beginning my tenure as the chief medical resident at boston city hospital. .. in recent years. this figure is unacceptably high. we also know that in the united states, the burden of hiv is not shared equally by population or

by region. population's most effected including men who have sex with men of all races, in particular african-american and latino men. women of color and transgender women, people who use drugs, and young people. especially young black men who have sex with men. the regions most effected include urban areas, the northeast, and the south. none of this is acceptable. so many in our country have contributed to building a system of early detection that by provide to ongoing care leads to viral suppression. but in the united states, only one in four people living with hiv currently achieves the level of eye value suppression needed

to preserve health and reduce the risk of hiv transmission to uninfected partners. national strategies are critical to effective country leadership on hiv. national strategies outline a framework for responding to hiv/aids in ways that reflect each country's epidemiologist, disease burden, and trends, and they demonstrate the importance of country ownership in the need to maximize the efficiency and effectivenesses of hiv/aids programs. in 2009, president obama made it a top priority of his administration to develop a comprise csh comp pre-- when drfting the plan the white house office of national aids policy

consulted with people living. hiv, community-based program, health care providers, researchers, public health experts, and others. the white house office of national ads policy consult reviewed existing hiv strategies from various countries in the global north and south. pepfar has long prioritized supporting countries as they development and implement national strategies. maximizing the efficiency and effectiveness of our programs is a shared area of emphasis between pep far and domestic hiv efforts. the following year, 2010, when president obama unveiled a national hiv/aids strategy, he noted, and i quote, the actions we take now will build upon a

legacy of global leadership, national commitment, and sustained efforts on the part of americans from all parts of the country and all walks of life to end the hiv epidemic in the united states and a-- around the world. [applause] this process of community dialogue continues today. the white house recently completed a serious of these committee dialogues across the nation where ideas of implement at the local level were diseases -- discussed with key stakeholders. it has reinvigorated our efforts and reenergized our communities. in a short period of time, we have demonstrated progress on

the national strategies three key goals. in particular, each of the goals is guided by strong evidence on what works benefit. we have the benefit of the world's leading scientist and research 'the national substitute of health, they and other researchers across the u.s. and the world have contributed to many of the scientific breakthroughs that provide us with the knowledge and tools to end aids. national strategy first goal is to reduce new hiv infections because after all, this is a preventable disease. by the year 2015, we seek to lower the number of new infections by 25%. we plan to do this by reducing the hiv transmission rate, and increasing the percentage of

people living with hiv who know their zero status. to reach these targets as well as support similar global efforts to reduce hiv incidents, nih continues to invest in cutting-edge prevention research related to vaccines and microbicides. we are so pleased to see greater emphasis on the use of treatment as prevention. also, last week approval of true have a that by the u.s. food and drug administration marks a milestone for preexposure and adds another tool to our efforts to reduce incidents. as part of the national strategy, all department of health and human services agencies are charged with realigning federal dollars to concentrate on both geographic

-- areas and places with the greatest need. to that end, the center for disease control and prevention launch high impact prevention strategies in the most heavily effected population and is promoting the rights that everied red aless dent and adult get tested at least once in the lifetime and those with increase risk get tested once per year. the center of disease control and prevention released a new social marketing campaign called testing makes us stronger. it was designed for and in consultation with african-american gay and bisexual men, the fact it's growing demographic in the united states for hiv infections. meanwhile, the department health resources and services administrations national networking of 8100 publicly

funded community health centers has scaled up hiv testing for low-income people, leading to a 13% increase in persons tested last year alone. [applause] communities are implementing more creative statries. here in the nation's capitol the d.c. makes hiv testing available at the department of mote vehicles. customers waiting in line for a driver's license or other services can get a free hiv test. [applause] up to 35 people are taking advantage of this resource every day. we need to continue to build on this effort and on others to reach people in nontraditional settings. the second goal of the national strategy is to increase access

to care and improve health outcomes with people living hiv since fewer than 50% are retained inconsistent care. currently, the health resources and services administration ryan white, hiv/aids program, a federal government program that provideses services to low-income people, and public funded community health centers are working together to expand nationwide access to care for people live. ing -- living with hiv. in addition, the new health care law signed by president obama two years ago is crucial for hiv aids and implementing a national hiv/aids strategy. [applause] thanks to the affordable care act, we're putting into place

common sense rules that prevent insurance companies from locking people with hiv/aids out of the market by capping their care or by refusing to sell or renew policies because of their preexisting conditions. [applause] specifically, the preexisting condition ban will apply to all americans on january 1st, 2014 and is lfer in effect for children. the affordable care act will soon prevent access to expending services including make hiv screening available to women at no cost. [applause] and in 2014, it will extend coverage to millions more americans that will result in a dramatic expansion of coverage to people living with hiv.

recently, the united states secretary of health and human services kathleen announced two actions relevant to the national strategy second goal. the secretary announced nearly $80 million in grant awards that expand care to an additional 14,000 low-income people living with hiv/aids and based on estimates provided by state administrators, will eliminate any waiting list for aids drugs treatments. [applause] also, secretary siebl use amounted that the department is working in parter inship to pilot a program that use mobile phone texting to provide important tips and reminders to people living with hiv. [applause] the third goal of the national

strategy is to address hiv-related health disparity in our nation. complex, social, and economic factors including poverty, stigma, and the lack of access to care limit opportunities for prevention and treatment. to better address, many of these social determinants of health, we have expanded our efforts to work cross programs administrated by our colleagues and other federal agencies such as the department of housing and urban development, labor, justice, and veterans affairs. we have also engaged leading national organizations to support population hardest hit by hiv. for example, the center for disease control and preventions act against aids leadership initiative represents a partnership of leading national african-american and latino organizations. it is designed to increase prevention efforts throughout

outreach communication and mobilization. in the united states, women and girls accounted for 23% of all new hiv diagnoses. among women, the epidemic effects women of color particularly black women. and traj render-drn women and girls are too frequently victimized by intimate partner violence and sexual assault. this not only increases risk -- blocks women and girls from seeking prevention options and treatment. this is unacceptable. [applause] so in an effort to address gender disparities the white house recently established an

interagency working group on hiv/aids, violence against women and girls, and gender-related health disparities. the group is working to share best practices, facility research and foster opportunity for partnerships. finally, we know that stigma drives discrimination and disparities. as a result, too many americans avoid learning their hiv status, disclosing their status, or accessing medical care. to overcome stigma, our efforts include a new center for disease control and prevention campaign called, "let's stop hiv together" which features people living with hiv standing with their family and friends and calling on all americans to join the fight against the disease. this communication effort will

not only address stigma, associated with the infection, but also complacency about the epidemic. we must prevent the next generation from suffering the burdens we have witnessed in the past. in conclusion, we are making important progress in the first two years of the national hiv/aids strategy but much more lies ahead. we can succeed by making our international public health community even stronger. over the years, the united states has been part of efforts to build that community along with so many domestic and global partners. and in particular, pepfar has coordinated the power of us working together to plan, coordinate, and collaborate to save lives. so as we go forward, let us

reflect on the past, but accelerate our efforts in the fight against hiv/aids for the future. here in the united states, we believe the national hiv/aids strategy can bring us closer to a vision of a society where new infections are rare and everyone receives a care they need and deserve. you can follow our efforts to implement the strategy on aids.gov. my hope is that together we can seize this moment of opportunity and channel its momentum toward achieving our goal of an aids-free generation. thank you very much. [applause] we go live to a discussion about new technology in the health care industry. we'll hear remarks from

information technology officials from the health and human services department on the possibilities and challenges in moving from paper records to electronic health records. the event is hosted by the alliance for health reform, you're watching live coverage here on c-span2. >> you're going hear from steve in a moment. the other cosponsor is the bipartisan policy. two from each party. which is the, i think, old only d.c.-based think tank that actively promotes bipartisanship and which has health care as one of the main focused area. we are pleased to have janet who chairs the bbc health information technology initiative. i'd like to turn to janet at this point. i think you got it. it. >> you got it.

>> thank you. it's a great pleasure to be here today. and to be talking about something that is very important to us at the health i.t. nichety at the bipartisan policy center. as ed mentioned, we were established in 2007 by senate former majority issues and focus on a broad range of issues one being health care. we are particularly interested in the discussion today, we're talking about how one could more effectively engage consumers and patients in the health and health care using electronic cools. something that we to focus a lot on in a recent released report of the bipartisan policy center on delivery system reform and health i.t. we're experiencing a number of pressure in the health care system between rising health care cost, uneven quality, and eroding coverage.

clearly, when you look at the rapidly emerging initiatives, move across the country whether sponsored by the federal government, states, or even a number of private sector health plans all of theme have a key goal of activating, engaging at the much higher level consumers and consumers and patients in the health care. we have a tremendous opportunity to leverage electronic tools, mobile technologies, online tools to make that happen. and in fact, what we're going to talk about today a number of consumers as we sound there's been a great deal of ridger in the area would like to use a smartphone or pda to monitor their health if they were able to access their medical records and not only download information but push information to the clinicians and care teams. and physicians too, some of the

research indicates there was an article that was published over the last couple of year 64% of physicians had never used a patient's electronic health record. 42% are willing to tie. we are seeing a lot of interest in the area. in fact, stage two, of meaningful use actually there's a proposed rule that is out there right now. it actually has a number of key requirements that are proposed around further engaging patients in the health and health care using e help tools like the one we're going to talk about today. in keying up the discussion, there's some key areas that we'll want to explore to make exciting things that we're hearing about in the panel today move forward in a more accelerated -- more accelerated pace. the first is, i'm looking

forward to hearing some of the presentations around how defeat policy and market action, clin in additions this is a new thing for them, how we can continue to support and educate and help them transition to the new ways of providing care and interacting with patients. i know, deven to my left and joy are going to talk about any clarification to policy issues and privacy maybe a little bit about security. one of the key things that we're hearing, i'm not sure that we'll get here today is about the need to align incentives further. to make sure that this happens and of course, continuing to build awareness among consumers. and assuring that nobody, no one gets left behind due to access to some of these technologies in the like. and the one, i didn't put it on the slide here for folks, the

other -- there are some technical issues that would also need to be figured out. i know, we have a policy add yen. but something called data providence. moo what is that? i think if you'll talk to the folks that use records as they deliver care familiarly clin in in additions fig -- where did it come from? so i have better understanding of the sources particularly data sources to deliver better care. with those. those are my comments. i look forward to hearing the discussions of the panel. >> terrific. thank you very much, janet. before we introduce the panel. let me go through the checklist, there will be a web cast and a pod cast available sometime tomorrow on kff.org which is the, of the kaiser family

foundation. in a few cays you can view a transcript of the discussion at our website all health.org. v c-span is broadcasting the briefing live right now. and probably in 2:00 a.m. reruns so you'll be able to catch it later on this week. if you are watching us on c-span right now, and have access to a computer, you can go to our website all health.org. and if you punch up the briefing available on the home page, you can follow along with the powerpoint slide presentations that the speakers will be using. there are green question cards in your packets that you can use to address a question to any or all of our panel. and a blue evaluation form, which we hope will fill out before you leave so we can

improve the briefings as we go along. so one other announcement, this -- and pardon my terminology. the -- briefings is being tweeted with the hashtag patient info. it was up on the general slide. it'll be back up there once the slide presentations are done. you can feel free to retweet or whatever it is that one does with tweets. [laughter] now, we have a terrific panel assembled today. as i said, i want to thank steve and the colleagues at the foundation to do that. and only fittingly turn first to steve now. he's the chief technology and information office at rwj making sure that the foundation's technology strategy is in line with the rest of the activity. he's the codeveloper of project

health design which is going to be front and center in today's conversation. steve, thanks for being with us. >> thank you very much. good afternoon. so let's start with the key development here which is that health is becoming digitized. and notice that i said health and not health care. i think we all understand that health care, we think of the care we get in hospitals, doctors officers, pharmacies, that's becoming digitized as well through the increasing adoption of electronic health records. we think of health differently. it is what happens when you're not at the places. it's your day-to-day experience. and it's increasingly understood as being a function of the environment in which you live, work, learn, and play. and the decisions you make and the behaviors you take on in the context of that environment. ingreece we have technology that can open a window on the the

day-to-day. there are two key drivers of the two technological drivers. the first is the smartphone. ginger io use data on the smartphone, the calls, the axel ram tear data and the gps data which shows you have been. they are able to analyze the data and develop what they call a behavioral signature about you. it's important in the case of mental health. you may have a behavioral signature. they can look at deviation at that. if you are prone to depression you might be sliding back into an dressive episode. you have to do nothing. i want to stress for everybody out there. this is not a secret experiment they're doing on the iphone right now. we're talking about consenting patienting, controlled studies.

is being done very carefully. what it does is gives you a sense of the power of the data available on your cell phone in the increasingly sophisticates things people can do that. second example i'm doing to use, second driver is about sensors. what i show here is a company called green goose. it takes tinny wire lessens or sos, very inexpensives and packages them you can slap on the stickers have competitions about who is doing a better job of brushing their teeth. it is an example of the creative and very inexpensive things you can do which will be ambiguous and powerful sensors. we're seeing it play out in the finance tracking city. fit bit which is a small devise about the size of your thumb. you can slip it into your pocket, it'll track your

activity, the calories. put it on a wristband and it'll tell you how well you slept. there's the wi-fi scale. step on it. and you will automatically log your weight and god forbid, you can tweet it too. [laughter] you can track your runs with run keepers. strap your phone to the arm and it'll figure how fast you did it, and how far you went. you can put on a wireless heart monitory while you're doing it. the next time you see your doctor and she asks you if you're getting any exercise, you can say more than yeah, you know, i'm trying. in fact, you can pull out charts of everywhere you have run, how far you have gone, how often you do it, and how fast and for extra credit, how fast your heart beats when you run that far that fast. now, don't try this at home. i don't recommend actually right now that you go to your doctor and do. the truth is they probably don't

need to do all the gory details. the key point is what used to be a vague answer to a fairly important question can be answered with great prevision. so it's not just limited to fitness no. you're increasingly started to see trackers that will relate to the mood. your diet, your sleep, and many indicators and drivers of health. but the big question in all of this is does having access to all that fine grain data really matter? that's the question that we've been trying to answer in plojt health design which is as i mentioned a program of the national robert john johnson. it's run out of the university of wisconsin. in the program, we have funded five teams to work with real patients to collect what we call observation of daily living or

odl. and think of odl as the measurement of the data associated with your day-to-day health experience. it's data on moods, sleep, diet, exercise, stress level, pain, the meds you actually take opposed to those you're prescribed and so forth. and in the studies, what we have done is the teams have created apps and services for patients to be able to capture and store the odl. then provide feedback to the pairktds on the data within them. and then, this is something we'll talk more about today is the tricky part of integrated it into clinical care processes. bringing that data into the doctor office and so on. we have five teams working, very different population and different con decision -- condition. breathe easy is working with low-income adult population with

asthma and typical mental health like depression. chronology md they use fit bit for sleep tracking, the wi-fi scale for weight and a special app on ipads to record moods, stress, energy level and actually just a journal to record subjective thoughts about how you're feeling. what they would do, the data get charted and bring them to the doctor's office and discuss them with the doctors. you see how the conditions were developing. a project that worked with seniors who ares at risk cognitive decline. what it illustrates the power of sensors. they looked at thread general daily routine tasks, making phone calls, making coffee, and

taking pills. they put sensors on those and show a little bit more confusion. they're making more mistakes or taking longer to do them pop to see you can notice the onset of cog five decline. a project that works with infants that are born prematurely that spent time in a new nay tiff intensive care united and have their parents track progress about the babies, things like number of diaper changes, weight, also look at things are the parents doing bonding activities with the children. look at the parent's well being. what's their mood day-to-day. anyone who has experienced parenthood for the very first weeks or so, know that it's a pretty intense time. you have to watch your own health during that. last one is intouch which worked with young women, teens and

young adults who are obese. and also suffering from depression. and they have a mobile app where they could record information about the cite and activity. the social activity and the mood as well. they review the data and give them feedback. i want to emphasize a couple of things about these projects. and first of all, is that they we're talking about with parents with serious health challenges. these are diseases they have consequences dent. these are patients that high cost to the system because of the complications of their conditions. these are also not typical sort of affluent tech savvy. a lot of these folks are from low-income backgrounds and had little familiarity with the

technology they were using in the project. i also want to emphasize the projects areing up. the evaluations have not been completed. we don't have hard, clear finding of that. i can share some preliminary on vases we seen in the experience of the project. first is sort of the question of would people actually do this track their mood or diet or using moble guys or ways. the answer is by and large, yes. certainly not everybody. and not everybody who did would track it all the time. but we saw substantial number of people who did put in enough effort of the tracking we could gain some value from it. there was definitely examples of where the directed feedback to patients made a difference. so for example, in the project showing somebody their day-to-day medicationed adherence when they are taking

their pills and when they are taking it. it brought insight. they thought i'm doing well, and they're not. they need to adjust their rei too tunes. the cases in intouch project where people who are track their diet regularly started to make real changes in the diet and other habit changes as women. and start to in -- in some cases lost a lot of weight. there's definitely examples of information making a difference in treatment. teff is going to talk about a couple of examples from the breathe easy. there is one from the chronology project. this is a quote from a patient, and who actually first writes, is there any way to extend the study. and says, quote, i'm finding this very useful. i have used this data with other doctors outside of the study, and as a result they're sharing data with other doctors. i have schainged the meds i was on. as a result of this med change, my quality of life has gone way

up. my weight has gone from 112 to 119 pounds. that's a good thing in this case. and i am not voting daily. -- vomiting daily inspect is about how the day to day information cannot only make a difference in the treatment but the change in treatment can make a difference in the person's health. it represents a real challenge to the system. i think we know that are doctors are extremely busy and the current mode of practice doesn't make it easy to review the data. the second thing we talk about electronic health records. they're not in a position to accept a lot. an the particularly the kind of odl. one thing to engineer in patient recorded ratings of blood pressure. it's another thing to record patient generated moods which there are few standards right now. so to summarize technology

creating a new opportunity to practice medicine differently. the small studies we have done, the early stoweds are showing there's real promise in there and not just with typical tech savvy affluent patients. it's often the case with technology lead innovation. the policy context was not involved with the innovation in mind. we have to take a look at that. joy is going to address that. i that's the conversation i hope we have today. thank you very much. >> thank you very much, steve. indeed, speaking of practicing medicine we dr. steven who is an associate professor at virginia and the codirector of the breathe easy project that steve

was talk abouting which is run with the health of the folks at vcu using advanced technology for caring of patients of asthma. he codistricts the practice based research networking and steve we're happy to have you with us today. >> thank you. good afternoon. i'm the lead clinical investigators on the project. i want to be assure to acknowledge dr. on the right side. she is the lead investigators of the entire project. and she works at rti as a leading researchers in user center design which was an important part of going the app. i want to reinforce what steve said about the variety of the different five projects in project health design i encourage you to look at those. frankly, we have more clinical immigration than some of the

project and a lot sense with the physical sensor and the electronic passive accusation of data. most of our data collection did require patients step to that. with that, let me got next slide here. good. all right. i'm going to talk first about the app and then go back to the patients and what we saw. so the patients in our project entered their odl d.a. d.a. through the android smartphone. i have a variety of screen shots for you. if you look at the one on the left it's enter your daily data. this is the place where the subsequent asthma would go on a daily basis to answer a series of questions for the odl we negotiated between patients and clinicians as being the one that we would track for the study. those include the use of controller medications if they were on one, use of rescue

medication andy they had to use it. their peak flow readings is which is a a measure of how well they're able to move air. exposure to asthma trigger, tobacco use, exercise, sleep, and asthma limited their activities and what symptoms they had. you'll see in terms of the user's experience they were checking boxes, places to type in numbers this is the basic process they would do. the next couple of icons on that left screen enter rescue meds and peak flow data. those were opt nation ones if they want to report additional odl. they could wait until the next day to enter them. the important one is the lash one that said dash board. i'm going to talk about the dash board in a. minute. this was the same data was viewable by the patient for the information that they entered in

their odls. okay. this is a screen shot of a clin -- they used it on the laptops or desk stops they use to access the electronic medical record in the practice. i want to point a couple of things to you. i know, it's hard to read it's not full screen size. at the top of the screen, you'll notice a green, yellow, and red bars. those are where we display the peak flow readings. we used the national asthma guidelines numbers of 80% or better of your predicted peak flow being green, that's good. where it should be. and if it's less than 50% of what it should be if it's red. that's the danger zone that definitely requires action and yellow is the middle for that.

