[Senate Hearing 111-574]
[From the U.S. Government Publishing Office]
S. Hrg. 111-574
NOMINATION OF ALEXANDER G. GARZA
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HEARING
before the
COMMITTEE ON
HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
of the
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
NOMINATION OF ALEXANDER G. GARZA TO BE ASSISTANT SECRETARY AND CHIEF
MEDICAL OFFICER, U.S. DEPARTMENT OF HOMELAND SECURITY
JULY 28, 2009
__________
Available via http://www.gpoaccess.gov/congress/index.html
Printed for the use of the
Committee on Homeland Security and Governmental Affairs
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Washington, DC 20402-0001
COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS
JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan SUSAN M. COLLINS, Maine
DANIEL K. AKAKA, Hawaii TOM COBURN, Oklahoma
THOMAS R. CARPER, Delaware JOHN McCAIN, Arizona
MARK L. PRYOR, Arkansas GEORGE V. VOINOVICH, Ohio
MARY L. LANDRIEU, Louisiana JOHN ENSIGN, Nevada
CLAIRE McCASKILL, Missouri LINDSEY GRAHAM, South Carolina
JON TESTER, Montana
ROLAND W. BURRIS, Illinois
MICHAEL F. BENNET, Colorado
Michael L. Alexander, Staff Director
Kristine V. Lam, Professional Staff Member
Brandon L. Milhorn, Minority Staff Director and Chief Counsel
Jennifer L. Tarr, Minority Counsel
Trina Driessnack Tyrer, Chief Clerk
Patricia R. Hogan, Publications Clerk and GPO Detailee
Laura W. Kilbride, Hearing Clerk
C O N T E N T S
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Opening statements:
Page
Senator Lieberman............................................ 1
Senator McCaskill............................................ 1
Senator Collins.............................................. 4
Senator Akaka................................................ 11
Prepared statements:
Senator Lieberman............................................ 19
Senator Collins.............................................. 20
Senator McCaskill............................................ 21
WITNESS
Tuesday, July 28, 2009
Alexander G. Garza, M.D., to be Assistant Secretary and Chief
Medical Officer, U.S. Department of Homeland Security:
Testimony.................................................... 5
Prepared statement........................................... 23
Biographical and financial information....................... 26
Responses to pre-hearing questions........................... 45
Letter from the Office of Government Ethics.................. 79
Letters of support........................................... 80
Responses to post-hearing questions for the Record........... 89
NOMINATION OF ALEXANDER G. GARZA
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TUESDAY, JULY 28, 2009
U.S. Senate,
Committee on Homeland Security and
Governmental Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:02 a.m., in
room SD-342, Dirksen Senate Office Building, Hon. Joseph I.
Lieberman, Chairman of the Committee, presiding.
Present: Senators Lieberman, Akaka, McCaskill, and Collins.
OPENING STATEMENT OF CHAIRMAN LIEBERMAN
Chairman Lieberman. Good morning and welcome to this
hearing at which the Committee will consider the nomination of
Dr. Alexander Garza to be Assistant Secretary and Chief Medical
Officer of the Department of Homeland Security.
Senator McCaskill, if you have other matters to go to, I
think not only out of respect for you as a fellow Senator, but
as a fellow honored Member of this Committee, we would welcome
you to do your introduction first and then we can give our
opening statements.
OPENING STATEMENT OF SENATOR MCCASKILL
Senator McCaskill. That is very kind. Thank you, Mr.
Chairman and Senator Collins, not only for the hearing this
morning, but for your really special leadership of this
Committee. You are both role models of how this should be done,
and I would say that even if I were not on the Committee.
Chairman Lieberman. Thank you.
Senator McCaskill. You work together closely, and you get
past some of the food fights that go on around here over turf
and who gets credit and all of that stuff, and it is
remarkable. I am honored to serve on the Committee because of
your leadership.
It is a special morning for me. People ask sometimes when
you are having a rough week, because of the nature of our work
and being in the public eye and being accountable for
everything we say and do, why do you put up with it if you have
to go through some of these things? Mornings like this morning
are why you put up with it because you have the opportunity to
meet and get to know people in your life who are the essence of
public service and you have the opportunity to come into a room
like this in the halls of the most deliberative body in the
world and advocate for a man like Alex Garza.
I am proud to be here to introduce him this morning. I have
to give a confession before I read my formal introduction, and
that is that his family is very close to me. His wife has
worked for me for a number of years in a number of different
jobs over my public life, and I remember when they met. I
remember when they fell in love. I remember their wedding,
mostly because I was a lot younger and a lot thinner----
Chairman Lieberman. You do not have to go too far with this
confession. [Laughter.]
Senator McCaskill. I remember the birth of all three
children, who are here today. They are gorgeous boys. I
remember the anxiousness and the anxiety that Melissa had when
he was serving in Iraq. I remember all of it, and there is no
man who is better equipped to step into these shoes today than
Dr. Alex Garza.
I have known him for over 15 years and I am confident in
saying there could not be a more qualified person for this
position.
I first came to know Dr. Garza when he volunteered as a
medical expert on the methamphetamine task force I directed as
Jackson County Prosecuting Attorney. In recognition of his
work, he was awarded the Presidential Citation by the Office of
National Drug Control Policy.
But his story of service and dedication to the medical
community did not start here. Dr. Garza grew up as one of five
brothers in a Maryland Heights, Missouri, middle-class suburb
of St. Louis. Being one of five children, he learned the
valuable art of negotiation at an early age. But more
importantly, his mother, who worked the night shift as a nurse
in the local emergency department, taught him the value of hard
work and serving his community, skills that will serve him well
as Assistant Secretary, if confirmed.
