Following Trump’s Threats to Withdraw Hurricane Response Efforts, Murray, Wyden Push HHS For Commitment to Remain in Puerto Rico & U.S. Virgin Islands As Long As Public Health is At Risk
Senators
In the letter, Senators Murray and Wyden express serious concerns regarding
"We have...been alarmed by
The Senator's requested information by HHS on the following critical areas by no later than
* Staffing and Resource Needs
* Power Outages
* Access to Health Services
* Medicaid, Medicare, and the
* Disease Outbreaks
*
* Domestic Violence and Sexual Assault
* Human Services, Child Welfare, and Child Protection
* Early Learning and Care
* Mental Health and Substance Use Disorder
* Drug Shortages
Full text of the letter below and PDF HERE (https://www.help.senate.gov/imo/media/doc/102617%20-%20HHS%20Hurricane%20Response.pdf)
The Honorable Eric D. Hargan
Acting Secretary
Dear Acting Secretary Hargan:
We write to request information about the
There is considerable work to be done in the short- and long-term to respond to this growing public health crisis and ensure the situation does not become even direr.[2] We are particularly concerned by reports of food, water, and fuel shortages even weeks after Hurricane Maria hit the islands. Much of
To help us better understand the Department's ongoing hurricane response efforts, please respond to the following questions no later than
Staffing and Resource Needs
There have been challenges in distributing personnel and resources to areas with unmet needs during the hurricane response. For example, the USNS Comfort arrived in
1. How is HHS dividing its resources in response to the hurricanes? What considerations have gone into HHS's division of resources?
2. How has the hiring freeze implemented across the Department earlier this year affected response efforts? How has the hiring freeze affected the Department's ability to deploy disaster response resources, while also completing its other work unrelated to disaster response?
3. Please explain how the hiring freeze affected the number of National Disaster Medical System (NDMS) reservists able to be deployed in hurricane response efforts.
4. Is a hiring freeze still in place within any HHS operating divisions or agencies?
5. How has HHS coordinated with other federal government agencies to ensure medical and public health needs are being met, including in instances where HHS has insufficient capacity?
Power Outages
The hurricanes have resulted in power outages, which can create unique health risks such as heat-related illness and carbon monoxide poisoning. Power outages pose especially grave risks to individuals who depend on medical devices that require power. In
1. How is HHS addressing the health risks associated with these potentially long-term power outages?
2. Using alternative sources of electricity such as generators amid a power outage can cause carbon monoxide to accumulate in enclosed structures.[7] What best practices, if any, is HHS sharing with hospitals relying on generators amid power outages related to the Hurricanes?
3. How is HHS working to identify and provide support to individuals who depend on medical devices that require power?
4. What safety information is HHS providing to consumers of food, water, and drugs in areas without power?
Access to Health Services
The hurricanes have resulted in temporary closures of a number of medical facilities, limiting access to inpatient and outpatient care.[8] The facilities that remain open are overpopulated, yet lacking in medical supplies to treat the influx of patients.[9] A recent report found that dialysis patients have seen treatment hours reduced by 25 percent, given fuel shortages to run generators. Much of
1. How is HHS working to ensure the hospitals, clinics, and community health centers that remain open have adequate resources, particularly with respect to staffing, medical supplies, and fuel, to meet patient needs?
2. How is HHS ensuring that it has accurate information about medical needs around the island?
3. How is HHS working with local health officials to reopen and restock medical facilities that remain closed or understocked?
4. How is HHS working with facilities that remain closed to support efforts to reopen?
Medicaid, Medicare, and the
The impact of the hurricanes has also demonstrated the critical importance of key safety net health care programs like Medicaid and the
In
1. How is HHS working with states and territories to ensure impacted individuals and evacuees have access to needed health care coverage and services, including temporary Medicaid eligibility, streamlined eligibility, moratoriums on redeterminations for already-eligible Medicaid beneficiaries, and self-attestation of income and displacement status?
2. Does HHS plan to issue any guidance to states and territories regarding Medicaid coverage of individuals and evacuees impacted by the hurricanes, including 1115 waivers similar to those issued after Hurricane Katrina to ensure impacted individuals have access to Medicaid coverage and needed care?
3. When does HHS expect
4. Does HHS plan to formally request additional funding under the Medicaid program for states and territories to provide health care coverage and services to impacted individuals and evacuees, as was provided in the Deficit Reduction Act of 2005 post-Hurricane Katrina?
