Infant Victims of Drug Abuse

The hearing was convened, pursuant to notice, at 10:00 a.m., in room SD-215, Dirksen Senate Office Building, Hon. Lloyd Bentsen (chairman of the committee) presiding.

Also present: Senators Moynihan, Bradley, Rockefeller, Daschle, Danforth, Chafee, Heinz, Durenberger, and Symms. [The press release announcing the hearing follows:]

[Press Release No. H-39, June 19, 1990]

SENATOR BENTSEN ANNOUNCES HEARING ON INFANT VICTIMS OF Drug Abuse; NUMBERS, Treatment Costs are StaggeRING, CHAIRMAN SAYS

WASHINGTON, DC.—Senator Lloyd Bentsen, Chairman of the Senate Finance Committee, announced Tuesday a hearing this month on "the most tragic victims of drug abuse," infants and other young children.

Bentsen (D., Texas) said the hearing on infant and child addiction will be at 10 a.m. on Thursday, June 28, 1990 in Room SD-215 of the Dirksen Senate Office Building.

The Secretary of Health and Human Services, Louis Sullivan, M.D., will testify. Other witnesses will testify by invitation only.

"Drug abuse has caused terrible problems for Americans, but nothing is more heartbreaking than infants who are born addicted to crack or other drugs," Bentsen

said.

"Thousands of these babies are born every year, many of them simply abandoned at hospitals. These children are the most tragic victims of drug abuse. More and more are born infected with AIDS, too, and virtually all of them have serious health problems at birth. The oldest victims of crack abuse are about 5 years old now, but their medical and developmental problems can last a lifetime," Bentsen said.

Bentsen said the hearing will focus on the effects of drug abuse on these children and their mothers, and on services provided under the Maternal and Child Health Block Grant, Medicaid, foster care and other Federal programs.

"I asked the General Accounting Office last year to go around the country and take a close look at the scope of this problem, and we'll be hearing that assessment at this hearing," Bentsen said.

"The costs-physical, emotional and financial-are staggering and growing. They put a real strain on our Nation's health care system and the social service systems that help these children enter foster care or be placed for adoption. According to information compiled by the Joint Economic Committee, just the neonatal intensive care for 375,000 babies cost $2.5 billion in 1988 and government at all levels will soon spend more than $15 billion a year to prepare these children for kindergarten at age five," Bentsen said.

"This is a tragedy that won't go away easily or soon," Bentsen said.

"I want to get some solid answers about the extent of the problem, what can be done for these kids and their mothers, and how to eliminate or at least put a real dent in the number of these tragedies," Bentsen said.

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OPENING STATEMENT OF HON. LLOYD BENTSEN, A U.S. SENATOR FROM TEXAS, CHAIRMAN, SENATE FINANCE COMMITTEE

The CHAIRMAN. The Chairman has the usual problem we have around here. I have to be in two other places. We will get this started and then I will have to return to the Budget Summit meetings. But we have dedicated this hearing to what has been a growing and an exploding problem in this country.

Over the last decade the use of drugs, like cocaine and crack, has an incredible increase. Each year, as we see it progress, the war against this menace takes more casualties, even down to the youngest and most vulnerable of all Americans, and of course that is infants.

Secretary Sullivan will be with us this morning to discuss the scope of the "drug baby crisis." We will also be releasing the results of the General Accounting Office report prepared at my request which contains new important information about the scope of this crisis. All one has to do is go to some of these hospitals that I have done to see some of the boarder babies that are there, to see the casualties of drug addiction by the mothers, and the results it has brought to them.

One of the things that the GAO report shows is it is grossly under reported. When you use some rigorous detection methods, the number of babies exposed to drugs is much higher than expected, an average of 16 percent or nearly one in six. At one hospital 42 percent of the babies were found to be drug exposed-42 percent. They are not all as healthy as that one. [Laughter.]

A recent estimate by the former Director of the Office of National Health Statistics puts the total cost of drug abuse at $60 billion annually. But even that may turn out to be too optimistic. When millions of women at child-bearing age use illegal drugs a growing epidemic of drug-exposed infants has resulted and has overwhelmed our foster and health care systems.

Some estimates suggest that up to 375,000 drug-exposed babies may be born each year. Yet the magnitude of that epidemic has been a dark and well-kept secret in America. I think only the tip of that iceberg has been seen thus far. These new numbers are devastating evidence that the war against drugs has been lost. The consequences of our failure in that are staggering.

The care and treatment of drug-exposed infants may well become the major public health challenge of the 1990's, rivaling even the cost of the savings and loan bailout. For example, in HHS an Inspector General report estimates that drug-exposed infants are four times more likely to be born premature, 10 times more likely to die of sudden infant death syndrome. Also, increasing numbers of these children are affected with the virus of AIDS.

Some researchers have estimated that roughly three-quarters of AIDS-infected births result from the drug abuse of the mother, with the other quarter coming from the drug abuse of the father. Now after leaving the maternity ward, an additional series of problems may develop with these children. Burdened with the stigma of being a crack baby many enter the foster care system. One survey showed that only 7 percent of the foster crack children in New York had been adopted. The rest facing the possibility of spending

years in the foster care system or perhaps worse, to remain in the hospital and becoming a boarder baby.