While attending college, he decided he wanted not to just
learn from the books, but to experience medicine from the
ground up. He delayed attending medical school to work as a
paramedic in Kansas City so he could learn from the front
lines. He continued his work as a first respondent as a flight
medic all through medical school, working weekends and holidays
to put himself through school.
He graduated from the University of Missouri School of
Medicine and began the next stage of his emergency medical
training at Truman Medical Center in Kansas City, Missouri. On
top of all this, he also heeded his mother's example to serve
by joining the United States Army Reserves Medical Corps.
He ultimately chose to make his career in medicine about
public service when he accepted a position as a member of the
faculty at the Truman Medical Center. He tenure was interrupted
when he was called into active duty in service of Operation
Iraqi Freedom, leaving behind his wife, who was in law school
at the time, and his then two small children.
Dr. Garza and his team were responsible for rebuilding
health care in Iraq. What he found were medical schools with
out-of-date textbooks and decades-old journals. True to his
form, he orchestrated a textbook donation program that led to
medical schools from across the United States sending texts to
fill the library shelves of schools throughout Iraq. Because of
Dr. Garza's tireless work rebuilding hospitals and clinics, he
became a trusted member of the Iraqi medical community and
developed important strategic relationships. In addition, he
also cared for an occasional Iraqi sheik, the soldiers in his
unit, took turns at his post, and cleared buildings when
needed.
When his tour was extended for an additional 6 months, I
consoled Dr. Garza's wife, Melissa, a longtime member of my
staff, who came to me in tears after learning her husband would
be spending Christmas in a bombed-out shell of a building where
he had volunteered to assist the forward surgical team during a
full-scale offensive operation in Samarra. He finally made it
home to his family and was awarded the Bronze Star as well as
the Combat Action Badge.
His career in academics and public service immediately
resumed when he returned to direct emergency medical services
for the City of Kansas City and also returned to the faculty at
Truman Medical Center. During this time, Dr. Garza recognized
that outcomes for cardiac arrest patients could be improved,
and he created a new cardiopulmonary resuscitation protocol
that challenged conventional dogma. His ability to think
outside the box led to a doubling of the survival time for
cardiac arrest patients in Kansas City. For his work, he was
awarded the Young Investigator Award by the American Heart
Association. Because of his work, health care workers around
the world are now changing the protocols and the way they
resuscitate patients.
Dr. Garza is one of those rare individuals who, through
hard work and sacrifice, has improved the lives of those around
him. He has saved the lives of his patients, working in the
emergency room, taught compassion and clinical skills to
medical students and residents, furthered medical science by
publishing numerous articles in peer-reviewed scientific
journals, served his country at war, and improved the way pre-
hospital care is rendered across the globe.
It is with great pleasure and it is an honor that I have
the opportunity to introduce Dr. Alex Garza to the Committee. I
have every confidence that under his leadership, the Office of
Health Affairs will serve the Secretary and the President and
the Department of Homeland Security in an effective and
meaningful way.
Thank you, Mr. Chairman.
Chairman Lieberman. Thank you, Senator McCaskill, for a
very impressive and, I would say, obviously heartfelt, and for
us moving, introduction. I would say that Dr. Garza deserves it
all. I thank you for taking the time to come and deliver it.
I don't know when we have last had an introducing Senator
kiss the nominee. [Laughter.]
It is a good way to go.
Senator McCaskill. It is progress. [Laughter.]
Chairman Lieberman. Thank you very much, Senator McCaskill.
There is not much I can add to that really extraordinary
and very compelling introduction. I will just say a few words
about the position for which you have been nominated.
The position of Chief Medical Officer at the Department of
Homeland Security was created by the Post-Katrina Emergency
Management Reform Act of 2006 that was authored, I am proud to
say, by Senator Collins and me, following this Committee's 8-
month investigation into why the response of our Government to
Hurricane Katrina was so poor. The Post-Katrina Reform Act
reconfigured the Federal Emergency Management Agency (FEMA) so
that it could, for the first time in history, respond really in
an excellent way to natural disasters and also beyond that to
catastrophic disasters equivalent to the swamping of New
Orleans in 2005.
Among the new positions created to achieve that end, which
was better protection of the American people in crisis, was the
position of Chief Medical Officer to be the chief and principal
advisor to the Secretary of Homeland Security and to the
Director of FEMA on both medical and public health issues.
Among the responsibilities of the Chief Medical Officer is
coordinating the Department's response not just to natural
disasters, but to terrorism, including particularly
bioterrorism, which is a special focus of this Committee in
this session, ensuring coordination of all medical preparedness
and response activities at the Department, and coordinating the
Department's workforce health protection. In short, the Chief
Medical Officer is responsible for ensuring that the Federal
Government is ready, ready to carry out a quick, comprehensive,
and effective medical response to disasters, both natural and
unnatural.
I would say that it is especially important, and I know the
Secretary feels this, that we fill this position right away.
As chief medical advisor, Dr. Garza, should you be
confirmed, you will play a vital role in our Nation's response
to the H1N1 outbreak, which is continuing. Though many
Americans and a lot of the news media have turned to other
matters, this epidemic has continued to spread. Cases now
number over 1 million in this country, and the flu has not
subsided, as expected, this summer. It has not surged up in
numbers, but it has continued at pretty much the same pace,
which is not what most public health experts predicted. It
continues to be most problematic for children and young adults,
and unfortunately, there is every indication that it will
spread more rapidly in the fall when the traditional flu season
returns. Obviously, it is imperative that we be ready for that
and we get the public ready for that, and I want to ask you
about that during the question and answer period.
The next section of my prepared statement was a recitation
of your really quite extraordinary, patriotic biography,\1\ but
Senator McCaskill did such a great job, I will just express in
closing here my admiration and gratitude for your experience
and your service to your country and how much I look forward to
hearing your opening statement and then questioning you as you
go forward on this nomination. Thank you.
