[Senate Hearing 117-190]
[From the U.S. Government Publishing Office]
S. Hrg. 117-190
NOMINATIONS OF DAWN O'CONNELL
AND MIRIAM DELPHIN-RITTMON
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
ON
EXAMINING THE NOMINATIONS OF DAWN MYERS O'CONNELL, OF THE DISTRICT OF
COLUMBIA, TO BE ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE, WHO
WAS INTRODUCED BY SENATOR MURRAY, AND MIRIAM E. DELPHIN-RITTMON, OF
CONNECTICUT, TO BE ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE
USE, WHO WAS INTRODUCED BY SENATOR BLUMENTHAL, BOTH OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES
__________
JUNE 8, 2021
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
46-770 PDF WASHINGTON : 2023
COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont RICHARD BURR, North Carolina,
ROBERT P. CASEY, JR., Pennsylvania Ranking Member
TAMMY BALDWIN, Wisconsin RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut SUSAN M. COLLINS, Maine
TIM KAINE, Virginia BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota MIKE BRAUN, Indiana
JACKY ROSEN, Nevada ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado MITT ROMNEY, Utah
TOMMY TUBERVILLE, Alabama
JERRY MORAN, Kansas
Evan T. Schatz, Staff Director
David P. Cleary, Republican Staff Director
John Righter, Deputy Staff Director
C O N T E N T S
----------
STATEMENTS
TUESDAY, JUNE 8, 2021
Page
Committee Members
Murray, Hon. Patty, Chair, Committee on Health, Education, Labor,
and Pensions, Opening statement................................ 1
Burr, Hon. Richard, Ranking Member, a U.S. Senator from the State
of North Carolina, Opening statement........................... 3
Bluementhal, Hon. Richard, a U.S. Senator from the State of
Connecticut, Introduction...................................... 6
Witnesses
O'Connell, Dawn, Washington, DC.................................. 7
Prepared statement........................................... 9
Delphin-Rittmon, Miriam, Meriden, CT............................. 10
Prepared statement........................................... 11
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.
Murray, Hon. Patty:
Letters in support of the Miriam Delphin-Rittmon nomination.. 39
Letters in support of the Dawn O'Connell nomination.......... 69
NOMINATIONS OF DAWN O'CONNELL
AND MIRIAM DELPHIN-RITTMON
----------
Tuesday, June 8, 2021
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The Committee met, pursuant to notice, at 10:04 a.m., in
room SD-430, Dirksen Senate Office Building, Hon. Patty Murray,
Chair of the Committee, presiding.
Present: Senators Murray [presiding], Baldwin, Murphy,
Hassan, Smith, Rosen, Lujan, Hickenlooper, Burr, Collins,
Cassidy, Murkowski, Braun, and Marshall.
OPENING STATEMENT OF SENATOR MURRAY
The Chair. Good morning. The Senate Help, Education, Labor,
and Pensions Committee will please come to order. Today we are
holding a hearing on Dawn O'Connell to serve as Assistant
Secretary for Preparedness and Response, and Dr. Miriam
Delphin-Rittmon to serve as Assistant Secretary for Assistant
Secretary for Mental Health and Substance Abuse. Ranking Member
Burr and I will each have an opening statement and then I will
introduce Ms. O'Connell. Senator Blumenthal is here today.
Welcome. He will be introducing Dr. Delphin-Rittmon.
After the witnesses give their testimony, Senators will
each have 5 minutes for a round of questions. And as I told you
all before the break, with the change in guidance from the
office of the Attending Physician, this Committee is now
returning to hearings that look and operate more closely to how
they did before the pandemic. And while that means that we have
Senators fully in the room and seated closer together, we will
also still be providing accommodations for those who require
additional safety measures.
Additionally, while we remain unable to have the hearing
fully open to the public or media for in-person attendance,
live video is still available for--on our Committee website at
help.senate.gov. And if anyone needs accommodations, including
closed captioning, you can just reach out to the Committee at
the Office of Congressional Accessibility Services. We received
Ms. O'Connell's formal nomination on March 25th, her office of
Government Ethics paperwork, including her public financial
disclosures and ethics agreement on March 31st, and her
Committee paperwork on April 4th.
We received Dr. Delphin-Rittmon's formal nomination on
April 27th and her Office of Government Ethics paperwork on May
4th, her Committee paperwork on May 17th. I want to thank all
of our witnesses for joining us, and I would like to welcome
Ms. O'Connell's husband, Ben, and their two daughters who are
here today, and Dr. Delphin-Rittmon's husband, Patrick. Welcome
to all of you. The Office of Assistant Secretary for
Preparedness and Response, ASPR, and the Substance Abuse and
Mental Health Services Administration, SAMHSA, do critical
lifesaving work. ASPR is charged with protecting families
across the country from health security threats like natural
disasters, chemical, biological, radiological, and nuclear
agents and pandemics.
Meanwhile, SAMHSA leads efforts to advance behavioral
health and reduce the impact of substance use disorders and
mental illness. These have always been critical missions, but
the COVID-19 pandemic has put both ASPR and SAMHSA in the
spotlight, and their work has now been more critical than ever.
ASPR has been on the front lines of this crisis, facing
challenges like how to manage and replenish the strategic
national stockpile, which provides critical resources to states
for needs like personal protective equipment and materials
needs for testing, treatment, and vaccination. ASPR also
oversees BARDA, the Biomedical Advance Research and Development
Authority.
Over the past year, Congress provided BARDA funding through
our COVID relief bills to purchase vaccines and work with
Federal and private industry partners to develop lifesaving
medical countermeasures such as diagnostic tests, therapeutics,
and of course, safe, effective vaccines. As we have seen
throughout this pandemic, ASPR's work can directly affect the
health and safety of American families and workers. It impacts
whether communities are able to do adequate testing to prevent
and respond to outbreaks, whether hospitals have equipment to
treat people safely, and whether people across the country are
able to get safe, effective vaccines.
While SAMHSA was already tackling its own set of challenges
before this pandemic struck, including an opioid epidemic that
has ravaged communities and a suicide rate that has climbed for
several years, COVID-19 has seen these crises become even
worse. Half of adults in our Country say the stress and worry
of this pandemic has impacted their mental well-being.
Hospitals in my state, from Seattle to Spokane to Tacoma, have
reported higher rates of mental health emergencies for youth.
And last year we saw a record number of deaths from substance
use disorders. Given the critical work both ASPR and SAMHSA
have ahead, we must make sure each agency has a strong,
experienced leader, which is why I am looking forward to
hearing from today's nominees, both of whom are well qualified
for their roles.
As a member of HHS leadership during the Obama
administration, Ms. O'Connell managed the Department's response
to past public health emergencies like Zika and Ebola. And
before returning to the Department under President Biden as
Senior Counselor to the Secretary for the COVID-19 response,
she was Director of the U.S. Office of the Coalition for
Epidemic Preparedness Innovations, a global partnership that
works to accelerate vaccine development, ensure equitable
access, and jumpstart research to prevent future epidemics.
Meanwhile, Dr. Delphin-Rittmon has served as the
Commissioner of Connecticut's Department of Mental Health and
Addiction Services since 2015. She also previously served as a
Senior Adviser at SAMHSA, the agency that she is now nominated
to lead. Before her time at SAMHSA, she spent over a decade at
Connecticut's Department of Mental Health and Addiction
Services, where she has served as Director of the Office of
Multicultural Health Equity, Senior Policy Adviser, and Deputy
Commissioner. And while today we are considering two nominees
to help lead us forward through the end of this crisis, we
absolutely must look back, examine our failures and successes
in managing this pandemic, and make sure we improve our
Nation's public health and preparedness infrastructure, so we
are better prepared to handle the next public health crisis.
I look forward to having hearings in the months ahead as
Senator Burr and I work to craft bipartisan legislation related
to that effort. We must look at how we ensure our public health
and medical systems have sufficient capacity to provide
services to those most at risk, improve and secure the supply
chain for critical medical supplies, tackle the health
disparities that impact so many of our communities, and
strengthen the Nation's public health infrastructure and
medical preparedness and response programs at every level.
Now, before I turn it over to Ranking Member Burr for his
opening remarks, I seek unanimous consent to put in the record
10 letters in support of Ms. O'Connell's nomination and 15
letters in support of Dr. Delphin-Rittmon's nomination. So
ordered.
[The following information can be found on page 39]
The Chair. Senator Burr.
OPENING STATEMENT OF SENATOR BURR
Senator Burr. Well, thank you, Madam Chair. Thank you for
holding such an important hearing today. Dr. Rittmon, welcome,
and Ms. O'Connell, welcome. And I welcome both of your families
that are here today. Both of you are signing up for roles that
will come with an unprecedented demand.
Federal service at this level always requires a significant
commitment of time and energy. But the pandemic has changed the
responsibilities of these roles. You will both be in the thick
of policy decisions to help Americans heal from a year of loss
and lockdowns and make us better prepared for future public
health emergencies. Strong, effective leadership is crucial for
both of these roles, and is the attribute I value the most in
my considerations. I plan to spend a majority of my time this
morning speaking about the role of the Assistant Secretary for
Preparedness and Response, which I commonly referred to as
ASPR.
Before I do, I want to take a few minutes to discuss the
difficult task at hand for the Assistant Secretary for Mental
Health and Substance Use, who will lead SAMHSA. Doctor, the
past year has been extremely trying on the American people.
Many have experienced loss of precedented levels, the loss of
loved ones, the loss of being able to hug a family and friends,
the loss of jobs and school and routine. Children are
increasingly having stress and anxiety, and doctors and nurses
are seeing more children showing up at the hospitals with
serious mental health conditions. Later this week, the
Committee will be marking up the reauthorization of the Child
Abuse Prevention and Treatment Act to respond to the crisis of
child abuse that has grown more acute due to the closure of
schools during the pandemic.
Alongside these challenges, we are in danger of losing
ground on all of the progress that we have made in the fight
against the opioid crisis. Should you be confirmed, you will go
from serving 3.6 million people in Connecticut to 332 million
in America. You have an opportunity to bring access to this
type of care to more Americans. Don't return to the status quo.
Let me say it again, don't return to the status quo. Embrace
the technologies that can better serve Americans in need as we
recover from COVID-19. Use your experience at the state level
to empower state and local leaders to design programs and
solutions that best fit their communities' needs. Ms.
O'Connell, welcome.
Candidly, I wish that this hearing had been held months
ago. This Administration had an Acting ASPR since January 20th
in the middle of a response to a pandemic. The statutory lead
on public health emergencies was left open during the most
significant public health emergency of our lifetime. ASPR
should have been one of the first slots filled by this
Administration. I will also point out to my colleagues that
there is another absolutely critical public health position
that has not yet been named, the FDA Commissioner. I have the
greatest respect for Janet Woodcock. She is leading the FDA
ably, and I think she has all the qualifications needed for
this moment, but we need a fully confirmed person in that role
in FDA.
We need a nominee, and I look forward to vetting her in
this Committee as soon as possible. And Ms. O'Connell, in our
previous conversations, we talked about the reason we wrote the
ASPR into the statute. It was to answer the simple question of
who is in charge during a public health emergency. The statute
is extremely clear. The ASPR is in charge and serves as the
Principal Adviser to the Secretary on all these matters. This
is not a political or personal choice for any administration.
It is the law. It is a role that we envisioned with two types
of responsibilities. First, the ASPR serves an operational
role.
During an emergency, the ASPR coordinates the public health
and medical response, whether that threat is a hurricane, a
novel virus, or chemical attack. Another part of the day job is
the assessment of and investment in our medical countermeasure
enterprise. As the head of the Public Health Emergency Medical
Countermeasures Enterprise, or FEMSA, and with oversight of
BARDA and the Strategic National Stockpile, this job covers the
research, development, procurement, and deployment of these
lifesaving products. Second, the ASPR is a policy job,
assessing the threat landscape and adjusting our strategies to
best position the United States for threats we face today and
more importantly, in the future.
My questions today are designed to make sure that you are a
good candidate for the entirety of the role as developed and
envisioned by this Committee. With each iteration of the
Pandemic and All Hazard Preparedness Act, or PAHPA for short,
we have adjusted our emergency preparedness and response
framework, including the role of ASPR. During the last
reauthorization, we more closely tied the position to the
intelligence community, providing the ASPR with greater line of
sight into the ever changing landscape of the threats that we
face. We made ASPR the head of FEMSA, to coordinate and make
decisions on medical countermeasure investments, and we updated
the ASPR's job description to ensure a focus on both the
operational and policy roles.
