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Senator ADAMS. Thank you, Dr. Gerbi. You answered the question that I had about how we get new students more productive, and I had a personal reason for asking that, too. My daughter graduated from Brown last year and is an admissions officer this year. So she has a direct feeling, and I am lobbied from another direction on your point.

Your testimony was excellent. The committee understands it. We appreciate very much your being here to testify.

Peter, it is very nice to see you again.

Dr. ALBERTS. Thank you.

Senator ADAMS. You are welcome.


Senator ADAMS. Our next witness will be the Honorable James Symington, American Orthotic and Prosthetic Association. Representative Symington.

Dr. SUPAN. He is not here.

Senator ADAMS. Well, you, I know are not Jimmy Symington because I served with him, but I welcome you just the same. Would you please introduce yourself, and I would be most happy to hear your testimony.

Dr. SUPAN. Thank you, Senator Adams. My name is Terry Supan. I am a certified prosthetist/orthotist, and I am here representing the American Orthotic Prosthetic Association as well as the American Academy of Orthotists and Prosthetists. I am an assistant professor of clinical surgery at SAU School of Medicine, and I am a board certified prosthetist/orthotist. We are the health care providers who provide individuals with disabilities with the means of returning to a more functional life. We provide orthotic and prosthetic devices which are known in lay terms as artificial limbs and braces.

The testimony I am giving this morning concerns RSA funding for orthotic/prosthetic programs. We are dealing with a very small amount of money. It ends up that the amount of money that RSA is committed to spend for orthotic/prosthetic education, which is the sole source of Federal money for orthotic/prosthetic education, equal to the amount of money that is estimated it cost to rehabilitate one individual with a quadriplegic spinal cord injury.

For background information, since the inception of RSA_they have been the sole group which has provided funding for orthotic/ prosthetic education. Since 1988 the funding for new grant approvals has been decreased by $800,000, from a total during that time period of $1.4 million down to the point where approximately $500,000 of new grant moneys or continuation grant moneys are available this year.

Even though Congress in its infinite wisdom has instructed RSA to reinstate the findings in orthotic and prosthetic education, RSA in their wisdom has decided not to do that. So the testimony I am giving this morning is basically to the fact that, again, needing support from the Appropriations Committee to instruct RSA again to reinstate the moneys that they have allocated in the past.

Last year their funds were increased, but they decreased the amount of money that was allocated for O&P education, directly in

opposition to what the Senate Appropriations Committee instructed them to do.


The amount of money this year has necessitated the closure of 2 of the 10 schools that teach orthotic and prosthetics education. University of Los Angeles, CA did not accept any students last year and is terminating because they are not a recipient of the grant this fall. New York University did not accept the junior class students last fall, and they are terminating their program at the end of this month.

I would be glad to answer any other questions. We have written testimony that has been submitted.

[The statement follows:]



The American Orthotic and Prosthetic Association (AOPA) is the national membership organization representing the approximately 1,100 facilities that provide orthotic and prosthetic (O&P) patient services to the physically challenged throughout the United States. Practitioners employed by AOPA members design and fit braces and prostheses that enable these physically challenged individuals to overcome often serious and crippling injuries and return to productive lives. AOPA appreciates this opportunity to participate in the Subcommittee Public Hearings. Because orthotic and prosthetic certification programs are in a financial crisis, we would like to direct our comments to the critical role the Rehabilitation Services Administration (RSA) plays with respect to the funding of O&P education.


Orthotic and prosthetic (O&P) services involve the patient care activity of a highly-trained, certified allied health practitioner who evaluates the needs of each individual patient, often in emergency situations, and consults closely with the prescribing physicians to ensure that the patient is fit with the proper orthosis (brace) or prosthesis (artificial limb) for his or her individual needs. The O&P specialist then designs and fits the orthosis or prosthesis for the patient. Once the initial fitting is completed, the orthosis or prosthetist continues to work with the patient, instructing him or her to properly use the brace or prosthesis and conducting follow-up care throughout the course of the patient's disability or rehabilitation "to ensure that the brace or prosthesis continues to fit properly and is properly used by the patient.

The O&P field is a relatively small one, with only about 2,600 certified practitioners available to serve the entire United States. The services of the O&P profession are rehabilitative in nature. Typically, they reduce the length of stay for beneficiaries in costly inpatient setting and help restore mobility and ability to function unaided, making it possible for the O&P patient to return to useful work.

