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STATEMENT OF THE FEDERAL PROFESSIONAL

NURSES ASSOCIATION

Mr. Chairman:

Despite the best efforts of this Committee, the quality of government employee health care continues to deteriorate and the job security of the full-time Federal nurses who staff PHS Units is in more serious jeopardy today than when we last reported to you. Another year has passed with no improvement.

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Two years ago after we nurses submitted testimony to you, the Committee adopted Report language advising the Department of Health and Human Services of your continuing concern that PHS, in its efforts to restructure its Federally staffed occupational health program, should protect the rights of career employees who staff the health units. The Committee expressed skepticism that the plan to reassign nurses in the Washington, D.C.

area, and to designate them as resource nurses, will prove cost-effective. The Committee encouraged PHS to provide at least one full-time Federal/Career employee at each health unit.

The Department has not complied with the Committee's directions.

Further, HHS persisted in the effort to implement its Resource Nurse Proposal, a scheme to remove several Federal nurses from the units where they serve in the Washington, D.C. area and to replace them with private contract personnel.

The Union has tried repeatedly, but without success, to get the Department to acknowledge and respect the directions of this Committee. Finally, faced with the threat of imminent implementation of the Resource Nurse Proposal, the Union was forced to file an unfair labor practice charge against the Department. The matter was resolved by the Labor Relations Authority.

Consistent with its campaign to discredit and get rid of the Federal occupational health nurse, the Occupational Health Managers appear to have adopted a more aggressive, non-compromising approach in their annual evaluations of the Federal nurses' performances. For instance, several Federal nurses have "coincidently" received their lowest ratings in years despite no actual diminution in the performance of their duties.

The Department's actions, we believe, place the health of government workers at risk. While the demand for the specialized services of occupational health nurses continues to grow, the Department insists on replacing full-time Federal nurses with private contract nurses. The use of contract nurses to staff Public Health Units is the reason for the deterioration in the quality of health care government workers receive in the workplace.

Most contract nurses are temporary employees. They do not stay long at any one agency. They do not get to know the employees and their environment. Consequently, there is no continuity in patient care. Contract nurses receive little or no supervision. Furthermore, the Department has yet to institute a screening process to insure that contract nurses are qualified in occupational health nursing. These qualifications according to the American Association of Occupational Health Nurses derived from several disciplines in the health sciences, including nursing, medicine, safety, industrial hygiene, toxicology, administration, and public health epidemiology.

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PHS officials admit privately that privatization of public health services cannot be justified either on the basis of efficient public health practices or by the claim of potential cost savings. Nevertheless, the Department continues to foist privatization on government employees with the promise that savings will be realized by contracting out nursing services under OMB Circular A-76.

These "savings" are specious; they have never materialized. In fact, the General Accounting Office testified that there is no proof that privatization saves money or promotes efficiency.

As you know, Mr. Chairman, the resources of our small Union are very limited. We nurses are no match in size or strength for the Department of Health and Human Services, which thus far has shown neither compassion for our position nor respect for your authority. We are compelled, therefore, to request your assistance, once again, for ourselves and for the government employees we serve.

We urge this Committee to include language in your Report prohibiting the reassignment of full-time Federal nurses from the PHS Units where they serve in the Washington, D.C. area in order to replace them with contract personnel. We also request that the Committee adopt language disagreeing with any proposed reduction in full-time nursing positions for fiscal year 1992 to comply with OMB Circular A-76 management initiatives.

We request further that you direct the Department to submit a report to the Committee which shall include an assessment of the impact of contracting out nursing services on the quality of health services provided to government workers at the worksite, as well as a comparison of the estimated versus actual savings for A76 studies performed over the past five years.

Finally, Mr. Chairman; we nurses want you to know how deeply we appreciate the Committee's efforts to preserve the quality of health care for Federal employees, and we are thankful as well for the concern you have shown for our welfare.

Proposed Appropriations Committee

Report Language

Federal employees occupational health

The Committee believes the Public Health Service proposal to reassign Division of Federal Employee Occupational Health Nurses in the Washington, D.c. area, and to designate these nurses as resource nurses, contravenes the express direction of this Committee that Government health units be staffed with full-time Federal occupational health professional positions. Therefore, the Committee directs that the Public Health Service suspend implementation of these reassignments pending study of the advisability of contracting out nursing services.

Moreover, the budget submitted by the Department of Health and Human Services has requested reductions to reflect savings anticipated as a result of contracting out certain activities to private industry pursuant to OMB Circular A-76. The Committee is concerned that these proposed "savings" may never materialize. Furthermore, the Committee has serious doubts regarding the

propriety of privatizing the provision of occupational health nursing services.

for these reasons, the Committee does not agree to the requested reductions for A-76 management initiatives. within the available budget authority provided the various agencies of the Department of Health and Human Services, those positions which were proposed for reduction shall remain available for full-time Federal nursing personnel.

The Department is directed to submit a report within 90 days on the impact to date of contracting out on the quality of health care provided federal employees. This report should also contain a comparison of the estimated versus actual savings for A-76 studies performed over the past five years.

STATEMENT OF U.S. ENGLISH

Mr. Chairman and Members of the Committee, my name is Ronald Saunders. I am Executive Director of U.S.ENGLISH, the leader of the Common Language Movement in the United States. am pleased to submit testimony on the fiscal year 1992 Department of Education Budget.

