to get the message out that we're not asking people to make a further sacrifice at a time when you are already feeling the pain. this is a transition that takes into account. the president said he it was for a clean energy transition as long as it did not conflict - inflict further pain on those unable to pay it. this means all the economic data that it does not cost more. there will be rebates to consumers. . .

it will save money. we know that it will be helpful as well. we also have up active program that is being spearheaded in part by the department of energy where we have goals to reduce and we are reducing our team -- are greenhouse gas emissions. that is not for me to comment on. >> i cannot answer that. >> this meeting was about community empowerment and how these two birds are stepping forward, not to talk about what the administration should do, but what communities can and must do if we're really going to transform. >> palin off at cabinet members

met and got -- ben n a developing these goals? >> scintillate the energy bill and climate dominance are important to epa as follows a number of agencies across the administration and to the white house. i have already testified before the senate environment and public works, and then i joined other secretaries in testifying before senate agriculture. epa has a range and wealth of technical expertise. we have a market based in san program, so we have made it clear to everyone that epa is here as a resource as they consider ways to move an energy bill through the senate. i talk to senators all the time and one of the things that we talk about is clean energy and the importance of adjusting the climate.

[unintelligible] >> it is important that we have been getting people engaged in this debate. at green for all, we have been embodied in the debate around a clean energy bill. what passed the house had strong provisions for communities of color and a piece to actually allow people to work in their own communities, a local hiring component. the sec it is worth a billion dollars in training money. -- beandthe second is worth a billion dollars in training money. we ought to say that environmental protection is strengthened, but this can get that down payment on a clean energy economy.

dollars thank you very much. >> a lot of people are talking about the cellphones now and they are not economically -- environmentally sound. a lot of communities have been talking about cellphones hours. -- towers. you need to put it on the paper there. >> ok. [inaudible]

>> how is c-span funded? >> i have no clue. >> may be some government grants. >> donations. >> advertising for a product -- for products. >> advertising. >> by taxes? >> americans cable companies created c-span as a public service, a private initiative -- no government mandate, no government money. >> now the commander of nato forces in southern afghanistan. he discusses the upcoming presidential elections in the country an ongoing security

operations in the region. from earlier today, this briefing from the pentagon is 25 minutes. >> and general, we have a good picture of you. let's make sure that you can hear is ok. -- that you can hear us ok. >> i hear you fine. >> thank you for joining us. it is now in here. thank you for being flexible with your schedule. i know that we meant this around a little bit. to the press corps here, this is brigadier general tom middendorp. he is the southern task force commander in afghanistan. he is responsible for the

security and stability of operations in regional command south. he took command in february of this year. he is now finishing up his time in afghanistan. he is currently speaking to us from the canada are -- kandahar airfield. he will be taking a few questions. thank you for joining us and let me just turn it over to you. >> ok, thank you. it is good to be here. i have just had a commanding -- a change of command yesterday. it is a province in the south of afghanistan as well. neighbors the provinces here. it is one of the poorest provinces of one of the poorest countries in the world. it is like walking to the old testament. it is the homeland of the chief of the taliban and also

president karzai. it is an important province. i've been there two years ago. i see at big difference -- i see a big difference in a securities it twice in an exchange for developments. a big difference in the attitude of the population. two years ago, there was a lot of fighting to do there. now the resistance of the taliban in that province seems to be broken. the have shifted more toward roadside bombs and rocket attacks. but we can provide the population was much more security now -- with much more security now. an afghan security forces can now take over. there was no army in that province and now there is almost a full brigade that is respected by the population and it is taking more and more a security role in the province. if we are now shifting efforts to training the police and improving their performance.