ASPR's responsibilities also now include the stockpile, a
move that strengthens, I think, the operational side of the
job. With the ASPR over the stockpile, he or she can follow
taxpayer investments from the advanced research at BARDA, all
the way through the last mile of deployment during an
emergency. Yet the office of ASPR has also been utilized in
ways that are outside of its scope. This distracts the ASPR
from its mission and ultimately makes us less prepared. When we
wrote the first PAHPA legislation, we hoped that we would never
have to use it, and it came into needing COVID.
A lot of the framework that this Committee designed worked
extremely well during the pandemic. We have three authorized
vaccines with more on the way, dramatically changing the
trajectory of our response to COVID for the better. But the
response was not perfect, and the work is not done. Instead of
looking to the ASPR, the last administration created its own
leadership structure for the COVID response, building the plane
and flying it at the same time.
Congress intentionally created ASPR to avoid this confusion
and to be the tip of the spear during a response. I know who
was supposed to be in charge because I helped write the law
putting ASPR in charge. So our Committee looks at what
improvements need to be made in the law. I hope that if you are
confirmed, you and my colleagues will work with me to see what
mistakes were made and how to learn from them, to make it more
clear that ASPR is, in fact, in charge and that we have the
tool--and that you have the tools you need, and that when the
next pandemic comes, because it likely will, the ASPR is ready
to stand up and take the lead.
The American people expect us to do all we can to protect
them from a public health threat and to communicate those
actions to them as clearly as possible. They deserve an ASPR
that can command the response and coordinate their colleagues
across HHS. And that brings the same urgency and vigilance to
the role in peacetime as in the middle of a response. I look
forward to our conversation today and hearing whether you are
ready to risk--to rise to the challenge before you. I thank the
Chair.
The Chair. Thank you, Senator Burr. We will now introduce
today's witnesses. Dawn O'Connell is an expert in public
health, emergency preparedness and response efforts, and
currently Senior Adviser for the COVID-19 response at the
Department of Health and Human Services. Before she was named
to that position earlier this year, she spent several years as
the U.S. Office Director at the Coalition for Epidemic
Preparedness Innovations, or CEPI, an organization focused on
global preparedness for disease outbreaks.
CEPI is a collaborative effort with public, private and
civil society partners from around the world. It works to
accelerate vaccine development, ensure equitable access, create
stockpiles against epidemics before they start, invest in
technology to speed up vaccine development for new diseases,
and coordinate Governmental responses and capacity in places
that need additional support. Ms. O'Connell's leadership to
help CEPI quickly become a key player in developing vaccines
against emerging infectious diseases like COVID. CEPI was a
founding member of the Access to COVID-19 Tools Accelerator, a
program that developed alongside the World Health Organization
to ensure vaccines were developed and distributed equitably.
O'Connell worked with others at CEPI to convene an
international group of stakeholders focused on speeding up the
purchase, production, and distribution of COVID-19 vaccines.
But long before this pandemic and her time at CEPI, O'Connell
was already focused on global health security.
As a Senior HHS staffer in the Obama administration, she
managed the Department's response to Zika, oversaw the response
to Ebola, and coordinated efforts with state, Federal, and
international partners, and lead HHS' work with the White
House's National Security staff, World Health Organization, and
partner countries to develop and launch President Obama's
global health security agenda.
Prior to her time in the Obama administration, she worked
for Congressman John Spratt of South Carolina in a number of
roles, including 4 years as his chief of staff. O'Connell
received her B.A. from Vanderbilt University and her JD from
Tulane University Law School. She currently lives in
Washington, DC. with her husband and two daughters who are
again here with her today. Ms. O'Connell, I am delighted to
welcome you and your family.
Thank you for joining us. And I look forward to hearing
from you today and working with you in the future. And with
that, I will turn it over to Senator Blumenthal to introduce
Dr. Delphin-Rittmon.
Senator Blumenthal.
STATEMENT OF SENATOR BLUMENTHAL
Senator Blumenthal. Thank you, Chair Murray, Ranking Member
Burr, Members of the Committee. I am really so proud to be here
today. It is bittersweet because for all the reasons that
Commissioner Delphin-Rittmon will be a great Assistant
Secretary, we will miss her in Connecticut. And I was last here
to introduce Dr. Miguel Cardona, the nominee for Secretary of
Education.
I almost want to say to President Biden, quit taking some
of our best people because Commissioner Delphin-Rittmon is one
of the most valued and dedicated public servants in the State
of Connecticut. And I want to speak personally because I have
come to know and admire her personally. She is someone who
shows up and she wears well. She may not be the splashiest
person when you first get to know her, but the more you know
her, the more you admire and respect and like her as a human
being of tremendous training and professional expertise, but
also someone who leads by example, leads with her heart as well
as her head.
Talking about showing up, I have seen her at countless
community forums and meetings with public officials,
professional experts, but also recovering addicts and their
families, and she is someone who knows how to communicate to
raise awareness and support. If there is a person in treatment,
a person seeking treatment, a person in recovery, a person who
needs someone to help them through the insidious disease of
addiction, Dr. Delphin-Rittmon is there. And as Assistant
Secretary for Mental Health and Substance Abuse, she will be
there for the Nation, as she has been for the people of
Connecticut. She knows that solving the problem of opioid and
mental health crises in our Country, we must meet people where
they are at themselves.
When she heard from the community about barriers to care,
she deployed a mobile medication treatment program to high need
areas. When she heard that people were struggling to access
care, she implemented a 24/7, toll free access line to help
people find access. And through transportation assistance, she
literally got to care for them in the way that they needed. She
has been the right person at the right moment for Connecticut,
and I think she is the right person for this job for our entire
nation. She has a background as a clinical community
psychologist and public servant who has dedicated her life to
helping people who suffer from the disease.
She, more than anyone, recognizes that addiction is a
disease, not a moral failing, and mental illness, which as I
think everybody on this Committee recognizes, is a problem that
we have failed to give sufficient importance to treating. And I
know that she will be a continuing advocate for mental health
parity, which I have fought to recognize, and I know Members of
this Committee like Chair Murray and Senator Casey and others,
Senator Baldwin, have as well. So I strongly recommend her to
this Committee.
There is no sugarcoating the problems that she has to
address. They are Herculean, and they will require a commitment
from the Nation and from this President, which I know will be
forthcoming, as well as from us in the U.S. Senate. And I am
very, very grateful for the opportunity to introduce her and
her husband, Patrick, to this Committee. Thank you very much.
The Chair. Thank you, Senator Blumenthal. Appreciate that
introduction. Welcome to you, Dr. Delphin-Rittmon. And with
that, we will begin our testimony today. And Ms. O'Connell, we
will begin with you.
STATEMENT OF DAWN O'CONNELL TO BE ASSISTANT SECRETARY FOR
PREPAREDNESS AND RESPONSE, WASHINGTON, DC
Ms. O'Connell. Chair Murray, Ranking Member Burr, Members
of the Committee, I am honored to appear before you today as
you consider my nomination for the position of Assistant
Secretary for Preparedness and Response at the U.S. Department
of Health and Human Services. Chair Murray, thank you for the
kind words of introduction. I must also thank President Biden
for nominating me to this important role, and of course, thank
my family, my husband Ben and daughters Maddie and Franny whose
love, support, and senses of humor sustained me through late
nights and long hours of work.
I am honored also to be on the same panel today with Dr.
Miriam Delphin-Rittmon, the President's SAMHSA nominee. I was
called to public service early in life, influenced by the
example set by my parents, an educator and social worker. This
vocation was further strengthened as a young staffer on the
Hill, witnessing the tragic events of September 11th. On that
day, I was evacuated from my office in the Longworth Building
and stood with colleagues just a few blocks from the Capitol
watching in horror on a portable television as the Twin Towers
fell.
A few weeks later, our office was evacuated again, this
time for several weeks while it was secured following the
deadly anthrax letters sent to Congress. And then in 2005, my
family with deep New Orleans roots was impacted by Hurricane
Katrina. Several of my aunts and cousins were forced to leave
their homes and a great aunt was among those evacuated from a
nursing home that was unable to maintain power and safe
conditions. It took our family several days to find her with
fellow residents on a tarmac in Memphis. Grateful to the
responders that got her there unharmed. These events ingrained
in me the importance of a strong emergency response system.
They also led to the formation of the Office of the
Assistant Secretary for Preparedness and Response, the role for
which I am being considered today. I took these lessons with me
to HHS during the Obama administration, where I served as
Deputy Chief of Staff to both Secretary Sebelius and Burwell.
In that role, I helped lead the responses to several public
health emergencies, including the Ebola and Zika outbreaks, and
hone their skills necessary to manage complex crises.
This experience, coupled with nearly 4 years working for
the Coalition for Epidemic Preparedness Innovations, an
international nonprofit whose mission is to accelerate the
development of vaccines to prevent epidemics, uniquely
qualified me to come back to HHS to serve as Secretary
Becerra's Senior Counselor for COVID-19. As part of the
Administration's current COVID response effort, I have seen how
critically important the mission of ASPR is at this pivotal and
unprecedented time. I have also witnessed the dedication and
commitment of the ASPR team. If confirmed for this role and
entrusted to lead this team, my priorities would be threefold.
First, to deliver us quickly out of the current pandemic by
continuing ASPR's work of accelerating the development and
distribution of vaccines and therapeutics, and securing and
distributing necessary PPE. Second, to restore and maintain the
public health emergency capacity that has been severely
strained by the pandemic, including replenishing the strategic
national stockpile. Third, to begin preparing for the next
public health emergency, whether natural or manmade, by keeping
vigilant watch of the horizon, scanning for what may come next.
If confirmed, I commit to working against each of these
priorities in a transparent and accountable manner, and to
always let the science lead. I also commit to working as a
partner with this Committee. Public health preparedness and
response is neither a Republican issue nor a Democratic issue,
it is an American issue. If confirmed, I will work with each of
you to ensure that the communities you represent have the tools
needed to prepare for the next public health emergency.
Finally, I pledge to do everything in my power to address
the serious challenges ahead of us as we navigate threats that
endanger Americans, our health and national security, both
present and future. I am prepared for the task ahead and
honored to be nominated to serve as the ASPR. Thank you for
considering my nomination and I look forward to answering your
questions.
[The prepared statement of Ms. O'Connell follows:]
prepared statement of dawn o'connell
Chair Murray, Ranking Member Burr, Members of the Committee--I am
honored to appear before you today as you consider my nomination for
the position of Assistant Secretary for Preparedness and Response at
the U.S. Department of Health and Human Services. Chair Murray, thank
you for the kind words of introduction.
I must also thank President Biden for nominating me to this
important role and of course my family: my husband Ben and daughters
Maddie and Frannie whose love, support and senses of humor sustain me
through late nights and long hours of work.
I am honored to be on the same panel today with Dr. Miriam Delphin-
Rittmon, the President's SAMHSA nominee.
I was called to public service early in life influenced by the
example set by my parents: an educator and a social worker. This
vocation was further strengthened as a young staffer on the Hill
witnessing the tragic events of September 11, 2001.
On that day, I was evacuated from my office in the Longworth
Building and stood with colleagues just a few blocks from the United
States Capitol--watching in horror on a portable television as the Twin
Towers fell. A few weeks later, our office was evacuated again--this
time for several weeks--while it was secured following the deadly
anthrax letters sent to Congress.
In 2005, my family with deep New Orleans roots, was impacted by
Hurricane Katrina. Several of my aunts and cousins were forced to leave
their homes--and a great aunt was among those evacuated from a nursing
home unable to maintain power and safe conditions. It took our family
several days to find her with fellow residents on a tarmac in Memphis--
grateful to the responders that got her there unharmed.
These events ingrained in me the importance of a strong emergency
response system. They also led to the formation of the Office of the
Assistant Secretary for Preparedness and Response (ASPR). The role for
which I'm being considered today.
I took these lessons with me to HHS during the Obama administration
where I served as Deputy Chief of Staff to both Secretaries Sebelius
and Burwell. In that role, I helped lead the responses to several
public health emergencies--including the Ebola and Zika outbreaks--and
honed the skills necessary to manage complex crises.
