI'l'Y.-The Secretary shall 

19 develop and make public a process for de-identifying data 

20 from the Firefighter Hegistry and making such data avail21 able without a fcc for research or other purposes. Such 

22 process shall provide that such data shall be made avail23 able for such research purposes only if there is an agree24 ment to make findings, journal articles, or other print or 

25 web-based publications derived from such research public 

•HR 931 IH 
82 


9 

or available to the relevant stakeholders identified in sub2 section (e). 

3 (g) PRIVACY.-In carrying out this Act, the Secretary 

4 shall apply to the Firefighter Registry developed under 

5 subsection (a) data security provisions awl privacy stand6 ards that comply with the best practices of the Centers 

7 for Dis('ase Control and Prevention ancl provide for data 

8 privacy and security standards similar to those in the 

9 liiPA.A privacy regulation, as defined m section 

10 1180(b)(3) of the Social Security Act (42 U.S.C. 1320clll 9(b)(3)). 

12 (h) AG'rnorm>:ATI01\ OF Ft:1\DS.-To carry out this 

13 section, there are authorized to he appropriated 

14 $2,500,000 for each of the fiscal years 2018 through 

15 2022. 

0 

•HR 931 m 
83 


115TH COXGRESS H R 1876 1ST SESSIO:\ • • 

To nmeHd the Public Health Serviee Aet to limit the liability of health 

enre professionals who volunteer to provide health eare services in response to a elisa ster. 

IN THE HOUSE OF REPHESENTATIVES 

AP!UJ, 4, 2017 

~Irs. BLAC'KBCRN (for herself, }fr. RHPPERSBERmm, l\Ir. BERA, Mr. ROE of 

Teunessec, 1\Ir. BTTCSHOX, HllCl 1\Ir. DAY.lD ScOT'!' of Georgia) introduced 

the following· bill; which was referred to the Committee Oll Energy m1d 

Commerce, allC1 in addition to the Committee on the Judiciary, for a period to be subsequeHtly determined by the Speahr, in each ease for consideration of such provisioHs as fall withill the jurisdiction of the committee eoneemed 

A BILL 

1'o amend the Public Health Service Act to limit the liability 

of health care professionals who volunteer to provide 

health care services in response to a disaster. 

1 Be it enacted by the Senate and House of Representa2 Nves of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the "Good Samaritan 

5 Health Professionals Act of 2017". 
84 


2 

SEC. 2. LIMITATION ON LIABILITY FOR VOLUNTEER 

2 HEALTH CARE PROFESSIONALS. 

3 (a) I~ GE~ERAL-Title II of the Public Health Serv4 ice Act (42 U.S.C. 202 et seq.) is amended by inserting 

5 after section 224 the following: 

6 "SEC. 224A. LIMITATION ON LIABILITY FOR VOLUNTEER 

7 HEALTH CARE PROFESSIONALS. 

8 "(a) LBIITATIO:\' 0:\' I~IADILITY.-Except as provided 

9 in subsection (b), a health care professional shall not be 

10 liable under Federal or State law for any harm caused 

11 by an act or omission of the professional if12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 if-

" ( 1) the professional is serving as a volunteer 

for purposes of responding to a disaster; and 

"(2) the act or omission oecurs-

"(A) during the period of the disaster, as 

determined under the la\YS listed in subsection 

(e)(1); 

"(B) m the health care professional's capacity as a volunteer; and 

"(C) in a good faith belief that the inchvidual being treated is in need of health care 

services. 

"(b) BxcEPTIO::-.Js.-Subsection (a) does not apply 

25 " ( 1) the harm was caused by an act or omission 

26 constituting willful or criminal miscomluct, gross 

•HR 1876 IH 
85 


3 

negligence, reckless misconduct, or a conscious tla2 grant indifference to the rights or safety of the indi3 vidual harme<l by the health care professional; or 

4 "(2) the health care professional rendered the 

5 health care services under the influence (as deter6 mined pursuant to applicable State law) of intoxi7 eating alcohol or an intoxicating drug. 

8 "(c) STA?\DAIW OF PrwoF.-In any ciYil action or 

9 proceeding against a health care professional elaiming that 

10 the limitation in suhseetion (a) applies, the plaintiff shall 

11 have the burden of proving· by clear and convincing evi12 deuce the extent to which limitation does not apply. 

13 "(d) PHEE:\IPTI0:\.-

14 "(1) b: GEl\EHAI,.-This section preempts the 

15 laws of a State or any political subdivision of a State 

16 to the extent that such laws axe iuconsistcnt with 

17 this section, unless such laws provide greater protec18 tion from liability. 

19 "(2) VOLUXTEER PROTECTIOX ACT.-Protec20 tions afforded by this section are in addition to those 

21 provided by the Volunteer Protection Act of 1997. 

22 "(e) DEFil\I'rHYt\S.-In this seetion: 

23 "(1) The term 'disaster' means24 "(A) a national emergency deelared by the 

25 President under the ::\ational Emergencies Act; 

•HR 1876 IH 
86 


4 

"(B) an emergency or major disaster de2 clared by the President under the Robert 'I'. 

3 Stafford Disaster Relief and Emergency Assist4 ance Act; or 

5 "(C) a public health emergency determined 

6 by the Secretary under section 319 of this Act. 