overall, we have a 80% of the population that have a more secure environment. within the secure areas, we shift area -- efforts to development. there is an increasing number of organizations coming into the province. we're out to 50 organizations that start working there to find it safe enough and secure enough to do there were there. that is it a sign of progress. even the un has opened an office there. i am very positive and i can look back at a very good period. >> thank you for that overview. we will take some questions here. let's start with candor from reuters. >> can you just give us an overview of the security situation in uruzgan? how many incidents are there on

a weekly or monthly basis? compare that to two years ago. >> when i was here two years ago, we had many incidents. we had a thousand contracts -- contacts over the last three years. if i look at it during my time, within the secure areas where we operate, we hardly had any contact. we only had incidents with the roadside bombs. these were quite frequent -- one or two week. we found many of those bombs but also some strikes we had to suffer. it is a big change compared to two years ago. i hardly attack us anymore. two years ago, when we went out of the base we were guaranteed to be in contact situation. now they do not attack us. we only have to be careful for roadside bombs. >> what needs that happen next

and uruzgan to get to the next phase? when need to be taken to build lasting security and stability in there. so that all your chips can go home finally? >> it's important that the population-centered approach, which we have done from the start, and we did not want to cover the whole province. we focused on the capital and make sure that these people felt secure, but they fell more confidence in their governance and in security forces, and was that was established, once the ngo's to take over one -- could take over from within, we started to expand. in the last eight months, we could double the size of the secure areas, a very good improvement. what needs to be happening is that the afghan ownership takes over, that the afghans take

charge of security. i'm very pleased with the progress that they have made, with a brigade commander that we have. i go there almost three times a weekend visit the bases and the villages. it is good bonding and get some more visibility. his unit is becoming more capable to take over within the secure areas so that we can focus on expanding areas in the outer district. >> tunney with bloomberg news. what are some of your greatest equipment needs a n d region, in terms of helicopters, better ied detection and equipment, what are some of your major needs? >> the number one need is the roadside bombs.

there is a constant effort going on to debate that threat. we have several capabilities. we need investigating capabilities, and i must say that the u.s. brought some great capabilities into the southern region. they brought their road clearing packages which are of great help. within a province of a uruzgan, they brought of italian it gives us more mobility and gives us an element of surprise in our operations. that is exactly what we needed. >> dna more transport helicopters from nato nations rather than simply the u.s. assets? are you pressing any nato nations to bring in more airlift? >> there are never enough helicopters. we have some helicopters from the attacks. we have an apache helicopter and

and transport helicopters but they are never enough. i am pleased with the aviation group that moved in. additional out -- apache helicopters and others. we now are sufficiently served. >> it gives you capability to go after the networks because of their ability to fire missiles and track targets on the ground? >> yes, but by the networks, the intel is up as cents. if you have good intel, then you can move in to take them out. but that three types of special forces units in the province and it played a crucial role. now we have succeeding in separating the taliban from the population. it has been moved out to the outer area of the province.

it is for the special forces to take out the statistics and target the ied networks. they are doing a great job in that. they had 15 leaders of the taliban taken up during my period. -- taken out during my period. . >> this is right in the center of the country. you have the other provinces bordering you. for the operations in those provinces squeezing the taliban, is that making your problem that much more difficult? >> no, i am very pleased with all the progress we have made in these provinces. the increase of u.s. forces means that we can cover a larger parts of those provinces. we can more effectively interdict the line documentation of communication for pakistan

and makes it much harder for the taliban to change leadership, to provide the logistic to uruzgan, and they have to concentrate their forces and their main effort in kandahar. that leads to the conditions for success and uruzgan. i am very grateful for the work done there. they allow me to make much more progress on the side of development. >> we have just a follow. what a nationalities in that province? dollars a main player is are the? , the lead nation. next to that, the australians. they have got a great force there. they focus on the mentoring of the aea, and concatenate -- combat teams going and what

that to help. then we have got the french unit, also a mentoring team. but that australian special forces, american special forces -- so we have different types of capabilities in the area. we have a great operation and i really have seen that multi nationalities can work. >> obama has traveled for support nhl in afghanistan. how's that affected your future involvement? >> can you repeat that question? i could not hear it. >> given your comments about how much positive progress you have made during york store in afghanistan, given that many