This experience coupled with nearly 4 years working for the
Coalition for Epidemic Preparedness Innovations--an international non-
profit whose mission is to accelerate the development of vaccines to
prevent epidemics--uniquely qualified me to come back to HHS to serve
as Secretary Becerra's Senior Counselor for COVID-19.
As part of the Administration's current COVID-19 response effort, I
have seen how critically important the mission of ASPR is at this
pivotal and unprecedented time. I have also witnessed the dedication
and commitment of the ASPR team.
If confirmed for this role and entrusted to lead this team, my
priorities would be threefold:
First, to deliver us quickly out of the current pandemic by
continuing ASPR's work of accelerating the development and
distribution of vaccines and therapeutics and securing and
distributing necessary personal protective equipment or PPE.
Second, to restore and maintain the public health emergency
capacity that has been severely strained by the pandemic
including replenishing the Strategic National Stockpile.
Third, to begin preparing for the next public health emergency
whether natural or man-made by keeping vigilant watch of the
horizon--scanning for what might come next.
If confirmed, I commit to working against each of these priorities
in a transparent, accountable, and collaborative manner and to always
let the science lead.
I also commit to working as a partner with this Committee. Public
health preparedness and response is neither a Republican issue nor a
Democratic issue. It is an American issue. If confirmed, I will work
with each of you to ensure that the communities you represent have the
tools needed to prepare for the next public health emergency.
Finally, I pledge to do everything in my power to address the
serious challenges ahead of us as we navigate threats that endanger
Americans, our health and national security--both present and future.
I am prepared for the task ahead and honored to be nominated to
serve as the ASPR. Thank you for considering my nomination. I look
forward to answering your questions.
______
The Chair. Thank you, Ms. O'Connell. We will now turn to
Dr. Delphin-Rittmon for your testimony.
STATEMENT OF MIRIAM DELPHIN-RITTMON TO BE ASSISTANT SECRETARY
FOR MENTAL HEALTH AND SUBSTANCE USE, MERIDEN, CONNECTICUT
Ms. Delphin-Rittmon. Thank you and good morning, Chair
Murray, Ranking Member Burr, Members of the Committee. Thank
you for considering my nomination to be Assistant Secretary for
mental health and substance use at the U.S. Department of
Mental Health and--at the U.S. Department of Health and Human
Services. And thank you to Senator Blumenthal for his kind
introduction.
I so appreciate his leadership and fierce advocacy for
mental health and substance use recovery needs of the people of
Connecticut and across our Nation. It is a true honor to be
here today. First, I want to thank President Biden for
nominating me and placing his trust in me. Here today with me
is my husband, Patrick Rittmon, a 22 year veteran of the U.S.
Marine Corps. I am ever grateful for his service to our Country
and for his support and understanding throughout my career. I
sit before you today the daughter of Haitian immigrants who
came to the United States filled with the hope and optimism of
America's promise.
My father, through perseverance, long hours, and a passion
for learning and helping others, became a psychiatrist who
practiced for over 50 years and achieved five board
certifications in the mental health field. It is with the same
passion for learning and aiding others that my parents raised
my three brothers and two sisters and me, emphasizing
education, hard work, empathy, compassion, perseverance with
faith through adversity, and cherishing the blessing of our
family. These are all values that are central to who I am today
and core values that influence and inform my work. Throughout
my 20 year career in the behavioral health field, I have had
extensive experience in direct care, academic, and Government
settings.
Emphasizing recovery, addressing equity and culture and
behavioral health service delivery, and system development are
prominent themes in my work, largely influenced by my having
received a SAMHSA minority fellowship in graduate school and my
subsequent payback experiences with the Yale University Program
for Recovery and Community Health in the Department of
Psychiatry, where I conducted research, clinical care training,
and consultation in community and State Government settings.
I am currently an Adjunct Associate Professor at Yale,
having been on faculty since 2002, and I am a testament to the
value of such fellowship programs growing our diverse
behavioral health workforce. As commissioner of the Department
of Mental Health and Addiction Services, a role I have held
since 2015, my focus has been on recovery--on promoting
recovery oriented, integrated and cultural responses services
and systems that foster dignity, respect, meaningful community
inclusion among the individuals that we are entrusted to serve.
The President has nominated me at an inflection point in the
Nation's collective mental health. The COVID-19 pandemic has
had far reaching ripple effects on aspects of our daily lives,
many aspects of our daily lives, and it has taken a significant
toll on mental health.
Across the country, we are seeing increased rates of
anxiety, depression, and tragically, tragically overdose deaths
have substantially increased as well. As we face this
behavioral health challenge of our lifetime, SAMHSA finds
itself with never before seen resources to address these
critical issues. Where we go from here will impact a generation
of American families. If confirmed, my agenda is clear. First,
we must increase access to mental health and substance use
services and supports to better address the behavioral health
challenges that children and adults alike are experiencing as a
function of this pandemic.
Second, we must enhance crisis and suicide prevention
services and supports in line with the implementation of the
988 National Suicide Prevention and Crisis Hotline. This
nationwide change in crisis response will allow Americans to
get services and supports where they need it and when they need
it. Finally, the overdose epidemic continues to ravage many
communities across the country. This is not a new problem, yet
it has exacerbated during COVID-19, and we see daily losses in
life nationwide. If confirmed, reaching people where they are
via innovative prevention, treatment, harm reduction, and
recovery solutions will be a hallmark of the work of SAMHSA.
I realize that we may not always agree on the best
approaches to solve these challenges, but I pledge to work
closely with you to ensure that our decisions are transparent,
that our team is accessible, and the SAMHSA listens to your
views. Before I close, I must acknowledge the outpouring of
support from across the country. I am deeply humbled and
appreciative of all those who wrote letters or called or texted
or helped with the letters. Thank you so much.
I see you all as vital parts of the village that it will
take to address this behavioral health challenge we are facing
as a Nation. Thank you for your consideration of my nomination,
and I look forward to answering your questions.
[The prepared statement of Ms. Delphin-Rittmon follows:]
prepared statement of miriam delphin-rittmon
Chairman Murray, Ranking Member Burr, and Members of the Committee,
thank you for considering my nomination to be the Assistant Secretary
for Mental Health and Substance Use at the U.S. Department of Health
and Human Services. And thank you to Senators Blumenthal and Murphy for
your kind introductions. I so appreciate your leadership and fierce
advocacy for mental health and substance use treatment and recovery
needs of the people of Connecticut and across our Nation.
It is a true honor to be here today. First, I want to thank
President Biden for nominating me and placing his trust in me. Here
with me today is my husband, Patrick Rittmon, a 22-year veteran of the
United States Marine Corp. I am ever grateful for his service to our
Country and for his support and understanding throughout out my career.
I sit before you today the daughter of Haitian immigrants who came
to the United States filled with hope and optimism of America's
promise. My father, through perseverance, long hours and a passion for
learning and helping others, became a psychiatrist and practiced for
over 50 years achieving 5 board certifications in the mental health
field. It is with this same passion for learning and aiding others that
my parents raised my three brothers, two sisters and me emphasizing
education, hard work, empathy, compassion, perseverance, with faith,
through adversity and cherishing the blessing of our family. These are
all values that are central to who I am today and core values that
influence and inform my work.
Throughout my over 20-year career in the behavioral health field, I
have had extensive experience in direct client care, academic, and
government settings. Emphasizing recovery and addressing equity and
culture in behavioral health service delivery and system development
are prominent themes in my work--largely influenced by my having
received a Substance Abuse and Mental Health Services Administration
(SAMHSA) Minority Fellowship in graduate school and my subsequent
payback experiences with the Yale University Program for Recovery and
Community Health in Department of Psychiatry, where I conducted
research, provided clinical care, training and consultation in
community mental health and state government settings. I am currently
an Adjunct Associate Professor at Yale having been on faculty since
2002 and am a testament to the value of such fellowship programs
growing our diverse behavioral health workforce.
As the Commissioner of the Connecticut State Department of Mental
Health and Addiction Services, a role I have held since 2015, my focus
has been on promoting recovery-oriented, integrated, and culturally
responsive services and systems that foster dignity, respect, and
meaningful community inclusion of the individuals we are entrusted to
serve.
The President has nominated me at an inflection point of this
Nation's collective mental health. The COVID-19 pandemic has had far
reaching ripple effects on many aspects of our daily lives and has
taken a significant toll on mental health. Across the country we are
seeing increased rates of anxiety and depression, and tragically
overdose deaths are substantially increasing across the country.
As we face this behavioral health challenge of our lifetime, SAMHSA
finds itself with never before seen resources to address these critical
issues.
Where we go from here will define a generation of American
families.
If confirmed, my agenda is clear--first, we must increase access to
mental health and substance use services and supports to better address
the behavioral health challenges adults and children alike are
experiencing as a result of the pandemic.
Second, we must enhance crisis and suicide prevention services and
supports in line with the implementation of the 988 national suicide
prevention and crisis hotline. This nationwide change in crisis
response will allow Americans in crisis to connect with support when
and where they need it.
Finally, the overdose epidemic continues to ravage too many
communities across the country. This is not a new problem, yet it has
been exacerbated during COVID-19 and results in daily losses for
communities nationwide. If confirmed, reaching people where they are
via innovative prevention, treatment, harm reduction, and recovery
solutions will be a hallmark of the work of SAMHSA.
I realize that we may not always agree on the best approaches to
solve these challenges, but I pledge to work closely with you to ensure
that our decisions are transparent, our team accessible, and that
SAMHSA is listening to your views.
Before I close, I must acknowledge the outpouring of support from
across the country. I am deeply humbled and appreciative of all those
who wrote letters or called or email and texted--thank you so much. I
see you all as vital parts of the village it will take to address the
behavioral health challenges we face as a Nation.
Thank you for considering my nomination, and I look forward to
answering your questions.
______
The Chair. Thank you very much. We will now begin a round
of 5 minute questions. And I ask all of my colleagues, as
usual, please keep track of the clock, stay within 5 minutes.
The COVID-19 pandemic has been devastating. And in the United
States, the virus has killed nearly 600,000 people and sickened
more than 30 million others. It has challenged our mental
health and it has pushed our frontline health care workers and
our public health systems to the brink.
The burden of all those challenges has fallen
disproportionately on people of color, women, people with
disabilities, and those with the lowest incomes. You are now
both nominated to lead offices tasked with responding to these
challenges. And I want to hear what steps each of you will take
to place equity at the center of that response. So if
confirmed, how will you prioritize equity in the ongoing COVID-
19 response and ensure it is a priority in the response to
future public health crises? And I will start with Ms.
O'Connell.
Ms. O'Connell. Chair Murray, thank you so much for that
question and thank you for your leadership on these important
issues. We have seen over this last year the disproportionate
impact of COVID-19 on communities of color and vulnerable
populations. And it has really brought into focus the need to
equitably distribute vaccines, therapeutics, PPE, and other
tools that are necessary to fight the pandemic. The Biden
administration has made equity a cornerstone of its response.
It is interwoven in all of the things that it has done,
including the distribution of vaccines. It has emphasized not
just going fast, but also going fairly.
If I am confirmed, I will continue that work from the
perspective of the ASPR in distributing PPE, vaccines,
therapeutics to make sure that the tools that we have been so
lucky to have developed so quickly in this pandemic are
distributed equitably because in America we are not going to
recover unless all Americans have access to these critical
tools. And I will commit to ensuring that the tools are
available to all communities.
The Chair. Thank you.
Dr. Delphin-Rittmon.
Ms. Delphin-Rittmon. Yes. Thank you, Chair Murray, for that
question. We know it is so important to ensure that individuals
that are accessing our services and systems, particularly
diverse individuals, as well as all individuals across the
country, to include individuals within rural areas, that they
receive optimal care and that we are able to both identify and
address any disparities that are present. Should I be
confirmed, I would be very interested in, for one, looking at
the data that we have. We know that SAMHSA has a good bit of
data. And so a part of addressing and focusing on equity is
having a good sense of what the trends and what the disparities
may be. So certainly that would be a part of our work.
SAMHSA has an Office of Behavioral Health Equity and I
would look forward to continuing to expand the work of that
office. I also would look forward to working with the
Secretary. I know this is a priority for the Administration and
so I would look forward to marshaling the resources necessary
to ensure that we address equity.
We know this is a challenge that we have seen in our
Country prior to the pandemic. And so, as I have throughout my
career, would be committed to working on this important issue
to ensure that diverse Americans, as well as Americans within
rural areas, and all Americans accessing services and supports
receive quality, equitable care to ensure strong health
outcomes. Thank you for that question.