7 "(2) The term 'harm' includes physical, non8 physical, economic, ancl noneconomic losses. 

9 "(3) The term 'health care professional' means 

10 an individual who is licensed, certified, or authorized 

11 in one or more States to practice a health care pro12 fession. 

13 "(4) The term 'State' includes each of the sev14 eral States, the District of Columbia, the Common15 vvealth of Puerto Rico, the Virgin Islands, Guam, 

16 American Samoa, the Xorthcrn :VIariana Islands, 

17 awl any other territory or possession of the United 

18 States. 

19 "(5)(A) The term 'volunteer' means a health 

20 care professional 1vho, with respect to the health 

21 care services rendered, docs not receive22 "(i) compensation; or 

23 "(ii) any other thing of value in lieu of 

24 compensation, in excess of $500 per year. 

•HR 1876 m 
87 


5 

1 "(B) Por purposes of subparagTaph (A), the 

2 term 'compcnsation'-

3 "(i) includes pay1ncnt under any insurance 

4 policy or health plan, or under any Pcdcral or 

5 State health benefits program; and 

6 "(ii) cxcludes7 "(I) reasonable reimbursement or al8 lmvance for expenses aetually incurred; 

9 "(II) receipt of paid leave; and 

10 "(III) receipt of items to be used ex11 elusively for rendering the health serYiccs 

12 m the health care professional's capacity 

13 as a volunteer described in subsection 

14 (a)(l).". 

15 (b) EFFECTlYE DATE.-

16 (1) I~ GE~ERAL.-This Act and the amcnd17 ment made by subsection (a) shall take effect 90 

18 days after the date of the enactment of this Act. 

19 (2) 1\.PPIJICATIO~.-This .Act applies to any 

20 claim for harm eauscd by an act or omission of a 

21 health care professional where the claim is filed on 

22 or after the effective date of this Aet, but only if the 

23 harm that is the subject of the elaim or the conduct 

24 that caused such harm occurred on or after such ef25 fcctive date. 

•HR 1876 IH 
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6 

SEC. 3. SENSE OF THE CONGRESS. 

2 It is the sense of the Congress that3 (1) Federal and State agencies and licensing 

4 boards should cooperate to facilitate the timely 

5 movement of properly licensed volunteer health care 

6 professionals to areas affected by a disaster; and 

7 (2) the appropriate licensing entities should 

8 verifY the licenses of volunteer health care profes9 siouals serving disaster victims as soon as is reason1 0 ably practical following a disaster. 

0 

•HR 1876 IH 
89 


115TII CO:\GRESS 

1ST SESSIO='I H.R. 767 

To establish the Stop, Observe, Ask, and HeRpond to Health and \YelhwRs 

Training pilot progTam to address human trafficking in the health care 

system. 

Ii\' THE HOUSE OF REPRESEXTATIVES 

J.\Nt'AHY 81, 2017 

l\Il-. Cmm:-\ (for himself, l\Ir. KlNZI:-\GER, l\Ir. c.\rmr;:-\AS, and :\Irs. WAGNER) 

introduced the following bill; \\'hieh was referred to the Committee on Energ)· and Commeree 

A BILL 

'l'o establish the Stop, Observe, Ask, and Respond to Health 

and vVellness Training pilot program to address human 

trafficking in the health care system. 

Be it enacted by the Senate and House of Representa2 tives ofthe United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the "SOAR to Health and 

5 \Vcllness Act of 2017". 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 

8 (1) HU.JIA::--J THAFFICKING.-The term "human 

9 trafficking·'' has the meaning given the term "severe 
90 


2 

1 forms of trafficking in persons" as defined in seetion 

2 103 of the Traffieking Victims Protection Aet of 

3 2000 (22 U.S.C. 7102). 

4 (2) Sgcm~TAHY.-The term "Seeretary" means 

5 the Secretary of Health and Human Services. 

6 SEC. 3. PILOT PROGRAM ESTABLISHMENT. 

7 (a) I~ GE:-.JERAL.-'l'he Seeretary shall establish a 

8 pilot program to be known as "Stop, Observe, Ask, and 

9 Respond to Health and \Vellness 'rraining" (or "S01\R 

10 to Health and Wellness Training") (referred to in this Act 

11 as the "pilot progTam"), to provide training to health eare 

12 providers and other related providers, at all levels, on 

13 human traffieking in accordance vvith the purpose de14 scribed in subseetion (b). 

15 (b) PnlPOBE.-'l'he pilot program established under 

16 subsection (a) shall train health care providers and other 

17 related providers to enable such providers to18 (1) identifY potential human trafficking victims; 

19 (2) implement proper protocols and proeedures 

20 for >Yorking with law enforcement to report, and fa21 cilitate communication with, such victims, in accord22 ance with all applicable Federal, State, local, and 

23 tribal requirements, including legal confi<lentiality 

24 requirements for patients and health eare providers; 

•HR 767 IH 
91 


3 

1 (3) implement proper protocols and procedures 

2 for referring such victims to appropriate social or 

3 victims service agencies or organizations; 

4 ( 4) provide such victims care that is5 (A) coordinated; 

6 (B) victim centered; 

7 (C) eulturally relevant; 

8 (D) comprelwusivc; 

9 (E) evidence based; 

10 (F) gender responsive; 

11 (G) age appropriate, with a foeus on care 

12 for youth; and 

13 (H) trauma informed; and 

14 ( 5) consider the potential for integrating the 

15 training described in paragraphs (1) through ( 4) 

16 ·with training programs, in effeet on the date of en17 actment of this Aet, for vietims of domestic violence, 

18 dating violence, sexual assault, stalking, child abuse, 

19 child. neglect, child maltreatment, and child sexnal 

20 exploitation. 