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\1\ The prepared statement of Chairman Lieberman appears in the
Appendix on page 19.
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Senator Collins.
OPENING STATEMENT OF SENATOR COLLINS
Senator Collins. Thank you, Mr. Chairman.
I join you in welcoming Dr. Garza to our Committee today.
As is so often the case, the Chairman and I have written
opening statements that are virtually identical. I, too, went
through the history of the creation of the Chief Medical
Officer in response to our investigation into the failed
response to Hurricane Katrina. I, too, outlined the
responsibilities and duties of the Chief Medical Officer. I,
too, talked about the threat of H1N1 and the fear that experts
have that it is going to return in the fall and winter with
even higher rates of infection and increased severity.
So rather than repeat what the Chairman has just said, let
me just wrap up my comments by saying that I am particularly
interested in hearing Dr. Garza's thoughts on our ability to
surge medical resources to respond to major medical events,
whether caused by a pandemic flu, the intentional release of a
deadly biological agent, or the detonation of a dirty bomb.
Last year, our Committee held a series of hearings on our
preparedness for the detonation of a nuclear device in a large
urban area, and we found many troubling gaps in our medical
surge capabilities. I contrasted that to what I saw in Israel,
where there is such preparedness to surge medical resources. I
think we have a long way to go.
In that area, Dr. Garza, having served as an emergency
doctor in both military and civilian settings, can help us
improve. I look forward to hearing his testimony today.
Thank you, Mr. Chairman, and I would ask that my full
statement be inserted in the record.\1\
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\1\ The prepared statement of Senator Collins appears in the
Appendix on page 20.
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Chairman Lieberman. Without objection, so ordered. Thank
you, Senator Collins.
That was actually a very good and different point that you
made at the end. I was thinking as you were saying what you did
that I remember saying when we switched roles and I became
Chairman and you Ranking Member that nothing would change
except our titles, and I realize that one thing has changed,
which is that I get to give our speech first.
Senator Collins. That is so true. [Laughter.]
Chairman Lieberman. Dr. Garza has filed responses to a
biographical and financial questionnaire, answered pre-hearing
questions submitted by the Committee, and had his financial
statements reviewed by the Office of Government Ethics. Without
objection, this information will be made part of the record,
with the exception of the financial data, which are on file and
available for public inspection in the Committee offices.
Dr. Garza, our Committee rules require that all witnesses
at nomination hearings give their testimony under oath, so I
would ask you to please stand and raise your right hand.
Do you swear that the testimony you are about to give to
the Committee will be the truth, the whole truth, and nothing
but the truth, so help you, God?
Dr. Garza. I do.
Chairman Lieberman. Thank you. Please be seated and please
proceed with your statement and feel free to introduce your
family.
TESTIMONY OF ALEXANDER G. GARZA, M.D.,\2\ TO BE ASSISTANT
SECRETARY AND CHIEF MEDICAL OFFICER, U.S. DEPARTMENT OF
HOMELAND SECURITY
Dr. Garza. Thank you for those remarks. Good morning,
Chairman Lieberman, Ranking Member Collins, and distinguished
Members of the Committee. I am humbled and honored to be a
nominee of President Obama and to seek your support today for
my nomination to be Assistant Secretary for Health Affairs and
Chief Medical Officer of the U.S. Department of Homeland
Security (DHS).
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\2\ The prepared statement of Dr. Garza appears in the Appendix on
page 23.
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If I may, Mr. Chairman, I would like to thank my wife,
Melissa, and my three sons. This is Alex----
Chairman Lieberman. Good morning, Alex.
Dr. Garza [continuing]. Samuel, and young Danny.
Chairman Lieberman. Good morning.
Dr. Garza. They have supported me here today as well as
throughout my career.
I am grateful for the leadership of this Committee for
ensuring the Nation is prepared to respond to all hazards and
all threats. The position for which I am nominated was
authorized by the Post-Katrina Emergency Management Reform Act
of 2006. Therefore, it is because of the work of this Committee
investigating the government's response to Hurricane Katrina
and the important legislation that all of you championed as a
result that I stand before you today. I want to thank you again
for your leadership.
I believe the role of the Chief Medical Officer is one of
the most challenging and rewarding roles for a physician in the
Federal workforce. The position not only requires experience
and knowledge in medical preparedness and response, but also
demands an understanding and awareness of intelligence and
security issues. My background as a local and State public
health official, coupled with my military service, makes me
uniquely qualified for this position.
My career has been dedicated to public service. I appear
before you today asking that you support my nomination so that
I may continue serving our country.
If confirmed, my priorities will be as follows. To continue
to build and strengthen the relationships between the Office of
Health Affairs (OHA) and its partners in DHS. The foundation
established by these relationships will permit OHA to deliver
the best possible advice and guidance to the Secretary, the
Administrator of FEMA, and our other component services.
Two, to continue building OHA's capacity. OHA must continue
to expand on its ability to respond to the various threats and
challenges of the DHS. The Office must adopt an all-hazards and
all-threats approach in order to prepare for a constantly
changing landscape of natural and manmade disasters and
catastrophic events. The office must be able to quickly assess
and adapt to the circumstances and to deliver rapid, yet sound,
response.
Third, protecting the DHS workforce. Those protecting the
homeland are absolutely vital to the mission of the Department.
OHA must continue to offer appropriate guidance to the DHS's
components in order to protect those who protect us.
If confirmed, I will pursue these three priorities. I would
build and strengthen OHA's relationships with all its component
services, expand its capacity to respond to all hazards and all
threats, and I will work with OHA's efforts on protecting the
health of the DHS workforce.
In closing, I am honored by the President's and Secretary
Napolitano's faith in my ability to effectively lead this
office and would like to put my knowledge and experience to use
in continued service of my country. I look forward to working
with this Committee, if confirmed, and I am glad to answer any
questions that you may have. Thank you.