The Chair. Thank you. Ms. O'Connell, the Office of the
Assistant Secretary for Preparedness and Response oversees and
coordinates the Department's response to emergencies like
COVID-19, as well as managing the strategic national stockpile.
We need a stockpile that can adequately address future threats
such as infectious disease outbreaks like we have seen, as well
as protect our frontline health care workers with the personal
protective equipment they need. I wanted to ask you, if you are
confirmed, how will you ensure that ASPR demonstrates both
effective and responsible management of the stockpile before
and during public health emergencies?
Ms. O'Connell. Chair Murray, thank you so much for that
question. If confirmed, I expect to spend a significant amount
of my time working on the strategic national stockpile. We have
certainly learned a lot in this last year and a half about what
it was and what it wasn't and what it needs to be. I think it
is important that we diversify what is in there to make sure
that it is fit for purpose for whatever the most likely public
health emergencies to come will be.
I also think it is critical that we secure a domestic
manufacturing base so we have a secure and resilient public
health and medical supply chain that we can rely on both in
peacetime and in times of need. There is going to be a lot that
we need to learn coming out of this pandemic. And I look
forward to working with this Committee on learning those
lessons and applying those lessons to the strategic national
stockpile and other places.
The Chair. Thank you.
Senator Burr.
Senator Burr. Thank you, Chair. Dr. Delphin-Rittmon, I
believe faith is a powerful tool for helping people find
community and healing. Under current law, faith based
organizations are eligible to compete as grantees for SAMHSA
substance use disorder programs while maintaining their
religious character because of a provision known as the
charitable choice. If confirmed, will you commit to upholding
this law at SAMHSA?
Ms. Delphin-Rittmon. I appreciate that question, Senator,
and again, appreciate the opportunity to appear before this
Committee. Certainly within my work in Connecticut, I have seen
the value of the collaborations with faith based organizations.
And so, yes, I can confirm that I would commit to upholding the
law related to this. I have seen significant impacts related to
faith based organizations connecting people to services and
supports and helping to promote long term recovery for
individuals that connect to services.
Senator Burr. Thank you for that commitment. Ms. O'Connell,
as I stated in my opening statement, I think the law is very
clear that the ASPR is in charge. Do you agree that the law
puts the ASPR in charge?
Ms. O'Connell. Thank you, Ranking Member Burr. I do agree.
Senator Burr. If confirmed, what would be the first three
things you would do differently to make it clear that you are
in charge?
Ms. O'Connell. Ranking Member Burr, thank you so much for
that question and thank you for your career long commitment to
these issues. It is an honor to be before you today, as I am
being considered for the ASPR role that you helped create. I do
think it is important that the ASPR is in charge. And I have to
say I was surprised coming back into the Administration and
into HHS in January to find the Coast Guard on behalf of FEMA,
coordinating within the Department, doing the interagency and
interagency coordination, a role I thought should be run by the
ASPR. So I agree with you that is a critical, a critical role.
Among the things I would do would be to take the work that
I have currently been doing, which is different in scope and
different in mission, but has helped build relationships across
the Department, and apply those relationships in the role of
ASPR to help coordinate on behalf of the Department both for
the ending of the COVID pandemic and any future public health
emergencies that might happen.
The relationship that I currently have with the Secretary
as his Senior Counselor will come into play. And I believe as
ASPR, I would have the full faith of the Department behind me
in the coordination of any public health emergencies.
Senator Burr. Today, the scope of BARDA is larger than when
we originally created BARDA as an entity. And there are some
that would like to expand that even further. And I am not
asking you to weigh in on the science behind BARDA's decisions,
but on ways to keep the agency focused on its mission. And how
would you ensure BARDA remains focused on the serious public
health threats?
Ms. O'Connell. BARDA is a unique agency within the
Administration, and it has stepped up and risen to the
challenge in this pandemic. Ranking Member Burr, it is the
partner with DOD and what was called Operation Warp Speed and
can share in the success of having these three vaccines
developed and under authorization within 11 months.
I believe in order for BARDA to continue to strengthen this
mission, it must do the work that it was intended to do, which
is to accelerate and ensure that countermeasures that will keep
us safe from any public health emergency are developed and
maintained. And I intend to make sure that BARDA is able to do
that, should I be confirmed.
Senator Burr. As you said, this is not your first rodeo in
an administration. You were in the Obama administration under,
I think, two Secretaries at HHS. And you said you led the
response during--the response effort during Ebola. Now, you
weren't ASPR then. The ASPR was actually delegated to
concentrating on the hospital network in the country for Ebola
patients that would come back to the U.S. What can you reflect
to the Committee now, that the ASPR should have been doing at
that time, and reflect what you will do?
Ms. O'Connell. Ranking Member Burr, thank you for that
question. I can't speak to the reasons why the Secretaries
organize the responses the way they do. But I do intend, should
I be confirmed as the ASPR, to lead the future of public health
emergencies and to be the Secretary's principal adviser on
public health emergencies and response.
Senator Burr. Right. And Madam Chair, if I could just say
for all Members, the question of PPE--PPE for the future, and
the supply chain is probably the biggest issue that this
Committee will deal with, hopefully in collaboration with the
ASPR. There is not an easy answer to it because as we have
learned, there is a difference between capacity and capability.
When the Federal Government is 4 percent of the PPE
purchases and 96 percent is outside of the Government, it makes
it very difficult to set up a supply chain that you can control
and assure that there is a base to sell to with the global
competition at ridiculous prices we see today. So it is going
to be challenging. Thank you.
The Chair. Yes, it will. At this point, I am going to turn
the Committee over to Senator Casey. I have to go to another
Committee. I will be back shortly. And the next two speakers
will be Senator Smith, Senator Cassidy, and Senator Casey will
be holding the gavel until I return. Thank you.
Senator Smith. Thank you so much. Thank you, Madam Chair
and Ranking Member Burr, and it is really great to be back
together in the Committee with everyone. And I want to also
just welcome Ms. O'Connell and Dr. Delphin-Rittmon for your
willingness to serve our Country at this most important time.
So thank you so much for being with us today. Dr. Delphin-
Rittmon, I would like to direct my first question to you. And
this is really about the pediatric mental health crisis that I
see that we are facing in this country.
The Star Tribune in my home State of Minnesota recently
profiled the stories of Minnesota families who are dealing with
this thing called emergency room boarding, caused by an
egregious shortage of pediatric inpatient beds where families
are so concerned about the health and well-being of their
children that they take them to an emergency room and then
there they stay because there is no place for them to go. And
sometimes they are there for days. This kind of boarding, of
course, is so traumatic and it aggravates symptoms of serious
mental health conditions.
It leads moms like Allison Yokum, who was quoted in this
story, to ask herself, am I a bad mom because I took my son to
the emergency room. But these are the choices that parents face
when there is no better alternative, and it is only getting
worse. Of course, we know, like so many things, this was an
issue before the pandemic, but the pandemic has made it--has
exacerbated it. So my question to you is, what can you tell us
about the risks of this kind of shortage of pediatric inpatient
beds? And what should we be doing at the Federal level to
address this issue and to expand access to inpatient health
care for young people who have a critical need?
Ms. Delphin-Rittmon. Yes. Senator, I want to thank you for
that question, and I also appreciate the time that we had a
couple of weeks ago to speak about these and other issues. You
know, this is a challenge that we are seeing across the
country. We know that there is a shortage of child
psychiatrists, for example, across the country. So certainly
workforce is an important area to address here. We know that it
is critical for children to be treated at the appropriate level
of care.
Children in emergency Departments for long periods of time,
that can create experience of trauma onto itself for the
children, and in some instances for the families as well. So it
is an area that we really need to come together on and do some
real creative thinking and innovative thinking around how to
address this, particularly in terms of workforce, but also in
terms of how to better meet the needs of children prior to
their being in crisis and needing an emergency Department.
HERSA has done a lot of work in this area.
In fact, they have recently put out a guide related to
children's mental health that includes information related to
assessments and triage and working with community providers and
partners. And so I think that is a real valuable resource that
is there. Dissemination of resources like that to hospitals I
think would be extremely helpful. If I am confirmed, I would be
very interested in meeting with you and working with others
across Government to further explore this critical issue.
We know it is important to get children connected to care
so that they can receive optimal health outcomes as well. But
thank you for the question and for your work and advocacy in
this area as well.
Senator Smith. Thank you so much. I appreciate it. I am
working with colleagues on a package of policy solutions to
expand access to mental health care, especially for young
people. One piece of this is a loan forgiveness. It would
provide loan forgiveness for providers who are able to practice
in shortage areas. This is a piece of legislation I am working
on with Senator Murkowski. Also looking at increasing Federal
Medicaid reimbursement for behavioral health. The reimbursement
is often so important. And then third, increasing access to
school based mental health care. You and I spoke about this.
This is something I and many of my colleagues have an interest
in and is a great way of reaching young people before they are
in a real crisis situation.
Before I--I am going to run out of time and a minute here,
I want to just briefly talk with Ms. O'Connell. The pandemic
exposed our Nation's dependance on countries for the supply of
our essential prescription drugs. Over 70 percent of
manufacturers that supply the United States with active
pharmaceutical ingredients are based overseas. We have a
serious issue here.
Senator Cassidy and I are working on bipartisan legislation
that would incentivize domestic manufacturing of essential
antibiotic drugs to secure our medical supply chain. In the
minus 3 seconds I have left, maybe if you could just comment
very briefly on that need.
Ms. O'Connell. Senator Smith, thank you so much for your
question, and I will try to be real quick just to say that I
commit to working with you and Senator Cassidy on this bill. I
do think this past year and a half has exposed some cracks in
our medical and public health supply chains. And I look forward
to trying to solve for that and incentivize more domestic
manufacturing.
Senator Smith. Thank you so much.
Senator Casey. Thank you, Senator Smith.
Senator Cassidy.
Senator Cassidy. Hey. Hello. Thank you both. I appreciate
the call that both of you gave. And Dr. Delphin-Rittmon, thank
you for your husband's service. So, thank you both. Ms.
O'Connell, let me start with you, please. And this will be
something we spoke about on the phone but I still think it is
worthwhile to publicly speak about. The--speaking of ASPR, and
how they kind of show got shoved to the back seat in this last
response to the pandemic, my appropriations guys, just kind
of--just kind of pointing things out.
They don't know how to dispense billions of dollars, HHS in
general and ASPR in particular. Inevitably, this is going to
fall to FEMA because FEMA knows how to dispense billions of
dollars. Unfortunately, FEMA doesn't have medical staff and so
it is going to be not as efficient as if they did. And that was
just as amusing when it started. And it turns out it was
absolutely true. So it is kind of a structural problem, if you
will.
How would you address that structural problem without
creating a gazillion other people who are working from home
during a pandemic?
Ms. O'Connell. Senator Cassidy, thank you so much for that
question and thank you so much for the good conversation we
had. And I enjoyed speaking about this particular issue. And if
I am confirmed, it is one I have been reflecting on because we
currently have, as I mentioned to Ranking Member Burr, BARDA is
the partner with DOD right now in what was the operation--
Operation Warp Speed. And what DOD has brought into the
Department is extraordinary capacity when it comes to
logistics, acquisitions, and contracting. And one of the first
things I will be faced with, if confirmed, is figuring out how
much of that capacity should be brought into the Department.
And I don't----
Senator Cassidy. Now, it does seem to be a duplication of
effort because it isn't often that this is required, let's hope
never again, so we don't want people just kind of twiddling
thumbs, waiting for the next pandemic. Do you see where I am
going with that?
Ms. O'Connell. Absolutely. Any capacity that we add to the
Department would have to be right sized and fit for purpose.
Also have a peacetime use as well as a pandemic or emergency
use. So I agree with you on that. But it is something that I
think the Department is having to face and think about. And I,
appreciated your question about that.
Senator Cassidy. Dr. Delphin-Rittmon, thank you again for
calling, and for speaking. And obviously, one of the criticisms
is what happened at the Whiting facility, if I am pronouncing
that correctly, or Whiting facility in Connecticut when you
were the Director overall. And so I just thought I would give
you a chance publicly to speak to that, because if I am asked,
I can refer to your public statement.