21 (c) FexcTroxs.-

22 (1) IX GE:-.;EHAI,.-'l'hc functions of the pilot 

23 progn1m established under subsection (a) shall in24 elude the f\mctions of the Stop, Observe, Ask, and 

25 Respond to Health and Wellness Training program 

•HR 767 III 
92 


4 

that was operating on the day before the elate of en2 actment of this Act and the authorized initiatives de3 scribed in paragraph (2). 

4 (2) At:THORIZED I~ITIATIVES.-The authorized 

5 initiatives of the pilot program established under 

6 subsection (a) shall include7 (A) engaging stakeholders, including VlC8 tims of human trafficking and any Federal, 

9 State, local, or tribal partners, to develop a 

10 flexible training module11 (i) for achieving the purpose described 

12 in subsection (b); and 

13 (ii) that adapts to chan~o,>'ing needs, 

14 settings, health care providers, and other 

15 related providers; 

16 (B) making grants available to support 

17 training· in health care sites that represent di18 versity in19 (i) geography; 

20 (ii) the demographies of the popu21 lation served; 

22 (iii) the predominant types of human 

23 trafficking cases; and 

24 (iv) health care provider profiles; 

•HR 767 IH 
93 


5 

1 (C) providing technical assistance for 

2 health education programs to implement nation3 wide health care protocol, or develop continuing 

4 education training materials, that assist in 

5 achiml.ng the purpose described in subsection 

6 (b); 

7 (D) developing a strategy to incentiv'ize the 

8 utilization of training materials developed under 

9 subparagTaph (C) and the implemeutation of 

10 nationwide health care protocol described m 

11 such subparagraph, as the Secretary determines 

12 appropriate; and 

l3 (E) developing a reliable methodology for 

14 collecting data, and reporting sueh data, on the 

15 number of human trafficking victims identified 

16 and served in health care settings or other re17 lated provider settings. 

18 (d) TER:\II;\ATIOK.-The pilot program established 

19 under subsection (a) shall terminate on Oetobcr 1, 2022. 

20 SEC. 4. DATA COLLECTION AND REPORTING REQUIRE21 MENTS. 

22 (a) DATA COLLECTTOJ\.-

23 (1) 1.:--J GE;\ERAL.-During each of fiscal years 

24 2018 through 2023, the Secretary shall collect data 

25 on each of the follm\'ing: 

•HR 767 IH 
94 


6 

(A) The total number of facilities that 

2 were operating under the pilot program estab3 lished under section 3(a)-

4 (i) during the previous fiscal year; and 

5 (ii) before the previous fiscal year. 

6 (B) The total number of health care pro7 viders and other related providers trained 

8 through sueh pilot program during each of the 

9 periods described in clauses (i) and (ii) of sub10 paragraph (A). 

11 (2) l)JITL\L HEPORT.-ln addition to the data 

12 required to be collected under paragTaph (1), for 

13 purposes of the initial report to be submitted under 

14 subsection (b), the Secretary shall collect data on 

15 the total number of facilities that vvere operating 

16 under, and the total number of health care providers 

17 and otlwr related providers trained through, the 

18 Stop, Observe, Ask, and Respond to Health and 

19 vV ellness Training program that was operating be20 fore the establishment of the pilot program under 

21 section ~)(a). 

22 (b) REPORTIXo.-Not later than 90 days after the 

23 first day of each of fiscal years 2018 through 2023, the 

24 Secretary shall prepare and submit to Congress a report 

25 OJl the data collected under subsection (a). 

•HR 767 IH 
95 


7 

SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 

2 There are authorized to be appropriated to carry out 

3 this Act sueh sums as may be necessary for each of fiscal 

4 years 201H through 2022. 

0 

•HR 767 IH 
96 


115TII COl\GRESS 

1ST SESSIO~ H.R. 

(Original Signature of l\Irmlwr) 

'ro the Public Health SetTiee Aet to impro\'e essential oral health eare for 

low-income all(l other tmclersmTed individuals by breaking down !Jarriel's 

to earc', all(! for other purposes. 

IN 'fHJ<J HOUSE OF REPRESENTATIVES 

:\Is. KELLY of Illinois introduced the following bill; whieh was referred to the 

Committee 011 

A BILL 

'fo the Public Health Service Act to improve essential oral 

health care for lovv-income and other nnderserved individuals by breaking down barriers to care, and for other 

purposes. 

1 Be it enacted by the Senate and Hmtse of Representa2 hves ofthe Un,ited States ofAnwrica in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the "Action for Dental 

5 Health Act of 2017". 

6 SEC. 2. FINDINGS. 

7 CongTess finds the follovving: 
97 


2 

1 ( 1) l\Iore than 181 million Americans -vvill not 

2 visit a dentist even though nearly half of people over 

3 80 suffer from some form of gum disease and nearly 

4 one in four children under the age of five already 

5 have cavities. 