5. In addition to Medicaid, the
6. HHS has announced special enrollment periods for certain disaster-impacted individuals who wish to enroll or disenroll into Medicare Advantage, Part D or exchange plans.[16] Does HHS plan to offer a similar special enrollment period for individuals in
Disease Outbreaks
The hurricane aftermath has produced an environment that breeds disease and other health risks. Public health officials are reporting at least four deaths from leptospirosis, a bacterial infection that can lead to kidney damage, liver failure, and meningitis.[17] The lingering standing water is also a breeding ground for mosquitoes, which may result in an increase in mosquito-borne diseases like dengue, chikungunya, and Zika. Finally, the lack of running water has resulted in an increase in diseases like pink eye and skin rashes, as basic hygiene needs go unmet.
20. What surveillance efforts are in place to diagnose and track disease in
21. Does HHS have a plan, in coordination with other agencies, for ensuring there is accessible drinking water in
22. What efforts are being made to communicate with individuals about how to protect themselves from infectious disease?
23. It has been reported that there is not lab capacity to test for leptospirosis in Puerto Rico.[18] Is there any diagnostic lab capacity in
Oral contraceptive access is of particular concern amid these disasters because oral contraceptives must be taken on a daily basis at a consistent time to be the most effective, and packs must be renewed every twenty-eight days. Numerous studies have shown that natural disasters disrupt availability of contraception and access to family planning services, which may lead to higher rates of unplanned pregnancy.[19]
24. How is HHS ensuring access to contraception as hospitals and pharmacies remain closed or inaccessible?
25. What efforts are being made to increase access to long-acting reversible contraceptives?
26. Is HHS helping to provide emergency contraception to individuals who may need it due to a sexual assault or lack of access to other methods of contraception?
Domestic Violence and Sexual Assault
Survivors of domestic violence and their children face increased health and safety risks in the aftermath of natural disasters. In the wake of Hurricane Andrew, calls to a local domestic violence help line increased by 50 percent, and more than one-third of residents surveyed "reported that someone in their home had lost verbal or physical control in the two months after the hurricane." [20] Similarly, after Hurricane Katrina, the Louisiana Coalition Against Domestic Violence received reports that women were being battered by their partners in emergency shelters.[21] Studies have also shown that the rates of child abuse are disproportionately higher in the months following natural disasters.[22]
Natural disasters can also lead to an increase in reported sexual assaults and violence.[23] Many of the circumstances that can contribute to sexual violence against women often exist during a hurricane response, including a lack of communal support systems for vulnerable individuals and lack of protection or security in shelters.[24]
27. Where is HHS directing domestic violence survivors, with their children as needed, to go when domestic violence shelters are closed or destroyed in the wake of the hurricanes? What is HHS doing to ensure domestic violence survivors have access to the resources they need?
28. How is HHS ensuring children have access to resources they may need to report abuse and receive necessary physical and mental health treatment?
29. How is HHS supporting sexual assault providers? What is HHS doing to make sure sexual assault survivors have appropriate health care services and other supports?
Human Services, Child Welfare, and Child Protection
The damage caused by hurricanes can have disastrous effects on the health and well-being of children and families. When businesses shutter and jobs are lost, many families lose their only source of income, increasing the strain on basic assistance programs to help families make ends meet. In recognition of these challenges, in the wake of Superstorm Sandy,
30. What is HHS doing to help states and territories serve families who are struggling with job loss and income loss? What basic assistance resources, such as cash assistance and other material supports, exist?
What is HHS doing to help foster care agencies and foster care providers ensure children in foster care have access to safe and secure placements and are receiving adequate health (including mental health) services?
32. What is HHS doing to ensure states and territories are meeting federal foster care requirements under Title IV-E of the Social Security Act, especially those related to case plan and case review requirements?
Early Learning and Care
Hurricanes take a significant toll on children and families, including families with young children. Hurricane Katrina damaged more than 200
33. How is HHS working to ensure that
34. How is HHS supporting
35. What is HHS doing to help states and territories meet the child care needs of families impacted by the recent hurricanes, both in the affected areas and where children and families have been displaced?
Mental Health and Substance Use Disorders
Hurricanes can exacerbate mental health needs and conditions in the short and long terms. One study found that a year after Hurricane Katrina, hurricane survivors experienced an increase in suicidal thoughts, more than doubling the proportion of people who experience suicidal thoughts from 2.8 percent to 6.4 percent. Likewise, another study found that a year after Hurricane Katrina, the number of survivors with diagnoses like depression and psychosis doubled.[27]
Stressful situations, such as a natural disaster, can also present a challenge to those in treatment for a substance use disorder (SUD), especially when existing sources of treatment are disrupted. Additionally, natural disasters and the trauma associated with them can lead to the development or exacerbation of a SUD, and a break in services and treatment can mean that those individuals are at risk of relapse. After Hurricane Katrina, the rate of hospitalizations for substance use disorder increased approximately 30 percent.[28]
36. How is HHS addressing short-term mental health needs? How is HHS preparing for long-term mental health needs?
37. How is HHS ensuring that children and young adults have access to resources to address their mental health needs?
38. How is HHS ensuring that people with substance use disorder have the services and treatment they need?
Drug Shortages
39. How is HHS ensuring that it has accurate information about potential drug shortages around the island?
40. How is
41. How is HHS coordinating with
42. How is HHS coordinating with
We share your commitment to organizing a rapid, effective hurricane response as this crisis unfolds. Thank you in advance for your attention to this matter.