Ms. Delphin-Rittmon. Yes. Thank you again, Senator, for our
conversation and for that question. The patient abuse that
happened at Whiting was a tragedy and should never have
happened. I take patient abuse very seriously. And so
immediately working with my team called in the state police
because I wanted an outside investigation in addition to our
H.R. investigation. Ultimately, 37 staff were separated from
state service and 10 staff----
Senator Cassidy. Can I interrupt you for a second, because
what seems critical here is, at what level were you relative to
the facility? Do you follow what I am saying? Because if you
are the head of a whole Department, but there is four layers
between, that is one thing. But if you are like in the office
at the Whiting facility, that is the other thing. So could you
elaborate on that, please?
Ms. Delphin-Rittmon. Yes, I appreciate that question. So as
Commissioner, I have a number of state hospitals, the two state
hospitals that I oversee. Whiting Forensic Hospital is one of
those hospitals. At the time, it was combined with Connecticut
Valley Hospital, but now it is a hospital unto itself. That was
part of the system change we put in place. So there is myself
as Commissioner. There was a CEO of the hospital. There was
medical Director, a full leadership team of the hospital. And
that was one hospital that I oversaw as part of the whole
Connecticut system of care.
Senator Cassidy. I am sorry I interrupted your answer. So
continue, please.
Ms. Delphin-Rittmon. Yes. So, of course, the first step was
ensure the safety and security of the patients there at the
hospital. Then also called in the state police, wanted an
immediate outside investigation. Ultimately, again, 37 staff
were separated from state service, 10 were tried and convicted
related to the abuse. Worked with the state legislature around
having a law said that if people fail to report abuse or
neglect, that is a crime.
Really worked on a specific system changes related to that.
Also worked on enhancing our security and camera systems
throughout the hospital. Brought in a consultant and reviewed
policies, procedures, and implemented other significant system
changes within the hospital. This work is ongoing. Ongoing in
terms of ensuring the staff have the appropriate training, that
they are aware of the policies related to reporting, and so it
has been an ongoing area of work. But ultimately, my aim is to
provide quality care to ensure the safety and security of the
individuals that we serve and to help people move into
recovery.
Senator Cassidy. If I may summarize, you are not directly
responsible, but you ultimately were, but still you were above
and you got a leadership team between you and these incidences,
and that subsequent to this, the corrective measures have been
taken as well as the punitive for those who were concerned,
correct?
Ms. Delphin-Rittmon. That is correct, Senator. Yes.
Senator Cassidy. There is many other things to speak about,
but I will defer to my colleagues on the--I know Chris Murphy
and I have worked so closely on many of these issues, too. So I
will defer to them on those other issues. But thank you both
for your answers.
Ms. Delphin-Rittmon. Thank you, Senator.
Senator Casey. Thank you, Senator Cassidy.
Senator Lujan.
Senator Lujan. Thank you so much. Dr. Delphin-Rittmon,
given the spike in opioid deaths last year, I very much
appreciate that the Biden administration is devoting
significant resources into addressing the substance use
disorder crisis. In New Mexico, drug overdoses increased by 25
percent in 2020, fueled largely by the increase of the deadly
synthetic opioid fentanyl. The recently released budget calls
for a 63 percent increase in funding for SAMHSA, $3.7 billion
increase over last year. Should you be confirmed, how do you
plan on utilizing those resources to ensure that Americans have
access to the treatments that can help curb those tragic
overdoses?
Ms. Delphin-Rittmon. Thank you for that question, Senator.
And for your advocacy on this issue. I also appreciated the
conversation that we had a couple of weeks ago. I appreciated
learning about your priorities in areas that we can collaborate
on, should I be confirmed. These resources are critical.
I can say as a state commissioner, have so appreciated the
Federal resources and commend Congress there. Should I be
confirmed, it will be critical that SAMHSA continue to support
states in funding prevention, and treatment, recovery, harm
reduction, that we work across also Federal agencies and
partners to ensure that our opioid response strategies are
strong, that they are meeting people where they are, that they
are helping people move into long term recovery.
You mentioned fentanyl. We know fentanyl is frequently
present in many of the overdoses. We see that in Connecticut
quite a bit. Thankfully, now SAMHSA states can use Federal
funds to purchase fentanyl test strips. That is a significant
change and will be of real value to states in terms of harm
reduction.
Certainly all of those areas, should I be confirmed, would
look forward to continuing to advance and would look forward to
meeting with you, Senator, as well, to learn more about your
needs and interests in this area as well.
Senator Lujan. Well, I look forward to more conversations,
especially learning about the kinds of initiatives that you
launched in Connecticut that you believe can be launched across
America to help people. Now, during COVID, we also have seen an
increase in not just opioid use, but rightfully so that has
been well documented. However, we have also seen an increase in
alcohol use disorder as well.
Although not generated nearly the headlines, alcohol use
disorder is far more prevalent than other forms of SUDs. We are
going to need to do a better job of screening and identifying
those with alcohol use disorders so we can get them the
treatments that they greatly need. Between the President's
proposed budget, COVID relief, and the recently passed American
Rescue Plan, how would you utilize the investment in SAMHSA to
help the estimated 15 million Americans suffering from alcohol
dependance?
Ms. Delphin-Rittmon. Yes, I appreciate that question,
Senator. We know that Americans across the country are
struggling with alcohol use disorder. Certainly see that in
Connecticut as well. When we met, I spoke about the recovery
coach in our emergency Department initiative. Our recovery
coaches connect with individuals who are brought to the
emergency Departments as a function of acute alcohol
intoxication, in many instances more than individuals who are
brought there as a function of opioids. So we know that this is
an area that is critical that we focus on.
If confirmed, I would be interested in working certainly
within SAMHSA around continuing to scale up and put in place
strategies to address opioid use disorder, and also be
interested in working with you to learn more about what you are
seeing and what the challenges and needs are within your state.
But definitely this is an area that we need to address. We know
Americans across the country are struggling with alcohol use
disorder as well as opioids and other substances. So appreciate
that question, Senator.
Senator Lujan. Thank you. Ms. O'Connell, Project Echo,
which we had a chance to visit about, is an innovative
telementary model headquartered at the University of New Mexico
and was once championed by my late father when he was a member
of the state legislature led by Dr. Sanjiv Aurora. On the 116th
Congress, I was proud to work with my colleagues in the House
and in the Senate to pass the Echo Act of 2019. How will ASPR
continue to utilize telehealth and programs like Project Echo
to create peer to peer learning networks to enhance
preparedness in the future?
Ms. O'Connell. Senator Lujan, thank you so much for that
question. And I enjoyed the opportunity to have this
conversation about Project Echo when we spoke a few weeks ago.
I think telehealth has been one of the successes that's come
out of the pandemic. The pandemic, of course, has stressed the
American society in so many ways.
But our ability to use telehealth and reach people to train
doctors and nurses, to be able to treat people and harder to
reach places, I think is going to be one of the legacies,
excuse me, of the pandemic that we take with us, and we will be
able to use in ASPR moving forward when we are working with
rural and hard to reach communities. So thank you and thank you
to your father for his support of that initiative.
Senator Lujan. Thank you. And I yield back.
The Chair. Thank you.
Senator Braun.
Senator Braun. Thank you, Madam Chair. My questions are for
Dr. Delphin-Rittmon. Last Congress, Senator Markey and I
introduced two pieces of legislation. One called the label
Opioids Act, requires prescription opioids to contain a warning
label specifying that opioids may cause dependance, addiction,
and overdose. The Safer Prescribing of Controlled Substances
Act would enforce new training regimens upon practitioners that
would incorporate best practices on how to prescribe the pain
medications.
HHS would prescribe these requirements in both of these
acts. I think my question would be in taking legislation like
that, and how do you view getting coordination between agencies
so that even if ideas like this don't get incorporated in the
law, that we do a better job of using the tools that we can
administratively to do common sense things like proper labeling
and practices that you would want practitioners to use in a
kind of an elusive area that we have had marginal results with.
Ms. Delphin-Rittmon. Yes, thank you for that question,
Senator, and for your work and advocacy in this really critical
area. We know that looking at prescribing practices is one
really key strategy for helping to address the overdose and
addiction rates that we are seeing, substance use rates that we
were seeing. And so I appreciate your work there. Should I be
confirmed, you mentioned the piece around collaboration. As a
clinical community psychologist, I love working from that
space, bringing groups together that are connected to or that
touch an issue to think creatively around how we can come up
with strategies that make a difference.
I would welcome that opportunity within HHS. There is an
internal HHS Behavioral Health Coordinating Council. That is
certainly one space where some of this work could be done, but
also would look forward to bringing together states. As a
Commissioner, I so appreciated the times when SAMHSA brought
the Commissioners together to have conversations. And we often
say that we love sort of bootlegging from each other, and we
love sort of taking the best practices that we hear working in
different states. And so I think there are opportunities,
should I be confirmed, to bring states together on a regular
basis for that state to state learning in conversation.
But I appreciate, again, your work in this area, should I
be confirmed. Would look forward to having follow-up
conversations, and do believe that the collaboration across
Federal agencies, states, as well as community partners is
critical here for addressing this challenge.
Senator Braun. I think in addition to alerting
practitioners and patients of all the pitfalls of using
opioids, that there needs to be some emphasis on other
methodology, other ways of trying to address chronic pain. Now,
where you at on trying to be a voice for alternatives in
addition to trying to do a better job with what we do with
opioids, in other words, new ideas?
Ms. Delphin-Rittmon. Yes, thank you for that, Senator. So I
am a full believer in the value of using really all that will
work. This is such a challenge in terms of the overdose rates
we are seeing across the country. I think it is critical that
we marshal all tools or resources we know that can make a
difference. There is a vast amount of literature on alternative
strategies for managing pain. It doesn't always have to be a
pill. For some individuals, meditation or reiki or acupuncture
can make a difference in terms of pain management.
I think it is critical to look at some of those evidence
based practices as well and offer them to individuals to the
extent that it fits with their treatment spectrum. But I
appreciate that question. It is something in Connecticut that
we have put in place. Auricular acupuncture has been shown to
help with cravings.
It is an emerging evidence based practice, and so should I
be confirmed, would look forward to exploring other strategies,
really, for addressing pain management. So, thank you for that
question.
Senator Braun. I think that is important in terms of
alternative methods and then maybe also for pharma to be
looking at ways that they need to invest in pain management
that doesn't rely on so much emphasis on opioids. So thank you
so much.
Ms. Delphin-Rittmon. You are welcome.
The Chair. Thank you.
Senator Baldwin.
Senator Baldwin. Thank you, Madam Chair. For Ms. O'Connell,
I appreciated the chance to speak with you a few weeks back.
And one of the things we talked about was our domestic
manufacturing capabilities here. I have long been a champion of
buy America policies and domestic manufacturing. And part of
the reason I became first interested in that was during my time
in the House of Representatives, we would have hearings on the
seasonal influenza vaccine, etcetera, and I became very
concerned that we didn't have any, in some cases, or enough
companies producing these vaccines here at home.
I think that presently we have seen very clearly that we
don't have enough companies making medical countermeasure and
devices, etcetera, here in America. It has been an erosion over
time, but it has left us really unprepared to respond to
pandemics, including the one that we are emerging from. Now,
the Pentagon is in charge of monitoring the defense industrial
base. But I think we need somebody charged with monitoring the
public health industrial base to monitor the domestic sources
of drugs, of raw materials, medical devices, personal
protective equipment, and other critical products that we have
seen in short supply during this pandemic and monitoring the
capacity available to make these products in a crisis.
Do you think that Health and Human Services, including
ASPR, should take a more active role in both monitoring the
public health industrial base and actively addressing current
domestic manufacturing constraints through improvements to long
term contracting and purchasing commitments and additional
transparency?
Ms. O'Connell. Senator Baldwin, thank you so much for that
question and thank you for the good conversation we had a few
weeks ago. I think you are right on, HHS should be charged with
monitoring and maintaining a resilient and secure medical and
public health supply chain. And the ASPR, the Acting ASPR right
now has been leading an interagency effort with the supply
chain coordinator at the White House, part of the COVID
response, to oversee this work. What we saw last year was
unprecedented.
We saw the global community all needing the same components
at the same time, and it was unprecedented, but it was also a
warning that we have been too reliant on international sources
for some of these components. I think if I am confirmed, a lot
of the work that I will do ahead will be to take on what the
Acting ASPR has been doing, and to make sure that we have a
secure and resilient public health emergency and medical supply
chain. The ASPR currently has something called the watchtower,
where they are watching and monitoring all of the medical
supplies to understand what the push and pulls are.