european countries are not supporting the afghanistan work, what kind of reflections or insights could you take back to your country so why they should be involved in the war in the future or not? >> it is a real political question that i cannot answer. i think that we are making a good contribution now. we were about to leave last year. the netherlands were ending their contribution in the south. but they decided to extend their stay there, and i think it is very good, because now we can take all the fruits of hard work for the last few years, and next year there is another decision moment for the dutch government , and it will decide what they want to do then. >> can you tell us what al luck

is there as the election approaches? what are some security challenges you are facing, related to the election in election campaigning? and since you have some perspective overtime, what is your impression of the attitude of the afghan war the afghans you speak to or the local leaders about turnout and their prospective -- their perception of the election? in some parts of the country, there is a certain amount of pessimism resignation and lack of enthusiasm about the election. >> it is very much from village to district. is it a better registration, earlier this year, quite successful. a lot of additional voters registered compared to the elections four years ago.

if i like all the preparations almost everyone is aware that the elections are coming. there are growing attentions to the elections. what we didn't and uruzgan, we sat together with the key leaders come up with the governor, up with the leaders of the army, and that she adeni aec, the independent election committee. we looked at the map and how can we cover most of the population and the province, enable them to cast their votes? we made good cooperation there. the cooperation between the positioning of the polling centers and the security they can be provided by the afghan security forces. i think we now have at this business and of bowling centers that cover at least 85% of the population, and all the polling centers can be secured.

that is a good result. with those leaders we sat together in several sessions and the police develop a plan to deduct less protection of all the polling centers. the afghan army developed an area of wide protection, too. there will also be air cover. we really want this to be afghan elections. we don't want to create the impression that we are in place and that in any way. it is afghan organize, it is at insecure as much as possible. -- it's afghan secured as much as possible. >> what about the afghans that you speak to? >> as i said, they are not all aware of the election jet. but you see that fever is

rising for the election. you see that several people are campaigning in the province, not the members themselves, not president karzai, but they have people that did that for them. there is increasing awareness that the elections are coming. >> the development effort that you spoke about, and i guess the un office that opened up, is that effective? we have not heard a lot ofrom te ambassador lately? >> the ambassador was here to open at. it was only a few months ago. they're getting it up and running. what i see it that they are taking over the coordination with increasing numbers of ngo's in the area, and good cooperation.

the dutch provincial reconstruction team was doing that. and now they are taking over. they live in the capital of urazgan, between the population, and i am pleased not only with their presence of what the people leading that agency. they are very cooperative and they are very willing to take charge on the development side. it is really needed. i think the security environment in uruzgan has changed in such a way to almost 50 organizations finding it secure enough to come. the un should increase their role and should take charge in that. >> abc news. you talk about that eager for the elections rising. what are some of the issues, local issues that politicians are campaigning for? he spoke about represented as

for the last -- and national races. are these personalities that are being protected? what a distinguishing is used to separating the candidates? -- what are the distinguishing issues being used to separate the canada? >> the main candidate is president kansai -- president karzai because he was born there. it is one of the easiest provinces for him to do his campaigning. to the extent that they are aware of other candidates, it is hard to assess. that is hard to answer. what i see is that the attitude of the population is changing, not only toward the elections, but toward the government. two years ago that were very reluctant to be in contact with us, with a governance. there is enormous illiteracy in the province, more than 90% cannot write or read.

it is very basic what you do there. they have had 30 years of conflict. they know that if they make a choice, it is wrong, they will be punished for it. if they are very careful in making their choices and choosing sides. the positive news is that after two or three years ago, especially in a secure area, they are starting to open up. they also started getting a taliban out of their area and are less receptive towards them. i see a change in the population there. >> he spoke earlier about the taliban pushing to the fringes of the province. kenya -- thing is say that you have successfully separated the taliban from the population so that you can proceed to the next level? how long will that process take? >> that takes a long time.