the below that, you'll see a lot of green and red dots. let me explain what those are. what we did is the oh odl we decided to display on the dash board was going on theist will control of meds, rescue meds, asthma triggers, anxiety, mood, smoking and asthma symptoms. those worked. we tried to make it easy for the clin in additions to say green is good and red is bad. green is a desired base. you were exposed to asthma triggers. red was you had to use the rescues inhaler, you smoked, or you had asthma symptoms. that's what the physicians looked at. i'm going to get to back to talking about the setting and patients. i wanted to be sure to mention that the before we did the six-month evaluation there was a whole series of steps with user

center design process in terms of having focus groups of patients and clin in additions and look at markups improve what we have done. go back to them and see if we got it right before we actually fielded it. there's not much going on with them we would see. we also did this study in two inner city practices that influence the patients we worked with predominately black women. 24 to 30 had low-income. 18 of the 30 had low educational attainment. this is a group more challenging to do the work in. if we can get folks who may have a -- might expect would have a harder time doing this, to do it successfully, then probably

anyone can. then they entered their odl data at the time of day of their choice. they got a text message to remind if they forget. each of them was given a smartphone with six months of phone and data service. i think two of the subjects had a smartphone already. and not all of this, i think, had cell cell phones those are the patients. two inner city places in rich medical record. -- rich medical richmond. we did this study on nurse dock teams which is specifically how we practice. once a week what the nurses would do, they had a protocall they would look at the dash board data and determine whether there was actionable information that needed to be escaladed to the physician to address. and we focused principally on

peak flow, whether or not they were using their control medicine, whether they had to use the rescue medicine,ly whether they were having symptoms. we knew what to do. some of the other ones we looked at like sleep we weren't as clear what we should we do. the practices were paid $500 to watch the subject. we modeled it in a way to reimbureaus the time. the insurance company would call it disease management or talk about medical home payments, perhaps. okay. so this first example i have two i'm going to show you. the first one here, is an exciting one. it's a young, relative healthy person who the biggest health problem is they smoke. the patient, i've actually collapsed i've show you six

months of odl you can see the pattern in the peak flows. it makes it hard to read the red and green dots i'm showing you the peak flow. the subject is beginning of the study was red and yellow most of the time. the nurse messaged the physician about it. it was a continued palletter -- pat american of this. right before it starts to go up into the yellow, the clinician who was they have not been getting the patient successful to come in. i'm going it start the person on a controlled medicine. they need one. that was called in, the nurse talked to the patient about how to use if. they started using it up. a week later up go the peak flows into the yellow to green zone. pretty much staying there the rest of the time. and not just the numbers but also if you look at the second row of rescue meds and the last row of asthma symptoms at the

bottom, there's less rescue med use and fewer day in the second three month after the study after they got on the controlled medicine. those looking notion it's red all the way across. the way we set it up if you weren't controlled medicine at the beginning you didn't get asked that question. it was not relevant for the subject. but that was exciting. that green dot up there is a typo or somebody collected it with a cough which makes it look higher than it is. i think a typo. this is the second one i want to talk about. this is a much more challenging patient inspect is a subject in the early 50s hyper depression, chronic pain, all three are common in the population. thank goodness most of them adopt as well lupus. a showing about two-months worth of data.

you can see the star and xes. when we started collecting the data on the patient. all of the numbers were in the red zone. the reason they look better than that now is the prepare care physician caring for the patient and i made a decision that obviously our predicted peak flow, which is the forwill based one was not accurate for this subject. we used the actual best readings they had done to reset the peak flow which moves them up into the green. if you look at those 300 is not a good number. so what happened with this subject is the nurse observed the lower peak flows, the patterns ever med, used their controlled medicine. they have to use the rescue medicine every day. they're having asthma symptoms every day. the clinician in the case decided to order a pull mare function test which is a fancier test than the peak flow that the patient did. what they found was not reversible.

it is supposed to be a reversible lung disease. the patient didn't see the better number. the diagnose of a different lung condition copd was entertained by the clinician. even though the patient doesn't smoke. they were referred to a palm enologist specialist. they did more test and decided it was asthma just severe refractory asthma. it was a candidate for monthly drugs we don't administrate at my practice. it's a specialty. they had not started those at the beginning. so if we're going last slide quickly, i'm running over time. we did separate patient clinician forums at the end of the study. and these are just a few things we are i want to mention we have learn that the point. facients found it easy to easy.

they enjoyed it and understand the asthma and triggers better. we're encouraged by this. it surprised me how well they could do. the clinicians were not over whemmed. say that reported it provided clinically useful information. there was education opportunities there were a couple of patients who the controller meds and the rescue meds exactly opposite. they misunderstood how to use them. it was corrected by the nurses over the phone. we had patients therapy escaladed between or at visits or during visits. i mentioned we had diagnoses changed. we had three ujt subjects diagnosed with copd. and one changed back to severe asthma. i'm done. >> thank you, steve.

we go back and forth. you have heard a couple of very interesting presentations about how some of these technologies work in the real world and now we're going turn to a couple of folks who know an awful lot about the policy implications ever starting to use these technologies. we're going start with deven mcgraw cho is the director of the health privacy project at the center -- she works on insuring privacy as health information is shared electronically. he's on the health information technology policy committee that was set up by the twine stimulus law. we're pleased to have den venn with us. >> thank you, ed. i do a lot of work on -- policy issue on privacy and security.

i took on what was a bit of a new role for me. i teamed up with a law firm, to be part of a legal and regulatory assurance team for the project health design to both assist them in kind of navigating the laws that would apply to the project as they were doing them and providing them with a path forward for where they wanted to go but also to surface some of the biggest policy implications that arose out of the projects collectively as well as individually. and that, you know, it's really exciting to have an opportunity think about the issues in a kind of on the ground implementation way and seeing where the rubber meets the roads. we started by providing them with legal them lows. thankfully my colleagueses handled this aspect of it.

just knity gritty. you have five in three different state and all of them subject to the health insurance portability and ability act rules. most known as sip pa. how do state law apply to the projects in terms of moving them forward. in addition to the concerns about basic compliance with the law, each of the early on in the project identified sort of three budget buckets of concern they had from a policy standpoint. one being security or the mobile tool that's patients were going to be using in each of these projects. you know, we won't go too down in the weeds about security and mobile devices. i think many of you may know that mobile devices often are not as secure as other forms of computer communication. sometimes you can buy and

purchase features that will make your mobile tools more secure, but most people dpobt tend to use them. it's often to difficult how to figure out how to do that. there was concerns about raised about potential professional or malpractice liability by the clinicians for the, you know, the potential to be receiving all of this data from their patients. what if they didn't see something in the data and if they missed it what would it mean for them in a professional liability standpoint? as i'll explain in a minute, hipaa, as privacy and security policy regime doesn't apply to all health data and all context. it covers some data some of the time but not all health data all of the time. give that some of the data was going to be collected and stores in environments that were not going to be covered by hipaa what did it mean for the patients. these were concerns primarily

surfaced by the project sponsors. but really on behalf of the people they were going to be asking to participate in these projects. i think an overarching theme that is important stress from the beginning the arrangements are unique and innovative. they can be done. these legal and policy concerns that were surfaced from the beginning, there were plans for managing them and certainly from a legal standpoint all could be done in compliance with the law. as i mentioned earlier, really hipaa alies -- applies to the data in the project when it's handledded by the health care providers. when it keep in to steve and the clinicians looked at it the data would be covered by the hipaa privacy and security rules. when the patients who were participated in the project were entering that data into their mobile devices the data was not covered by hipaa.

and so you had a regime where you had a certain set of rules that would apply to the part of the projects like half maybe or 0%. but the other project would not covered by clear or less than clear rules. rules that are basically, you know, if you pick up and start using a mobile device and entering data in a mobile app you need to read the privacy policy to read the data sharing rules that apply to the data. those promises can be enforced by the federal trade commission. it's not the same as having a comp hnsive set of rules. there may be state laws that i my. we had three of them in california, two of in two other states. sometimes the state laws, the application of the law is different in terms who they apply pop even at the state

level there seasonal typical a regime where all health data is subject to some sort of protection. but each was responsible for complying with the own state law. we did have a project that involved minorrers. the intouch project. and the adolescence and teens struggling with weight issues and sometimes mental health issues. there state law provides a big role in determining who can access data and places some protections around data in the case of that particular project which took place in california. there are actually strong rights for minors to be able to direct and control their own data in the health care system. it is not as aplinl -- applicable outside the system. one thing helpful is all of the institutions involved treated this as a research project which

meant it was subject to internal review and all the participants were consented into the projects they understood what was going on, how their data was going to be used and collected in an environment that isn't always private in the private sec which you talk about using off the shelf product. it created moments of transparency and education for the patients that we don't always have when we're talking about the purchase and use of tools in a commercial space. as these projects are wrapping up, we're trying to take the experience of the project health design and manning these sort of critical policy issues and turn them into papers that can help inform others who might seek to engage in similar projects. and the first paper that we did was really about mobile device security and actually been published in the journal of

health information management in the summer issue and i think there's a copy of it in your packets. it's also available online. remember the mobile tools are being used by the patients. many of the sort of security devices and policy recommendations that you might mandate be used in a provider context, when you're talking about patients yiewghts using the tools and able to utilize in a comfortable way, you might have a different equation. for example, if you say to a patient, you have an ability to password protect your device but you can't make patients password protect their devices. they extent to which they use them was up to them. another example was where we -- they took the discretion out of the patient's hand but put in the capability to remote wipe the device of data.

it's something the patient doesn't feel or is not impactful to them but gives them a level of comfort. it did happen. at least one of the project there was a guys that was lost and they were able to remotely wipe the data off the device. so that the -- it couldn't be accessed by persons who were not authorized to see it. so the paper includes a number of best practice. we look to hipaa security rule for the guy dense. it was a rule where the didn't necessary apply and applies a best set of practice. a second paper we have in draft and we're seeking to have published how did the professional liability concerns get managed. essentially there are sort of two overarching themes to the paper. did not happen in any of these

projects. they were carefully thought through as doctor mentioned. there was an negotiation between the providers and patients about what data would be collected, who it going to look another at it, how often not in any project did the data get dumped into the electronic health records without decisions being made about what d.a. when, how, very careful planning on the part. as a result, there was a level of comfort by the clinicians participates in all the projects as well as the patients about, you know, in terms of the expectations were very clear and people stuck to them. ..

>> and we don't have them necessarily for the other part of the equation. and what does that mean in an environment where we really are trying to encourage patients to use these tools in a more robust way, particularly where they are outside of a research project where you have those kind of built-in opportunities to talk to people about, you know, what this means for them, what the potential risks are, what the potential benefits, and then they can make decisions accordingly. what does that mean, um, for policy going forward, and that's a paper that we're actually trying to write, not as we speak right now, but we're working on that. so i think that's all i had to say about that. um, but i'm certainly going to be here to answer questions

about how we dealt with those issues in these particular projects. thank you. >> great, thank you. thank you so much, deven. let me pass that down and turn, excuse me, finally to joy pritts who is the original chief privacy officer in the office of the hhs office of national coordinator for hit otherwise known as the onc. she's been at that post for two-and-a-half years, and we've asked her today to tell us a bit not only about privacy concerns, but also about her office's interest in patient-generated data more generally. and, joy, thank you so much for being with us, particularly on the short notice that you got to be part of the event. >> thank you. thank you for having us. um, my office -- before i start, i wanted to explain a little to you who are not familiar with

our office is it's the office for the national coordinator formally created in the high-tech bill which is part of the economic recovery act. and our office is designed to incentivize people to adopt health information technology and health information exchange. so it is a somewhat, it is a unique office in the department because it really is totally focused on health information technology and exchange. but hhs as a whole has a real interest in putting the patient at the center. anybody who has read the affordable care act knows that hhs and this congress, the congress when they drafted the affordable care act put the patient in the center. we are going to follow the patient, not just have isolated instances of care.

and as that it's essential that the patient be a partner in their care. they are the one who has a lot of the information as everybody has said about what their evidence life is like and how that impacts their care. most care, as you all know, doesn't take place within the clinical setting. it actually takes place outside of the clinic, and so it's really important that we know what's happening outside of that environment. people who are engaged in their own care demonstrate better health outcomes, and i think all of these projects that are being run by project health design demonstrate that. that it's a challenge sometimes to get people engaged in their own health care. people have a lot of other things on their plate to do. and they also, um, face a lot of i would say cultural challenges in becoming more involved in their health care. because this is one of those

areas where the culture is changing even as we speak. but when people are engaged, they do have, um, can have better health outcomes. and as janet was mentioning earlier, patients now, they expect to be engaged through i.t. in everything that they do including in their health. the fact that health has been so far behind the ball in this area is somewhat surprising because it is one of those things that is really core to people's lives, every bit as essential as any financial management. so hhs has a number of patient-centered initiatives, one which many of you have probably heard of is text for health which involved a lot of different, smaller programs where primarily they were focused on providers generating text messages to patients, text

for babies was one in which providers generated reminder notices of appointments and things of that to women who were expecting children. this program has greatly expanded, and there are a number of projects available. we have a list of resources at the end of my slide, so if you're interested in seeing some more of these prompts, you can read about -- projects, you can read about them on that web site. and some of the more recent projects are going to be much more interactive. hhs also as a whole has shown, um, interest in giving patients access to more of their own health information by releasing a notice of proposed rulemaking almost, well, a little bit over a year ago now. almost a year ago now. with the cli sparks the hipaa privacy role. and for those of you who are not familiar with this little piece of hip la lore -- hipaa lore,

when individuals were given access to their health information under hipaa, there is a little carveout for information which was held by clinical laboratories who are subject to the clinical laboratories improvement act. to make a long story short, the notice of proposed rule making -- which is a joint role because there are pieces of hipaa as well as pieces of the clia that had to be changed in order to make this happen -- it would expand the rights of patients to directly access their lab test results. and it's designed to empower patients, it's to be -- inform partners with their health care providers. and as janet mentioned earlier in more detail than i will go into, there is also, there are also provisions in the nprm for meaningful use stage ii that also focus on making information for accessible to patients -- more accessible to patients.

onc in particular has really taken a focus on this area and has, in fact, created an office of consumer engagement which is currently being, um, run by the acting director who many of you are familiar with. and this really, i think, demonstrates how committed onc is to not only making sure that providers are meaningfully using health information, but also that patients can also to the same thing. do the same thing. the consumer engagement strategy is based on what we fondly refer to as the three as; access, action and attitude. and it is very much kind of oriented towards meaningful use for patients, that they should have access to their own health information, that they should be able to easily take action with that information in a meaningful way and that some of these

attitudes that have been kind of ingrained in some areas of health care for a while that patients are something that health care happens to instead of that patients engage in need to change. and we are working on all three of these three as in many projects. in particular onc has a number of patient-generated data initiatives, and one of these is a paper, a white paper which was commissioned from rti. and it was released in april of this year. and it discusses the technical, operational, legal, cultural and education issues that surround patient-generated data. as deven was mentioning earlier, this is an area that is a little bit different than the way we have thought about health information in the past, as being something that's just generate inside a clinical context and just one way. the policy committee, which was

created under high-tech, also had a hearing on patient-generated data in june of this year, very recently. and this hearing material is also available on our web site for those of you who have more interest in it. there's also a study on patient access to their health information which looks at patients getting access to their information, reviewing it and giving feedback to their providers. and it's exploring how the patients and the providers are able to engage with this and whether some of the challenges which people thought would occur with patient-generated data have occurred in the system is similar to some of the questions that were raised and some of the project health design projects. this project is being considered at the guying singer, and the

anticipates release is the first quarter of 2014. and as d everything ddeven has raised earlier, the patient-generated data does raise a number of legal issues and in particular privacy and security issues. um, as you all know, um, we in this country regulate in a very sector-specific way. so we have some rules that apply to this little piece here and other rules that apply to this piece here. and a lot of people, particularly consumers, do think that hipaa protects all of their health information, and that is not the case. as deven mentioned, it does not apply when individuals are entering their own information into a system such as ones that have been described.

we recognize this. as a matter of fact, the administration has recognized that there are a number of ways which, in which people interact on the internet where the privacy protections probably do need to be heightened. and so there is a white house initiative on internet privacy, and it would actually provide what i like to refer to as kind of a safety net protection that would cover some information that's exchanged on the internet when it is not covered by hipaa or other federal laws. in addition to these large kind of policy issues, we have done a lot of work on mhealth and privacy and security in my office, in particular in the chief privacy office -- office of the chief privacy officer. one of the things that we looked at was the security in mobile devices that was mainly done from a provider perspective, but we looked at it from the devices

as they came out of the box, and it is very interesting to look at. there's just a sea of red. even some devices where you could not set a password if you wanted to. in addition to that, we are conducting a focus group research, this came out of a text for health recommendations that we look into this issue in particular, about consumer attitudes to privacy and security on mobile devices. and what were the trade-offs that they were willing to make and some potential safeguards. in addition to this, we're also working with the national strategy for trusted identities in cyberspace which is another acronym calls nstic. i address this as one of the issues that janet raised when she did her opening about proofing, identity proofing patients and awe they want candidating them when -- authenticating them when they are working, submitting information on the internet.