6 (2) .:VIany volunteer dental projeets sponsored 

7 by national, State, and local dental societies provide 

8 free care now to those most in need. Annually, den9 tists deliver an estimated $2.6 billion in free and dis1 0 counted care according to the America's Dentists 

11 Care Foundation. 

12 (8) It is estimated that emergency department 

13 (ED) charges for dental complaints totaled up to 

14 $2.1 billion in 2010. Xearly 80 percent of the dental 

15 emergency room visits were nonurgent and could 

16 have been seen in a dental office. Shifting those ED 

17 visits to a dental office translates into potential cost 

18 savings of up to $1.7 billion a year and offers the 

19 possibility of establishing a "dental home" for these 

20 individuals. 

21 ( 4) Seniors, especially those in nursmg homes 

22 and long-term care facilities, often have special den23 tal needs and complieated medical histories that re24 quire consultation between dentists and fellow med-
98 


3 

1 ical professionals in providing an interdisciplinary 

2 approach to their overall health needs. 

3 SEC. 3. VOLUNTEER DENTAL PROJECTS AND ACTION FOR 

4 DENTAL HEALTH PROGRAM. 

5 Section 31 T:Yl of the Public Health Service Act ( 42 

6 U.S.C. 247b-14) is amended7 (1) by redesibrnating subsections (c) and (f) as 

8 subsections (g) and (h), respectively; 

9 (2) by inserting after subsection (d), the fol1 0 lowing ne1v subsection: 

11 "(e) GRAl\TS To Sl:PPORT VOIJUXTEEit DEXTAI, 

12 PIW.JECTS.-

13 "(l) l:-.J GEKEHAL.-The Secretary, acting 

14 through the Director of the Centers for Disease 

15 Control and Prevention, may award gTants to or 

16 enter into contracts 1vith eligible entities to obtain 

17 portable or mobile dental equipment, and pay for ap18 propriatc operational costs, for the provision of free 

19 dental services to underscrvcd populations that are 

20 deliYered in a manner consistent with State licensing 

21 laws. 

22 ''(2) ELIGIBijE ENTITY.-ln this subsection, the 

23 term 'eligible entity' includes a State or local dental 

24 association, a State oral health program, a dental 

25 education, dental hygiene education, or postdoctoral 
99 


4 

1 dental education program accredited by the Commis2 sion on Dental Accreditation, or a eomnnmity-based 

3 organization that partners -vvith an academic institu4 tion, that5 "(A) IS exempt from tax under section 

6 501(e) of the Internal Revenue Code of 1986; 

7 

8 

and 

"(B) offers a free dental serviees program 

9 for underserved populations. 

10 "(f) ACTIO:'\ FOR DEXTAij HEAijTII PROGRA:\I.-

11 "(1) Ix GEXEHAL.-The Seeretary, aeting 

12 through the Director of the Centers for Disease 

13 Control and Prevention, may award gTants to or 

14 enter into eontracts with eligible entities to eollabo15 rate -vvith State, county, or local public officials and 

16 other stakeholders to develop and implement initia17 tivcs to accomplish any of the follo-voving goals: 

18 "(A) rro improve oral health education and 

19 dental disease prevention, ineluding through 

20 community-\ov'ide prevention programs, through 

21 the use of dental sealants and f1uoridc varnish, 

22 and by increasing oral health literacy. 

23 ''(B) To make the health care delivery sys24 tem pro\'iding dental services more accessible 

25 and effieient through the development and ex-
100 


5 

1 pansion of outreach programs that \Vill facili2 tate the establishment of dental homes for chil3 dren and adults, including for the aged, blind, 

4 and disabled populations. 

5 "(C) To reduce geographic barriers, lan6 guagc barriers, cultural barriers, and other 

7 similar barriers to the provision of dental serv8 lCeS. 

9 "(D) To help reduce the use of emergency 

10 departments by individuals \vho seck dental 

11 services more appropriately delivered m a dcn12 tal primary care setting. 

13 "(E) To facilitate the provision of dental 

14 care to nursing home residents who are dis15 proportionately affected by the lack of dental 

16 care. 

17 "(2) Er,wun,E E:'\TITY.-In this subsection, the 

18 term 'eligible entity' includes a State or local dental 

19 association; a State oral health program; or a dental 

20 education, dental hygiene, or postdoctoral dental 

21 education program accredited by the Commission on 

22 Dental Accreditation, or a community-based organi23 zation that partners with an academic institution, 

24 that-
101 


6 

1 "(A) is exernpt from tax under section 

2 501 (c) of the Internal Revenue Code of 1986; 

3 and 

4 "(B) partners vvith public and private 

5 stakeholders to facilitate the provision of dental 

6 services for underserved populations."; and 

7 (3) in subsection (h), as redesignated by para8 graph (1), by inserting "and $18,000,000 for each 

9 of the fiscal years 2018 through 2022" after "fiscal 

10 years 2001 through 2005". 
102 


INTERNATIONAL ASSOCIATION OF 

Providing leadership for the fire and emerzenry services since 1873 

4025 FAIR RIDGE DRIVE • FAIRFAX, VA .1.203_{-2868 • TEL:. 703/273~09H.., FAX: 703/273-9363 •WW\v.iafcorg 

Mayl7,2017 

The Honorable Michael Burgess 

Chairman 

Subcommittee on Health 

Committee on Energy and Commerce 

U.S. House of Representatives 

Washington, DC 20515 

The Honorable Gene Green 

Ranking Member 

Subcommittee on Health 

Committee on Energy and Commerce 

U.S. House of Representatives 

Washington, DC 20515 

Dear Chairman Burgess and Ranking Member Green: 