Chairman Lieberman. Thank you, Dr. Garza.
I am going to start my questions with the three standard
ones that we ask of all nominees. First, is there anything you
are aware of in your background that might present a conflict
of interest with the duties of the office to which you have
been nominated?
Dr. Garza. No, sir.
Chairman Lieberman. Second, do you know of anything,
personal or otherwise, that would in any way prevent you from
fully and honorably discharging the responsibilities of the
office to which you have been nominated?
Dr. Garza. No, sir.
Chairman Lieberman. And third, do you agree without
reservation to respond to any reasonable summons to appear and
testify before any duly constituted Committee of Congress if
you are confirmed?
Dr. Garza. Yes, sir.
Chairman Lieberman. Thank you.
We will start with a first round of questions of 7 minutes
per Senator.
As I indicated in my opening statement, in a relatively
young Department of Homeland Security, the Office of Health
Affairs is itself a relatively young office. The position of
Chief Medical Officer was not formally authorized until 2006.
Since then, the office, OHA, has grown to over 100 in staff and
a budget of approximately $150 million, but in many respects,
it is still young and still in its formative stages.
I want to ask you, because you are coming in to manage at
this point--you will be more than just a singular advisor to
the Secretary, you have got an office there--to just develop a
little bit more of what your priorities and vision is for the
future of OHA.
Dr. Garza. I understand and I can fully appreciate the
relative newness of the office and what challenges it brings
with it.
The priorities that I envision for the office, if
confirmed, are as outlined in my opening statement. When I met
with the staff over the last couple of weeks to try to get a
better handle on what the office was doing, I asked each
program manager at the end of our session, what was their
biggest challenge. Without any hesitation and overwhelmingly,
the program managers said the biggest challenge was integration
and cooperation with other agencies. So I believe that should
be at the very top of my list, trying to build relationships
with our Federal agencies, Department of Health and Human
Services (HHS) in particular, but as well as our other agencies
since the Department of Homeland Security spans a greater
breadth and depth than just medical issues.
So we would do this, what I described as both vertically
and horizontally. We would go across our components. The office
would reach out to its other agencies and other partners. But
the office should go up and down, as well, and by that I mean
we should be able to cooperate and work with State, local,
tribal, public health providers, first responders, law
enforcement, emergency management, as well as critical
infrastructure and key resources.
So that would be one of my priorities, and the second would
be making sure that the workforce is protected. I know that
there are challenges that have been identified by this
Committee. I know it is the Secretary's priority to make sure
that the workforce is getting clear guidance, that they are
operating with the best equipment, with the best training, with
the best knowledge so that they can execute their duties.
I have particular interest in this because of my military
background as a battalion surgeon, where I fulfilled this role
in making sure our soldiers were medically prepared to go to
war, including vaccinations, and that included smallpox and
anthrax, taking care of them while they were deployed, as well
as doing post-deployment medical-related issues. So I fully
understand, comprehend, and am passionate about that, as well.
One of my other priorities is to build capacity within the
office. I realize that the office spans a great many things.
However, we must continue to build on a foundation of
excellence, and that sort of fits in with building our
relationships, as well. We have to build that capacity in order
to get better information, in order to work collaboratively in
building that capacity so that when we are advising the
Secretary, the FEMA Administrator, and whoever else our
customers are, be it the other Federal agencies, this
Committee, State or local governments, that we are able to give
them the very best product, the very best advice that we can.
Chairman Lieberman. Are there particular areas in which you
want to build the capacity of the office, where you think it is
short now?
Dr. Garza. Yes, sir. One of the areas that is of particular
interest to me is in the area of biosurveillance. I do have
some experience in this in the civilian world. I have worked
with various emegency medical service (EMS) providers. During
my time as a Medical Director in Kansas City, we made it a
point to develop syndromic surveillance using emergency data.
Chairman Lieberman. And this biosurveillance is to set up a
system where you would have as close to immediate notice as
possible of a potential biological attack?
Dr. Garza. Absolutely, sir. And so with the syndromic
surveillance, what we were doing is we were looking for any
patterns that were out of the normal for the community.
Chairman Lieberman. Please say a little more about what
syndromic is, as in syndrome.
Dr. Garza. Yes. And so what we tried to develop for the
City of Kansas City was looking at all of the calls that came
into 911. Now, the dispatch center for the EMS service uses
computer algorithms to arrive at what we call presumptive
conditions. So by interrogating the caller on a series of
questions, we arrive at what we think is the most likely
diagnosis or complaint. Those are all coded on computer. It is
all in real time.
One of the beauties of 911 data, which sets it apart from
emergency department data, which I have written papers on, is
all these calls are geocoded, and so we know exactly where the
caller is calling from, so we know where the incidents will be
coming from, as well.
So we collect this data, and we do a continuous sweep of
the computer, and we plot it up against what we know our
normals are for that time of day, for that time of year, things
like this.
Chairman Lieberman. That is a very good idea. I was
thinking you were going to talk about detection devices around
areas, in other words, technological devices----
Dr. Garza. Sure.
Chairman Lieberman [continuing]. But what you are really
talking about is taking advantage of an existing flow of
information and trying to draw from it quickly----
Dr. Garza. Exactly.
Chairman Lieberman [continuing]. A warning sign that
something is happening.
Dr. Garza. Exactly. And the way we reasoned it is that we
can analyze this data much quicker than waiting for the
emergency department to pull the data together from multiple
different sources. One of the beauties of emergency dispatch
data, as well, is that it is a single center. Everyone who
calls 911 calls to the center. So you are not pulling data from
different emergency departments to try to bring all that data
together. You have a single source. You have a single
algorithm. You have a single pattern that you can look at in
order to decide if this is something that is out of the
ordinary.