and those are some of the main things that we're focusing on. and we do have this list of web sites that you can go to for more information on the work that we're doing in this area. >> terrific. thank you so much, joy. we are now at the opening up of the conversation stage in this program. there are microphones that you can use to go to and verbalize your question, and as i mentioned, there are green cards in your packets that you can write your question on if you will hold that card up, somebody on our staff will pluck it from your fingers and bring it forward. and to get us started, janet, you've been scribbling questions as the presentations have gone ahead. why don't you get us started. >> thank you, ed. i'd like to direct my first question to dr. roth -- roth

rothemich. it was terrific to hear about all of the positive outcomes that you experienced as a result of using these technologies. so let's just say if we were to look at scaling this, you know, across the country, you know, improving these types of interactions among clip in additions and -- clinicians and patients which is very exciting, um, what actions, either policy or otherwise, would -- do you believe need to be taken to assist particularly your fellow clinicians going forward? >> well, this audience is probably more policy expert than i am, but, um, one of the things that i think we saw was that even with 30 patients in two practices this was a sizable amount of work, additional work, new work that they were taking on to do this. and so i think one of the policy implications would be that, you

know, with any work that gets done, at the end of the day, someone's got to pay for it to get done. so whatever the mechanism of payment might be, perhaps it's something that's directly reimbursable, perhaps it's manager that is a potential savings -- something that is a potential savings to the organization if it's an accountable care organization or something like that. so i don't know what the exact solution is there, but i do want to acknowledge it's a fair amount of work. from the practices perspective, i think that, um, we would not have wanted or found it useful to do this with every patient in our practice who had asthma. so we're focusing in on the ones that there was more likelihood of benefit. and we did see for six months the clinicians and the patients both felt this was doable and useful. but i don't know that either would necessarily say that after two years. so one of the things that i

think we want to think about is there are probably certain times where certain patients would benefit from collect -- looking at this information this intensely. the patients who are having repeated visits to the er, we can't get their asthma controlled. and for a time that that would need to be looked at very closely. and then, obviously, the practices have to figure out how to do this work flow that is working. >> thank you. >> we have a number of people lined up at the microphones. i would ask you to, a, identify yourselves and, b, keep your questions as brief as you possibly can so we can get through everybody's inquiries. and i don't know who was first. we'll start on my right, your left. >> sure. good stuff. this is nathan cansky from the hiv medicine association. my question is about utilization, so if you could talk about, i guess, two parts of utilization.

one is in terms of increasing a patient's ability to understand their own health care. if there is any resistance from insurers who may not want to dewhat might be covered, what might be -- detail what might be covered, what might be free. based on people not utilizing health care as much as they could be. so if there's any barriers or resistance or if there needs to be change there, you know? maybe your insurance provider doesn't want you to know that you get a free pair of glasses, or you get this free, whatever it is. on the other side is opportunities, and do you think this will effect, perhaps, the co-pay structure (for example, if you get alerts saying, hey, get your free hiv test, it's that time of year, get a free flu shot. so what do you see happening as far as utilization goes and what barriers lie ahead? >> steve, everybody seems to be turning to you. [laughter] >> great questions. i mean, i think the utilization

is really probably going to depend very much on the cases of who's using it, under what circumstances, i think as steve detailed. in some ways what steve was srt of arguing is you need to find the case, almost the business cases. because you think that's going to make them healthier and in the long run maybe reduce utilization. and that does point to models like accountable care organizations where, actually, razeeing those savings -- realizing those savings makes a difference and is part of the business model. and to be honest, we haven't engaged deeply with the insurance industry on this, other than having an adviser from that industry, and these projects were kind of dope off books in that sense. the co-pay is really interesting because this sort of model of practicing care yets you a -- gets you a little bit away from

the notion that health care is delivered in doses where you show up to an office and receive a treatment. this is sort of saying it's much more kind of a continuous relationship, and the idea of a co-pay, you know, starts to make less sense. or maybe the co-pay is, yeah, if you really want to come into the office and talk to somebody, a co-pay, but if you went in this direction, maybe there's no co-pay at all. so i don't know if others have thoughts on that. >> anyone else? nope, go ahead. >> yes, hi. my name is al with guide consulting services, and i represent netsmart technologies which is a vendor that provides electronic health records to mental health and addiction providers. and this is a question to joy pritts. the, we have become concerned about reports, confirmed reports that state health information exchanges are not accepting momental health and addiction

electronic health records because of conflicting interpretations of state and federal patient confidentiality concept laws, particularly related to addiction records. and we know, joy, that you're working with the substance abuse and mental health services administration on these issues. so i've got two questions quickly. number one, if you could just tell the audience a bit about how onc works with samsung on the special confidentiality needed for records, and secondly, anything you could say about this pressing hie matter i think would be helpful to us. i'll take your response seated. >> in response to your first question, we work very closely with samsa on the confidentiality rules. for those of you who are not familiar with those rules, there is a federal, a set of federal

regulations that apply directly to substance abuse and mental health -- well, substance and alcohol abuse treatment facilities that receive federal support which is very broadly defined. those rules are more stringent than the hipaa privacy rule, and they require an individual's express permission to share their information even for treatment purposes. the purpose behind that rule when it was originated was to make sure that people who had these conditions would come in and get treatment. without fear of being arrested, frankly. and to our knowledge, that last piece has not changed oaf the years -- over the years, that there is still danger, potential risk of this information falling into the wrong hands. so the challenge that has evolved is that the rules were

written very much at a time for, in a paper world. and so although the policy may not have changed, the implementation of that policy into an electronic environment has proven to be somewhat challenging. we work, as i was saying, we work very closely with samsa. we are work with them on the trying to find some solutions to this. we have heard, as you have stated, anecdotally that some of the health information exchange organizations that are forming are hesitant to accept information that is generated from these substance abuse and mental health facilities because it's one of those areas where the protection actually follows the data. because, so if it's generated in

a when we call shorthand call a 48sr part 2 facility, then if it goes into patient's concept for it to be shared and the recipient gets it, they may not disclose the information unless they have the patient's express permission. so we're working on a number of different fronts on how to tackle this issue because we recognize, and the administration recognizes how important it is to have these substance abuse and mental health really integrated into primary care. one of the things that my office has been doing for the last year is working on standards development for medi-data tagging this information that might provide, help provide a technological solution to this challenge. and as you know because you

mentioned it, samsa has been working with all -- with a number of states to try to find the ways that they can not necessarily harmonize, go back and redraft all kinds of laws and things, but look at the interpretation that exists in their states to see if at least they can come up with some common solutions of approaches to some of these issues. one of the accused here the people need to understand is that the preemption, the federal preex, the way hipaa treats federal pre'em shun is that a state law that is equal or more stringent than the private protections, in any state law where there is -- where state law mandates that an

individual's consent be maintained for these purposes, it's become a challenge. and i think it's important to point out it's a much wider issue. >> joy, while we have you thinking about the reach of hipaa, a question on a card that i think we can dispose of fairly quickly. and the questioner would like to know whether the health and history information they enter into a terminal in their doctor's office is covered by hipaa. >> provided that your health care provider is covered by hipaa, yes. it should be. >> okay. yes, we're back here. john. >> hi. john green with the national association of health underwriters. e wanted to know if the panel shared a concern i have relative to apps. and a vision in purdue for that would give oversight of approving apps through the fda.

and that whole process which is, can be very timely and costly, where the shelf life of an app is short, and a lot of these people who adopt them are working out of their garage, for instance, and coming up with that. you've got to make it worthwhile for them, so i'm wondering if you had concerns, anyone, relative to this overright sight of, you know the smartphone now is it a medical device? we'd still be waiting for angry birds if it had to go through fda. >> whoever answers that, would you take a moment to explain to some of us what padufa is? is it a town in illinois? [laughter] >> i think that's paducah. prescription drug user fee amendments? i'm getting nods. >> a law that was reauthorized

this year. >> yeah, yeah. i -- >> and, you know, this whole issue of apps was included -- >> yep. finish because, fda now says they'd like to have a peek and whether or not it's a medical situation. how long it takes to get things approved when they don't have the staff and management now to do the work that they already have now want to take this on. >> so, joy, did you want to take that one? because i'm happy to talk about it. >> i'd prefer not to. >> okay. since she doesn't work for the fda. so i want to put -- so, yes, it is the case that the food and drug administration is looking at the ec tent to which it's congressionally-authorized authority would extend to certain things on your phone

like an app. i doubt it's going to extend to angry bird. >> there aren't any studies that show it improves health or decreases -- >> no, no. i think it's a difficult line to draw because on the one hand, if there are two guys in a garage creating an app that a health care provider is going to use to make a decision about me clinically, whether it actually operates a lot like a medical device in terms of of saying hes what that perp's blood pressure is at that moment, here it is after they do a certain thing, and somebody makes a clear decision on that. i want somebody to actually look at it and make sure it actually works as it's being presented to the world and being sold to the world. on the other hand, if you've got a device that's basically helping you track your finance level where you may be using it in terms of deciding whether you're going to run faster the

next day, and maybe if it's off by a tenth of a mile or two nobody's going to die, that doesn't need to go through full regulation advise procedure. what the faa is trying to draw a line. what's a mobile medical app, for example, and what's a wellness app, and what are the types of information that are sort of more on the clinical medical side used to make a clinical decision versus information that's used to help your wellness. that is not an easy line the draw, as steve downs made the point. you know, information that doesn't look like health care information in one context is, in fact, relative to your health in other contexts, and how do you draw that line? >> from somebody who represents consumers in some of these discussions, i don't know i want to say fda, go away. ..

but i don't think it's as easy as saying option deregulated, at all. because some of them actually argues for clinical decision-making. >> i agree with deven. go back to the example i used earlier, the company that looks at the data on your cell phone and establishes behavioral signature and is able to look for changes against that signature.

if the output of that was to say we notice a change in your behavior. it appears you may be sliding back into depression, you should double your dose of prozac immediately in order to stave that off. you kind would want that regulated. if what your doing is to say we've noticed a change in your behavior where you may be concerned about this, you might want to discuss this with your doctor to figure out appropriate course of action. i mean, and so those are sort of easy lines to draw i think, but what you here in the developer community, the most important thing is however they are drawn, they are drawn and they are clear. because i think that's the hard thing is you are the two people in the garage trying to build a company and you have something and it's really unclear whether or not you're going to need fda approval. that's really hard, those are hard circumstances to work. >> what you just said, steve, sounds like whatever the line is government might be drawn less on the actual app than on the

use to which the information is put. >> it depends on what is the app and -- i think that's right. it's less about the data collected, maybe even less about the analysis more about any recommendation for action about that. and actually that brings up another point. in the focus group research that was done with chronology done in the project after patients that had a chance to use that, they talk about being able to see connections on different aspects of their health. so for example, crohn's patients who were saying when you look at activity level and sleep and noticed more activity, more sleep, real affect on the energy level but actually their energy level being increased at it real affect on decreasing the pain level. that's an important insight that you can get from an outcome you can get from algorithms, and you can make changes in your

behavior that can help you take advantage of the i don't think anything in their necessary rises to the level of medical treatment. or providing medical advice. but yet at the same time it's important insight. >> i just want to be clear that i didn't mean to suggest that there should be no oversight, okay? i think oversight is good, but it's got to be reasonable, timely, and it's got to make sense financially. >> fairpoint. >> yes, we are out of this microphone. >> i'm with the "national journal" of hygiene and environmental health. i hope this is far-fetched, but can you imagine a scenario where it is required or mandatory to provide odl data in order to be eligible for certain health care plan and how could we prevent that? >> wow. >> interesting question.

>> i will take the first crack at that. the technology infrastructure to make that possible is obviously there. that could happen. that's where policy comes in, and that's why it's as important i think when you technology and applications of technology energy that you bring in policy so you can have discussion about values, and what sort of rules you would want to put on a. again i think this is another example it's what you do with information that ought to be subject to laws and policy, and play out in the proper law and policy arenas. >> anybody else? okay, yes, go right ahead. >> i'm a primary care physician. in my last life i was an attorney. i just wanted to comment on the doctor's observation that there

was no, that they were, the doctors were not overwhelmed by the information and that the whole thing went pretty well. 30 patients in a seven physician setting, small number, over a short time, and you picked out one problem. say for instance, and a lupus patient who had five or six problems. that could've been followed and monitor. if that were scaled up, limited to sick patients as it should be, that a lot of work. and $20 per patient per month management the is not going to cover that. if you want physicians to use it and do it and keep up with information, which they must, as a lawyer i know a common cause of malpractice lawsuits a something that was missed and then turns out, goes along and turned to do something much serious. so you can't afford to overlook

things. if you want people to do, it would be a good idea, until we get to the great aco in the sky, pay docs, look at information and pay them for telephone calls. there's already a code for it. you would save everybody money. it's convenient for the paper. saves the doctor time and money. it saves the payer time. i don't understand why they can't pay for phone calls. there's no congressional law forbidding it that could start the administered thing going tomorrow. >> my response i guess a a become an adult history with anything you said, evidently anything i say disagrees or is counter to what you said. either we find a way to pay for this or it would need to be bundled into, and you're quite right that if we have had every patient with asthma and diabetes, you name it, collecting this data, that would

be impossible. but if we had found that for these 30, the small number of 30 that the commission said no, this is too much, that might be a death knell for this kind of work. but i think we have to be selective, and you're right, it's got to be reimbursed. at the end of the day it takes somebody's time. >> and aco will not take it strictly if it's not reimbursed. it will just be one more thing. >> has anybody heard of and interest level from acos, if the private ones or the ones running through cms in adopting any of the use of odl's or other kind of data that we are talking about, patient generated data? >> i would welcome if people have come in edge to that, on

the panel that would be fine, since we don't have cms folks on the panel. [inaudible] >> how that data flows back. then reimburses back. they have very different components that their networks are looking at that. i think some of the more aggressive things. >> since you were out of microphone range i will condense the answer by saying yes. [laughter] particularly in minnesota. thank you very much. do you want to identify

yourself? >> thank you very much. yes, sir. >> i'm an advisor of health for management, and strategy for different organizations and small business. i was a former fda fellows i'm going to just give my 2 cents about the mobile, very briefly. first of all i'm going to agree with deven. what she said is absolutely right. so it cannot try to regulate the whole mobile application, platform, they are trying to focus on specific high lease applications that has to do with clinical decisions that affect the patient's drastically. so we have seen these risks and benefits and decide if this is something we need to regulate. so it's not just the application. they may also be the mobile device because mobile devices not just yours phone.

they can be a sensor, a monitor, it can be together with other devices. so that's the main concern. so i want to mention just a complement what deven answered, and then the other aspect is something that some people don't know so well about, the definition. according to the government. so biomedical software specifically when it's -- [inaudible] is under regulatory authority of fda. they haven't involved the authority and all this aspect because for several reasons, and also spent a lot of good work the last years, taking action on that. but they can go ahead and regulate biomedical software. but, of course, for the sake of innovation we don't want to make this not affordable. so that's my other point. so just to give a little bit, then my quick question is, is

this. to all of you, i think we have seen the affordable care act ruling already passed and we're looking now for development after that. there are several positions -- provisions there, especially in reporting that has to do with limitation of information and technology. and i'm going to mention what state has to do what, collect and report different measures. they will need to implement and other things, in other parts, they need to be given to innovators to make this work in the quality report. so in this part of information, technology, what do you see as a timeline for the state and federal, and also for innovators as we now go to the implication

-- how we can do this better or what you see in the future? >> that such a devastatingly complex question. >> i would say again, since we sort of have ways of influencing the health care industry and health care policy that are kind of nested within a bunch of different agencies within the federal government, if you're even thinking about the federal government and then you have all of the interesting initiatives that are happening and the private sector, it's not one clear timeline. it's kind of sort of multiple initiatives going on somewhat simultaneously, each one getting back at the other one. i can say at least on the health i.t. policy committee perspective, we all return to look at what the criteria would be for the third stage of the

ehr and send program which will include a set of objectives for being a meaningful user, as was what the technology has to include in order to be certified and then all that subject to eligibility for federal subsidy. we are definitely exploring the capability to be able to incorporate patient generated data in a potentially wide variety of sources with the provider having the option to choose which one works best for his or her particular patient population, and starting with a relatively low pressure for patients taking into account all of the provider issues that are discussed. so there's one sort of set of initiatives, again being discussed very early stage three discussions but it's still sort of hearing in looking at sort of where the potential is to really move the needle on quality and cost issues and trying to drive some incentives in that direction. >> hi.

i'm -- i was one if you go into more detail about some of the incentive structures. you mentioned a couple, but incentive structures to really encourage physicians to integrate some of these technologies, and down the line how much really going to affect their meaningful use requireme requirement? >> yeah, sure. i mean, i think we're really at the start of the incentives that are really sort of more kind of aggressively focusing on bringing the patient view into the process versus really the focus for stage one. and much of what we've seen are staged to has been about a quick impatience with the data. that they might need, that they can get venues themselves which is a necessary first step. where the bidirectional flows are concerned, that raise additional issues, but from a policy of acknowledge standpoint and that's why they are really getting a more meaningful talk for stage three, which feels like it is way out there but it's actually really not.