On behalf of the 12,000 members of the International Association of Fire Chiefs (IAFC), I thank you for 

holding today's hearing on "Examining Initiatives to Advance Public Health." Specifically, the nation's 

fire and emergency service leadership is grateful for your focus on H.R. 931, the Firefighter Cancer 

Registry Act of 2017. This legislation will create an important resource for researchers looking to 

understand and prevent the growing occurrence of cancer among our nation's firefighters. As a 

consistent supporter of this legislation, the IAFC urges the subcommittee to mark-up this legislation. 

While there is still a need to do more comprehensive research about the relationship between cancer and 

our nation's fire and emergency service, there is an overall higher risk for cancer among firefighters than 

the general public. Research has shown that there arc significant increases in the risks of cancers in the 

colon, prostate, intestine, lung, bladder, kidney and other organs in firefighters. For some types of 

cancer, the risk relative to the general population can be 229% higher. However, more research needs to 

be done to identify what causes such increased risk of cancers and how to prevent them. 

H.R. 931 would create an excellent opportunity for cancer researchers and the fire and emergency 

service community by creating a voluntary national registry for firefighters that could then be linked to 

state cancer registries. The data in the registry \vould include important information about the 

tircfightcr's medical history; demographic information; number of incident responses and years in 

service; whether the firefighter was career or volunteer; what other jobs the firefighter might have had; 

and other risk factors. In addition, the registry is directed to include under-represented types of 

firefighters such as women, minorities and volunteers. Most importantly, researchers that use the data 

ti·om this registry would have to make their research and results available to the fire and emergency 

service, so that these findings can be included into updated firefighting procedures, tactics, and personal 

protective equipment. It is our hope that future researchers will be able to reduce the occurrence of 

cancer in our nation's tire and emergency service. 
103 


The IAFC thanks you for focusing on this important legislation in today's hearing, Cancer is a daily 

concern for many of the nation's active and retired firefighters, and it must be addressed. We think that 

this legislation will help researchers identify the causes of cancers for firefighters and help us take steps 

to prevent it. We look forward to working with you to pass this legislation this year. 

Fire Chief John D. Sinclair 

President and Chairman of the Board 

C: The Honorable Chris Collins 

The Honorable Bill Pascrell, Jr. 

: kpl 

2 
104 


SUBCOMMITTEE ON HEALTH 

ENERGY AND COMMERCE COMMITTEE 

U.S. HOUSE OF REPRESENTATIVES 

"EXAMINING INITIATIVES TO ADVANCE PUBLIC HEALTH" 

MIKE SIMPSON (ID-02) 

May 17,2017 

As an original co-sponsor of H.R. 2422 "Action for Dental Health Act of 20 17", I am pleased the 

subcommittee has included the bill on the agenda for your hearing today as you examine 

initiatives to advance public health. Thank you Chairman Burgess and Ranking Member Green. 

As a dentist, I know that that the causes of dental disease arc varied and complex and that the 

solutions are equally as complex. H. R. 2422 helps to address these complex issues by 

supporting breaking down the numerous barriers to accessing oral health care services. Action 

for Dental Health (ADH) docs this by providing funding for organizations engaged in volunteer 

dental projects that provide free dental care directly to those in need. But it also establishes a 

second grant program to promote oral health initiatives designed to facilitate private-public 

partnerships- collectively called Action for Dental Health initiatives. 

A good example of a successful volunteer dental project is the American Dental Association's 

"Give Kids A Smile" program, which has provided free oral health care services to over 5.5 

million children since 2003. Also, since 2003, Mission of Mercy events have helped more than 

243,000 patients and provided $159 million in free oral health care. 

While these are important programs for individuals who cannot afford coverage, I know that 

offering free oral health care services is not a long-term solution to access to care problems. 

That's why it is so important that the bill also supports programs like Action for Dental Health 

(ADH), which was launched by the American Dental Association in 2013. ADH is a nationwide, 

community-based, movement composed of eight initiatives designed to address specific barriers 

to care. 

I believe that two of those ADH initiatives-- emergency room (ER) referrals and community 

dental health coordinators- could be especially beneficial in helping to address access to oral 

health care services barriers. Many people without dental coverage postpone seeking treatment 

until their dental pain grows so severe that it sends them to a hospital emergency room. They are 

unaware of dental access locations and visit emergency rooms as a reflex action. Emergency 

room visits for dental problems cost nearly $3 billion from 2008 through 2010. Providing dental 

care in ER settings costs more than providing regular care by oral health professionals. Also, 
105 


most ER visits only provide patients with pain medication and antibiotics, and do not treat the 

underlying problem. 

Currently, there are hundreds ofER referral programs in virtually every state in the United 

States. While recent research indicates that the current ER referral programs are working as the 

use of emergency rooms for dental conditions is decreasing, we cannot let up now. More still 

needs to done to expand ER referral programs and H.R. 2422 will help. 