Chairman Lieberman. So what are you thinking of, trying
from the Chief Medical Officer's position to advocate that at
least the major urban areas in the country do similar ongoing
screening of 911 calls?
Dr. Garza. Sure. Presently, there are quite a number of
communities that do this. That was in reaction to what we had
done.
Chairman Lieberman. Right.
Dr. Garza. So currently, this monitoring is done in over 80
cities around the country, including Canada. So it does seem to
be a fairly robust and equitable system.
I think the point of me bringing that up, though, is to
explain that we need to start thinking a little bit more
globally on where we can look for syndromic surveillance and
for other data bits in order to give us a complete picture of
what is going on out in the community.
Chairman Lieberman. My time is up. I want to say I hope
that, if you are confirmed, and I sense that you understand
this already, you will not simply be there waiting for the
Secretary to ask you for advice or the FEMA Director, but that
in the areas of readiness, public health, medical, you will be
a very aggressive advocate and initiator of policy.
Dr. Garza. Absolutely, sir.
Chairman Lieberman. Thank you.
Dr. Garza. Thank you.
Chairman Lieberman. Senator Collins.
Senator Collins. Thank you, Mr. Chairman.
Dr. Garza, I was very pleased to hear you say that
workforce protection is a high priority for you. The Department
is going to have to make a decision on whether or not Customs
and Border Protection officials, for example, should receive
priority for vaccination against the H1N1 virus once the
vaccine is fully developed. In addition, the Department needs
to develop more complete protocols for the FEMA Emergency
Response Teams that are deployed to disaster areas so that they
are protected from hazards that they face.
Your predecessor made it a priority that OHA would create a
uniform set of policies for workforce protection. Yet in
response to questions from the Committee, you seem to see your
role more as advising the Chief Administrative Officer. I would
tell you that is not what we envisioned. You are supposed to be
the direct and principal advisor to the Secretary on a whole
host of issues, including workforce protection.
I am going to ask you again what role you think that your
office should play when it comes to DHS workforce protection.
Dr. Garza. Yes, ma'am. I share in your concerns for
workforce protection, and I know it is one of the top issues on
the Secretary's list, as well. So let me try to assuage your
fears of us abdicating our role.
OHA has a very strong presence with the Secretary. I view
the role of the Chief Medical Officer and the Office of Health
Affairs as being intimately involved in whatever posture that
the border takes, that our workforce takes, and giving the
Secretary the very best advice that we can, as well as
assisting in developing policy.
I do have some experience in this, I think as is evidenced
by my biography, while working with the military. I was the
chief advisor to the battalion as the battalion surgeon and as
well as to the division staff on civil military operations. And
so I do have some familiarity with that.
Now, as the battalion surgeon, you assume a lot of roles,
and so one of those is what sort of posture should your
soldiers take while operating in a hostile environment, and
that includes chemical protection, protection against known
biological threats, and things like this. So I am completely
comfortable with that role.
As far as developing policy and procedures for our
workforce, let me emphasize that our workforce is the most
important asset of our organization, and there are no doubts
that I, as well as my staff and the Secretary, take that role
very seriously.
Senator Collins. I just want to make very clear that we
look to you to develop those protocols and provide that advice.
It is not the job of the Chief Administrative Officer or the
Under Secretary for Management. It is the job of your office,
and I am confident from your response, in contrast to your
response to the pre-hearing questions, that you do understand
that.
I want to go on to two other issues in the time that I
have. Last year, the Commission on the Prevention of Weapons of
Mass Destruction (WMD) Proliferation and Terrorism found that a
biological attack was ``more likely than not'' to occur
somewhere in the world by the year 2013. Seven years ago, we
authorized the Select Agent Program in the wake of the anthrax
attacks on our Capitol and on the Postal Service. I believe
that DHS needs to play a stronger role in evaluating the
security of labs that are working with the most dangerous
pathogens.
I, for one, was surprised and alarmed to realize how weak a
regulatory structure we have and how dispersed these pathogens
are in labs all over the country, many in academic or medical
settings, with very low levels of security.
Do you believe that we need to reexamine and strengthen the
regulation of labs that are housing these very dangerous
pathogens?
Dr. Garza. Yes, Senator. I, as well, share your concern
about biological agents with a potential to do harm to the
community. As far as the biosafety level (BSL) labs and issues
like that are concerned, I know that the Office of Health
Affairs will work collaboratively with the Office of Science
and Technology, which is, I believe, mostly charged with
biosecurity instruction and things like that.
So where I believe, as Chief Medical Officer--if
confirmed--the Office of Health Affairs can be of assistance
is, once again, getting all of the best science available to
advise the Secretary on the threats that this would pose to the
community as well as working with our component services and
the Office of Science and Technology in developing plans to
make sure that if there were such an event, we would have a
robust response, as well as discussing any security issues and/
or things of that nature. As a physician and as a community
provider, I think it is important that we get the best
available evidence for the Secretary to make those decisions.
Senator Collins. I hope that you will also work with the
Members of this Committee.
Dr. Garza. Absolutely, ma'am.
Senator Collins. I personally think that we need to
strengthen the law in this area and come up with a risk-based
security scheme where greater level of scrutiny and regulation
would be applied to labs with the most dangerous pathogens and
that we come up with that kind of approach, similar to the
approach that we took with chemical facilities security.
Dr. Garza. Yes, ma'am.
Senator Collins. I see my time has expired, so I will wait
for the next round. Thank you.
Chairman Lieberman. Thanks, Senator Collins.