The practice of orthotics and prothetics (O&P) is unique among allied health since if calls for a mix of clinical and mechanical/engineering skills. The teaching of those skills necessary to provide specialized O&P clinical care is a painstaking process. It retires each student to be introduced to an extensive interdiciplinary curriculum that includes such varied subjects as anatomy, physiology, kinesiology, and materials property.


For over twenty years, the profession of orthotics and prosthetics has relied exclusively upon the Rehabilitation Services Administration (RSA) to provide funding for the schools which provide orthotic and prosthetic education. These funds have been critical to this very expensive and very specialized education. Many of the ten schools which have historically provided such educational opportunities are state institutions. They are restricted by their respective legislatures from charging a selfsustaining tuition for the O&P programs which rehire costly materials and fabrication laboratory facilities.

The O&P profession is experiencing a funding crisis. Since 1988, O&P education funding has been substantially cut. Total cuts have approximated $800,000 and have resulted in the potential abandonment of three programs: New York University; University of California-Los Angeles; and Florida International University. Though seemingly insignificant cuts were made in new monies per year, the cumulative cuts will cause irreparable harm since no program has ever been resuscitated after losing its RSA funding. Additional school closings will occur if RSA continues on its present course.

Currently, the RSA is exploring ways to determine "need" for government financial support among the various allied health disciplines. Unfortunately, whatever the method chosen, O&P is simply too small a profession to have any impact on the needs identification process. Other allied health disciplines have larger constituencies in place to argue their case, both in Washington and in the field.

RSA first asserted that their funding priorities must, by statute, be directed to allied health disciplines where significant personnel shortages could be demonstrated to exist. The agency attempted to base its decision to reduce financial support to O&P on the Pevalin study. The study purported to show that no shortage of O&P personnel existed, and even if did, that personnel shortages in O&P ranked low in priority when compared to other health care areas.

The Pevalin study, though used initially for funding determinations, has since been rejected by the RSA as a flawed study with questionable conclusions. In fact, the organized O&P profession has since produced reports that show a very severe personnel shortage. It is estimated that in excess of 70 percent of those needing D&P health care services are unable to receive appropriate care. The situation is likely to get worse as O&P schools continue to close, thus reducing the O&P field's ability to replace O&P practitioners lost to attrition.


Despite numerous attempts by the O&P field to secure relief, the RSA has persisted in ignoring the needs of this fragile profession, and continues to disregard the will of the Congress. According to the Education of the Handicapped Act, the RSA is clearly permitted to expend funds for education in O&P, and has done so for nearly twenty years. However, the recent reductions in O&P education funding serve to dilute the objectives of the Congress outlined in the Americans with Disabilities Act (ADA) recently approved by Congress, and defies the congressional directive of restoring O&P training funding in 1991, outlined in the fiscal year 1991 Appropriations Committee reports. In addition, direct inquiries from the Senate have failed to illict an appropriate response from the RSA.

Although Congress has been clear with respect to its intent to continue funding O&P education, the RSA continues to resist congressional intent and continues to reduce O&P funding. The result has been the anticipated closing of three of the ten existing O&P schools. If these schools close, and funding is later restored by the RSA, the agency will have to spend additional monies for the startup of closed programs-sums that would be saved if the RSA kept these programs alive. If these programs close permanently, the needs for O&P training that they provide will simply not be met.

Historically, O&P programs have consistently scored highly in the peer review process and have been recommended for funding, Consequently, factors of need, merit and history all support a substantial reconsideration of the RSA's funding decisions with respect to O&P.

Orthotics and prothetics has the potential to help children, the elderly and especially trauma victims to live full and productive lives. However, the success formula requires a continuous stream of qualified practitioners. In addition, the RSA's actions to date may jeopardize the realization of the goals envisioned by the passage of the Americans with Disabilities Act. Without RSA financial support and the resulting decrease in practitioners, the needs of America's disabled cannot be adequately served.


AOPA urges Congress to take steps necessary to insure that the RSA will continue to provide adequate funding for O&P education. By restoring the funding of O&P schools to its former $1.5 million level, a small amount by federal standards, this important, but fragile, rehabilitation field (O&P) will be able to address its continuing challenges and serve the nation's disabled population.

Senator ADAMS. Without objection, your full testimony will be included in the record as though given.