I believe that the use of community dental health coordinators (CDHC) can continue this positive 

trend by connecting patients to dental homes and ensuring that care is delivered in the most 

appropriate, cost-effective venue possible. The CDHC program trains individuals to directly 

address the underlying social determinants of health by providing patient navigation, oral health 

information, and preventive self-care for people who typically do not receive dental services. 

The role of a CDHC is threefold: 

• educating the community about the importance of dental health and healthy 

behaviors; 

• providing limited preventive services, such as fluoride varnish and dental 

sealants; and 

• connecting the community to dental teams that can provide more complex care. 

CDHCs work in inner cities, remote rural areas, and Indian Country. Most grew up in these 

communities, allowing them, through cultural competence, to better understand the problems that 

affect access to dental care. The CDHC model has been adapted to numerous community 

settings, including clinics, schools, Head Start centers, institutional settings, churches, social 

service agencies, and others. 

It's important to note that an evaluation based on 88 case studies of CDHC programs 

demonstrated the real world value of the CDHC in making the dental team more efficient and 

effective. Screenings, dental education and certain preventive services were delivered by the 

CDHCs and individuals needing additional care did not "fall through the cracks" of a 

complicated delivery system. 

Chairman Burgess, Ranking Member Green, and members of the subcommittee, I believe that 

the Action for Dental Health Act of 2017 is an important piece of legislation that will enhance 

ongoing efforts to reduce the barriers to oral health care facing many Americans today. Thank 

you again for the opportunity for H.R. 2422 to be included in this hearing and I look forward to 

working with you to advance this important legislation. 
106 


AMERICAN ASSOCIATION OF 

NEUROLOGICAL SURGEONS KATHLEEN T, CRAIG, Executive Director 

5550MeadowbrookDrlve 

Roll1ogMeadows,ll 60008 

Phone: 888-566-AANS 

Fax: 847-:HS-0600 

mfo@aans.org 

@American 

Association of Neurological 

"-~ Surgeons I~ 

STATEMENT FOR THE RECORD 

of the 

CONGRESS OF 

NEUROLOGICAL SURGEONS REGINA SHUPAK, CEO 

lONorthMartingaleRoad,SU!tel<m 

Schaumburg,JL 60173 

Phone:877-517-1CN5 

FAX:847-240-0S\l4 

info@•1CNS.o1'9 

American Association of Neurological Surgeons 

and the 

Congress of Neurological Surgeons 

to the 

Subcommittee on Health 

Energy & Commerce Committee 

U.S. House of Representatives 

SUBJECT: H.R. 1876, the Good Samaritan Health Professionals Act of 2017 

May 17, 2017 

For More Information Contact: 

Adrienne Roberts, Senior Manager, Legislative Affairs 

AANS/CNS Washington Office 

725 15th Street, NW, Suite 500 

Washington, DC 20005 

Office: 202-446-2029 

Fax: 202-628-5264 

Email: aroberts@neurosurgery.org 

WASHINGTON OFFICE KATIE O. ORRICO, Dfredor 

725 Fifteenth Stree:, WN, Suite 500 Washington, DC 20005 

Phone: 202·62&2072 Fax: 202-62&-5264 E-mail: korrico@neurosurgery.org 
107 


The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons 

(CNS) would like to express their strong support for H.R. 1876, the Good Samaritan Health Professionals 

Act of 2017, and would like to thank the subcommittee for holding a hearing on this bipartisan legislation. 

Introduced by Reps. Marsha Blackburn (R-Tenn.) and David Scott (D-Ga.), this bill is designed to provide 

liability protections to out-of-state volunteer health professionals (VHPs), including physicians, who 

volunteer to assist victims of federally declared disasters. 

As defined by the Robert T. Stafford Disaster Relief and Emergency Assistance Act (P.L. 93-288), the 

President is authorized to issue major disaster declarations in response to certain incidents that 

overwhelm the capabilities of tribal, state, and local governments. Swift and timely medical response in a 

disaster or terrorist attack can significantly decrease the loss of life and improve outcomes for patients 

who desperately need care. 

While neurosurgeons have a long history of stepping forward to assist disaster victims, medical 

volunteers are often turned away due to the inconsistency of Good Samaritan laws and confusion and 

uncertainty about the application of these laws. This was, unfortunately, evident during the aftermath of 

Hurricane Katrina in 2005 when thousands of physicians were prevented from helping those most in 

need. Sadly, this lack of state uniformity has hindered the ability of VHPs to provide care, and in many 

cases, physicians could not provide these critical services - even if they wanted to - due to lack of 

liability protections. H.R. 1876 will help ensure that health professionals who volunteer their services in 

future disasters will not face similar uncertainties, thereby allowing them to focus on providing aid to 

victims. 

Specifically, this bill would provide VHPs with the level of civil immunity that they have in their home state 

when they provide this urgently needed care. Removing these barriers will allow neurosurgeons, in 

particular, with their training in trauma and emergency care, to provide Americans with access to highquality specialty care during a declared crisis. 

It is also notable that during these disasters the timely verification of health professional's licensure is not 

always possible. H.R. 1876 expresses a sense of Congress that the appropriate entities should verify the 

licenses as soon as is reasonably practical. 

Most importantly, H.R. 1876 does not apply if the volunteer engages in "willful or criminal misconduct, 

gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the 

individual(s) harmed by the health care professional." 