I just wanted to echo what Senator Collins has said. This
will be one of our legislative priorities this year, which is
to legislatively beef up the oversight and protection that we
provide to the American people from bioterrorist attack. I
mean, you are now moving into a position, if you are confirmed,
which we live with. We are all about defense. We are all about
defense of the homeland in the post-September 11, 2001, period,
and in some ways we spend a lot of time imagining worst case
scenarios. But after September 11, 2001, that is what we have
got to do. And this is one, particularly coming off of the
Graham-Talent WMD Commission report, that I think we really
want to focus on, and I will come back with one or two
questions afterward.
Senator Akaka, good morning. Thanks for being here.
OPENING STATEMENT OF SENATOR AKAKA
Senator Akaka. Thank you. Good morning.
Let me congratulate you, Dr. Garza, for being the nominee
and welcome you and your beautiful and handsome family. It is
good to see Melissa here and also--is that Alexander Junior?
Dr. Garza. He has a different middle name, sir. I would not
want to burden him with my name.
Senator Akaka. I also welcome Samuel, Daniel, and the rest
of your family here, and also friends and supporters, as well.
Thank you for being here.
Dr. Garza. Thank you.
Senator Akaka. As you know, Dr. Garza, the Office of Health
Affairs is tasked with protecting our country from bioterrorism
as well as natural agents that threaten our health. Given the
increasingly difficult challenge of protecting our Nation, I
urge you to focus on working collaboratively and communicating
effectively with partner agencies and other stakeholders. It
was good to hear your priorities about strengthening
relationships with other agencies. There are a lot of agencies
and departments where the relationships have to be
strengthened.
Like you, I believe that our workforce is our most valuable
asset, and I understand that one of your priorities is to
protect and help build the morale of that workforce. I hope in
particular that you will focus on the growing shortage of the
Federal veterinarian workforce and how it will affect our
public health and food safety.
Dr. Garza, your wide-ranging experience in emergency
medicine, academia, and the military gives me confidence that
you will bring a valuable perspective to the office. Again, I
congratulate you on your nomination and look forward to working
with you and again commend you for your priorities.
As I mentioned in my opening remarks, I am concerned about
the Federal veterinarian workforce and its shortages. I
requested that the Government Accountability Office (GAO)
conduct a comprehensive review of the Federal veterinarian
workforce and held a hearing in February of this year, which
focused on the challenges facing this workforce. GAO found that
within the next 3 years, more than one-fourth of the
veterinarians at key agencies for public health, homeland
security, and food safety will be eligible to retire.
As you know, OHA veterinarian agro-defense personnel
provide advice on zoonotic diseases and agricultural security
related to food and water. Keeping in mind that most Federal
veterinarians work outside DHS, what steps would you take to
address this critical workforce challenge so that Federal
veterinarians are able to help address the Nation's
vulnerabilities in these areas?
Dr. Garza. Senator, I share your concern about our
veterinarians and their declining numbers in the workforce.
If I may, I would like to discuss how the Office of Health
Affairs intersects with veterinarian medicine. Now, as with
almost the whole of DHS, it is multi-ingrained with many
different aspects and partners and things like that, and the
same is true of the Office of Health Affairs. The Office of
Health Affairs does not necessarily just deal with human
disease. We value the all-hazards, 360-degree situational
awareness, and that includes zoonotic disease as well as
agricultural issues, as well.
If we take a look at the big picture, we would understand
how important the surveillance, the response, and the handling
of zoonotic disease is to the importance of human health. So I
share in your concerns that we must keep a robust, a very
active and involved participation with our veterinarian
colleagues, who, by the way, are some of the smartest people
that I have ever met.
So as a role of the Chief Medical Officer and the Office of
Health Affairs, I believe it is important that we support our
veterinarians and that we enhance their capabilities, as well
as interacting with partners in other agencies, such as the FDA
and the Department of Agriculture, in order to leverage our
abilities with them and also to showcase the importance and the
value that they bring to the table, as well as push this down
to the State and local agricultural partners and our veterinary
partners.
So I value their input. They are an important part of the
Office of Health Affairs, and if confirmed, I would further
continue to try to improve our relationship with them and
improve their standing in the Federal workforce.
Senator Akaka. Dr. Garza, until recently, the Department of
Health and Human Services operated immigrant health services
while working with Immigration and Customs Enforcement (ICE)
under a Memorandum of Understanding. Now, the Division of
Immigration Health Services operates within ICE. In recent
years, ICE's medical services have come under great scrutiny
due to the numerous reported deaths.
What role do you expect OHA will play in guiding the
decisions and policies to improve the oversight and quality of
medical care for immigrant detainees?
Dr. Garza. Yes, Senator. Again, I think we share the
concern for detainee health. I have read the same articles in
the newspaper that you have. I know that this is a priority for
the Secretary, so much so that she has a special advisor
particularly on detainee health.
I have spoken with her, and she has shared with me her
assessment as well as some issues that she sees going forward.
During the conversation, I implied to her that, if confirmed
and if I assume this office, the Office of Health Affairs will
be more than happy to assist her in whatever medical issues she
would need guidance on as well as giving her the best science
and policy advice available.
Senator Akaka. Thank you very much.
Dr. Garza. Thank you, Senator.
Senator Akaka. Mr. Chairman, my time has expired.
Chairman Lieberman. Thanks, Senator Akaka. Perhaps we will
just do a few more questions if my colleagues have them.
Dr. Garza, under Section 516 of the Homeland Security Act,
as I read it, the Chief Medical Officer is actually responsible
for coordinating all the biodefense activities of the
Department. So you would play a very important role, and that
is why, if you are confirmed, we will want to work with you----
Dr. Garza. Yes, sir.
Chairman Lieberman [continuing]. On the legislation that we
are going to introduce.