###
[1] http://www.cnn.com/2017/10/12/politics/donald-trump-puerto-rico-tweets/index.html
[2] https://www.hhs.gov/about/news/2017/09/19/secretary-price-declares-public-health-emergency-puerto-rico-and-usvi-due-hurricane-maria.html; https://www.hhs.gov/about/news/2017/09/08/hhs-secretary-price-declares-public-health-emergencies-georgia-and-south-carolina-due-hurricane-irma.html; https://www.hhs.gov/about/news/2017/09/07/hhs-secretary-price-declares-public-health-emergency-florida-due-hurricane-irma.html; https://www.hhs.gov/about/news/2017/09/06/hhs-secretary-price-declares-public-health-emergency-puerto-rico-us-vi-due-hurricane.html; https://www.hhs.gov/about/news/2017/08/26/hhs-secretary-price-declares-public-health-emergency-in-response-to-hurricane-harvey.html.
[3] https://www.nytimes.com/2017/10/10/us/puerto-rico-power-hospitals.html?_r=1
[4] http://www.miamiherald.com/news/nation-world/world/americas/article178702921.html
[5] https://www.nytimes.com/2017/09/22/us/hurricane-maria-puerto-rico-power.html
[7] https://www.cdc.gov/disasters/carbonmonoxide.html
[8] http://www.politico.com/story/2017/10/03/puerto-rico-hurricane-crisis-trump-243391?lo=ap_c1
[9] https://www.nytimes.com/2017/10/10/us/puerto-rico-power-hospitals.html?_r=1
[10] https://www.nytimes.com/2017/09/27/us/hurricane-maria-virgin-islands.html
[11] https://www.nytimes.com/2017/09/27/us/hurricane-maria-virgin-islands.html
[13] https://publichealth.gwu.edu/sites/default/files/downloads/GGRCHN/Policy%20Research%20Brief%2043.pdf
[14] https://www.ssa.gov/pubs/EN-05-10521.pdf
[15] https://www.macpac.gov/wp-content/uploads/2016/09/Medicaid-and-CHIP-in-Puerto-Rico.pdf
[16] https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Disaster-Memo-Medicare-SEP.pdf
[17] http://www.miamiherald.com/news/nation-world/world/americas/article178702921.html
[18] https://www.nytimes.com/2017/10/10/us/puerto-rico-power-hospitals.html?_r=1
[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388024/
[20] https://www.nytimes.com/2017/09/12/us/domestic-violence-hurricanes.html?_r=0
[21] http://www.ncdsv.org/images/BeatenSexuallyAssaultedLivingHurricane.pdf
[22] https://www.ncbi.nlm.nih.gov/pubmed/11057702; https://www.nytimes.com/2017/09/12/us/domestic-violence-hurricanes.html
[23] http://www.nsvrc.org/sites/default/files/Factsheet_sv-in-disasters.pdf
[24] Disaster Rape: Vulnerability of Women to Sexual Assaults During Hurricane Katrina, https://28b3dd4c-a-e2cc6547-s-sites.googlegroups.com/a/jpmsp.com/new-jpmsp/Vol13Iss2-DisasterRape-ThorntonandVoigt.pdf?attachauth=ANoY7cq6ykyhJwx6WVRunl44gNgqO0nS6s7DLnD34-hCDMZDWGdRJmPzq5cRAY02mHm5ERp40oyOosxKw2IMzSo3ayD96T3zds9Pm3ZPb2IIo0ZryrooMvlmAkQPTCGU6fVJLPDIr7QBVpgf9M2pp4BdKdDisSlkkJmpQp9vc0TZucP2paCZ-FaLQGzJwwfG1ip_uoVJjrOBBXWK4SkxoWXGytt-ZYgyOPBMHcUkpwG9uAAn9fXrHOI%3D&attredirects=2
[25] https://www.acf.hhs.gov/ocs/programs/ssbg/hurricane-sandy-supplemental-funds
[26] https://www.acf.hhs.gov/sites/default/files/opre/katrina_final2.pdf
[27] http://www.nature.com/news/hurricane-katrina-s-psychological-scars-revealed-1.18234
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