Good Samaritan Laws 

Good Samaritan laws generally provide basic legal protections for those who assist a person who is 

injured or in danger. In essence, these laws protect the "Good Samaritan" from liability if unintended 

consequences result from their assistance. All 50 states and the District of Columbia have some form of 

Good Samaritan law. Who is protected under these statutes - physicians, emergency medical 

technicians, and other first responders - and how these laws are implemented vary from state to state. 1 

These laws typically do not apply to employees on duty or those with a pre-existing obligation to provide 

care. Good Samaritan laws provide limited immunity from civil liability for ordinary negligence to 

protected volunteers. They do not provide payment for defense costs, judgments or settlements. As 

with other volunteer protection statutes, Good Samaritan laws do not cover gross negligence or wanton 

misconduct. 

1 Health Resources and Services Administration. "Emergency System for Advance Registration of Volunteer Health 

Professionals (ESAR-VHP)- Legal and Regulatory Issues." Appendix D. Available at 

http://www.publichealthlaw. net/Research/PDF /ESAR%20VHP%20Report.pdf 

[1] 
108 


Volunteer Protection Act of 1997 

While the Volunteer Protection Act of 1997 provides protection to non-profit organizations' and 

government entities' volunteers, like the Red Cross and the National Disaster Medical System (NOMS), it 

does not apply to heaHh professionals who unexpectedly volunteer of their own volition. 

Uniform Emergency Volunteer Health Practitioners Act IUEVHPAl 

Some states have adopted the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA). 2 

Under the UEVHPA. VHPs can register through governmentally established registration systems (e.g., 

ESAR-VHP or Medical Reserve Corps), or with registration systems set up by disaster relief 

organizations, licensing boards or national or multistate systems that associations of licensing boards or 

health professionals have created. UVEHPA liability protections take effect upon the state's emergency 

declaration. But again, these protections only cover VHPs who have already registered and are in the 

system. 

Disaster Relief Fund 

It is important to note just how often disaster declarations are made and potentially how often VHPs are 

needed throughout the country. A total of 936 major disaster declarations was made between FY 2000 

and FY 2015, which resulted in more than $133 billion obligated from the Disaster Relief Fund (ORF). 3 

This funding includes public, individual, and hazard assistance, in addition to Federal Emergency 

Management Agency (FEMA) administrative costs and mission assignments. 

A total of 19 major disaster declarations were made in Texas alone, totaling $8.8 billion from Tropical 

Storm Allison in 2001, Hurricane Rita in 2005 and Hurricane Ike in 2008. Other states of note include: 

Louisiana with $36.6 billion (Hurricane Katrina); New York with $23 billion (Hurricane Sandy in 2013 and 

9/11); Florida with $10.6 billion (Hurricanes Frances, Ivan and Jeanne in 2004; Hurricane Wilma in 2006; 

and Hurricane Katrina in 2005); and New Jersey with $3.8 billion (Hurricane Sandy) 4 The DRF data 

demonstrates (by one measure) the scope of federal disaster declarations and, therefore, the need for 

federal legislation to provide the necessary protections for physician volunteers. 

Conclusion 

While there are several opportunities for health professionals to register with different non-profit 

organizations and government entities, as mentioned above, these same health professionals are not 

provided with the same liability protections if they spontaneously volunteer in a disaster area. This 

patchwork nature of statutory protections for volunteers indicates that a federal legislative remedy is 

needed to unify these protections. The Good Samaritan Health Professionals Act of 2017 would alleviate 

this problem. 

The AANS and CNS look forward to working with the subcommittee further and encourage passage of 

this crucial legislation. In the meantime, thank you for considering our comments. 

2 Uniform Law Commission. UEVHPA. Available at 

http://www.uniformlaws.org/Act.aspx?title=Emergency%20Volunteer%20Health%20Practitioners. 

3 Congressional Research Service. "Major Disaster Assistance from the Disaster Relief Fund: State Profiles." 

Available at https:l/fas.org/sgp/crs/homesec/R43883.pdf 

4 Congressional Research Service. "FEMA DRF Major Disaster Assistance: State Profiles." 

[2] 
109 


Statement of 

American College of Surgeons 

To the Subcommittee on Health 

Committee on Energy and Commerce 

United States House of Representatives 

RE: Good Samaritan Health Professionals Act of 2017 

May 17,2017 
110 


On behalf of the more than 80,000 members of the American College of Surgeons, we would 

like to thank you for the opportunity to submit testimony in support of the Good Samaritan 

Health Professionals Act of 2017 (JI.R. 1876), legislation that would ensure disaster victims' 

access to medically necessary care in a declared emergency. 

In recent years, the U.S. has witnessed large scale disasters that could only be described as 

catastrophic and which were among the worst in our nation's history. The resulting devastation 

triggered mass relief efforts by local, state, and federal government agencies, as well as private 

organizations and individual health care providers. 

These disasters exposed gaps in federal and state laws intended to encourage health care 

professionals to volunteer by providing limited liability protection. Often after a disaster the most 

pressing need is for trained health care volunteers. After Hurricane Katrina, for example, 

thousands of volunteer health care professionals rushed to the scene to provide desperately 

needed services. Unfortunately, many of them were needlessly delayed in providing care or, in 

some cases, turned away due to inconsistent state and federal volunteer protection laws as well as 

confusion and uncertainty about the application of these laws. Similar problems were reported 

following the terrorist attacks on September 11, 2001 and also following the devastation from 

Hurricane Rita. 