The WMD Commission, Senators Graham and Talent, recommended
that we do everything we could to ensure that we had a much
more robust response capacity to a biological attack. And I
understand you are just going into this, so these are
preliminary thoughts, but beyond the upgrading of the
biosurveillance that you talked about earlier, what thoughts do
you have--this does tie into what Senator Collins mentioned in
her opening statement--about our concern, which we share, about
the relative lack of capacity to surge our public health
infrastructure in case of a biological or pandemic attack that
takes off?
Dr. Garza. Yes, sir. The Office of Health Affairs is the
primary biodefense office within the Department of Homeland
Security and so the way that I envision in response to a
biodefense or a biological event is, I think, in my priority
with building capacity. And so in building capacity, I do not
feel that the office should purely focus on surveillance
activities and data acquisition and things like this. I believe
that the office must take an almost holistic view for all
threats, all hazards, as well as working with our component
services, such as the Centers for Disease Control and
Prevention (CDC) and the Office of the Assistant Secretary for
Preparedness and Response (ASPR), in the response capabilities,
as well.
One part where we are particularly effective is in working
with our first responders, with our emergency managers, and
with law enforcement. Should I be confirmed, I would put
emphasis on this office, as well, to get information and
guidance, policy directive, down to these individuals, as well,
who are going to, frankly, be where the rubber hits the road
and the first folks on the scene. They deserve this sort of
support from our office.
So I am trying to take more of a systematic approach to our
biodefense capabilities with building the structure so that no
matter what the threat, whether it is manmade or natural,
whether it is a weather-related event or infectious disease or
other issues, we would be able to appropriately detect,
appropriately respond, and appropriately recover from that
event.
Chairman Lieberman. Let me focus finally on H1N1, which we
talked about. I think that Secretary Napolitano along with
Secretary Sebelius have done an admirable job in both
responding and, as importantly--maybe more importantly--keeping
the focus on preparing for the flu season to come in the fall.
But everybody agrees, we have a lot of work to do, and there
are very critical questions about whether, for instance,
vaccines will be ready in time.
So I wanted to ask you, assuming you are confirmed, what do
you see are the major challenges that we face as a Nation or
the Department faces over the next couple of months as we head
into the fall and the more traditional flu season to get ready
for a possible rapid spread of H1N1?
Dr. Garza. Yes. I believe everyone on the Committee as well
as Secretary Napolitano and myself and the office shares your
concerns with H1N1. I know it is a priority of hers. I am
familiar with her meeting with Secretary Sebelius and the
Department of Education.
So the issues that need to be coordinated before our
presumed second surge of the virus are multi-faceted and multi-
pronged. And so the issue that we have with OHA, which sort of
separates us from the rest of the field, is we have to have
better interaction with our partners over at HHS.
I have met with Dr. Lurie at ASPR, talked with the CDC, and
sat down and had discussions with Craig Fugate at FEMA, as
well, and this seems to be on the top of their list, as well.
So the issue for the Office of Health Affairs would be
coordinating with these folks to strengthen our relationships.
I know that we have a physician in our office who is
particularly involved with vaccine as well as distribution of
vaccine, prioritizing, protecting our workforce, which is on
the top of our list, as well as disseminating information down
to our critical infrastructure and key resources, as well as
our emergency responders, first responders down at the front
level, as well as providing guidance to the American people. So
all of these issues, I think, put together are issues that the
Office of Health Affairs really needs to focus on to get us
prepared for the presumed second wave of H1N1.
Chairman Lieberman. Would you say that in the meetings you
have had with people at DHS and HHS, for instance, the
presumption is that we will have a serious problem with H1N1
this fall and winter, obviously hoping that is not so, but
people are going forward acting as if this is going to be a
genuine public health crisis?
Dr. Garza. Thank you, sir. In my meetings with these
individuals, they did express to me their concern for the
coming fall.
Chairman Lieberman. Right.
Dr. Garza. They did not expressly say whether they felt it
was going to be worse than our spring. Of course, the big fear
is that the virus will mutate and assume some sort of different
form and then we will be in a lot of trouble. But they did not
express with any confidence whether they felt it was going to
be worse. So when I was discussing these issues with them, we
mostly discussed our needs to better collaborate and work
together on H1N1 issues.
Chairman Lieberman. Thank you.
Dr. Garza. Thank you.
Chairman Lieberman. Senator Collins.
Senator Collins. Thank you, Mr. Chairman.
Dr. Garza, earlier this year when we held a hearing with
the Secretary to look at the Federal response to the flu
pandemic, we found that there was a great debate over whether
our border with Mexico should have been closed and also whether
there should have been more rigorous screening at the border.
Now, I, for one, accept the medical advice we heard that
closing the border was not the answer. For one thing, the virus
was already in our country.
Dr. Garza. Yes.
Senator Collins. However, I am concerned that the
Department seems to be very hesitant to use technology more
fully to try to identify travelers who may be carrying H1N1 or
some other new communicable disease. Other countries have
successfully used technology that is able to scan travelers to
identify fever. This was used back when the severe acute
respiratory syndrome (SARS) epidemic was in full force, and
some countries, including Japan and Singapore, have been using
it during the flu pandemic.
What are your views on the use of technology to better
screen travelers at the border? After all, I think we have to
remember that while our Customs and Border Protection officials
and our immigration agents are highly trained, they are not
physicians. They are not nurses. They are not health officials.
Dr. Garza. Yes, Senator. I understand your concerns, and I
appreciate them, and I would like to work further with the
Committee in order to help with this issue. I know the
Secretary keeps this on the top of her list, as well.
So in regard to the border protection, this is of prime
importance to the Secretary. It is her responsibility for the
protection of the border. I know that she values good, active,
actionable intelligence and information in order to decide what
actions and what posture she is going to take at the border.
With that being said, I also appreciate the tremendous
strain that our Customs and Border Protection agents were under
during this event. You are correct, they are not medically
trained personnel, and so quite frankly, I think it makes them
a little uneasy to be performing duties such as these since
they are not medically trained.