Am I right that a continuation of RSA's present policies will lead to a further closing of O&P programs such as those that are at the University of Washington?

Dr. SUPAN. That is correct. University of Washington will be up for the grant application next year. Again, it was in 1988

Senator ADAMS. Well, the reason that I asked that is not just because it happens to be my hometown, home university and so on, but the development of the foot that has been done there, I see it not only on Senator Bob Kerrey here, who is, as you know, a Vietnam veteran who lost a foot, but I saw it with Warren Magnuson. This is an incredible advance compared to what we had seen in the past. I would hate to see us lose the ability to do this kind of thing. So we will look into this very carefully for you.

Dr. SUPAN. I appreciate that.

Senator ADAMS. Thank you for your testimony.


Senator ADAMS. Our next witness is Wayne Thacker of NASADAD. I will not try to pronounce all the names at one time, but welcome. We are very pleased to have you here this morning. We will hear your testimony either in written form or however you wish to present it. If you will just indicate to the Chair how you would like to proceed.

Mr. THACKER. I will read a prepared statement, if I may, and I think that the full testimony has been given to staff.

Senator ADAMS. Without objection, the full testimony will appear in the record as though given. However you wish to proceed, we look forward to your testimony.

Mr. THACKER. Thank you. Good morning, Mr. Chairman and staff of the subcommittee. I appreciate the opportunity to appear before you today and comment with respect to the 1992 appropriations for the Federal alcohol and other drug abuse programs. I am Wayne Thacker, director of the Office of Substance Abuse Services within the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services, and I am appearing before you today as a member of the board of directors of the National Association of State Alcohol and Drug Abuse Directors, NASADAD.

NASADAD is comprised of State and territorial officials who administer the publicly funded alcohol and other drug abuse prevention and treatment system. Alcohol and drug abuse agencies are grateful for the support of Congress in making available additional resources to assist States and local communities and expanding treatment services to more alcohol and other drug-dependent persons and to initiate more programs to prevent our young people from becoming alcohol or drug dependent. Our efforts are having a positive impact on the lives of millions of Americans.

However, much remains to be done. Our Federal drug abuse policy, which does not acknowledge the devastation caused by alcohol, still persists in allocating 70 percent of Federal resources to law enforcement and interdiction activities and only 30 percent to education, prevention, and treatment. Alcohol and other drug abuse problems continue to grow in magnitude and severity. States and

local communities in all parts of our country, rural and urban, have a significant and growing need for additional Federal resources for alcohol and other drug abuse prevention, intervention, and treatment services.

Treatment capacity must be expanded. Additional prevention and treatment activities to reduce the AIDS/HIV crisis must be undertaken, and new prevention, intervention, and treatment activities targeting special populations must be initiated.

The members of NASADAD support funding increases for the Federal prevention, treatment, and research efforts of the Alcohol, Drug Abuse and Mental Health Administration. We would like to highlight the needs of only three ADAMHA programs, the ADMS block grant and two that the administration has targeted for elimination, the Community Young Activity Program and the NIAAA homeless demonstration grants.

NASADAD requests that 1992 funds for the Alcohol, Drug Abuse and Mental Health Service's ADMS block grant be increased to $2 billion. Since 1981 the ADMS block grant has been the primary Federal funding mechanism for alcohol and other drug abuse prevention and treatment services and for community mental health services. The ADMS block grant remains the most viable manner to equitably distribute Federal service dollars and to insure systematic and coordinated delivery of services to all States, territories, and local communities.

There is escalating unmet treatment demand and needs in urban and rural areas of the country, and the magnitude of the increase we would request would begin to address the real needs for treatment and prevention among the Nation's citizens. It is our hope that as reauthorization efforts occur, the role of the ADMS block grant will be reaffirmed and strengthened and that issues such as the need to develop a more equitable distribution formula will be resolved.

We also request that the Community Youth Activity Program be continued and expanded from the 1991 level of $20 million to $30 million for the 1992 level. These programs dealing with high risk youth help prevent the early onset of addictive disorders that require additional treatment attention frequently later in life.


The third program, the NIAAA homeless demonstration projects, we recommend that they be extended to $20 million for 1992. These are the only Federal demonstration efforts that focus exclusively on homeless individuals with alcohol and other drug abuse problems.

[The statement follows:]

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