That is something that came up, I believe, under Dr.
Kadlec's leadership in the last year, and it is something,
should I be confirmed, as ASPR would expect will be a critical
part of the work that I undertake to secure the medical supply
chain.
Senator Baldwin. Thank you. In the previous administration,
there was very little transparency when it came to
understanding how decisions were being made with regard to
combating COVID-19. And I think the lack of critical
information impacted our ability to respond. And going forward,
I think we must work to ensure that members of the public and
certainly Members of Congress have accurate and necessary
information when it comes to both our preparedness needs and
our response to future crises.
We must ensure that we make responsible investments and
that those are informed by science and public health and not
special interests. And so how will you work to improve
transparency when it comes to ASPR's work and spending? And
will you commit to combating the power of special interests at
the agency?
Ms. O'Connell. Senator, thank you for this question. I
think one of the major lessons learned over the last year and a
half is how critical open and transparent communication is. And
when the information changes, how important it is to let the
American public know what we are now learning has changed.
If I am confirmed as the ASPR, I commit to open and
transparent dialog with this Committee, with other Members of
Congress that are interested in the work that ASPR is doing,
with the constituencies and stakeholders that are invested to
make sure that I am held accountable for the work that I am
doing and that it is fitting in to the priorities that Congress
has set out for ASPR, and that the American public expects from
ASPR.
Senator Baldwin. Thank you.
The Chair. Thank you.
Senator Collins.
Senator Collins. Thank you. Dr. Delphin-Rittmon, yesterday
we had a good conversation about our shared concern that the
country is going in the wrong direction with respect to overall
drug use and overdose fatalities. It is said very plainly in a
newspaper headline from Maine, Maine's overdose deaths set a
new record in 2020, and 2021 started out even worse. Maine saw
a 32 percent increase in overdose deaths in 2020 and actually
more people died from overdose deaths than died from COVID.
This trend, unfortunately, is true nationally as well.
COVID certainly played a role and was a setback. It caused the
increased isolation, new stresses, challenges in accessing
prevention and treatment services. It impeded recovery
supports, like peer support programs, which I know both you and
I believe can be highly effective. But the fact remains, we had
502 people die in 2020 of drug overdoses and that far surpassed
the previous high in 2017, which we thought at the time was the
height of the epidemic.
The subsequent years started edging down and then we had
this large increase. What specifically do you think we should
be doing to counter drug overdoses?
Ms. Delphin-Rittmon. Thank you for that question, Senator,
and for the conversation that we had yesterday. And my
condolences to the people of your state. It is--the overdose
deaths are hard. They have ripple effects across communities
and families and individuals. And so this is a challenge that
as a country, we have been grappling with it and we really need
to continue to grapple with it. I think we can take what we
have learned and what we have seen up to this point that makes
a difference. When we look at data across the country, we see
that fentanyl is one thing that is driving many of the overdose
deaths.
We know now that Federal resources can be used to test
substances for fentanyl. That could make a significant
difference. If individuals are aware that there is fentanyl in
the substances, that could help to bring overdose deaths down.
It is a harm reduction strategy. And so in addition to, giving
people a fentanyl test strip, there is an opportunity to let
them know about services and supports. And often when people in
recovery are running the harm reduction centers are a part of
that work, there is also an opportunity for people in recovery
to give individuals hope and to let them know that they can
make it to the other side of their addiction. And so we have
seen that make a difference in Connecticut.
I think fentanyl test strips can make a difference. As we
have talked, I think recovery coaches and emergency Departments
can make a difference. We just finished an analysis in
Connecticut that shows that--so we looked at data. It shows
that individuals who have a recovery coach within this 3 year
period that we are looking at where 2.6 times less likely to
die by the end of the study. So recovery coaches can help
connect people to services and supports. And that is what we
found in this study. It was an invited evaluation that SAMHSA
asked us to do based on this initiative.
We now currently have recovery coaches in 25 emergency
Departments across the state. We also know medication assisted
treatment makes a difference. It is one strategy that is an
evidence based practice that can help people move into long
term recovery. One thing that we have implemented in
Connecticut is mobile medication as a treatment. People aren't
always going to come in to services and supports, but we can
bring services and support to community members, particularly
if we use data and take a data approach to have the mobile
medication assisted treatment vans go to where hotspots are and
go to where we know vulnerable populations are.
I think there are things we can do looking at what we have
done up to this point that makes a difference. And should I be
confirmed, will be happy to have conversations with you about
this and about what you are seeing in Maine. So thank you.
Senator Collins. Thank you. Ms. O'Connell, last month, HHS
devoted more than $2 billion meant for other health initiatives
toward covering the cost of caring for unaccompanied immigrant
children, migrant children on the Southern border. The
redirected funds that included $850 million that Congress
originally allocated to rebuilding the Nation's strategic
national stockpile. Well, another $850 million is being taken
from money that was set aside to expand COVID testing. Out of
all the programs that could possibly be chosen to reprogram
funds, why was the SNS chosen, and what is the plan to make
sure it is not shortchanged?
Ms. O'Connell. Senator Collins, thank you so much for that
question. When the American Rescue Plan was being negotiated,
the Department became aware of how expensive it was going to be
to care for the increasing number of minors at the border in
times of COVID. COVID required that these minors be separated
so the shelters had to be larger, less full, the minors had to
be tested. There were just significant costs that came along
with caring for the unaccompanied minors in a pandemic.
At that time, the Department worked with Congress to have
$850 million appropriated to support that work. And it was in
that bucket that you are referring to that money was added. And
so my understanding after talking to our budget team is that it
was a zero sum, that money, the $850 million was put in for
that purpose and has been used for that purpose and that the
stockpile has not been impacted.
Senator Collins. I will say that is not my understanding.
Thank you.
The Chair. Thank you.
Senator Casey.
Senator Casey. Thanks, Chair Murray. I want to thank our
witnesses for your commitment to public service and your
commitment to excellence, as well as you do that service and
obviously the commitment of your families to that service that
you have engaged in. I want to start with Ms. O'Connell. Both
in reference to the pandemic all hazards legislation over time,
as well as a bill that I have introduced, the so-called Ready
Act, it is a Real Emergency Access for Aging and Disability
Inclusion for Disasters Act, a long name that needs an acronym,
the Ready Act. I have prioritized, including both people with
disabilities and older adults in all phases of the disaster
process, both preparation and response, as well as recovery and
mitigation.
When I outlined that, I don't mean simply having older
adults and people with disabilities give public comments or be
advisory board members. I mean, be on the panels and on the
Committees that decide how best to prepare for disasters and
be--really be part of the process of responding and deciding on
what mitigation should look like. So I am looking for true
engaged participation in all of these processes of protecting
Americans and responding to their needs. So I ask for your
commitment regarding these Americans.
Again, I am talking about people with disabilities and
older adults. Ensuring that these Americans are represented and
have a strong voice in all phases of emergency and disaster
processes, and I ask you to commit to report back to the
Committee how you are including these Americans in the work
that the ASPR does.
Ms. O'Connell. Senator Casey, thank you so much for that
question. I appreciated the conversation we had a few weeks ago
where we were able to touch on some of these important issues.
And I want to thank you for your long time leadership
representing and supporting these vulnerable populations. These
vulnerable populations are often overlooked in planning and
preparedness exercises. And should I be confirmed as ASPR, you
have my commitment that I will not overlook these populations
and will work to ensure that they have the tools they need in
any public health emergency.
Senator Casey. Look forward to having some feedback after
your confirmation. Dr. Delphin-Rittmon, I wanted to ask you
about children's mental health, in particular as we consider
where we are after, or we hope, coming out of the pandemic.
Even before the pandemic, we were facing both a behavioral and
mental health crisis, particularly for children and for
teenagers. The pandemic obviously has amplified this need with
both rising numbers of patients and increased severity of
symptoms that require more substantial treatment resources.
At the same time, we have urgent workforce shortages. In
Pennsylvania, pediatric health care providers report that
children are waiting sometimes not just weeks, but even months
to get the mental health care services they need, which, of
course, puts them at risk for worsening illness and suicide. If
confirmed, how would you use SAMHSA's authorities to work with
Federal and state, as well as local partners to strengthen the
pediatric, mental, and behavioral health workforce, to meet the
needs of children and teens experiencing mental health issues?
Ms. Delphin-Rittmon. Thank you for that--thank you for that
question, Senator. We know that this is such a critical area
right now in terms of the workforce shortages we are seeing
across the country within children's mental health, but really
across the board. In terms of children's mental health, we are
seeing a shortage of psychiatrists and other behavioral health
workers who are trained to be able to work with children. I
think SAMHSA can play a real role here, collaborating with
other Federal partners that are working on this area.
HERSA does quite a bit related to workforce development,
and I think there are opportunities to collaborate with HERSA
and other Federal partners. We know that loan repayment
programs or fellowship programs do make a difference in terms
of bringing providers into a field. They are real valuable
incentives. And, I am a testament to that being a fellow of the
minority fellowship program. So certainly that is one area that
we could look at to begin to grow and expand the workforce.
Other things like telehealth though. I think to address the
immediate needs that we are seeing in terms of shortages,
particularly in rural areas, telehealth can play a real value
in terms of connecting kids and families to services and
supports where providers may not physically be.
I think there are opportunities there. But should I be
confirmed, would look forward to working across the range of
diverse partners that touch this issue. Community providers
touch it, states touch it. There is quite a bit of innovation
happening at the state level. And so as a Commissioner, again,
I think one thing SAMHSA can do is bring together states from
state to state learning around best practices.
I think that is certainly a key strategy. But appreciate
the question, Senator. And should I be confirmed, I would look
forward to following up with you on this as well to hear about
some of your ideas.
Senator Cassidy. Thank you, doctor. Thanks, Chair Murray.
The Chair. Thank you.
Senator Hassan.
Senator Hassan. Well, thank you, Chair Murray and Ranking
Member Burr. Thank you to our nominees for being here today,
both of you, and for your families, for your willingness to
serve. I want to start with a couple of questions to you, Dr.
Delphin-Rittmon, and I appreciated our conversation just
yesterday. As the opioid epidemic has devastated communities
and families across the country. You just spoke to that
eloquently a few minutes ago. Since 2017, I have worked with my
colleagues to secure funding for state opioid response grants,
including more than $86 million for New Hampshire. This funding
has enabled states to expand access to lifesaving treatment and
services for those struggling with substance use disorder. But
I am concerned that hard won progress may be in jeopardy.
As we discussed yesterday, some of the hardest hit states,
including New Hampshire, are at risk of a dramatic cut in state
opioid response grant levels under the program's current
funding formula. So, doctor, from your experience as
Commissioner of the Connecticut Department of Mental Health and
Addiction Services, can you speak to the importance of
reliable, robust funding for mental health and substance use
disorders services for states?
Ms. Delphin-Rittmon. Yes, thank you for that question,
Senator, and for our conversation yesterday. I appreciated
hearing about your priorities and what you are seeing within
New Hampshire. We are neighbors, so what happens in New
Hampshire impacts the region. What happens in Connecticut
impacts, New Hampshire? So, the reliable funding is critical.
It is important to be able to keep programs going in a stable
way to ensure that the programs are available for individuals
that are relying on them. We routinely have internal
discussions around sustainability and how to think about
continuing programs. So the reliable continuity of funding is a
critical issue related to maintaining robust service systems.
Senator Hassan. Well, thank you. If confirmed, will you
commit to ensuring that the funding formula for state opioid
response grants does not cause States like New Hampshire to
experience dramatic funding cliff?
Ms. Delphin-Rittmon. Yes. No, I appreciate that question,
Senator, and your advocacy, your fierce advocacy for the people
of New Hampshire and across the country. If I am confirmed--
again because we, we are seeing the rates continue to rise, and
if I am confirmed, I commit to doing all that we can to address
the overdose rates that we are seeing across the country, to
include ensuring that, states receive resources that they need
to be able to address the crisis.
Senator Hassan. Right. And I understand that you are a
nominee, and it is a little bit difficult when you are not yet
part of an administration to make a commitment. But I am asking
for a specific commitment here for a reason. I have asked the
same question of the HHS Secretary, the Deputy Secretary, and
others during their confirmation processes. They tell me that
they are not--at that point, they told me they weren't yet part
of the Administration, but now they have been confirmed and the
Department is still not committing to fixing this problem.