it's just around the corner, especially if we have an expectation that the technology vendors who are still busy implementing stages one and two will be able to get a product upgrade in time to be really ready for stage three. so first focus being, you know, of joyce three a's, the access piece of it, do patients have access to electronic data that they can really use. we've seen the blue button initiative. we've seen cms to a blue button initiative. there's discussion about how to make that sort of ability for you to get a view and download other health information, be able to take that elsewhere. so others may want to talk about it. i think we are just, and on accountable care organizations, the financial incentives are driven towards outcome. so to the extent that there are, you can actually realize the outcomes by taking their patients better when they're

still in their home, that's something i think, it doesn't surprise me that they are exploring it because that's a very appealing way to leverage resources and get better outcomes. >> i think the way i would think about it is, to remind everyone come very early days on this kind of work. studies were done, very small, not specifically statistically significant, claims to make care but what we're seeing is promised but not all patients come out all the time, not all circumstances. so for me the question is less about how do you provide an sinister people to do this, and more to create a policy environment where it makes sense, or where you're able to do this when it makes sense and when you can find value in it. and not be hampered by policy that says don't do this even if it's a good idea because we have structured repayment or we've structured the rules to prevent it. in some ways that's our purpose of trying to share this work at

this point, this is coming along. there may be some real opportunities here, and you want to make sure that the policy of i'm in naples this opportunity to be realized. but not necessarily create incentives to say you all need to be doing this now. >> i'm from the american academy of neurology and the question is, i think she pretty much asked the same question i wanted to ask. i was just thinking from a provider perspective with respect to the smartphone apps, it wasn't clear to me when i was listening to the discussion exactly how this would be implemented, or who would be the decision-maker? what it come from the physician and say i would think would be great for this, or would it be the patient who would be the app and say, i would have access to the app and said i think this'll be a great way for me to kind of manage my care bucks it was a

little confusing to me if who was the entry point? is it the physician who identify the patient and then they go from there? and the reason i ask that, because it was mentioned that perhaps an emergency department, physicians bear or clinicians may identify patients who would be eligible, you know, to use the app. so if you just provide simplification on exactly what is the intent. it was supposed to use this, the physician identifies the patient, or was it the patient? i would appreciate that. >> i think at the end of the day is going to have to be some negotiation between those two parties. it is not a unilateral decision. but in a medical home world it wouldn't has a chilly just be the er physician that listing is patient in the ear. i would note that as the primary care doc that they had been in the er. and timmy i don't know if there's a right -- and to me, i don't know if there's a right or

wrong answer. in a position i'm thinking more physician centric we. we would be identifying these people. >> so it would not replace the physician? >> now i don't think so. i think it's an integral part, you're just another tool. >> okay, thank you. >> good afternoon. my name is richard brennan, executive director of the home care of america. an affiliate of the national association for home care and hospice. so i think someone, i will give credit maybe to janet, as far as health happens outside the clinic, maybe one of the things i heard on the panel that came out today. one of things that we're trying to do is off-line with a group of providers who provide incidents for electronic health records along with acute care, those providers with non-acute-care and post acute care providers. and so we've identified is this

a huge need to try to make sure that we have alignment across the spectrum of care. i've been working in that regard under the sni framer, a committee led an initiative to create a longitudinal care plan. and i would come apart my question is informational just make sure you're looking at model, the home health plan care, our case is just developed with a framework and we'll go through each. that we plan on using and hoping to use across a platform of care providers, in other words, physicians, partnership with them. but other partners could use this as an electronic means establishing goals, interventions, and also all those being measurable backed up by clinical data that can be collected either by remotely, by remote patient monitors or onside by clinicians. so i just wanted to come as part

of my question, ask is more overarching look, i know we've had a very specific look today at specific programs in interventions, but what new models of care coordination are going to be needed in order to better engage patients in their care? and have you thought of how this will happen on sort of a holistic way? thank you. >> i can take a stab at that. bipartisan policy center released a report earlier this year looking at the attributes of high performance, reducing costs, improving quality in health care and the patient activation engagement piece is huge, and a common attribute across the number of organizations that we interviewed. i think him and this relates to the other, there were two questions around payment. i think looking, as steve mentioned, at specific actions and reimbursing them, is very

different from actually come and we are very encouraged to see a number of the delivery system and payment models that are being tested by cm and i, a member states, a number of health plans across our country and providers that are actually providing incentives for better care, coordinated care, accountable care. and this is just a piece. so clinicians, doctors, working with those who provide financial support for these models, working with patients that are heavily involved in governance and a number of these initiatives is the way forward. we applaud your leadership around, you know, home care and this is really the way of the future. >> hi. my question is about data aggregation. it seems like we're talking about patient entering, you know, old metrics over any

medium and the physician is the one who aggregates that data. you know, instead of perhaps a different way of doing things like perhaps target which has more data points, or health care provider i'm guessing, and you can also forget when people are pregnant without having to ask them. so what kinds, are we heading that way? at the same time, with such systems would necessitate the computerization of health care allow people to operate at the top of their license, as we say? and also, are there barriers to our physicians will feel like watsons technician, watson is the ibm computer which is made to do this sort of thing. >> so that brings a whole interesting area, and there are companies like patients like me and care together with people and a lot of information about themselves, their treatments, their experiences and think and 30 in the aggregated crowd how they're doing relative to

others. there's some great stories, patients finding that they were only on 10 milligrams of something because their doctor said that's all anyone should really take him and then they find out that 90% of people with similar conditions are actually getting 100 milligrams. they can go back to the doctor and say, what gives? i think there's a ton of opportunity there. i think again, sort of who's doing what with insight is was a good question. soaking, an example of a person was on an awfully low dose, they can go to the doctor and they can say, i'm not saying i need 100 milligrams, but evidence which suggests other people are on it so let's have a conversation about that. the other thing that i think this does is it really does open up the question of what professional skills are needed to do what tasks associated with providing care in a court knitted theme-based fashion. and i think the example is pretty easy would have, in fact

nurses returned the data, the dashboard from the patients and then triaging escaating to physicians was a good example of saying, let's put the right task with the right person with the right skills and giving up the work that we. i don't know if steve were others, if you have thoughts on the. >> if i remember correctly, steve, didn't every project in debt with a model like that where there was them in none of these projects did they decide the physician was going to be the first viewer of the information? >> yes, absolutely. there's always some element of team going on. >> you get th last question. >> thank you. good afternoon. taking it back to reimbursement, and a nice lead in with every model ended up with a different care team, maybe taking a piece of it before it got to that end care provided that might make a decision, but each one of those pieces of the puzzle comes with

a salary, right, and the need for reimbursement. so a couple things that came up, the physicians brought up earlier around visits is the chapter 10 of the broadband plan really spoke about the visits. this is dark and we're going on for years sitting on that plan. components of that plan. so how do we, want to move policy forward to that it keeps up with the technology at hand? were looking at those visits for one. were looking to up the very antiquated reimbursement for telemedicine which is probably five years behind on the books which means 10 to 15 years behind the terms of what the technology can do today. so applaud the ac all model and what's happened with innovation center, but how can we raise that discussion both that cms to look at moving this reimbursement structures forward? and then also how can we look at other industries and what is

happening in the microfinance world? so, we talked earlier about co-pays, but if you look at, for instance, the music industry, one of the ways that apple turned that on its head was you could buy a song 4909 cents. well, i could sell an album for $20, why would i want 99 cents? because the way that they made it so easy for people to grab that music, and he would look at have a look at other industries and the way microfinance issues and is being used in other parts of the world, not in the u.s., and bring to bear on health care, what if it meant a provider just got very many, many small payments, maybe not out of the insurance industry, but directly from patients? i would be willing to pay, but we don't have the financial structures in place at all in the u.s., or barely, so we had a square that moved in, that's the beginning. but how can we look at it in some of the other things that happen in other industries that might help move us along?

>> i think rather than a question, aetna, you've just thrown out several really important challenges for all of us who are sort of looking to move, see the need to move on health care both for patients and providers, and you know, we didn't come to the table with any experts on reimbursement. ..

>> do we have time for another question? >> i'm afraid we don't and i apologize to all the folks who put questions on cards, that we didn't get to, but we have run out of time. and, i want to come back and thank are friends of the bipartisan policy center, our colleagues at the robert moore johnson foundation particularly stephen downes. before speaking with an acronym filled, mind stretching discussion at least for some of us. i want to take a second to note also and thank jackie and hannah who have labored for the alliance as interns this summer as this will be her final day. i don't know if jackie is going to be around when we have our preview on friday, but when you join me in thanking the panel for a great discussion, you will

also be thanking them. [applause] and to see yourself in reruns throughout the week. [laughter] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] >> some news today coming from capitol hill. the u.s. house has filed suit against attorney general eric holder. they have asked a federal court to enforce a subpoena against the attorney general demanding he produce records related to the gun tracking operation known as "fast and furious." in june the house voted to hold the attorney general in contempt of congress. again that story from the "associated press." later today c-span's wrote to the white house coverage continues

>> hello. leaders of scientology we are anonymous over the years we have been watching you irk us be if anything is more of an internet phenomenon or a movement. it's many different people elaborating together on line to protest against all sorts of

different reasons, and also to harass people sometimes for fun. last month australian prime minister julia gillard visited residents. the coastal capital city located in western australia. she took questions on a number of issues including the newly imposed carbon tax which was executed in july. the impact of the eurozone debt

crisis and same-sex marriage. this one-hour program is courtesy of the australian public affairs channel. >> good evening a welcome to sky news form. i am the moderator for this evening. as you can see tonight we are joined by the prime minister, julia gillard we also have around 200 voices here who have been selected by an independent research company. i have no idea what questions are going to be asked and neither does the prime minister. of course it kicked in a couple of weeks ago and since then the pm has been out and about trying to turn around -- we are assuming that tonight she will -- you will be more informed. we will be polling the audience to find out whether or not they have been convinced by the prime minister this evening or whether she still has a way to go. no doubt there will be contingent issues as well but

those of you this evening would like to talk to the prime minister, she is happy for that as well. i think we can all agree tonight that the prime minister is being very generous giving up an hour of her time to answer your questions directly. let's go over to the prime minister and warmly welcome her here to perth. [applause] >> thank you very much for that introduction i really should be saying yankee to each of you for giving up more than an hour of your time by the time you traveled to and from whom to be here this evening. i just wanted to start by sharing one experience with you and then it will be over. today in perth i had the opportunity to go and look at a place called hard a key way. it is generating electricity

from the power of the ocean, from the power of the waves. low pollution and new jobs are western australia. it is an insight into what i want our nation to achieve through putting a price on carbon. what do we need to reduce carbon pollution? me know the world is warming and climate is changing. the decade between 2,002,010 was the hottest on record and we know that extreme weather events like hurricanes and floods have increased by 300% since 1960. and this is caused by the carbon pollution that we are putting up in our atmosphere, so we need to act and we need to cut that carbon pollution putting a price on carbon is the cheapest and most efficient way of cutting the carbon pollution we

generate. our economy now is one of the most initiative and tense up in the world. we generate around the most carbon pollution of anybody on earth. putting a price on carbon is about reducing that carbon pollution by 160 million tons in 2020, the equivalent of getting 45 million cars off of our roads. while we do what i want to make sure we see job growth, we get new clean energy in the future and we protect the budgets of households particularly those people who need government assistance the most. that is a pretty fast, pretty hot and serious debate. i am sure you will have your questions. as ashley has said if you want to talk more broadly than about the carbon price i'm happy to do that to maximus is your opportunity and i'm looking

forward to having this conversation. thank you very much. [applause] >> lets get right down to business. at this time if you can look at it directly down the barrel there and let's take it away. first question. >> my name is daniel and i'm a small-business owner. i just want to ask you a quick question. does the government truly believe a carbon tax would be more beneficial in reducing our carbon footprint than in incentivize program for our major polluters to actually invest in research and developments just like the freemantle company that you mentioned before? >> well we certainly do believe that is the most efficient mechanism and the economic advice here and around the world is telling us that if you want to reduce carbon pollution, the best way is to put a price on it and the reason for that is at the moment the businesses that generate a lot of carbon pollution can put it in the atmosphere for nothing so why

not put any amount up there because it's not going to cost you anything. but if we start putting a price on it, a price on big businesses and we are talking about less than 500 businesses in australil look at that cost on their balance sheet and they will say what can i do to reduce its? what can i do to achieve my carbon pollution? that is the effect we want to have and that is what will draw the reduction in carbon pollution by 2020. but you are also right, while it will be done by putting a price on carbon there is a role for complementary measures. some of the money that carbon pollution generates we are putting in a body called arena which is going to partner with renewable energy projects and we are also putting $10 billion in a corporation called the clean energy finance corporation. that will be making commercial -- but it will be taking that new

technology and upscaling itself that it grows in size but the driver has to be that price on carbon pollution. if people can put it up there for free the big businesses than we won't see a reduction. >> can you tell us what small business you have and what costs you are worried about in particular? >> probably it won't have a direct impact on me however i look at ways at recovering their costs and major polluters are going to pass it down to the consumer. i'm just wondering what sort of protection the consumer will have? >> well, that is a central concern people have had. so we know the big polluters are going to pay the price but we also do know that some of that price will be passed through to the consumers. consumer's. we know that there is going to be 7% consumer --

and a 0.7% increase in our cost of living. but because we are going to save our our flow-through impact into things like electricity, that is why we are providing household assistance to the tax cuts, the family payment increases and the pension increases. now the next logical question is, how do you know -- how do you know they have all that bright? the jury is sent on the single biggest impact to families. the single biggest cost impacted families is in electricity prices. we argue now that it will put electricity prices up by 9 cents. that is less than $3 a week, whereas the average assistance for families per household is $10. here you are entitled to say i have already got increases in my electricity bill's.

that is nothing has nothing to do with -- it's about poles and wires in new transmission towers. what we do know from the carbon pricing is uw eyes noticing. >> let's move onto the next one. >> my name is kate and i'm a structural designer. my question is, with the carbon taxing so unpopular and given the fact that -- didn't vote for it can you guarantee that the money will be spent wisely and it will be open and transparent? >> absolutely. you will be able to see where it goes and you will be able to see that on the government's budget and i can tell you now where it is going. more than half of the money is being used to fund those tax cuts family increases in pension increases to help people with the flow-through costs are go

more than half of it is going to that. been a section of the money is going to help expose businesses and manufacturing businesses to help them with clean energy technology. and then the balance is going to supporting renewables in the way that i talked about in the first question on clean injured -- energy and promoting land diversity. you always be able to know where the monies money is coming in from carbon pricing is going to. >> will this actually be published? >> they are published. they were published when we first announced carbon pricing. the details in the middle of last year and they are available in the government's budget for anybody who is interested. >> thank you kate. the next question now.

>> how are you doing? my name is rick. i guess i made tree farmer. kind of danish market out there but my question is regarding the revenue raised from the carbon tax. as far as i know, currently some of it goes towards reimbursing some of the polluters at the moment. is that correct? >> some of it goes towards or through trade permits. people would have heard that the carbon price is $23 for our businesses that trade with the rest of the world, there's a system that supports it. the price they are paying is $1.30 per ton and we are also funding to help businesses address -- adjust to a cleaner

energy future so that might seem like replacing old refrigerators with refrigerators that use less electricity. >> okay, so this leads me to my main question. how long will that funding go back to those companies for and what will that funding be used for after that? >> those businesses are going to be supported for carbon pricing across across the government's budget so all of that is clear. there will be a review in the future about the need for industry assistance so that will be taken into account, how the rest of the world is moving so that will be in the future. as far as the -- all of that assistance will flow. >> thanks rick. let's move onto the next one. >> okay. >> good evening prime minister.

i am a mining recruitment consultant. many experts are warning of a very serious severe economic worldwide crash. would you consider capping or removing the carbon tax for the us trillion economy? >> well i am not predicting an economic event like that, so i don't think we have to worry about that economic problem. we just tie down the biggest economic problem in my lifetime and in the lifetimes of i suspect everybody here. it's the biggest economic event since the great depression in the late 1920s and that was the global financial crisis. and because we do know pull together, we came out of that strong and we didn't have a recession. we have low unemployment and is drawn public finances and good growth. there are still some problems in the world economy, predominantly in the eurozone so this is all of the stuff you see on your tv

screens about chancellor merkel and greece and the greek elections in spain and portugal. now the impact on us -- we are not immune to all of that but the impact is quite modest because our future has really been written in this region of the world where we see it so our future is being written by chinese growth, growth in india, continued relationships with japan and korea, growth in indonesia. so the atmosphere of our economy is a strong one. it will continue to grow and as we continue to grow, we will be cutting the amount of carbon pollution that we are producing. >> thank you. let's keep moving on so we can get to as many as we can tonight. next question. >> hello prime minister. my name is daniel. i'm going to take you up on your offer of --

i think a lot of people would agree with the perception that the influx of the figures are out of control particularly when you think of the stress causing the -- [inaudible] on the indonesian coast. does your government have plans for bringing this under control and if so could you elaborate? >> sure, i'm happy to do that and i would agree with you. it's a very deep and very pressing problem for our nation and i can understand and i think i can hear it in your voice and lots of people in the audience who share these views, that you are frustrated by it and you think there is a political impasse around it and you want to see something done. i can hear that in your voice and i can hear that loud and clear from the community. and so i want to get something done too. the government -- one little part of the story, the high

court basically brought an end to that under current legislation. we need to get legislation through the parliament. there has been an ongoing political debate about who has got the right plan. the government supports the transfer agreement with malaysia. the opposition supports having a detention center. i would say let's just put the two together. let's just do both. government plan, opposition plan. we haven't been able to get the opposition to agree to that are the parliament. so given all of that, given everybody's -- and we do need to act, i now have asked a very expert panel led by the former chief of the defense force to provide a recommendation back to the parliament, back to all of us about what our nation should

do next to get out of this frustration and to get some pink done. and that will be coming back to all of us so it will be released publicly before the parliament in august. >> thank you for that. just picking up on that point in the meantime of course we'll keep coming -- in the past 24 hours also. many years ago you did support turning back the dash don't we have heard that over and over from the liberal party. wendy get to the point where you need to scrap malaysian start from the beginning again and come up with a plan began that doesn't include malaysia because that is really the sticking point. >> well, the reason we have advocated malaysia is we have got the clearest advice from the experts and good public servants who advised --

a specific solution. we have got the clearest advice from them that it would be the most effective. now we will be guarded as to what -- and i've been prepared to compromise here. this book with pose the single element of the opposition's plan together with the governments government's plan to get it done. so that is why we are asking malaysia but i will seriously be listening to every word of what angus houston and his panel has to say. concerning -- we know something now that we didn't know a few years back. we have got the benefit of expert advice from the people who rank most ranked most highly in our navy who tells us it's dangerous for navy personnel. so as a nation we have got to make a decision about whether you ask young australians to join the defense force, joined the navy and to put their lives

at risk for a policy where you haven't actually got anywhere to tow the vote's because indonesia is then very clear it won't take them back. and the labor of the opposition obviously knows that because he didn't try raising it with with the president of indonesia. i'm not going to put naval personnel that kind of risk. >> the coalition's argument is hopefully we can ask you more about that. let's move onto the next question. >> good evening prime minister. my name is sally ross, and i am a retired finance officer. and my question is, carbon dioxide is a gas, measured by volume, and can you explain how the federal government is taxing

the gas by putting the measurement in tons? how can they do that? >> well -- >> where do the tons come from? >> well, the tons come from our very clever scientist who can weigh carbon dioxide and can measured by weight. guess you try to imagine how much must be in that time, but when you add up all of those carbon dioxide molecules then yes you can weigh it and that is the way that it is done around the world. we are not, we are not pioneering here and putting a price on carbon per ton so it's not something that we are doing that no one else is doing. around 850 million people in our world live in places that puts a price on carbon and they do that by putting a price on carbon per ton. so different places do it in

different ways. europe does it differently from california. california does it differently from reddish colombia. i will do it differently from what south korea's going to do or the 2 million people -- back 200 million people in china who will be in pricing carbon but that is what is happening around the world. so we have uplifted that knowledge and obviously used it as we have designed our scheme. >> thank you for that. do you have another question ready to go? >> really the smoke still goes up the chimney, doesn't it? >> yes, smoke still goes up the chimney but it's more like carbon pricing is applying to big businesses that generate more than 25,000 tons of carbon pollution each year, so it's not one little chimney. its huge volumes. >> let's move on. >> my name is sandra middleton

and my question relates to the -- society. how much did the fabian society of which you are a member influence the plan for a carbon tax? >> not at all. not at all, sir. for those sir. for those of you who do not no, the fabian society is a progressive debating group, think group that is then associated with the labour party for decades and decades and decades. >> absolutely. your good friend bob hawke when he was prime minister said in 1994 a gladly knowledge the dead of my own government. i know that your government owes a lot of debt do you owe any debt to fabianism? >> i am not aware of any fabian society paper on carbon pricing. someone will inevitably prove me wrong but i have not read a. >> let's have fun. we have a bit of a generous followed so we want to get as many people as we can.

i will ask you to stick to one allotted question. >> my name is kirsti and i'm currently a stay-at-home mom raising my two children. my question for you is what is your position on forcing insurers to provide indemnity insurance for those midwives who choose to support those who -- birth? >> well, that is obviously not about carbon pricing but it's a very good question. we have been working and -- started it when she was minister 10 years ago, and we have been working with midwives to support women having a choice as to how they have their children. i know that the indemnity insurance has been one of the big problems. in terms of that choice and whether or not people can use independent midwives. i know that we have been supporting independent midwifery but on the absolute details of how we are now dealing with the insurance issue, to be frank, i will have to get back to you on

that. i know nicola did work on that and you're obviously still thinking there's some problem there so i would be happy to take that question with me and gets specifically back to on a. >> obey said the concern being if insurance is offered is cost prohibitive. and. [inaudible] >> the prime minister will take that back with her and get back to you with more information on that. this time i really mean it. let's move on. >> back to the carbon tax. i am just extremely skeptical about the drivers behind it. i don't know whether it hasn't been solved well or explained all that well, but you know x many billion, goes back into tax cuts and so on, but to me if this is all about an environment about stopping pollution and about the earth, where do they go on global warming pollution?