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with 400,000 members nationwide, U.S.ENGLISH is a national non-profit, non-partisan educational foundation dedicated to promoting English as the official language of government in the United States and promoting opportunities for all who live in the United States to learn English. U.S.ENGLISH believes proficiency in English is the key to economic, social and political opportunity in the United States.

U.S.ENGLISH advocates full funding of programs to meet the special needs of the ever-increasing number of limited English proficient children, with the goal of helping these children learn English. Assistance should be short term and transitional. The choice of a teaching method should be left solely to the local school district.

While U.S.ENGLISH does not advocate any one type of program to serve LEP children, we ask the Department of Education to take note of the different types of successful programs when awarding funds. A survey of research on bilingual education, submitted by Christine Rossell as expert testimony in Teresa P., et. al V. Berkeley Unified School District (U.S. District Court for the Northern District of California, Case No. C-37-2346 DLJ) noted that there is still no evidence that supports transitional bilingual education as a superior method for teaching English or content matter.

A language is best acquired by working in that language. The Department of Education's recently released study of early-exit bilingual education programs, late-exit bilingual programs, and English immersion programs reached the

same conclusion: the different methodologies are equally successful. Rossell also pointed out that successful transitional bilingual education programs had at least a 70% English language component. We encourage you to give preference to programs that emphasize the quick acquisition of the English language along with all other content planned in the school curriculum.

We also ask the Department of Education to encourage local school districts to develop appropriate and innovative instructional programs as directed by revisions in the Bilingual Education Act ("that states and the local school districts should be encouraged to determine appropriate curricula for limited English proficient students within their jurisdictions and to develop and implement appropriate instructional programs"). To this end, we request that the cap on the percentage of funds available under Title VII, the Bilingual Education Act,

for "alternative methods" be removed. Title VII is a demonstration program and as such should not give preferential treatment to any specific methodology. All pedagogically sound educational approaches ought to be given an equal opportunity for federal funding.

In addition to the millions of limited English proficient children in elementary and secondary school, there are alarming numbers of adults who are not proficient in English. There are literally tens of thousands of adults on waiting lists for English language programs in our major cities. without English, these people are ill-equipped to take full advantage of the social, educational, economic and political opportunities this country offers. U.S. ENGLISH advocates full funding to assist limited English proficient adults in acquiring English language proficiency quickly and efficiently.

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Many adults are increasingly choosing to learn English in programs administered by community-based organizations. Community based organizations need funding to continue to expand their English literacy programs. Many have used the English Literacy Grant Program to do

Unfortunately, funding for the English Literacy Grant Program has been slashed some 90% under the Administration's proposal now before the Committee. Private sector initiatives must continue to be encouraged with supplemental public funding through the English Literacy Grant Program. without public encouragement, the private sector will be unable to expand its programs to meet the expanding demand for community-based English language instruction.

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U.S. ENGLISH wants to contribute to the pursuit of all individuals of limited English proficiency to

fuller participation in the United States. Knowledge of our nation's common language is the key to this empowerment. U.S. ENGLISH intends to play a constructive role in the continuing dialogue on how to educate the limited English proficient population in America. U.S. ENGLISH and I, personally, are at the Committee's disposal to examine future concerns that require attention in this realm.

Thank you for giving me important concerns.

the opportunity to address these

STATEMENT OF THE AMERICAN ACADEMY OF

ORTHOPAEDIC SURGEONS

Mr. Chairman and members of the committee-

I am Augusto Sarmiento, M.D., Chairman of the Department of Orthopaedic Surgery at the University of Southern California, and President of the American Academy of Orthopaedic Surgeons.

I am pleased to appear before you today to present the Academy's position on the need for continued and, if possible expanded funding of research on the musculoskeletal system at the National Institute of Arthritis and Musculoskeletal, and Skin Diseases.

MUSCULOSKELETAL SYSTEM

The musculoskeletal system provides the structure and motors enabling the human body to move about and function in that remarkably coordinated way that we all take for granted. It is composed of bones, linked together by complex joints, and activated by a highly sophisticated system of muscles, controlled by the nervous system.

STATEMENT OF PROBLEM

Musculoskeletal diseases afflict an estimated 32 million Americans and account for over $65 billion in medical expenses and lost earnings each year. These diseases and disorders affect all age groups. For example:

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Osteoarthritis-- originally thought to be caused simply
by wear and tear on joints of the body, but now known to
involve other factors-- afflicts more than 16 million
Americans and markedly diminishes the quality of life.
Birth defects, spina bifida, scoliosis, and brittle bone
diseases (osteogenesis imperfecta) are just some examples
of crippling disorders which strike infancy and
childhood.
Low back pain will affect 50-80% of all individuals at
some time during their lifetime. It is the major na-
tional cause of limitation of activity under age 45,
accounts for one-sixth of all occupational injuries,
and is responsible for almost $16 billion in economic
costs annually.

Trauma to the spine and limbs, especially as a result of
industrial, vehicular and sports related accidents, af-
fects one out of ten Americans each year. The direct
and indirect cost of these injuries is enormous and per-
haps reducible by more effective prevention and treatment
methods.

Osteoporosis-- loss of bone mass-- affects over half of all women above the age of 45. This condition is considered the leading factor in the 200,000 hip fractures women suffer every year. The costs associated with osteoporosis amount to over $7 billion annually.

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