So as far as the technology is concerned, I am somewhat
familiar with the technology. I cannot say that I am an expert
at the technology. But from what I have understood is that it
still is not where it needs to be.
Given that, though, I believe the OHA mission should be
taking all available resources in order to screen or identify
or protect the country from infectious agents and other things
coming into the country, and that, of course, includes new
technology such as what you were talking about with the thermal
scanners. I believe the Office of Health Affairs as well as
Science and Technology, we do have a duty to look at, evaluate,
and understand all these technologies. It is on the forefront
of our agenda every day to protect the people, and it is a
priority of the office to make sure that we are using all
available resources.
With that being said, I think we should also rely on best
science, as well, to dictate what our priorities should be and
what equipment we should use and what sort of posture we should
take at the border.
Senator Collins. The thermal scanners are not perfect, that
is certainly true, but they are a tool----
Dr. Garza. Absolutely.
Senator Collins [continuing]. That can be used to screen.
It does not mean that you allow that tool to make the decision,
and there are, I believe, five developed nations,
industrialized nations, using them----
Dr. Garza. Yes.
Senator Collins [continuing]. So clearly there is some
value. If they were so inaccurate or unproven----
Dr. Garza. Right.
Senator Collins [continuing]. I doubt very much Japan would
be using them. So I really urge you to take a look at this. We
need to be willing to use all the tools that we have.
Technology should not be used to make the decision, but it can
be helpful in assisting individuals who do not have medical
training in making the first cut, if you will, in making the
preliminary screening more effective.
Similarly, last year, there was a case where a Mexican
citizen with a contagious form of resistant tuberculosis was
able to cross the border, back and forth, 21 times despite the
fact that the Department of Homeland Security had his name and
his date of birth. This was an example where the left hand of
government did not talk to the right hand of government. The
CDC had identified the individual as having this kind of
contagious tuberculosis. It was known to the government that,
for business reasons, he frequently crossed the border. And yet
there was a failure of communication between the CDC and DHS.
First of all, are you familiar with this case?
Dr. Garza. I am somewhat familiar. I cannot say I know the
intimate details, but yes.
Senator Collins. What will you do to make sure that we do
not have these egregious gaps in communication? Here, we have
an individual who has specifically been identified by the CDC,
and there is just poor communication.
Dr. Garza. Yes. I understand the concern of the Committee
with this, and I believe it would be on OHA's priority list to
do, as well. But I think what you have brilliantly illustrated
is what I was trying to put forth in my opening statement and
answers to other questions, and that is capacity and systems
building as well as developing relationships with our component
services.
So, if confirmed, one of the priorities in my office would
be to make sure that those relationships and those systems are
robust enough to not let this issue happen again. And if
confirmed, I look forward to working with the Border Patrol,
CDC, and DHS as a whole so that these sorts of issues would not
occur again.
Senator Collins. Finally, our Committee held 24 hearings
looking at the failed response to Hurricane Katrina. Of all
those hearings, the one that stands out most in my mind because
it was so tragic and so preventable was the hearing that looked
at the number of homebound individuals and elderly, sick
individuals in nursing homes who died because of a failure to
evacuate them. It was so tragic and so outrageous that it
happened.
After that hearing, I had a number of home health care
groups with whom I have worked closely come to me and say, we
know where the homebound elderly are because we serve them. We
visit their homes. But we have never been asked to be involved
in evacuation planning.
What will you do to ensure that all resources are brought
to bear by States, by local governments, and by the Federal
Government to ensure that we never again see homebound elderly
individuals who are incapable of evacuating themselves, or
people who are in a nursing home who, again, cannot evacuate
themselves, become victims of a disaster due to a failure of
planning and a failure to mobilize all possible resources?
Dr. Garza. Yes, Senator. I think that question absolutely
goes back to my previous answers of capacity building. And so
for us to effectively deal with the entire population, we must
make sure that we are cooperating and connected with the entire
population, and so that includes populations that you
mentioned.
Now, I am not sure if you had a meeting with the FEMA
Director right before I did, but that was on the top of his
list, as well, when I met with him. And so I do want to assure
you that it is on a lot of people's minds. And in particular,
Mr. Fugate's direct question to me was, we need better planning
on at-risk populations, and I consider the homebound and
nursing home population an at-risk population.
I believe that also speaks to the Office of Health Affairs
having to think outside the box. We cannot just simply accept
the normal response to an event which is very well contained,
such as a small event. We have to be prepared for all hazards,
all threats, and all people in response to a catastrophic
event.
Senator Collins. Thank you. I look forward to working with
you.
Dr. Garza. Thank you.
Senator Collins. Thank you, Mr. Chairman.
Chairman Lieberman. Thank you very much, Senator Collins.
I thank you, Dr. Garza. I do not have any further
questions, and I think we have reached the limits of the
impressive patience of your sons. They have really been very
well behaved today. I do not think we should ask more than this
of them. [Laughter.]
Dr. Garza. He almost made it.
Senator Collins. A good period on that.
Chairman Lieberman. He expressed a sentiment often felt by
people who sit in this room but rarely expressed. [Laughter.]
Without objection, the record will be kept open until noon
tomorrow for the submission of any written questions or
statements for the record.
It would be the intention of our Committee to have, as we
call it, an off-the-floor markup sometime soon of your
nomination and hopefully get you confirmed before we break for
August recess on August 7.
But I thank you for your willingness to serve. I thank your
family for their willingness to back you up as you serve. As
Senator Collins said, we really look forward to working with
you on these urgent matters of homeland defense. Thanks very
much.
Dr. Garza. Thank you.
Chairman Lieberman. The hearing is adjourned.
[Whereupon, at 11:04 a.m., the Committee was adjourned.]
A P P E N D I X
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