maybe it is but how much of that is spent on solving the actual problem as an -- [inaudible] so no tax cuts, no compensations or whatever. we pick up that alien and we burned back on cheap environmentally friendly energy production and that then solves everything else after that, do you know what they mean? so this is the moral thing, then do the bloody moral thing and let's not worry about the money. >> okay, i understand where you're coming from. the way we are supporting the research, we are putting just over $3 billion in two a body called arena which is about renewable energy research. its job is to fund the research to get the new good ideas. then there is $10 billion in the

clean energy finance corporation. its job is when those ideas are proved up so that they could be commercial, but the ordinary banks and all the rest of it are still a bit anxious about funding it. the clean energy finance corporation can move in and fund and get it from the research stage to the commercial stage. so that is the efforts that we are making in research and commercialization. we do have to worry about the flow through four households. we do have to worry about that, pensioners and people on fixed incomes households that earn less than $90,000 per person. we do also have to help our businesses do the transition particularly our businesses that are exposed but the research efforts are being funded, and i

agree with you. things like carnegie way are going to be a huge part of the solution. >> let's move onto the next question now. is. >> hi my name is ellie and i'm a student. my questions regarding the current nerd equality that has been going on and i know you have been asked this question thousand transfer come from my perspective i've heard a really good argument that taste on financial statistics wedding in this country are worth a few billion dollars. given our current budget step is to think that is a good argument towards helping out what that? >> that is a good angle. i've never heard that one before. >> i think you are analyzing all about public policy issue. luck, this to me, this is about the government's budget or about money circulating in our economy. it's about some very personal questions for people. people in different circumstances will make different judgments calls that i

know a lot of people don't agree with my judgment call and sort of so be it, but what we are to do as the labour party is enable our members to be able to vote whichever way they like. so i'm not going to try to tell anyone how she is going to vote when a bill to change the marriage act because -- comes before the parliament and there is one before they parliament now which i anticipate will be voted on before the end of year. you will see labour people vote every which way and i think that is appropriate. >> thank you for that. prime minister and no you don't pay any attention to the polls that come out in a very regular basis but our friends in western australia have given us the results if they pull coming in and the 222 people here the cross-section of people who have been selected by an independent research company, 30% of the people came here today saying they support the carbon tax. 38% say they oppose it in 32%

say they are undecided so that is your test. we will bring you the results later on tonight on sky news once you have handed in the results. let's move onto the next question. >> stephen boylan state public servant. prime nister, you have said for the purpose of the taxes to change industries behavior but given the significant compensation packages given to those industries most affected by the carbon tax, is there really any genuine incentive for those industries to quickly and significantly change their behavior? >> yes, there is, and already i am having discussions with business people. you've got to remember everyone has been on this carbon process for a long time and we have been talking about it for a long time and we announced all the details a year ago. i have party already had discussions with business people who are moving to cut their electricity use, who are moving to new ways of doing things to

cut their carbon pollution. now you know, just one way that people can pretty easily touch and feel, people may have seen when they go to the supermarket that the refrigerators are starting to be different. instead of just having those open cases that you walk past in the cold air is cascading out at you, they are putting doors on the refrigerators. you can reach in and get what you want, cutting electricity use. that's a good thing. business is adapting. so yes, businesses will change and if i can just give you one example of the things happening in our economy. since we announced carbon pricing business investment has gone up by 20%. that is a pretty good statistic. i think that represents a lot of people who are thinking about the future, understanding that there is going to be a carbon price. >> thank you for that. next question. >> good evening prime minister. i'm a risk engineer with one of those big 500 companies.

my question if you is as the first woman prime minister of israel you would you hope your legacy will be for future generations of -- women? >> that is a very good question. i don't, i don't kind of wake up every morning thinking i am the first woman to do this job. i just go into the job. but i am conscious that having a woman do this job means that people have thought about it and i get a lot of young girls in schools who have run up to me and people who get me to sign things for their daughters. actually a friend of mine told me, she was talking to her young son about you know what he might do when he grew up. she said to him, you could be prime minister and he said to her, no i couldn't. everyone has to know you have to be a girl to do that. so i'm not sure i want young boys growing up quite thinking

that but by doing this job, it has made a girl, any girl annie blair think that is the path for me or something that i thought was closed no longer is close to me, then that is a fantastic thing and i think there will be a lot of women to come. practically of course we are trying to support women's lives through supporting their choices, more money in childcare, more options and more flexibility at work but as all my friends with young kids tell me there is still a lot more to do on all of that to help support women's lives and women's choices. >> thank you. let's move onto the next question. come on down. >> good evening prime minister. my name is andrew cooper. i too secured in the weekend so i'm mixing it up. i have the funniest question. what is it like being a prime

minister? >> how long have you got? a it is an amazing privilege, an amazing privilege and the best thing about it, you get tim meet lots of australians in all different walks of life and all different circumstances. i really enjoy that, but the best thing about it is you get to see things that are wrong in our nation, times when we are not properly prepared for the future. you get to think about what would fix it and you'd not only get to think about what would fix it, you get to put it in place. sometimes that means people don't agree with you and they can make some pretty harsh judgments along the way but i would rather the harsh judgments and feel like i am getting things done them not to get those things done. so, you know tremendous privilege and what a great nation we have had so no better

job. >> let's move on. >> hi. i am a small businessman, a one-man business. as you can see i am no youngster. the carbon tax probably won't worry me too much because i don't know how long i will be around but tensions certainly worries me. any of my friends have gone on to the pension and are now looking for work to supplement, to get back to decent standard of living. i would like to know what your vision for his pensioners is going to be in the next 10 years and will we ever achieve the pension being the minimum wage? >> look, that's a good question. we engaged in what was and historic lifting of the pension so a very big increase in just a related to the conversation we have been having about carbon pricing with increasing the single pension and extra $338 for the average pensioner will

be better off. they are getting more money in their pension than they need to deal with the flow through influx of carbon pricing. it particularly means at this point in time a lot of people who are mixed pension -- have been doing it tough because the global financial crisis, but if returns went down and people are still struggling to come back from that. for me, my vision is, we have always got a pension system that we properly support and that supports a decent retirement. i think that is a shared australian fish and that over time, we will see. people retiring with more -- so if you look at some of the younger people, the man behind you for example, by the time he retires, having moved from nine to 12% that is going to give him a decent retirement and he is less likely to be reliant on the pension.

>> thank you for that. >> i hope you didn't mind me using you as an example. >> no, that's fine. on the political science -- >> i bet this is going to be a hard question. >> the coalition is pessimistic and hyperbolic. australia's competitive advantage in the economy will be decimated by the carbon tax. would you agree prime minister with a more optimistic view that the carbon tax that will in long-term pipistrel you ahead of the pack internationally and transform our economy from carbon-intensive to green and provide a cleaner, greener brighter and ultimately more economically prosperous and sustainable future for australia? >> that is what we call a dorothy dickson. >> i'm going to be pretty happy to say yes to that one. one thing i would say though is i don't really feel --

i know the debate here has been the oh we are doing something that no one else is doing around the world. i don't feel that. i get to go to a lot of international meetings and i'd have to sit at tables with other leaders and whether i'm talking to the president of mexico or the president of brazil or the president of korea or the prime minister of the united kingdom and the list goes on, they are talking about what they are doing in their economy to put a price on carbon. so the real risk for us is that we end up cantering in front of the world the real russ -- the real risk for us is we end up being lagged behind and in i'm absolutely determined that we are not the week course at the back of the pack, that we are transforming our economy and seizing a cleaner energy future as a result. >> prime minister you mentioned what other countries are doing.

new zealand has a carbon price, the new zealand government pretty much -- about $6 a ton at the moment. have you looked at dropping the carbon price? if not, why not and how likely do you think that the full price will be negotiated down? >> well, just on new zealand i should think the central lesson from the new zealand story is, is it a bit of a worry that new zealand can do a carbon pricing so far in advance of us, they have have a carbon price for quite a long time now -- so while we continue to have this debate nationally. it will be the pride that we legislate, the price that is in effect now, the $23. on comparisons overseas, europe has volatility and all the european -- but if you look at the u.k. they are bringing in a

carbon price on electricity. the floor is going to be 24 australian dollars per 10. if you look across nations like sweden, when we are worrying about air-conditioning they are working about -- there tone is more than $100. cat providences canada, the prices as we have legislated it are on the floor price of just explain that to people. there's a fixed-price for the first three years. the carbon tax as it has been referred to her cabana becomes an emissions trading scheme. that means there's a cap on the amount of carbon pollution in our economy can generate and there is a market to sell the permits for that carbon pollution and the market sets the price. we are consulting with business and we have been for some time on what the floor price arrangement should be when we move to that full in missions trading scheme. >> prime minister justice to

follow is -- [inaudible] >> i haven't got any news for you. >> it was worth a try. let's move on with the questions. >> good evening prime minister. my name is colleen and my question is not a carbon tax on. in 2010, without action australia faces the continued decline if it's shipping fleet and the loss of -- earlier this year a federal court ruled that people working on australia's migration zone which is up to -- how does the government intend to rectify australian shipping and loss of maritime skills base and how it can guarantee the conditions including wages and safety of workers if australian and eligible for 57 holders are no longer being employed in the industry? >> i have got what i think is good news for you, which is the parliament, past a new shipping

bill which anthony albanese had worked on for a long period of time. as a result of that new shipping legislation, we will see australian flag vessels start to operate again in shipping. so we basically lost their maritime industry and now through the new shipping legislation we are on a strategy to bring it back. so there will be australian ships with australian flags with australian crews, with australian conditions and then i think we can do with a lot of the issues that you are focusing on and i can understand why you are focusing on them. it's been a really big problem i think for a nation that we have seen all of the foreign flagships and we have worried about the terms and conditions of the people who work on them. that we are on a strategy for an australian industry now. >> thank you for that. let's keep it moving. >> hello prime minister. my name is jackie davis and i am

a retired midwife and father of six. i have four adult children. you presented the carbon tax as an investment into the future and in my 25-year-old son has put a deposit down on an apartment which is yet to be built. he said part of the pledge was thousands in payment of the carbon tax. now my question is, is it really possible for a successive government to reverse the tax and if so, what would happen to those monies once it has been passed as part of our present and future? >> just for circumstances for your son, first and foremost make sure he gets all those figures checked because he is not paying a carbon tax. that is the big businesses so in a flow-through, you want to make sure you're not getting more claim than should be and people are seeing the competition. desye ccc have been out and about in been pretty figures about that.

what will happen next, this carbon -- it. for all of the "fast and furious" debate and carrion there has been, i do not believe that if mr. abbott ever becomes prime minister he will reveal his tax. there might be a little name change or some kind of thing there but -- and i don't think that is really surprising when both nature parties went to the 2007 election promising to put a price on carbon when people like malcolm turnbull have strongly advocated a across on carbon. once it is in and working, then people will see -- businesses will be transforming. people will have got their tax cuts and will be very happy when mr. abbott comes along and says he wants those tax cuts back even though he is absolutely pushed to do that type of tax

cut. so we will have a -- and our economy will change as a result and the amount of carbon pollution we generate will go down as a result. >> next question. >> good evening prime minister. my name is frank. i am a grandfather and ex-schoolteacher. if you you have already said that the negotiating with business on the ats was originally going to be $15 i believe. my question is what mechanisms are in place to stop the scheme? for example they could concentrate on purchasing international credits -- the government issued once. couldn't a levee be placed on the arts yards to offset any price differential between the government issued credits and the international credits?

>> okay, thanks for that question. just to give people a little bit of context, because other countries have moved to put a price on carbon, when we moved from its being a fixed-price, the carbon tax, when we move to being an emissions trading scheme we will be able to link with other initiatives around the world and buy and sell permits for carbon pollution across -- that sounds complicated but it's really important because it means the price that is being paid here by businesses is the world price. it is the same as businesses are paying in other states around the world. that means businesses are transforming at the same cost other businesses are around the world. when we get to that stage, we will make very vigorous processes to make sure that those international credits are

legitimate and right and we have built that into the system right from the start. rigor and assessment of those credits and we have the ability to learn here from the european scheme which has been a very long-standing and initially had a problem with that, being tightened up and we have had the ability to learn from the tightening up. >> thanks, frank. next question please. >> hi, how are you? my name is tom. year ago i attended a form much like this and i asked you a question which you could not answer, despite your office taking my details. i haven't heard back so i would like to ask the same question if i can. i am in a same-sex relationship and after completing the on line carbon tax calculator to show that my partner and myself would be subject to a cost. my question is, my relationship is attackable but why are we

still an eligible for marriage equality? >> well i am happy to answer your question. like other couples in terms of carbon pricing assistance, it would be very tax cut and so it's a question of your income and a question of your partner's income. that income is as an individual and that would be the same for a married husband and wife if obviously the family payment system deals with household income. the tax system deals with individual income, so for a husband and a wife, you and your partner is a question of whether or not your income is less than $80,000 per year. if it is, you will get a tax cut and for people who work part-time they will get sizable 500, 600-dollar at your tax cuts. so that is the way the carbon price works. on marriage equality, i think

you know from the earlier forum that you and i don't have the same view on it, no we don't. but we have worked as a government to equalize treatment across federal laws. so the superannuation center used to treat same-sex couples differently from heterosexual couples and that is no longer the case. the social security system is due in the same thing. the immigration system and we have worked with that. >> thank you. >> our next question please. >> good evening prime minister. my name is angela. in principle i agree with the carbon tax in all of that goes with it but i think the biggest worry in my circle of friends and my mother and father and aunts and uncles and the people that i speak to is that there is going to be, when you open a bill there is going to be a large sum of extra money that you have to pay for your fill.

how do you ensure to the everyday australian that they are not going to be companies profiteering adding on monies or expenses down the track so that people aren't paying? is there any way of checking that are the averages trillion as such? >> yes. yes, there is. but first, when you open your bills, in my perfect world you would see for example in your electricity bill, something that clearly explains you how much the carbon price is. and w. a. that is 9% and in some states of australia there'll be an insert in the next electricity bill to ask elaine precisely that. here in western australia -- hasn't agreed to put that in. call me a cynic but i think it has something to do with the fact that state government

decisions have led to a 57% increase in your electricity bill. with no real assistance for households and you would be pretty unhappy if you look looked at your electricity bill and that is all the carbon tax. that 57% is in the carbon tax. the carbon tax on your electricity bill is the 9% so i would like everybody to have that information. gas bills, they are also talking about -- and the foods in anything you buy from the shops, supermarket. we are talking about less than half, less than half a cent and a dollar. when you factor all of the assistance to take that into account. will there be some unscrupulous people who say you know, that has gone up 20% because of the carbon tax, if anybody says that to you, then you get straight onto the ac c.c.. it is more than a

1 million-dollar fine for misrepresenting the impact of the carbon price and people would have seen already that they have been pretty hard on some businesses that have been putting out false information about carbon pricing. so that is the mechanism for making sure that there is not profiteering as we certainly don't want to see that. >> thanks angela. next question. >> my name is rebecca. i'm a medical student. i was just wondering what the government is planning on doing to combat -- that will be revised in the next few years? >> that is a good question and when we have had to have a real think about. because we have -- there was a time when we were cutting back not under our government that the earlier government for makeup back on the number of medical places. we have expanded the number of medical places. you have probably got one of the places that we have expanded so that is good for more doctors going into our universities to

study. then they come out of the universities and they have to have an internship to end up with that all-important license to practice. part of what we have done in our health care reform is really expand the amount of money in hospitals. in part so they have the resources they need to do the training to support the system. because if we don't have more doctors and more nurses, then we are not going to be able to support the system the way we need to. we have increased funding. it's about a 20 billion increase. we are stepping up to being a partner in the growth in health costs, 50-cent -- 50% press and 50% for the state and through that there should be new sources in the system to help you get that internship place. >> thank you. we probably have about 10 minutes or so left so we will try to get as many questions in as we can. >> my name is matthew.

we are actively looking to reduce energy consumption on side. the question is, who is monitoring and measuring the emissions produced from a site and to confirm any changes made or have been affected? >> there is a report and -- reporting and monitoring system so it just the same way government tracks things very closely in the tax system, we track things very ghostly in the social security system. there is a system for reporting and monitoring. we are not making the assumption that we start with carbon pollution that they will always have to pay for that so if they take their carbon pollution down the they will pay less. for foundries, there's a special -- i talked before about the claim technology money that is there to help this is a debt. there's actually a special stream of that money that is for

foundries because we knew that they would face pretty or issues because of their high electricity consumption but there are some things that businesses and foundries can do to reduce that amount of electricity consumption and consequently the cost. i can certainly assure you we are not assuming if you make the change you will see the benefit of the change. >> matthew thank you for that. >> good evening prime minister. my name is peter and i am retired. many thousands of west australians have installed solar panels, making their homes self-sufficient of electricity. why should they have to pay a carbon tax to a w. a government service provider who do not provide one unit of power to their households? >> well if you are truly so self-sufficient you are not getting an electricity bill, then i don't see how you would

need -- any component about carbon pricing. so if you are truly self-sufficient that is a good thing. that is a bright thing but in some particular circumstance you are worried about -- >> by self-sufficient prime minister i mean we produce enough power. a the carbon, the carbon process on the electricity that is being used, so the 9% that i've talked about in western australia if you are generating so much power that you are putting power back onto the grid then i suspect your electricity needs are quite modest indeed. zero. >> we still will get a carbon tax part of the bill or the bill from synergy of our horizon or western power or whoever it

might eat. they will include a carbon tax. let me follow that one up for you. >> good evening prime minister. ..

india's road was detained march this year. enough energy trading, energy efficiency trading 500 businesses there. such changes are happening around the world including exporting. even looking at the carbon pollution we generate here tell you and i leave looking at our own nation, looking at what we do. we generate more carbon pollution than basically anywhere else on earth so most circumstances we have to change

and export our resources. of course we want to see other countries change. but we would be making a mistake to think that other countries are not changing. and as they change, we can't with an economy as commissions frisk they leave behind. >> time for just a few more questions. >> good evening. my name is ashley. on a university student with a question on the carbon tax. the community criticized australia regarding our treatment of asylum seekers. comparing to the rest of the will we take next to no refugees. it's 2% of the world's population of refugees. with this in mind and the fact we are talking about people's lives, not numbers are what the government implement cost efficient processing on shore and the most humanitarian thing to do? >> well, they do -- we do process asylum more quickly and

efficiently than i think in the past so that is whether someone is a genuine refugee. but i think we've learned something about this past period about the risk it can take on their journeys and about how many people wind up buying as the result. so we have a different view about what is the most humanitarian approach in this circumstance. the most humanitarian approach i think is to try to deter people from making those journeys so that we don't see people live their lives and that's why did you think we need effective programs and why we continued to advocate the arrangement because the advice is the would be the most effective deterrent. but i would worry about and it seems you strongly believe in what you just said what i would worry about is what you just

said that we would see more and more people try getting on a boat as a result and we would end up seeing more and more of the dreadful tragedy is we don't know exactly how many people have lost their lives but we know it is a large number of people, some 60,000 mechem 80, 90 some of them women, some of them children. >> thank you. >> good evening primm minister. i am a small-business owner. question on afghanistan. the other day we had a funeral here for the 53rd killed in afghanistan. today there's nearly 3,000 people being killed off through coalition, 2000 from america, former for under 50 from the united kingdom. has it all been worthwhile?