Is it your understanding that SAMHSA has the authority to
make adjustments to the state opioid response grant program,
for example, increasing the number of hardest hit states beyond
10? Do you understand that you have--that SAMHSA has the
authority to do that?
Ms. Delphin-Rittmon. Senator, I am not at SAMHSA yet. And
certainly one of my priorities is expanding access to mental
health and substance use services. The funding component of
addressing the crisis is quite critical. Should I be confirmed,
this certainly is one of the areas that I would be interested
in looking at. And it would be critical to look at to get a
better understanding of the funding processes.
Senator Hassan. Well, we will follow-up with you on this,
because this is an issue about the Department and your
understanding of SAMHSA's authority. Will you work to ensure
transparency and collaboration between congressional offices
and SAMHSA on this and other issues related to funding
formulas?
Ms. Delphin-Rittmon. Absolutely, Senator. I love working
from that space and would ensure transparency, collaboration,
ongoing discussions as necessary to further unpack and address
this issue.
Senator Hassan. Okay, I am going to follow-up with
questions on the record on this topic before your markup to get
more precision and clarity about the path forward. Because what
I want to stress here today is that simply shifting grant
funding from state to state as data shifts and as a substance
use disorder crisis worsens just isn't a viable long term
solution. We are going to play whack a mole. One state is going
to bump into the top 10 so we are going to shift funding there.
Other states, the crisis will worsen, we will shift funding
back. That doesn't help us get to where we need to be, which is
to combat the substance use disorder as the epidemic and health
care crisis that it is.
[The following information was not submitted for the Record.]
I am really looking forward to working with the Administration
on this, but I am also looking for commitments from the
Administration. I also just wanted to briefly touch on the X-
Waiver. One of the limits that we have in accessing substance
use disorders treatment is the existence of this so-called X-
Waiver. Doctors can prescribe an opioid without getting special
permission, but they can't prescribe medication, assisted
treatment without getting this waiver.
Senator Murkowski and I have a bill to eliminate that
waiver. Will you commit to working to expand access to
medication assisted treatment by supporting efforts that
Senator Murkowski and I are undertaking to eliminate the X-
Waiver?
Ms. Delphin-Rittmon. Yes, I appreciate that question,
Senator. And so we know medications as a treatment, as I
mentioned, it absolutely helps people move into long term
recovery. As one of my priorities around expanding access to
substance abuse and mental health services, that includes
expanding access to medication assisted treatment. So I can
commit to certainly meeting with you and to working to expand
access across the country.
Senator Hassan. Okay, thank you. It is going to be critical
to getting existing doctors able to provide this treatment.
Thank you. Thank you, Madam Chair.
The Chair. Thank you.
Senator Marshall.
Senator Marshall [continuing]. Figure out which mic is
better for me to use. Thank you so much. My first question is
for Ms. O'Connell. Ms. O'Connell, dealing with antibiotic
resistant bacteria continues to be a challenge. And here is the
challenge. You don't need to use these antibiotics very often,
but when you need to, you really need them. If a patient is
sitting there dying in the ICU because of a bacteria that is
resistant to antibiotics, we need a special laser to go in
there and treat the problem.
Anyway, most of the pharmaceutical companies are not
developing them because it is not profitable. They don't get
used very often, but yet we need them, right. So I hope you are
little bit familiar with the challenge there. There is just not
a good return on investment. There is 43 antibiotics in
development right now.
My question for you is, how can we work together to ensure
that BARDA provides the private sector and the necessary
resources to strengthen antibiotic research and development?
Ms. O'Connell. Senator, thank you so much for your
question. And I really appreciated the opportunity to speak
with you a few weeks ago. Antibiotic resistance is a
significant issue. When I was Deputy Chief of Staff in the
Obama administration, one of the jobs that I was responsible
for was implementing President Obama's antimicrobial resistance
agenda across the interagency, it was called CARB, Combating
Antibiotic Resistant Bacteria.
As part of that initiative, BARDA took on something called
Carb-X, which was a private, public partnership to accelerate
the development of antibiotics and to try to get pharmaceutical
companies willing to begin looking at new antibiotics. Since I
have been back and working solely on COVID, I am not sure where
we are with the Carb-X initiative. But Senator, I commit to
you, if I am confirmed as ASPR, that is one of the first things
I will do and look forward to working with you and reporting
back on where that progress is.
Senator Marshall. That is great. If there is anything we
can do to put wind beneath your sails, if you are confirmed,
please reach out to us. It is an issue near and dear to my
heart. My next question for Dr. Delphin-Rittmon, if you don't
mind, I want to talk about certified community behavioral
health clinics for a second. And one of the biggest challenges
I see in our hospitals is dealing with mentally ill, having a
mental crisis in an emergency room. And this has been a problem
going back to when I was in medical school.
This typical situation is, we admit a patient in the
emergency room that is a danger to themselves and others. And
really, there is just no good discharge plan so that patients
sits there for 24, 48 hours at a time. We have a special room
for that person. We have to put a nurse one on one. Our
sheriff's officers or police officers have to provide an
officer, one on one to take care of that situation. And they
are just, certainly at the state level, we need more
opportunities.
But we did a consolidated appropriations grant in December.
We authorized millions of dollars to certify community
behavioral health clinics. Our sheriff's officers feel like
they are being left out of the loop on how to use those moneys
and what the solution looks like. And I am not sure if you are
familiar with that grant, but I sure hope that we include law
enforcement, that these community behavioral health clinics
reach out to the law enforcement and to the nurses and the
hospitals. It needs to be a team effort.
I can tell you story after story of, a person that the
sheriff's office thought was headed to the mental health
center. They were discharged later without notifying the
sheriff's officers and a murder resulted. And unfortunately,
this happens too often and any light you can shed and
commitment to this issue.
Ms. Delphin-Rittmon. Yes. Thank you for that question,
Senator. And I appreciate our discussion several weeks ago as
well. This is a critical issue. And I do have to say that
CCBHCs, so the certified community behavioral health centers,
we so appreciate those resources in Connecticut. We have
several that have been stood up across the state. It is a real
opportunity to provide integrated care, to get people connected
to both primary care, but also behavioral health services and
supports.
Certainly, it is an opportunity also to connect with other
community providers, as you mentioned, to include police
officers. And so I think that is a valuable component of that
framework. I think a role SAMHSA can play there with the
CCBHCs, but also with the enhanced crisis services and supports
through the 988 implementation--I think there is a real
opportunity to bring in police Departments and officers there
as well as part of the crisis continuum response.
Certainly, if I am confirmed, would be--look forward to
working with you and others there. But this is a real critical
area in terms of getting people connected to the needed
services. And the role that community, policing your community
officers can play as it relates to connecting people with
mental health services and supports.
Senator Marshall. Well, great. If we have the opportunity
to get some of the pieces of the puzzle together, our office or
someone from your staff, we would love to talk too. And thank
you so much, Madam Chair. I yield back.
The Chair. Thank you.
Senator Murphy.
Senator Murphy. Thank you very much, Madam Chair. Thank you
both for your service and your continued willingness to serve.
Commissioner, I am very sorry that I was not here at the outset
of the meeting to introduce you, but I know that Senator
Blumenthal did a more than adequate job. I just wanted to spend
1 minute at the beginning of my few moments of remarks to just
commend Commissioner Delphin-Rittmon to the Committee. She and
I have known each other. We have worked very closely together.
I got the chance to chair the Health Committee when I was
in the state legislature, and the Mental Health Reform Act that
Senator Cassidy referenced passed in late 2016, was a product
of the work of this Committee, the collaboration of Senator
Cassidy and myself, but also the result of I don't know how
many meetings that the Commissioner and I did together in
Connecticut, developing ideas for the legislation and seeking
input from a cross-section of consumers, patients, and
providers, and advocates in Connecticut.
I am deeply grateful to her for how much work she put in to
trying to help us develop sound Federal policy. And some of the
work she has pioneered in Connecticut, we have lifted and
brought to the whole country. For instance, Connecticut modeled
a program whereby we put recovery coaches inside emergency
rooms. These are, folks who have had lived experience often
with recovering from substance abuse.
We have them anchored in our emergency rooms. And so when
someone presents often with an overdose, the minute that they
interact with a provider, they are also interacting with
someone who has gone through the same experience they have. And
that recovery coach funded by the Department of Mental Health
and Education Services in Connecticut stays with them after
they leave. And that early interaction, we have found, has made
a very big difference.
We now have a Federal grant program that will allow for
other states to copy Connecticut's model. So I am deeply
appreciative of the work that she has done to pioneer some
pretty innovative programing that we now are being able to
disperse nationwide. So I am very, very, very glad to have you
on the precipice of this incredibly important role. Have
enjoyed our time working together in Connecticut. I just have
sort of one question for you, Commissioner. In the Mental
Health Reform Act of 2016, we elevated the role of SAMHSA
Director to an Assistant Secretary position. We thought that
was really important because there are so many conversations
that happen at the leadership level in HHS that SAMHSA needs to
be at the table on.
I will give you two examples and maybe ask you to just
comment on how you might be able to sort of move forward the
conversation in two regards. First is on the issue of physical
and behavioral health integration, something you have spent a
lot of time working on in Connecticut. For instance, we have
tried to get more mental health services into our community,
federally qualified community health care clinics.
I would love to see there be a more aggressive conversation
Department wide on making sure that we are providing grants to
states that incentivize mental health and physical health
services coming together. Second is the issue of parity. Again,
a conversation that happens at HHS but also has intersections
at DOL because they regulate a lot of these insurance plans.
Senator Cassidy and I introduced legislation, I think, just
yesterday that continues to build upon our efforts to enforce
existing Federal parity laws, meaning you cover mental health
just like you cover physical health.
But we can't make progress on that unless we are
cooperating across Departments. And that is, again, an
opportunity for an Assistant Secretary as opposed to the prior
sort of more compartmented role, just overseeing SAMHSA, to be
able to make a difference. So in the minute that I have left
you remaining to just comment on the priority you may place on
integration and parity.
Ms. Delphin-Rittmon. Yes. Thank you for that question,
Senator. And I just so have appreciated your advocacy and work
in Connecticut. The recovery coaches were just thrilled to be
able to have that work elevated at a national level. And we
know that work can make a difference. So both parity and health
care integration would be in our priorities for me. I see those
as connected to expanding access to mental health services and
supports which one of my primary priorities. You are right,
though. The parity piece requires quite a bit of collaboration
across HHS and community partners and state partners as well.
And as a clinical community psychology, I love working from
that space. I think that is where the work often happens.
Bringing people together and figuring it out. Staying at the
table and really figuring it out.
Should I be confirmed, I would look forward to that. I do
think there is a real opportunity now that the SAMHSA role has
been elevated as part of HHS. And I thank you for your
leadership and advocacy there as well. And so, again, there is
just an opportunity to work across HHS agencies that touch the
two issues that you mentioned, both health care integration as
well as health care parity or mental health parity.
Should I be confirmed, I would look forward to working
across Departments, but also with you and others in Congress to
address those important areas. So thank you for that question.
Senator Marshall. Great. I look forward to working with
both of you. Thank you, Madam Chair.
Senator Burr. Senator Rosen.
Senator Rosen. Well, thank you, Senator Burr. And, of
course, Madam Chair, for holding this hearing. And to our
nominees, thank you for your prior service, your willingness to
serve again. I would like to speak a little bit about our
supply chain safety net. As the pandemic spread and critical
medical equipment such as masks, gowns, even ventilators,
became scarce and in high demand, so many of our small and
medium sized manufacturers, they just stepped up, including
several companies in Nevada. They retooled their facilities.
They did their part to meet the needs brought on by this
public health crisis. And they no doubt saved many lives by
doing that. And we are very grateful. So, Ms. O'Connell, as
Congress and the Administration, you are going to consider
changes to the strategic national stockpile. What
considerations are being made to develop a domestic backup
supply chain? This could be a network of smaller manufacturers
who may do something else during normal production times and
then they ramp up.
Well, how do we support them to maintain their readiness?
How do we use them to improve our future readiness? And would
you commit with me to work on this.
Ms. O'Connell. Senator, thank you so much for that
question. What we saw in this last year and a half was a real
warning sign that we did not have a secure and resilient public
health and medical supply chain. And one of the reasons is we
had such reliance on international components. So if confirmed,
one of the places I expect to spend a lot of my time is
figuring out how to increase domestic manufacturing, what
incentives we should offer. It has been extraordinary what some
of the small manufacturers, including those in your state, did.