The Congress needs to get a better handle on the cost associated with this kind of a crisis. In my own State, the State Medical Association estimates that between $3,600 and $50,000 is spent on hospital care per drug-exposed child-for each one of them. Here in Washington one youngster at the Howard University Hospital required at 245 day stay costing upward of a quarter of a million dollars.

But defining the problem is not enough. We must also search for solutions, one of which may be improving prenatal substance abuse treatment.

Now testifying before us today will be Dr. Richard Lowensohn, who is the associate professor of obstetrics at Oregon Health Sciences University, whose Portland, OR clinic has achieved a 50-percent success rate in obtaining drug-free births. Model programs such as his may be able to develop a strategy to address this kind of a problem.

As the drug problem in this country grows and as the costs associated with it become more and more apparent, we begin to comprehend the scope of the problem facing the health and the foster care systems of this country over the next decade. During today's hearings we are going to learn more about the nature and extent of this crisis and in particular what Dr. Sullivan and our witnesses believe to be the Federal Government's role and responsibility in addressing this kind of a difficult challenge.

As I stated, I have to participate in the Budget Summit meeting and I will be turning over the hearing then to my good friend, Senator Moynihan.

Senator, will you take over?

OPENING STATEMENT OF HON. DANIEL PATRICK MOYNIHAN, A U.S. SENATOR FROM NEW YORK

Senator MOYNIHAN. Good morning. I know what a disappointment it is to Chairman Bentsen that he has to go off to that Summit. This is a matter of the very most pressing concern to him. He initiated the request of the General Accounting Agency for the report we will hear about later in the morning and will of course know what transpires here and the testimony we hear.

I would only make a few remarks. But I hope I can convey a certain vehemence; and I hope I can persuade later in the day-later in the morning-Secretary Sullivan for whom we have great regard to be open with this committee about this subject, and that is the Medicaid care of children who are born with syndromes associated with crack cocaine use by their parents.

This administration, Doctor, has been in contempt of Congress in this regard. The Office of National Drug Policy has been just contemptuous of our concerns here and as near as contemptuous of the children involved as it could be. I do not take any pleasure in saying this. But in 1968-I'm sorry, in 1988-we enacted the AntiDrug Abuse Act of 1988 in which we specified in statute, and I wrote the words that "there would be treatment on request for drug addiction."

We created the Director of National Drug Policy, the so-called "Drug Czar"-Dr. Bennett. It is now his post. We created two deputies, one for supply and the other for demand. We took those usages from economics and we made demand the first deputy, the people who will use the material. We were pleased when Dr. Clabor came down from Yale to fill that position.

Then slowly we were astounded to learn that although the bill specified that there would be equal attention to treatment with law enforcement that the Office was not going to provide that equal provision. Then we learned that Medicaid was not reimbursing, would not reimburse, pregnant women using crack cocaine who sought treatment. Pregnant women using crack cocaine seeking treatment are not reimbursed by Medicaid.

So we asked, isn't that illogical? Is that not what the law says otherwise? And the statute clearly contemplates that kind of care. And the Office of Drug Policy-I quote from the Associated Press last June 13, a spokesman for Dr. Bennett and Mr. Hamilton said, "Bennett continues to oppose Medicaid reimbursement," according to Hamilton. No.

We appealed to the head of the Health Care Financing Agency, Dr. Wilensky, and we have from her a two-page letter, which I know you know about, sir, which I would like to put in the record at this point. A letter of May 23 that says as best I can read Medicaidese, it says, "Of course we can reimburse a hospital providing care for a pregnant woman. Of course we can. But the White House says no.' Mr. Bennett speaks for the President in this regard and he says no.

I note that Mr. Bowsher in the report that he reprepared for the Chairman with the characteristic directness that we have come to associate with his reports says that pregnant women should they need treatment, then that treatment should be reimbursed by Medicaid. We will hear from the Comptroller General, whom God knows is a refreshing event in Washington these days, later. [The letter appears in the appendix.]

Senator MOYNIHAN. The Senate has just passed a bill on this subject, S. 1673, which I was the Senator-I'm sorry about the "I" but we have to locate these things-I was co-chairman with Senator Nunn of the task force that drew up the Senate side of the drug bill in 1988. When we learned by late 1989 that the Administration was not going to provide Medicaid reimbursement we introduced a bill, S. 1673, amending title 19, saying you will do so. And that bill passed the Senate unanimously and with the specific support of Senator Dole.

Is the administration for the bill? No. The administration does not believe that Medicaid should reimburse hospitals for treating pregnant women using crack cocaine. The Drug Czar says that is his view and his view is the White House view. He is located in the White House. I do not know what else there is to be said. I cannot imagine. It is barbarous and it is devastating.

I would hope, Dr. Sullivan, that you are changing this position. We have done all we can do with Dr. Bennett. He is not a Member of the Cabinet, you are. You are the chief health officer of this government. We look to you, sir, and we look forward to your testimony.

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