>> having been to the funeral saturday, and when we go through that kind of loss it's obviously for the family. they are the ones that have the toughest circumstances. but for all of us - when we year that we look to soldiers and i've had to deliver that news to the nation a lot of times, so i know what that feels like and i know what it's like to get that call and get david smith on the phone at night and if he brings that late it is only for one reason and i know what that feels like. and every time i've had to reflect is it worth it and come to the conclusion it is. we went there originally because terrorists who had been trying

to clive's and put in australia and 9/11 elma and terrorists to costly in lives in large numbers and bali and we will commemorate the tenth anniversary of that later this year. when that is happening and will continue to happen that they could try to come and to ghazaliya they had an obligation to make sure that afghanistan wasn't continue to train terrorists. and we had an obligation to our ally, the united states, given the huge loss of life they saw on 9/11 and all these years later and i know it's been a long time and we've lost a lot we can see the end of the mission, we can save the time that the bulk of the forces will come home. we can see the time when the afghan national security forces will be able to provide security in their own nation.

that's my answer. you might have a different view, and i can understand it's one of those really hard questions very reasonable people can come to a different view but i'm very confident that of that view to we need to see the mission that we run through >> this gentleman has been patiently waiting. one more question before we wrap up for the evening. >> give me evening prime minister my name is michael. if the cabinet is successful and the emission is controlled there are various ways to store carvin plants being the fastest way. do you have any plan to actively increase? >> that's a good question and

i'm glad you asked it because if neglected that all evening to really speak about to parts of the carbon which goes directly to that. one is called the carbon initiative by changing their land management practices can actually draw carbon dioxide out of the atmosphere and we are creating an income stream new way of earning money and it's tough being a farmer and good to the environment because it's getting some of that carbon dioxide out of the environment and being stored in land and there's also a fund, a billion dollar fund, which about the three precious environment and the devotee of our environment to act as the kind of longs for

the planet and began absorbing carbon dioxide so very important measures in the carbon pricing package. >> thank you, prime minister. we do appreciate your time. did anyone change their mind tonight after sitting through an hour of explanations about the carbon tax? make sure you fill out the questionnaire on your way out and we will bring you the news later on this evening. thank you prime minister. [applause]

it's more of the internet phenomenon or a movement. many different people collaborating together online to protest against all sorts of different reasons and also to harass people for fun. >> one of the fascinating things about the olympics i think has been -- and i think it will be really interesting for the media, the people in the media industry to understand this change the we are going through from a filtered out side view of

the event where there is a broadcaster and the interview michael phelps before or after the race and you get this kind of a linear progression delivered to you in a certain way. before and after the event you've got this very much on filtered inside out of view of that even from the participants and people who are at the event even some of the participants taking a photograph of the guy three lanes over. >> it's worth feeling sorry for the folks which is time delay and with lots of ads and feature stories and wonderful narrative's of how the athletes and personal stories and so forth. there's an alternative narrative which is watched the olympics over twitter. >> you can watch this discussion

starting 8:30 eastern five pacific on c-span2. >> the institute of the discussion about protecting marine and endangered marine wildlife. witnesses from the coast guard and justice department talk about the funding and logistical challenges in protecting different species. this is an hour and 45 minutes >> i think we are ready to get started. first i would like to welcome everyone in the room, everyone that is calling in ever since the teleconference line, everyone is watching the lie of stream today. i am the deputy director of the ocean pergamon a staff attorney here at the environmental institute. if you're not familiar, you are either in the room and hopefully becoming more familiar with it but we are a nonprofit environmental policy research outreach organization, and we've

been here in d.c. for over 40 years and we work domestically and internationally to strengthen environmental difference. the seminar today as part of the ocean seminar series every year we host a series of seminars to highlight persistent the merging ocean and coastal issues and we bring together panels of experts to discuss the show the injustice and potential paths forward. this is made possible by the generous support of an account foundation we would like to extend our gratitude to them. we are delighted to welcome you to today's event. this is actually one seminar in the series focus on critical issue of ocean and coastal law enforcement. the sun are posted a couple months ago focus on fisheries enforcement. today's seminar focuses as you are aware protecting the marine species and its third seminar will take place next month and focus on water quality protections. if you have any questions about

them please visit our web site or contact tester ackley or join in the mailing list for any questions. before we get into the substantive part of the section i will just get through a few logistical notes and one if you need to leave the room they're both down the hall and the keys are outside on the front desk. second, if you have a cell phone and wouldn't mind turning off the wringer we would very much appreciate it. third, for every one that is listening or watching if you have any technical issues please contact marcia at mcrumin. as for the format of today's session we have expert speakers today each one of them will give introductory remarks. after that we will have a few questions to pose to the panel at large for discussion and then open the floor for questions from all of you for watching. if you are in the room we will ask you to stand up and ask your

question and if you are attending remotely please e-mail your questions to the same address mcmurrin@eli.org. with that we will turn to the actual topic today. in forcing protected species lives in the marine environment. we have a complex statutory regulatory framework for protecting species and the oceans and the coast to the statutes in the endangered species act there are many others talking about a national marine sanctuaries act and other places regulations or something like a lazy act. today's event looks at how those are enforced with a designed to restrict harm to an organism or habitat that depends on this compliance with it. finton sharing compliance with at sea and land this difference. these are used to detect and ultimately to lead the tour

regulations of the protection. u.s. agencies tasked with these enforcement measures include the fish and wildlife service, the department of justice, the department of state and others. today we are bringing together current and former members of several of these agencies as well as non-governmental organizations to discuss what has been the challenge is, what are the current efforts and how can we move forward and strengthen the protection and enforcement remark. to discuss these important issues we have four speakers. our first speaker is steven tucker from the u.s. coast guard, deputy chief for the marine species in the coast office policy living resources division. a division he's held since 2008. he represents the coast guard on a task force and is a participant in the marine protected area federal what size

of a committee and the working group among many as to the to various other roles. prior to the decisions of the coast guard he worked in the coastal reproduction in england. mr. tucker will begin the presentation by assessing the marine protected species enforcement program including its structures experiences and key challenges faced. the second speaker will be mr. tracy dunn, acting deputy director of the oceanic and atmospheric administration's office of law enforcement. he's been a special agent for over 22 years from putting enforcement with an emphasis on complex civil and criminal investigation. during his time in the phill commission was instrumental in setting up the first joint enforcement agreement. after leaving the field he can the deputy special agent in charge of saint petersburg florida where he managed programs including emand cooperative efforts that effort. mr. dunn will discuss the noaa

office for protecting the species from work focusing on their work and the endangered species act and the marine mammal protection act to read our third speaker what mr. john webbed feet to a webb of the internet national resource division in the u.s. department of justice. he sits at the department from 1986 until his retirement last year in the nation's expert on domestic and international wildlife crime enforcement. among many other achievements he developed innovative prosecution methods, cooperation and federally and state wildlife agencies, increased international cooperation and multilateral wildlife and for some efforts and promoted awareness and proficiency in prosecuting wildlife cases by u.s. attorneys offices. today mr. webb will address the white-collar crimes to be used in addition to or in place of environmental laws. finally, concluding the individual presentation will be

mr. phil kline, the senior ocean campaigner at greenpeace u.s. and is a recognized expert on the ocean policy and an active proponent of conservation and successfully lobbied in support of system will fisheries under the stevan sect and was instrumental in the reauthorization in 1996 and 2007. he's represented the international commission meeting a western central pacific fisheries meeting and he's also a founding member and former board member of the pacific marine conservation council and currently serves on the board of directors and is the co-chair of the marine conservation network. during his comments he will conclude by discussing the role of ngos and implement and enforce that of the protected species framework in putting litigation under the species at risk on which they depend and sometimes the uncommon partnership to develop along the way. we are delighted to have all the

speakers here today to speak with you and without any further delay will turn it over to mr. tucker to begin. >> thank you. i would like to thank you for convening the panel and to tell a story. looking forward to the conversation. succumb to talk about the coast guard activities i think it's important to look back in time. the coast guard is an agency that has evolved and has come together since 1790 and it's been housed in a number of different agencies and it's worked under the auspices of a number of different administrative frameworks with their own set of goals. one important thing i hope to hit is the coast guard's consistent attention focused on the marine sources and green protected species getting back to the times they were not quite depleted yet.

going back to the 1800's shortly after the formation we understand there was a great deal of pressure on the marine mammals particularly of in the north of alaska. and we approach that task by using the touchstone from alexander hamilton. if you see freeze like the for inclination might be but the nexus is the species are protected are subject to harvest and extraction and basically the raw materials for the coastal commerce and the coast guard's ensure the duties are paid initially. that transitioned not too much leader around the etds. as pressure increased at a plant in this example, the population

the coast guard's for transition somewhat. we became aware of the consequences of some of the season the northern latitudes of the drawdown in the biological resources caused by a number of nations competing to harvest as much as they could for their own use and the uss telstra claim for some of the most corrupt if grounds of alaska. the coast guard at that point was this dispatched come and as early as 1892 and really prior to that the vessels both american and foreign flag that were acting contrary to those protective regulations. a few years later in 1987 the fisheries commission now noaa took steps because it was

essentially decimated. so it is an example of a parallel or corollary between protected species that are not fragile, vulnerable, depleted from what they once were and the current model that is more commonly understood as commercial fisheries and they're commonly being heavily utilized and managed to resist an objective that sometimes falter on the side of being over. moving forward in time to 1930's, 1940's many national externalities' affecting the coast guard rules but one of them was acting as a representative of the government in the primary enforcement agent for u.s.. coast guard officers were installed on the vessels and they went for more than a year. they collected biological one

frisian about the methods of harvest and documented any circumstances that appeared to contradict the controls or the u.s. regulation for commercial willing. it was the apex for the primary a sample of that type of work from 1937 to 1938 and compiled an extensive report and really helped turn the tide and enlightening what unfolded and whether the practice was sustainable or not. jumping forward a few decades to today. when we entered the endangered species act the policy act was adopted a great deal of attention was directed towards the habitat and more species became enlisted as the numbers dwindled. let's look of the coast guard addresses the challenges now

from an organizational perspective. a number of authority is the most sweeping of which come from our authorizing legislation establishing the coast guard is the principle u.s. government. they also cited specifically the endangered species act as an agency that enforces the provisions and notice as well the training or the terminology used as the secretary for the department of which the coast guard is operating that is fairly consistent through much legislation that addresses the coast guard because the coast guard is the conduct to the context. the change was moved from agency to agency and host to host over time. but again there are some things that carry forward throughout period. the coast guard has 11 stitchery missions that can be grouped in number of different ways with their homeland security missions form of homeland security but still supported by the coast kurd and carried out by dhs and this example the vendor but

under free passes we take to heart in terms of prioritizing our operations. safety, security and start shipping. looking at the office specifically within the office of enforcement policy is comprised you see the statutory missions and other law enforcement as if for some of the boundaries and safeguarding that from incursion and fishing from a better nations or registered vessels. enforcement captors of the domestic activities including as you see the marine protected species. we have an and doctrinal purchase some of our work we have instructions thus goblet requirements regulations that fit our expectations for how one engages in this work and the

protected resource is one such document and a double the growth rates and a structure we can address the headquarters level and a very broad sense still have a degree of recurring other day where local concerns of the district level are accounted for in the district compile a program in the form of a plan they addressed specific species that may be of concern. there's an enforcement concern or something requires a change in operational recalls and the plan for that in advance and establish a trajectory or road map for how that applies to the enforcement effort is available to address threats to that species. ocean stewart as the capstone document that's basically a statement fedex assigned by the, but back in 2000 and sets forth the principles how they come out protected species and their habitat. as you can see these are broad

sweeping standards that are not very operational. in practice how we undertake this work is shaped by the challenges the are inherent. it's a fast surface area 3.6 miles is a dispersed group of users out there some recreational and the taken point from the perspective is that regardless of the amount of effort dedicates the protected species issues specifically we have to expect and encourage, to compliance. there's too much area to expect we can fully monitor and interdict and preclude violations of the species regulations. our actions support management

regimes and that it contributes to broad goals to conduct the authors activities as in the interest of a sustainable resource it's not just to go out and catch a particular violator or the fact that we've had in violation as a result of that our marching orders to the law officers include for the program and fisheries service and to share expertise what is likely to work best from an operational perspective. we have to apply these forms of players to cover that area to try to have a presence to make sure there's an understanding the coast guard takes these accountability cerise leave and the coastguard may not be in plain view of all times and leverage partnerships to work with expertise thamay be

greater than a particular species were characteristics in the defined areas and to work on the strategic communications and that involves not just news releases are telling the world when we do. it involves being a strategic and saying how we freeman message is consistent with our partner agencies so it does support the broad goals sustainability. to give an example some of the activities we can engage in these are the bulk of the coast guard resources enforcement activities occur at nautical miles. the coast guard has a strong presence inside that founder but i'm talking about the activities that are managed by the resource program that tend to focus on activities that on fold not site of three nautical miles south of the occurrences such as this or some partners in this network with the dissenting moment has a dual purpose.

number one of responsive for the charge in endangered species act that the use their authority is in the number to there's a potential crime scene. it is possible if animals are acting here if the garrison to noncompliance with regulations there could be additional fallout that takes place so we have a role in the circumstance such as that. additionally something that we encounter in the course of normal operations in the field something that is actionable in the waters is the guidance or regulations that will protect and safeguard the mammals from curious onlookers or commercial whale watchers were commercial setting to the fishing. that is a challenging role and one that is in fact they may not understand or be aware of the protections in place with the standards that are there and we may encounter people that are aware of them but chose to go for deliberately. the challenge is how do we

prioritize our effort we put a great deal of effort and resources into activities that are rarely seen not in the open where coastguard vessels are not in cuba are likely to catch somebody and we put a high degree of effort in track to redo it activities visible at the time there's probably not the violations we are witnessing but yet the broad affect may be that there are few violations overall so that's something we have to make a decision on based on local concerns as well as national priorities and we are undertaking a study now that simply going to shed light on how that question unfolds in different circumstances, what are the protected species. this is an example from some prior work it depicts what could be the latter case of somebody that may know the regulations and may choose to act in a better manner any way. this is just a small-scale fishermen choosing to fish

basically. there's a campaign for a short period of time because his year is a violation to the marine protection act it's not anticipated to cause mortality so it's just something that shouldn't happen and from an agency perspective the fact someone was able to capture these pictures folks for doing this and plan to speaks value we have additional work to do out there. so that could be an example of the 2% if there is a sort of general rule of thumb not used for professional decision making 2% of the actors out there probably intentionally drilled and do something that is deliberately contrary to the regulations. the other 98% in the field accidentally in compliance be there's a social contract they think they ought to do the right thing or they have an economic interest so we are to support all of that rather than just cannot and appointing regulations in the field.

a nearshore activity provides a limited area in which to apply a very specific regulation so that's a very easy enforcement package for us to address when we have the resources to get out there and will work well put a flea with federal officials to do so. and a question that comes up from time to time regardless of this long history and the involvement going back to the antecedents in the 1800's is why i do this. for many of us here or watching and anticipating as probably self-evident one explanation deserves a little boxter commentary and that's because we always out. i'm prone to rail against that, and going forward and doing something in an on thinking manner as objectionable but in this case i think it is a different application this is carrying forward of different activities and attention to the nation's natural resources so i

think that is important from the cultural perspective. finally, this is the coast guard say and we take this to heart this is part of what we do it's a small facet for those 11 missions tasked with but it's we are to go out and take care of the area that we operate in and acknowledge by protecting the species and assist them if they are in jeopardy we are working with them and have to be extremely careful. we understand that and we take this to heart. >> thank you very much. >> questioned? >> i apologize for her calling an expert. we have an expert players chosen to do the job. i will do the best i can. it's kind of a frankenstein presentation i started pulling in from everywhere could so hopefully we have some kind of

flow. i'm the acting deputy director which means i still have training wheels on so we will work through that. our brand new director ensure a lot of people are aware we've been through a change and i will get into that in a bet. now which button do i have to push? just a little bit of laundry this is where we are located all the way down and noaa under the national fisheries service, but we have authority to enforce law for all of the noaa offices so that includes sanctuary. our structures we have six divisions with a special agent in charge and each one and the maker of investigators and officers. our mission if we have one -- there we go. we are the only dedicated

federal law enforcement agency so this is our one and only mission, and we take it to heart but we have to act as subject matter experts for other people that do this. they can't possibly stay up with everything we try to help him out as best they can. the tools jurisdiction and work with our state agencies. we have the highlight of the ones we are talking today looking over there but i have to keep track. then our jurisdiction for the number of people we have this similar to the coast guard and it becomes quite a challenge, so obviously we have to partner. obviously we are fairly small. we can't do this on our own sweet to work a lot with the coast guard. as mentioned they are considered the enforcement restructured our enforcement more for a land base

but we have spent a lot of time sharing that wonderful ride with them. the way it works is it a success lowercase that can be handled directly the coast guard will deal with that. the have a fisheries training center that will help process the case and they send them vertically to our office and we process it and then if they run into anything the requires more work they contact us and we will send an agent down to try to take it from there but as was mentioned they are a multi - an agency and again cannot always be where we need them despite everything we may try to be as we have turned to the states. they've always been deputized with us but what we did before if they did a case we tried to figure out how to get them reimbursed. the was very difficult. we in that setting up a joint enforcement would work and pay them up front which has worked very well for us but now we have

a patrol force that again this is what they do for us and they are doing that job in the ways we have the federal mission and of course there's a lot of overlapping interest. real quick i will get through them. same sort of deal layers of this to handle the minor violations those are very important regardless. small fish are if they get up can be every bit as important so don't get me wrong but we ask if they could to come through their state court. state courts are handled better but if they have bigger cases then again we send an agent down to work with them and their investigators. a very fruitful relationship. getting into some of the changes we are going to make. normally we had just investigators because the coast guard campbell of the patrol we

were able to stuff to early investigators. years they've recent program that cannot mononuclear that needed to have more enforcement officers and there is a need for them. we tried to increase that program some time ago but the funding didn't come through. what they would do verses with the investigators to their validity to interact with the enforcement agreement partners who do the petrol and now we have someone acting directly with them and they would help deal with compliance measures on educating the public on the fisheries and hopefully we get a better deterrence and we don't want to be dealing with an intentional violation any way. so as we increase the number of and for some officers and our staff and they will be taking on those measures. wanted to get into what they would be doing for us. again the same sort of thing is the coast guard would be doing

dealing a lot with the enforcement. we just had a huge effort down in the gulf of mexico. we haven't been able to put a lot of hours into that and obviously we had some large stranding efforts we've dedicated a lot of people to that and it's made a huge impact if you bring somebody from enforcement even if it is in compliance mode people want to hear from them. we have had a lot of experts doing wonderful our reach if enforcement person was there they took the at fais and went about their business but we have seen a huge increase so that is the goal is to get compliance. it would be dealing with marine mammal harassment and we need to put people on the scene to be visible so we have a few bad

actors so we deal with that and it's just like feeding. we have to do in actual patrol to keep people in check with feeding walls and what not. the north atlantic white wheels thus these zones we worked closely with the coast guard and we were able to deal with the that directly. we have agents dealing with it but it's something enforcement officers can do but we still work through a large numbers of cases and we are seeing better compliance with the industry now that we've been able to apply outreach and that brings us to the agent rule which is sets us apart than the other agencies working living marine resources. the coast guard as a petrol

service which is what we need not enough people to do that we can never cover the ground we need to. but with that as was mentioned when you have a patrol boat on seen people are going to follow the law if you see a police car everybody slows down and we know we have that same problem with people who do not so we have investigators that will look at things more complex and our new regime of staffing we see this as a positive. these are a number of positions we have that they will be more dedicated to that and that is with that statement looks that we understand the investigators are still important you have to comply and cultural component but we still have to have the investigators to get the dedicated poachers. those too large and that the

federal training center just like every other federal investigator in the system except for fbi and dea so we did that seem transcend the marine law enforcement trends of the understand a little bit about not everybody comes from a boudin background. i spend two years as a navigator so i had a better leg up and a lot of them do not have that background so we give them that the image of the sector and that brings them up to speed on the fisheries, regulations and what not and then from there it really is on the job training spend time in the industry and learn from those people that help us out within the industry and you hear this a lot there are a lot of people that like enforcement and want to see that. these are the ones following the law and what we do is protect their interest as well so we get a lot of support from people in the industry. our investigators country advanced training. they get investigative training, interviewing which is our bread and butter investigators should

be able to garner more information than the average and for some person and that is what we train them to do not that the or not trusting the they want now to ask questions to get to the bottom of it. fraga training programs and what not. so the role as the complex scheme, in port scheme and what not and a lot of the smuggling techniques are used. so it takes more training to get somebody ought to that speed. both rules are extremely important. investigators are highly trained as far as the certain aspects the petrel function is still deeply important so we look at major violations of the investigative side, large scale poaching fraud and smuggling. a lot of these things d.c. with endangered species come to smuggling they are trying to hide that product.