We heard the stories early in the pandemic of the vodka
company that started making hand sanitizer, or I think in
Colorado there was a mattress manufacturer that started making
masks. We should reward that kind of innovation. That is
exactly what built America and what we are going to need in
order to move out of this pandemic. And so I just look forward
to working with you and Members of this Committee on figuring
out how we can incentivize and encourage that sort of domestic
manufacturing so it is not just a once in a pandemic
experience, but it is something that we can maintain and rely
on and create a secure supply chain.
Senator Rosen. Yes, I couldn't agree more. I think we have
to incentivize them to kind of do this maybe in the background
from their regular business, so they are ready to surge up if
unfortunately we need them, because there are so many lessons
that we learn from emergency response, because the pandemic has
just literally changed almost every aspect of our life, how we
work, how we socialize, and now we take steps to move back to
normal.
Look, here we are in this hearing. So, Ms. O'Connell, what
do you think, and I know we only have 2 minutes, so it is
bigger than 2 minutes, but what does HHS's role and what are
the most important lessons that we learn from this so we can
start thinking about how we support our communities and our
Country doing all of this going forward?
Ms. O'Connell. That is such a critical question at this
time, where we hope we are at an inflection point in the
pandemic as we are working to get 70 percent of adults with at
least their first dose of vaccine by July 4th. We are starting
to see America return to normal, and we do need to start
capturing the lessons learned. And one of the commitments I
will make, if confirmed as ASPR, is not just to go through a
lessons learned process, but to actually apply those lessons
moving forward.
Often in response efforts, we review what happened and we
write up a report and we put it on the shelf until the next one
comes. What I would like to do is actually apply those lessons
and make sure that we have the advantage of everything that we
learned this time to be ready for the next public health
emergency.
Senator Rosen. I think that is a great idea, apply the
lessons. And something that I would like to move on quickly in
my last few seconds, Dr. Delphin-Rittmon, grief counseling. So
many people have just lost their loved ones. I know we have
over 40,000 children who have lost a parent, that the grief is
enormous, enormous burden for so many across not just our
Country, but in the world too. What should we be doing to
provide grief counseling in the wake of COVID even more
robustly than we might already do in hospice situations or some
of those things? And this is trauma. It may be in a different
way than when we have disasters or public health emergency.
What do you think about grief counseling and the role there?
Ms. Delphin-Rittmon. Thank you for that question, Senator.
So grief counseling, as we know right now, is so critical. The
last year, in addition to losing friends and loved ones and
family members, there has been losses related to just the daily
rhythms of our lives, children not being able to participate in
sports events or not being able to participate in the rhythms
of family events.
I would say that the grief and loss related to the pandemic
related experiences is some of what is contributing to the
higher rates of anxiety and depression and substance use that
we are seeing across the country right now. So grief counseling
is, I think, a critical part of the mental health work that
needs to be done across the country. So states right now, I
mean, I certainly from a state perspective, and SAMHSA can
support this, so states have increased resources related to the
block grant, the American rescue dollars, and, all of those
resources at a local and state level are being used to expand
services, whether it is mental health or substance abuse
services.
I think the grief counseling on the mental health side
could certainly be part of--it needs to be part of that mental
health work. SAMHSA can play a role there from the treatment
and technical assistance area we provide--or SAMHSA provides
quite a bit of technical assistance to states. I know we
certainly appreciate it in Connecticut and welcome those
dollars.
I think this is an area where some of those TA dollars can
be used to strengthen the counseling skills of individuals
within states to the extent that it needs--may need to be
expanded. So appreciate that question. I think this is
certainly an area that is important to look at, an area that
SAMHSA can play a real role in. Should I be confirmed, would
look forward to working with you further on this. Thank you.
Senator Rosen. I think we really need to work on this in
our schools in particular, as these kids go back. They are so
vulnerable. Thank you so much.
Ms. Delphin-Rittmon. Yes. Thank you.
Senator Burr. Governor.
Senator Hickenlooper. Thank you, Senator. First, before I
say anything, just thank you both for your service, especially
at this time when there is, as you are clearly aware, such
great need. Let me start out with Dr. Delphin-Rittmon. I
appreciate tremendously your commitment. And as someone who
lived in Connecticut for 10 years, a long, long time ago, I
appreciate your service there and your comments about the
issues around child mental health. We have seen a 90 percent
increase in behavioral visits at our children's hospital in
Colorado--a 90 percent increase in just these past years.
There really is a pediatric mental health pandemic and it
certainly is also tied--the question I want to get to is, we
have a just a terrible, terrible challenge with the opioids, as
you well know, and the Colorado Health Foundation recently came
out with a survey that more than half of Coloradoans suffer
from increased mental health strain from the pandemic. This has
led to just out of control increases in drug overdoses and drug
use.
In May 2020, we had 130 people die of a drug overdose. That
is nearly double the average rate of all of 2019. And we have
seen just a dramatic uptick this year as well. I know that
addressing opioid use has been a major priority for you. And
how can we make sure that states like Colorado and so many
other states are able to access all the resources available to
them through SAMHSA and ensure that they are--that we are using
those resources in the most efficient way?
Ms. Delphin-Rittmon. Yes, thank you for that question,
Senator. And I appreciate the meeting that we had a couple of
weeks ago. I appreciate hearing about your priorities and your
advocacy for the people of your state and the country. So, yes,
SAMHSA can play a real role in assisting states around the
resources that are being provided. We know that work in the
area of prevention and treatment and recovery, harm reduction,
even working with criminal justice systems and supports can
help to make a difference as it relates to opioid patterns and
trends, as well as the mental health trends that we are seeing
in the country.
SAMHSA can certainly play a role there in terms of
supporting states. Would be happy, if I am confirmed, to meet
with you, to learn more about what you are seeing and
experiencing within Colorado. As I mentioned previously, that
bringing states together for the state to state learning and
sharing around best practices, around what we see that is
making a difference, SAMHSA can play a real role there as well.
Through the Behavioral Coordinating Council.
Again, that would be an internal group. Many different
agencies touch this important work. And so there are
opportunities to do important work there as well. But should I
be confirmed, would look forward to having follow-up
conversations with you and working across HHS, as well as with
states and community providers on this critical issue as well.
Thank you.
Senator Hickenlooper. No, thank you. And thank you for your
time and your commitment. Ms. O'Connell, thank you as well
for--this is a unique time to step up and I really appreciate
that. The Biden administration has made significant efforts to
really begin making inroads into reaching out to the minority
communities when it comes to COVID-19 response and the
vaccination effort.
I think the key here is we can't stop with what we have
seen from the COVID-19 response, and we need to invest in the
public health infrastructure necessary to make sure that we not
only maintain but expand the contact within these communities
so that in the next pandemic, the next disaster, we don't find
ourselves triaging at the last minute, but we are able to be
out ahead of this and have relationships and networks in place.
So question, how will you continue the Administration's
outreach efforts to these sometimes hard to reach communities?
Ms. O'Connell. Senator, thank you so much for that
important question. The Biden administration has made equity a
cornerstone of its response, and that has been important to me.
It is interwoven in everything that it is considered and done,
including, as you mentioned, the vaccine distribution efforts.
It focused on not just going fast, but fairly. And I think
that's an important lesson that I will carry with me, should I
be confirmed as ASPR, that it is critically important that the
PPE, the vaccines, the therapeutics, all of the tools needed to
fight the pandemic are equitably distributed to all the
communities.
One of the tools that we are currently using are trusted
messengers. Making sure that trusted community leaders are
sharing the message and helping communities access these
critical tools. Should I be confirmed, I would continue to use
that approach. The ASPR has a role with regional and local
communities in helping prepare them for the next public health
emergency, and it would be critical to me that equity is a part
of that effort.
Senator Burr. Senator Murkowski.
Senator Murkowski. Thank you, Mr. Chairman, and thank you
for your commitment, your good work. Front page, front page of
the Anchorage Daily newspaper this morning is kind of
discouraging. An Alaska public health alert sent out on the
increase in heroin overdose emergency Department visits in
2021. Since March of 1921, Alaska has experienced an increase
in heroin overdose emergency visits compared to 2020. The
average number has more than doubled. So we have seen a
doubling from March 1 to May 29. And these are overdose deaths
that are occurring in all regions of the state, but most
increases in the South Central, Southeast area. There is still
further review that is going on with regards to this, in terms
of why this increase.
Is it supply, is purity of potency? It is, of course,
always a concern, but when you see that dramatic increase, it
causes lots of questions to be asked. One of the things that I
would like to raise here as we are in the--we feel like it is
the aftermath of COVID-19, but I have heard from so many around
the State of Alaska on the need for recovery, housing for those
that are experiencing homelessness, and substance abuse
connected with that. So many of our rural communities lack
detox centers or any recovery services whatsoever.
This is--this continues to be a struggle for us. But as we
are looking to particularly our rural areas and the capacity
issues and the funding to offer recovery services, how do we
expand access to comprehensive recovery programs in addition to
the tools that I am sure you have discussed as medically
assisted treatment? And these are big questions that are not
possible to really resolve in a few minutes. But just Dr.
Delphin-Rittmon, if you would respond to that.
Then also, are we seeing in other parts of the country
equally dramatic increases in instances of overdoses in our
emergency rooms around the country?
Ms. Delphin-Rittmon. Thank you for that question, Senator,
and for the meeting that we had a couple of weeks ago. It is
tragic, to hear some of the stats related to the overdose
deaths and the increases that we are seeing. I think it is
critical to look at those things we know that can make a
difference, and to the extent possible, to look at the data, to
see what is driving some of the trends. Should I be confirmed,
I would be interested in following up and having some follow-up
conversations and discussions with you.
One thing that we saw in Connecticut was that fentanyl was
driving some of our overdose deaths and so increasing the
availability of fentanyl test strips. I think that can be of
real value in terms of, helping to potentially reduce
overdoses, but also potentially connect people to services and
supports. So I think that could be a valuable strategy. In
addition, recovery coaches, as we know. You mentioned the
recovery housing.
Recovery housing can also make a real difference. Often
within recovery housing, recovery coaches are available. Other
wraparound services and supports are available. It does provide
an opportunity for people to be connected to other needed
services. And so that is a real valuable resource as well.
Should I be confirmed, would be very interested in, and again,
having follow-up conversations with you. I think the resources
that are currently available to states in terms of the block
grant as well as some of the American rescue plan dollars,
appreciate the Congress's work there, can help to fund some of
these innovations that you have mentioned, whether it be
recovery housing or enhancing even telehealth.
Telehealth, we know, can make a difference in rural areas
where there are challenges with connectivity and connecting
with providers. So those are just a few strategies that can
make a difference. Certainly, this is one of my priorities,
should I be confirmed. Would be interested in working with you
and of course other states and across HHS on this critical
issue. So thank you.
Senator Murkowski. I appreciate that recognition. Also in
our conversation that we had, and I appreciated that, the
discussion about suicide and the very unfortunate, again,
statistics that we face in Alaska with the rates of suicide and
particularly with our younger populations. We had--since March
2020, Juneau, Alaska has experienced 15 suicide attempts by
children under the age of 15. And, you just--your heart just
goes out. Most of those are the common--most common method that
we saw there was pharmaceutical overdose.
Again, how we can deal with these issues that truly just
eat away at the hearts of our communities is something that I
want to be focused on. SAMHSA does have an important role in
these services. But everything that we can do to promote
suicide prevention, suicide prevention resources, reduce the
stigma that is associated with seeking out mental health care,
these are all problems that we should share in common and seek
to address. Madam Chair, thank you.
The Chair. Thank you very much. That will end our hearing.
And I want to thank all of our colleagues for their thoughtful
questions. Ms. O'Connell, Dr. Delphin-Rittmon, thank you for
your time. Thank you for your very insightful answers. For any
Senator who wishes to ask additional questions, questions for
the record will be due tomorrow, June 9th at 5 p.m.
The hearing record will remain open for 10 business days
for Members who wish to submit additional materials for the
record. And this Committee will next meet on Thursday, June
10th at 10 a.m. in Dirksen 106 for an executive session to mark
up the Child Abuse Prevention and Treatment Act Reauthorization
of 2021.
Additional Material
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[Whereupon, at 12:04 p.m., the hearing was adjourned.]