The Good Samaritan Health Professionals Act of 2017, introduced in the House by 

Representatives Marsha Blackburn (R-TN) and David Scott (D-GA), removes this barrier by 

providing civil immunity to health care professionals who volunteer in response to a declared 

national disaster. H.R. 1876 uses the same civil immunity standard provided to other volunteers 

under the Volunteer Protection Act of 1997 (P .L. 1 05-19) and still allows individuals to hold 

health professionals accountable if the harm is caused by willful or criminal misconduct, gross 

negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the 

individual harmed. 

Providing a clear, uniform federal Good Samaritan standard for volunteer health care 

professionals who respond to large scale disasters will greatly facilitate the rapid deployment of 

needed health care services to disaster victims in the future and can greatly decrease loss of life 

and improve outcomes for patients who require urgent medical assistance. Surgeons in 

particular, with their training in trauma and critical care, play a major role in the health care 

community's response to most disaster situations. Properly trained volunteers arc essential in 

such circumstances. 
111 


H.R. 1876 would provide volunteer health professionals with the same level of civil immunity 

that they have in their home state when they provide urgently needed care in a declared 

emergency. Removing barriers that prohibit licensed surgeons and other qualified health care 

professionals from voluntarily administering medically necessary care during disasters will 

ensure citizens access to high-quality surgical services in the event of a crisis. 
112 


American 

~ Hospital 

Association. 

May 17,2017 

The Honorable Marsha Blackburn 

United States House of Representatives 

2266 Rayburn House Office Building 

Washington, DC 20515 

Dear Congressman Blackburn: 

800 10th Street 1M! 

TwoCityCen!er,Suil1!400 

Washingtnn. DC:mlt-1956 

(2()2)631!-1100Phone 

www.aha.org 

On behalf of our nearly 5,000 member hospitals, health systems and other health care 

organizations, and our clinician partners- including more than 270,000 affiliated physicians, 

2 million nurses and other caregivers- and the 43,000 health care leaders who belong to our 

professional membership groups, the American Hospital Association (AHA) is pleased to 

support the Good Samaritan Health Professional Act (H.R. 1876). By extending to licensed, 

volunteer health professionals the protective standards included in the Volunteer Protection Act 

of 1997, your legislation takes important steps to help ensure victims have access to critical 

onsite medical attention during declared federal disasters. 

This legislation is a positive step toward removing an impediment for physicians and other 

clinicians who would like to volunteer in another state during a disaster. While current state and 

federal laws provide some level of liability protections for licensed health care professionals 

administering health care services in response to a declared federal disaster, your legislation fills 

the gap in current law by extending liability protections to health care professionals crossing 

state lines to ensure people receive needed health care during such an emergency. 

We are pleased to support this legislation and look forward to working with you and your 

colleagues to achieve its passage. 
113 

Æ 


TPIAA Our Expertise !s Medica! Liability Our Passion Is Quality Healthcare. 

May 17, 2017 

The Honorable Michael Burgess, MD 

House Energy and Commerce Committee 

United States House of Representatives 

2125 Rayburn House Office Building 

Washington, D.C. 20515 

2275Researci1Btw:!.,Suite2SO 

Rockville,MD20850 

Phone:301.947.9000 

Fax.:301.947.9090 

www.piaa.us 

The Honorable Gene Green 

House Energy and Commerce Committee 

United States House of Representatives 

2322A Rayburn House Office Building 

Washington, D.C. 20515 

Subject: "Good Samaritan Health Professionals Act of 2017" 

Dear Chairman Burgess and Ranking Member Green: 

On behalf of the more than 50 domestic medical and healthcare professional liability 

(MPLIHPL) insurer members of PIAA, I am writing to thank the House Energy and 

Commerce Subcommittee on Health for examining the Good Samaritan Health 

Professionals Act of 2017 (H.R. 1876) during the subcommittee's May 171h hearing. This 

much needed legislation will ensure that victims of federally declared disasters will have 

adequate access to medical care following a catastrophic event. 

Following national calamities like a natural disaster or a terrorist attack, it is crucial for 

injured Americans to have access to adequate medical resources in a timely manner. 

Unfortunately, federal law does not provide adequate protection to health care professionals 

who spontaneously volunteer their medical services during disasters, nor does it protect 

those volunteers who cross state lines to treat victims of these catastrophes. Compounding 

this problem, the current patchwork of state laws that aim to encourage medical 

volunteerism are ambiguous and inconsistent, especially when applied to large-scale 

disasters. These issues create an environment where vital medical volunteers may be 

turned away or forced to limit their services at a time when their help is most needed. 

The Good Samaritan Health Professionals Act of 2017 corrects these problems by providing 

civil liability protections to licensed health care professionals who volunteer their time and 

skills to treat disaster victims. Additionally, the bill only applies these protections to care 

delivered during the duration of a federal disaster declaration. 

In closing, we thank you again for examining H.R. 1876 and hope that Congress enacts this 

bill into law before a major disaster strikes the United States again. 

Brian K. Atchinson 

President and CEO