another violation you can see we have a couple protected resources. if anybody wants to talk about that afterwards that was an interesting one. i won't bore you with details right now. what i did this went through the website and pulled that some of the press releases to show the work, the end product of what an investigator will deutsch and this will segue into what mr. webb will be talking about so as you can see this resident was importing endangered and threatened species and some of the sentences i'm not worried about the sentence as much as the fact we were able to get this and criminal court and his actions were criminal we have a lot of dealings were people have what would be a civil violation but by their actions with us smuggling, false statements, false documents the ticket in the criminal realm. this was interesting again down

by the saudis and nobody can argue throwing a bomb at adolph s. the right thing to do so this was a good thing. atf like that at the bottom of the people we work with because normally we don't do these by ourselves we are small and normally have one investigator in the area when i was in the field so the only investigator in south carolina, and i'm not sure if that's because nobody wanted to work with me or i was just that good. wherever we can bring other people into the mix, we are glad to have them. so to this one, told a protected surgeon overseeing but when you're on probation that means they do anything wrong with him a year they will be going right back before a judge and that never works out well for them. thought i had a few more that's fine this will work out perfect to we wanted to put a plug for the crime museum the of the

display on our efforts and everybody's efforts so i guess that's been extended, too. that's it. i put it is for talking so fast. i didn't want to get an elbow in the side. >> good afternoon. i don't have the power plant so you'll have to listen. i naturally going to try to talk a little bit about the work the department of justice does which i did for 25 years as a prosecutor and what item titled the presentation this the white collar crime supplement to prosecuting environmental crimes because quite honestly a prosecutor today who prosecutes an environmental crime is as likely to reach for the general crimes title 18 brought on the shelf as they are for the conservation statutes in title title xvi and i will explain why that is the case but i dillinger

reduction i wanted to read. crimes committed in the internet protected species are prosecuted by the u.s. department of justice using both white-collar economic crimes and specific unfair metal fences. the term poaching while that is still used as heard less frequently. instead prosecutors are likely to reach for their copley of title 18, the crimes volume of the united states code as they are for title xvi which addresses conservation. no harm no foul is not a defense nor is lack of intent to commit a crime a defense. conduct interfering with of the legal process can be culpable and can be prosecuted when no harm occurs either to the marine species or the environment. you've got to be assured of one thing. the united states is a jury hostile place for people who commit environmental crimes, and

that hostility actually began back in about 1978 when president carter sent an environmental message to congress saying that now that we've enacted this new treaty endangered species in florida we have noticed a sudden spurt if you will in the smuggling of these rare and valuable animals and the smugglers themselves are members of organized crime who are using techniques sophisticated enough to avoid our detection practices. we need to have a country as prosecutors prepared to fight this organized crime effort and that was the genesis in the department of justice fought crime to the in the department of justice and the environmental crimes section there are as many as 15 or 20 prosecutors prosecuting environmental crimes

nationwide. among the u.s. attorney's office scattered through the united states there are prosecutors who work full or part time. u.s. attorneys of miami have a dedicated staff that does nothing but environmental crimes including crimes involving species in the marine environment. that's the good news. it is a dedicated group of prosecutors out there who are experts if you will and will law applies to read the white collar crime supplement was developed to recognize the shortcomings of the current environmental statute. the shortcomings of our based upon one simple fact for the most part the statutes that we are enforcing do not have strong criminal provisions. the punishment provisions are politically weak. we have an endangered species

act that we use to hopefully turnaround is a threat of extinction that animal's face to the punishment we can expect on the statute is just a misdemeanor. the punishment is one year in jail and the maximum fines are significantly smaller so we don't have a really effective tool in order to deter and punish which is one of the ways that you want to be able to address this kind of crime. the department of justice put out in a united states attorney's bolten back in december of 1999 a statement of the white color supplement is a necessary addition to the portfolio of environmental prosecutors and the article is entitled many tools and good results. the important cases part of the title address the fact that

environmental prosecutions are important. we've gotten over that hurdle long time ago at the department of justice to wait many tools and the recognition to the environmental statutes that congress enacted described very generally here in a minute or just one of the hours if you will that we could file violators and the white collar crime supplement was also available and we discuss it in great detail with the opportunities were to have gone to the portfolio that a prosecutor and the last, good results. the most dramatic change that took courage occurred in the 1980's with the enactment of the sentencing guidelines. the sentencing guidelines that apply to wildlife law were prepared by the the part of justice and approved by the sentencing commission.

they now enable us in many more cases than before the guidelines to get major violators incarcerated so they're now is a tool judges, prosecutors, investigators have that is transparent determining what are the factors the court is supposed to address to determine the severity of an environmental problem. and all those factors present in this case. guess what? if the court is looking at the factors to determine what the sentence is, instructing investigators when i'm a prosecutor to look for those three same conductor investigations. i'm going to get into the supplement and the second but what we talk about the two or three statutes that are used better title 16 offenses. the first one as the endangered

species act to the in danger species act has a misdemeanor penalty it's not a felony violation to violate the statute, it is loaded with effective management enforcement tools. i wish it had a stronger punishment but let me give you an idea of some of the things i was capable of doing which are all incredibly beneficiaries to the enforcement efforts in the marine environment. first of all it said robin to take should, kafta, collect so it includes in the definition we could call the attack the incomplete event. a great language and the fish and wildlife service have expended on the definition of what it means to harass or harm, and it's a very powerful taking

that can be used on the high seas. and commerce what happens when animals that they've been harvested a legally and that any foreign country and are bought and sold and other sellers are u.s. citizens to as a definition that actually allows the u.s. government to prosecute u.s. citizens could conduct occurs in a single foreign country whether buying and selling animals that have been in the environment and are protected by the endangered species act, as we have a great foreign commerce provision that hasn't been used but it's there and all we need is the appropriate case, and there will be 11 day and we will be able to use that reach in a foreign country to prosecute a u.s.

citizen. the broader regulatory authority the statute has creates criminal offenses. what i mean by that is when you look at how congress, the agency's implemented the endangered species act provisions that apply to shrimping in the gulf of mexico and what they are able to accomplish using the management tools of the endangered species act they have a full-blown program to protect sea turtles. it's not just the actual taking of sea turtles that can be criminally in first but the failure to comply with regulations on how you set the nets and are you harvest all of the management tools that were reduced to try to reduce the sea turtle mortality during shrimping that also can be prosecuted in the endangered species act gives you a prosecution tool not only for the actual taking of an animal

but for the violation of the management tools that were used to try to reduce that mortality. it is an incredibly powerful tool to have. ..

these environmental statutes, you have to ask yourself a series of questions. what animals are covered. what conduct is prohibit? are there permits available to thors what otherwise would be prohibits conduct. were they effective? if not you have to look at oh exceptions that applicable. prosecutors, these are different statutes for prosecutors will learn. let me tell you that ever prosecutor gets involved in the environmental case, at some point if they are using endangered is flustered by the complexity. that's why another reason why they give a little bit more comfort to prosecutors who don't routinely handle the kinds of cases. no ore kinds of the endangered

species act. someone tell me when i run out of time. >> i will. weak no punishment. >> we have to show the conduct was submitted knowingly. for years we had a number of cases that said no one required us to show that someone was awared that particular animals were -- there was a question this was a wolf. cooler on it. it was killed. the defense was raced at one time, they didn't know what it was. we had a series of appellate decisions that the united states does not have to know when kind of animal they were killing. which can be important in an machine environment. we have a direction come from the solicitor general who is responsible for all of the appeals of the department justice that said, well, even

though we won the cases, the better read into the law is that you have to be able to prove awareness of the biological identity of the animal on the part of the defendant. what that simply meanses is that we have to be able to show that the defendant was aware of the facts substitute the offense. that's what knowingly means. one of the fact is the identity of the animal. before we said they were shooting at animal it turned out to be endangered. it was sufficient. now they have to know they were shooting at the wolf. >> we can get around it. i will won't tell you how but we can get around that. [laughter] i won't get into this in great detail. this i can't. this is one of the area that the imprement tab best inadequate. they have a whole realm of regulation of species that are introduced from the sea, but you

try and ask people around the federal government about what are the% for these and how is it enforce and it's really been languaged. and so if you're thinking about one of the areas that is inadequately addressed by most of the federal agencies, the introduction from the sea requirements societies. and i've never had a sea case in twenty five years. that'll give you an idea about the lack of focus in the particular area. the society enforcement, l.aally one of the things that was done there was a possession probix they bring how the illegally and possess them illegally. it's a possession violence that say as long as you continue to possess that and come into the united states. lacy act, i don't have much time

but the act keep in mind the act allows us to have a felony punishment scheme we have illegal importation and knowledge that there is something wrong with the wildlife. the person we want to prosecute has to be aware there's taint associated with the life they're dealing with. the real interesting part about the lacy act also has a false statement. it's unlawful to make or submit a false labellization of wife life that has been or continues to be transfort of commerce. it you bring wildlife into the united states and you lie about it. p. we have felony false statement. for those familiar with the material yaity. it doesn't have to be filed by the government. you can keep it in your books in your office. if the books are false, and they

are discovered, that can be the basis for a prosecution. there are also state landings laws. one of the big areas for marine protection are state landing law. that's underutilized as well. we can force them through the lacy act. generally the lacy act has no exto territory effect. can't apply it to somebody overseas. like i can't for instance apply it to u.s. citizens who conduct trade in moo rain ma'ams. and magson act. i won't talk much about mfpa. in my twenty five years if i had throw or three years that was a lot. the mmpa is poorly drafted.

it has permits that are available or permission without available without the person having a permit. for a prosecutor it's difficult to put yourself in an mmpa prosecution because the uncertainlity about learning whether or not it's unlawful. you have accept as permittedded. i have to show the doesn't have permission. the burden of proof is on the prosecution to show lack of a product. that's true with the endangered species act. there's a much better system in place that allows us to say aye, or no. the marine mammal protection act is infrequently used. it's a rarity a rare

prosecution. lastly, punishment. make the criminal pay. one of the big developments right now to the extent that foreign countries are involved who species may have been taken in violation in the marine environment. there's a possibility for us to get restitution for foreign governments incoming state governments, i would assume in the united states for the loss of resources. and we have a favorable opinion about that from one of the apellet courts in the united states. complicated issue imagine we can now restore some value back to a country who'souses enter exploited and get the money from the defendant. now one of the white collared crimes we're using now. we're using the conspiracy law. 371 basically we're looking at

more than one person involved in trying to commitment the crime. anwe're also looking at the second parking less frequently used simply this, it's unlawful as well, to, and i wrote it down. unlawful for one or more persons to effect the -- excuse me or to defraud the united states, and the defraud is important. because it doesn't mean the kind of fraud you're thinking about. interfere with government functions and so it's possible you can have a conspiracy without a crime that they're try to be commit as part of the conspiracy. the conspiracy can be conspiracy that are fraud. it's a concept that has a lot of

potential development, you know, it has a lot of legs. you do a lot of things there that will be used for. we use it in the environmental pollution arena. the next thing i would bring to your attention would be false statements. right now there's a case involving a feeding of a marine mammal, a whale, out the west coast out on monterrey bay. the prosecution involves false statements. faults states are part of the prosecution, the feeding with vessel getting too close to the animal. it's a small part of the prosecution, the bulk of it is the false statement and lastly, the one area that you need to look at. you need to read it when you get out of the room. is 18use1519. on obstruction of justice.

if you destroy evidence that is used in a basis that's not been done yet but you can be prosecuted. it's a powerful tool are they are beginning to explore the parameters on. these white collared crime supplements are as likely to be the statutes under which a defendant who really committed an environmental scene of the crime is prosecuted which you would have thought would have been pry the mare statute used to prosecute the case. thank you. >> thank you very much. >> okay you're not getting a lawyer now. [laughter] or a powerpoint. the endangered species act and they are effective in politicking marine mammals.

and they have much more penalties than magson or some other laws. they don't have criminal penalties of putting the person in jail. they certainly have we can take away the permits and file a lot of money, take away their boats, restrict their activities on the ocean. it's more than the cost of doing business. i don't think i can say that for magson. and two of the reasons why they are successful and well-used law one, is the high level of monitoring and enforcement we have in the u.s. the cost guard do a good job considering how big of a job they have to do. and the marine community, whether it recreational or commercial is really gossipy. and they have lots of trade papers and now the social

media. if someone gets busted and prosecuted in nefngd someone will ask about it almost immediately. there's been some cases that have been violated closed areas and forth by vms that made the whole vessel monitoring system for fishing fleets around the country and make it possible for us who have marine sanctuaries and reserve that we can be confident that i things are going well. you have the occasional sneaky criminal. it happens across all kinds of things. environmental organizations have used both ps and the mmpa usually through litigation, but for getting enhanced protections of marine mammals oftentimes it's when we actually don't think that the government is implementing the laws well.

so i'm going to just run through a quick example of some litigation on sea lions and the endangered species act that highlights the strength of the law and some of the weaknesses. for the most part, these laws don't have a lot of exceptions except they actually do. [laughter] especially if you're a special interest and has a lot of influence, and i'll get to that a little bit later. the sea lion case has some interesting twists along the way, and it shows how through extended litigation, things evolve and, you know, strange bedfellows development, et. cetera. and also points to who really

has the final say on this. and it's actually congress. they made the law, they can change the law, they can give exceptions to the law whenever they choose to. you have to get them pissed off enough. in naight the stellar sea lions were -- it's true the islands all the way down to california, and under the endangered species act. you have what are called reasonable and prudent alternatives that are mitigation tools to put in and try to stop whatever is causing the species heading toward extext. unfortunately it doesn't require rebuilding pop rations. it requires you to not let them go extipght. so the they were considered one

stock. rrgs pa were put in a critical has been at a time. the endangered species act is a good tool to use to protect broad soil and water assessment soil and water assessment -- as a toll protect a functional chunk of an ecosystem because the critical has habitat that comes along with the law. so they are list the as threatened. fisheries closures are put in around rook i are, critical has been at a at a times designatessed, and then we have another biopen come out in 1997 was a extensive look back at. the science had progressed and the agency had determined that the sea lions actually had two distinct population segments in the eastern population and the western population and the

western population is basically the islands and the eastern population comes down to continental u.s. it was from dna investigation and we're getting more science involved in species identification, and finer resolution of distinct population of animals that really is coming into play and salmon and other things that you see. but the critical habitat designation really gives a broad tool for protecting chunks of ecosystems probably all of you have promoted the spotting owl case we have thousand of forest that oversite protection. the sea lion is a hundreds of square miles of protected areas for them. biological opinion, for the

first time, found jeopardy in adverse modification because of the removal of pollic from the fish fishery. it didn't sit well with the fishery industry. the pollic and at that time had one of the most powerful champ champions for the continued status quo and senator ted steven who was chairman of the appropriation committee, somebody with lots of power. in this the biopen that came out with the adverse modification and jeopardy find forget pollac fishery it didn't look at and talk about the mack really a and cod fishery. at that time it was more about internal politics than it was about a bilogical imperative to look at everything.

when '02 dealing with a dollar fishery there's plenty of politics that can be financed along the way. one thing that was came to light was that the fishing effort had increased to the highest levels in the prey field forging areas that had also been designated as critical habitat for sea lions even though they had implemented mitigation measures previous after the 1990 bilogical opinion. in 1998, green peace and american ocean campaign stepped up and filed suit with both esa and knee pa claims that government had not given -- needed under the endangered species act to the sea lions. 1999, another new bilogical

opinion was put out, and this one, again, found jeopardy and adverse modification for the poll lack fishery and nothing had changed. there had been no changes in the water. for one of the rare instances. i don't know if it was the only instance, but we were able to actually obtain an ab junction to stop all. said, hey, the pesky environmentalists have stopped us. we feed some relief.

and when you're claim of the appropriations committee, and it's actually appropriations season and your last appropriation bill on the table and you're chairman, you can put in a writer that does just about anything you want. this is when we saw ted stevens put in an writer overroad the endangered species act and gave the authority to the north pacific counsel which is dominated to write up their own reasonable and prudent alternatives that would be adequate once they put that in place. plus, there was a first $30 million of our tax money that senator stevens dedicated to increase science to find out more about the sea lions. the ones they pick proved it had no effect on the sea lions.

it wasn't too long after that, and this the council's reasonable and prudent alternatives we had a lot of pet names for the at the time. i'll call it counsel of rpas, and so remember this, that they got a free pass because of steven's to implement what agency had drawn up as mitigation measures. so the judge kind of has hands are ties. said i want to review the effectivenesses of this. i'm going need another biological opinion after the few years. and we'll see what's really going on. and so he ordered another biyop to be down in four years.

there were a lot of delays and drafts that never see the light of day. i'm sure some people saw them and this is what caused the delays, at any rate, we finally had a new quite comprehensive lie logical opinion issued in 2010. in this biological opinion, not only dpt pollack fishery still take the lead in a jeopardy adverse modification call, but the mackerel and fisheries in the western were also indicated. so this and the agency had a strong rpas for protecting stellar sea lions they were going to close the fisheries so they wouldn't catch the fish the sea lions needed to eat for

food. this was what a leading scientific hi pot sis was pointing out and still is. you can imagine the industry response on this one. they immediately when they released biological opinion, literally within days had called a special meeting of the pacific meeting counsel to discuss what we're going to do about this, and jim, the regional administrator for noaa and the region got out in the press and said, well, of course we're going take our lead from the north pacific manage i ares could believe because eight years previously because of the writer had stevens had manipulated they got the authority do that. stevens left the scene and they didn't have the authority to do that. and secretary, for the first time, step about a week or two after he made the decoration and

said we are supporting the work of the scientist we are going imprement this and close the fisheries. which they did in january of 2011. these are fisheries that are directive on has been at a time in the western. we were pleased. the industry was mad. they decided, well, it's their turn to sue. they're going to sue the government to overturn the outcome of the last biological opinion. and this is where the strange green peace stepped in to an intervener to defend the biological opinion that as a result of the litigation that we started in 1998. and that case was settled last year. and the plaintiffs lost and the biological opinion stood and the fisheries are still closed.

but we're -- they haven't a story yet. this is 14 years after the original litigation was filed, and the judge said, he remanded it. it's still under his care until he sees a new full environmental and tax statement. and so the saga continues on the war of the stellar sea lions. i mentioned early that are strong laws but that have exceptions some of the exceptings are huge. particularly for the department of defense, or drill for offshore oil recently the department of defense got a waiver under the marine mammal act to do low sonar testing they estimate -- up to 10,000 marine mammals for ten years. they have a free pass on 100,000 marine man malls to play with their sonar out there.

and more recently, a month or so ago, the obama administration gave an outrageous one to the oil drillers in the gulf of mexico, they gave them -- i think there was a dozen species of whales and do fins listed that instead of removing the oil platforms that are no longer producing oil and they're past the life. they are going blow them up. the little -- end up on the bottom of the gulf of mexico. there are healthy population of do dolphins where they blow up oil rigs and don't have to be concerned about the whiles and dolphins. >> thank you. i'd like to thank all of you very much for your presentations. for all of us here, we have heard about what's going on now with the efforts and programs that are in place to detect

violations whether at sea or on land. the civil prosecution that result from it, the criminal prosecution and where it may go and the nongovernmental efforts to enforce the management frame work. ly buy everyone of you a little bit of time. you can jot notes about the excellent questions. if you're listening in remotely, please e-mail your questions. but i'm going to buy a few moments by throwing out the first question. to all of you. and this comes back a little bit to the beginning to how we actually detect some of the violations in the first place. i've heard many of you speak to this exact issue. i hope all of you will chime in and discuss the advancements ments in technology over the past few decades that have basically increased our ability to detect violation and change the overall structure both at

sea on on land. i was shopping -- hoping you can comment on it and the effects they had and where they are going and what we may need to focus on next. >> sure. technology is always an interesting topic there's clear. thing is some things that might come to mind right away. better communications helps all parties. we can share information collect information and pass it around greater dexterity than we can when the communications systems are more fragile in addition to advances new how we can view things at sea remote platform. that's all beneficial. what i think i would bring up as a good bright hierdzen is the technology being apply to the species we're protecting. and by that, i mean, systems such as pastic acoustics that help us where they are present and not. i'm thinking of advances in how

we ocean graffic data and ago graciouses of may be at particular times. and too that's time of improvement, i think, can inform how we address large scale operations. commercial vessel traffic. one the information comes into sharper resolution we have folks that are looking at, for example -- part of that discussion is understanding when the sense or it receptors are the animals are in a place so we can understand if it is a disturbance. it helps us through a ton of decisions do a better job of working with industry and mariner to preclude the impacts when they occur. the ideal outcome would be to work industry and help industry step up. they underit's in their interest not have adverse interaction with the species and center industry take a stronger role in

using the tools that available to avoid potential interactions and impacts. i hope on the cusp of that. i hope commercial shipping could be one area of activity that's ready to go. advancements in helm controls in again, the vessel information as expect that could facility that. >> as far as my office is concerned, of course, that's a monitoring system have done a great deal for us. we know where vessels are. and if a fishery is required that helps. but really, it's old fashioned police work for us. it's using informants. people come forward and provide information. and following up on it. cameras are create and optics. those have been around for a long time. clearly the basic tools that all law enforcement people have used are really still quite functional and we rely on them.

>> i want to second what he just say is that of course the department of justice has independent investigators fort. we are looking to the various agencies to conduct these investigations and develop them in the prosecution's using the tool that are available to the department of justice like the grandeur and the subpoena power and things like that. we encourage the use of informanhattans. we encourage the use of undercover investigation and tip steers. all the traditional techniques are very much at play. in addition we now have newer tools that our technology-based like video surveillance that we can conduct away from the target in an area where they won't suspect or be under surveillance. cameras now allow us to see literally into a cooler at five

or six or seven miles. those are technologies that make the ability to detect violation much more likely. that's still one of the cardinal ways we prosecute these cases. we have an eye witness. that's what we're looking for people to say i saw it. crewmembers make a great source for a lot of information. and lastly, with the animals come from. mat rein species where they are coming from? as we're going much more sophisticated analysis of particular animals or plants that we're dealing with we're getting much more knowledgeable about where the geographic locations were that they came from. that's going to be a big ticket item as long as we convince the courts eacialt the testimony they're hearing about where the animals originated is

reliability, expert testimony. >> we're rapidly entering in to the 21st century. boats everywhere. the old mariner with the come us. and the watch has been replaced by the computer age. no boat out there operates without a computer for navigation and whole bunch of communication and other things. recognizing that, recently i borrowed in partnership with noaa built an app for an ipad specifically to identify to mariners where north whales are and recommend speed and course changes to avoid ship collision which is is a major source of mortality for the whales. it's been well received. i hear there are now expand football are the west coast for the entrance to the santa

barbara whales. and the proliferation of ipads and ic international meetings any indication, they're probably on the boats too. but these kinds of tools are brand new, and coming. >> thank you. >> and with that, i will open up to the floor for any questions that anyone has in the room. and when you ask your question, if you wouldn't mind stating your name and afghanistan -- affiliation after you say your question, i will repeat the question. -- nay name is -- [inaudible] i'm with the marine mammal commission. you mentioned the size of the penalty -- has denlt penals thatten the marine mammal

protection act or the esa. i guess the question is for john or tracy. how does the size of the penalty effect what -- [inaudible] will be pursued. you make priorities for cases in which the penalties are larger or they're easier to prosecute, and how are these supplemental approaches that you talked about effecting what cases are actually investigated and complicatedded? >> what are the components from the marine mammal commission for tracy or john. is the penalty contained within the different statute and how the effects the prioritization of cases and prosecution efforts whether it's based on the potential penalties that will be leavied or the ease of prosecution and it's effected by

the white-collar crime commission. >> [inaudible] that's a great question. the real reason i think, the white-collar crime supplement got adopted is to have available as a punishment incarceration, imprisonment, that the real deterrent out there oftentimes the financial one. it's the loss of liberty. and so we like to be to be have as prosecutors like to be able to have that as a potential punishment, and we know whether or not we have that as a potential punishment now because we have transparency sentencing guidelines that are published that allow us determine the fact not only for the environmental crimes but all over the white-collar crimes what the likelihood much someone who is convicted of the crime would receive imprisonment upon conviction. there was a time when the

science guidelines were imposed, they were -- when they first imposed they were manned storied they were followed by the court the courts still use them as guide post to faction the sentence. prosecutors use them as a way to rate cases they may have on their desk about when is the most to prosecute. it's a way for the agency to rank the indications that the investigations have been assigned to and look at the likelihood of incarceration as a punishment. let me tell you when we do negotiations with defense attorneys in a case that may involve marine pee cease someone never before had contact with the department of justice and law enforcement authorities the conversation usually starts out with how much money do you need to keep my client out of jail. we don't bargain away jail time for money. the amount of money that can be

offered bay wealthy businessman who wants to try to stay out of jail is remarkable. so you to look at they are not only prosecuting individuals but organizational. there's a whole another arena that is out there of the tools used to investigate and prosecute the organizations and the employees. so i think we're doing a good job this that regard in terms of having a full array of potential sanctions out there including imprisonment for the environmental vai later who not have been available. lastly, i haven't mentioned it yet. it's important to do so. the department justice uses the resources nongovernment obesers frequently. we have more often than not sentencing brought in those people from the nongovernmental organizations who can describe to the court what the harm was caused by the particular

defendant. the conduct. we may not be required to prove that. the judge wants to learn what's caused the impact conduct and what the impact is. it is a persuasive testimony before the court. and we find ourselves a lot saying at the same counsel table with our nongovernmental organizational cooperators for lack of a better districts. >> anything you want to add? >> office of law enforcement, we are definitely the fact finder. the prosecution handed in the fines and everything handle by the prosecutor either civil or criminal. we went through a length think process looking at priorities. we have a set set of priorities we're supposed to be focusing our investigative effort on. with that said, if we have a

good indication, we will address it. we base it we deem what is the harm to the resource. by the nature what they're doing is going to be more harmful. we take that case and work it. there's a lot to deal with the resources are limited we need take the cases that have the best impact on protection of those resources. >> thank you. and next question? [inaudible] mike conservation substitute. do any statutes you talked about have any citizens provisions private citizens can either require the government act or actually sue the individuals or corporations that may believe are harming the environment? mike conservation substitute. do any statutes you talked abou have any citizens provisions private citizens can either require the government act or actually sue the individuals or

i don't know. endangered species act. i know that you can sue. it provides for assistance. the reason i don't know that much about it. i'm a prosecutor. there's actually a group of attorneys in the department of justice and the wildlife section who do the civil side of the environmental enforcement. they are the twhoarns represent the united states when the united states is below -- [inaudible] in litigation. the organization may be suing and it's against department of -- against the agency. also, to, there the administrative procedure act which allows private citizens and organizations to sue the government for not complying with the law. and oftentimes you have not only the citizens supervision of a particular statute at play but also the more general procedure act provisions i think found in

title v code. will tell you in the united states in and i haveble position of the almost encouraging the citizens to ensure the government follows the law. if we're not, they'll tell us. we'll tell the agencies they're not. guess what? the persons responsible for bringing the suit will get reimbursed for the expenses they incur in order to bring the suit. if you go anywhere in the world to explain it to anybody. they are flabbergasted that the government has an open-door followed adverse litigation. i think it's a welcome to development in our society. [inaudible] individuals or corporations directly not asking the government to do it. the direct suit against individuals or corporations for behavior they think action or action is illegally. >> you're asking me. >> [inaudible conversations]

the act has a citizens provision. >> the question is direct litigation between citizens and the potential violaters. >> i can't answer that particular question for you. i've never been in that position where i've been a private citizens for violences that have involved the endangered species act. i would assume there would be some cause of action out there. i'm sure there's a whole series of attorneys out there who are plaintiff lawyers who are knowledgeable about that. but i'm not one of them in that particular topic. >> and actually, i want to take a moment and follow up on somethings you mentioned. application of the law and enforcement of them. compared to other countries in the international context some of the differences. i was wondering for you could comment on a moment for the how enforcement domestically is going on internationally or in

other foreign countries. years old like to begin? >> i i don't want to -- hog the forum. i'm very talkative. i guess that's why i was a prosecutor. but the -- i work right now with a group over in the countries in southeast asia. the wildlife enforcement networking. it was an effort to provide the enforcement cape inability the countries in southeast asia. it's had mixed success. what you will learn is simply we have more dedicated resources in terms of prosecutors. we have a cooperative relationship among our investigators and prosecutors. we work as a team frequently. there's a loot of money that is dedicated to our work. there's a lot of support for our work within the government. and the most important i think component of our work in the

united states as opposed other foreign countries out there, we're basically corporation free. there's a great deal of political influence. it's not the raw core. the bad govern innocence you see in foreign countries everything is up for grabs. er spoke with prosecutors about cases they were working on. big environmental cases in indonesia. they want to do the cases over there. you ask them about what happened to the cases. what are the results? welt the vessel that was illegally fishing of owned by a general in the army. the land that was polluting the ocean was owned by a cabinet member. what happened to the case? well, nay just disappeared. that's the problem you see in the laurels is a lot of good governance issued have to be addressed. that's one of the major problems oversays. we do it best as we can.

one of the things we're looking for addressing some of the problems overseas is just to find somebody who has the heart do. you'd be surprisedded at what one dedicated heart can establish in a foreign country. they can literally change the landscape. that's the goal that we try to set out to find the dedicatedded hearts that are willing do the battle in their own country. >> often time they don't have the laws, let alone the corruption you might no have the government tomorrow you had the day before. they don't have the basic laws behind them to begin with. one thing we haven't really touched on probably would be interesting in the significant is nepa and how it interplays in all of this the environmental policy act. when it comes into play it gives civil society a good place to

weigh in in that it's not an action forcing law. but it is -- when you're writing an environmental impact statement, it forces a wide range of alternatives to be considered from status quo to whatever the other extreme nothing is allowed to happen in between. and a wide range of alternative. in between those. i know, from the essential has been at a time litigation i was involved in they really an effective law. none of the regional could believes took seriously what magson mandated about protecting fishing has habitat from the -- they got to actually look at what happens which you dragnets across the bottom of the ocean

and the new england counsel was the first that took action and actually closed areas to bottom trolling and gill netting and two to protect the deep sea sponges specifically because they learned having to review the document. and so, you know, i urge everyone if you're involved in these kinds of undevelopment of impact at the same statements to start at the beginning when they scope for knee pa. put your issue on the table and make sure you get alternatives you can advocate for. from that initial new england counsel protection from bottom trolling now. there's over 700,000 square miles in all regions we never see a net on the bottom again. it started with the analysis.

i got a pointer from the marine mammal commission. circle back to the previous question about citizens supervision. the endangered species act has. the marine mammal protection does not it can be important. endangered species act for bears as to what the implications are of extending the incident l provisions to the lower 48 states potentially could open up the possibility that environmental groups would bring suit against those releasing large amounts of greenhouse cases for polar bears. there are differences that may or may not important depending upon how they look at the approximate cause issues there. my question was it seems that one of the weak spots of the marine mammal protection act

which is the harassment definition which is low rung. and there are some instances no aa promulgated. but i guess my question for those of you who prosecute or investigate or whatever your roles are, what difficulty does that am but giewty harassment definition cause you when you're decides whether to bring cases and what would you advocate be done to clarify those am beau giewties? [laughter] >>ly not justice to your comment or question. however, the come -- [inaudible] and first the comment essentially going back to the citizens suit question. endangered species act have a

citizens super vision. it's being discussed with the and the greenhouse gas emission curbing associate with that. the question was regarding the definition of take under the marine mammal protection act. a weaker definition than that contained in the endangered species act how the different may effect the prosecution with any of the acting agencies. >> i'll start off. you can a fine job. it is tracy dunn, yes, harassment is kind of the bain of our existence pfs i i was waking for the picture case. it never came. everything in between is a lot more difficult and the laws in

nay law. i served on the counsel as trying to advice as to scharty of law, the cleaner it is the more readily it is prosecuted or investigated. harassment requires behavioral changes to who decide that on minor change? and it's very difficult. how it effects that, i don't have a clue. it was a big step for us. clearly that you can't do it. and they included that as part of the package. it helped us with a lot of things. harassment came from a lot of the feeding issues. that clear where you can or can't do. we're always look forking that. those are hard to find. >> we're generally referred to a previous workshop session the cost out there encowrptding the things in real time. our field offices our boarding officer have a serious support

networking. it there is a question about the merits or element what they're encouraging they can tap into expertise with officers back in headquarter as well as with noaa. there are occasions where we will touch base with essential agents in noaa. there's a good degree of work that goes into weighing the particular fact pattern in particulars what happens with that. the officers on scene after the fact. i make the observation oftentimes there is a accompanying violates that goes with harassment issue. so my presentation touched on the species program. whey didn't talk about the amount of work that takes place under normal fish are i fisheries and forest men.

because of the principle object to work with the magson act. at the same time there's a perfect fit for checking the species levels. >> i want to add more comment. even with feeding as we are able to make cases, the industry is able then to figure how not get caught. we had people actually -- it was blatant at first. easy cases to make even from a patrol vessel. they stop. investigators on the boat documented they were feeding that far and one of the cases, they were underwater feeding. we had to get photos of it. we arnl to do it. it is the cat and mouse game figures how to get around the laws. >> i think we have time for one final question. [inaudible] from the international community foundation. i work primarily in mexico and central america. my question for steven tucker. the access in the mandate you

have it seems that in other countries, the drug enforcement agency are starting to take on more -- [inaudible] surveillance of fisheries and marine mammal laws. i'm wondering for the u.s. coast guard is involved in training for you participate in of the activities if you deem -- [inaudible] successful examples where it's working here or over seas? >> [laughter] question was ann from the international community foundation and the question concerned basically in other countries the inclusion of other not necessarily traditional environmental enforcement entities such as drug enforcement agencies in taking on some of the marine protection and if the u.s. coast guard has been involved in any of the training or implementation. >> i can speak to that in general terms. it is generally focused on

waters and activities. but the living marine resources enforcement program does engage in training overseas whether there's a natural union with concerns of smuggling contraband. i can't speak with great where it's takes place or not. just with coast guards in afghanistan and persian gulf. we are coast guards that are able to deliver training in pacific and central america and take a look at fisheries in place there and look at the host nation's boarding practice, the capability they have again for ensuring terrorist a sustainable approach to fisheries. some of the issues jelled together. >> and we will conclude with one quick question from a remote audience. of the high seas program at the

marine contsz elevation. it was a followup question on the ipad discussion. but whether there's been any thought about crowd sources and for example you think iphone apps to bring in basically citizens information and spotting into the prosecution context? >> i totally at the loss to answer that question. we need a 20-year-old. [laughter] >> yes, we have looked a at a lot of that. we look at information from the public. our enforcement cannot work without the public self regulating. we look for opportunity. our agency looks for what particular social media will work in getting that information to us. we have about every way you could register a potential violence that you can imagine. if i may, real quick, i want to add a comment to the question.

we do capacity building in central network. it's -- we're not as debt candidates as we'd like to be. we work protected resource people. we work with enforcement efforts on conservation and the force that do that are the traditional naval forces. it's a little bit different than us. they are are spread thin. again we a lot of enthusiasm for doing that work. it's a different kind of work. as we're able to do something besides patrol and do -- they're own version of homeland security. they are excited about it. >> thank you. i hope you'll join me to take a moment to thank the panel lists for joining us today. [applause] and thank you as twoal all of you who came today or listened in. we great pr