what i have learned is that there are no quick fixes. if you clear an area, the area is not clear. if you hold the area, it takes time to really hold it. after a clear operation, they are always successful, but in comes the hard part -- maintaining a presence in the area and gaining the trust of the population. that is two years in a secure areas that we were in. now you see the population making a choice, and now you can move to the hold phase. you see the development organizations moving in and was moving out. it is a process of years and it is a process of any trust of the population, of having many interactions with the population, and it was also a process of being there day and night. in my period, we move toward a sustainable presence all over the area.

we've got certain patrol base is in the area covering paul area where the population lives. from these patrol bases, we patrol every day. we don't do many big operations, but we have many smaller operations. we're there during the night, we go into the area with foot patrols, it getting out of our population, and they really see your presence, they really feel the security that you bring. if you do that over a longer period, they start trusting you. but it takes a long time. there are no quick solutions. >> and general, we want to thank you for taking the time, particularly at the end of your tour here, to give us insight into the southern region. it is a perspective that can only come with the amount of time that you have had on the ground there. before i bring it to a close, let me ask and see if you have any final comments that you like

to make of the u.s. defense press corps here. >> i think that general mcchrystal, i met him. i think he made a great choice. he chose for a population- centered approach. it is all about the population. we have taken that approach during the last few years and we have seen that yet works, if you have patience. if you look at the number of taliban, less than 1% of the population is related to the taliban. 99% or more is i related the taliban. we should not treat them as potential enemies. we should treat them as potential friends and start gaining their trust. that's the way -- that is the road general mcchrystal has chosen and that is the road i fully concur to. i think that is the right road to do. >> thank you, general, and we

wish you in your troops a safe and speedy redeployment. >> ok, thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> how is c-span funded? >> i have no clue. >> may be some government grants. >> i would say donations. >> advertising for products. >> bloody, i am sure. >> by taxes? [laughter] >> how is c-span funded? america's cable companies created c-span as a private initiative, no government mandate, no government money. >> now from this year's national urban league's conference, a discussion on a recent white house meeting between president obama, and as low as gates jr.,

and cameras police officer james crowley. a panel discusses the case and race relations in america. a portion of this program contains objectionable language. from chicago, this is about 55 minutes. >> we're going to do questions and answers out there for about 30 minutes up -- and i will answer it up for questions from a 4 per use the microphones on every aisle. you will be able to line up area lineup and we would get that about halfway through. let's begin with our

introduction. we began with john jackson, who has spent an adviser on education matters for president clinton and the obama-biden transition team. please join me in welcoming him. >> michele bernard, the president and ceo of the independent women's forum and msnbc political analyst and political strategists who is chaired by washington, d.c. plan and served on the bush-cheney inaugural committee. please join me in welcoming

michelle to the show. melissa is an associate professor of politics and african-american studies at princeton university and the award winning author. her next book is "sister citizen perhaps nice to have you, melissa. next is a political motivator on the tom joyner morning show. he has been a senior adviser to people for the american way and has a book coming out. "everything i am not, everything i am pe per." gwendolyn grant is the first female leader in the focusing on an improvement of education, corporate diversity, and she is a graduate of the at i citizens

academy. please welcome her. -- the fbi citizen's academy. please welcome her. this man became one of the premier intellectuals, author of the latest "can you hear me now? cuwe'll work together many time. please join me in welcoming professor diike. let's start with the year. but that is what everyone else is watching. 6:00 p.m. eastern time, the president and sergeant and a professor are supposed to sit down and enjoy a beer together. that will talk about what has pretty much been leading the news for the last little while. let's begin with you, michael. what can be said about this over

this year? >> it is a significant brouhaha, such as speed. [laughter] >> it is gonna be a very long panel. >> very long. >> we have the same argument between professor gates, sgt crowley, and the president, but we know that it is bigger than that. after the beer is had, after they engage in polite conversation, and defer to each other in chester, that the real problem is still on the streets were disproportion month of black and latino men and women are subject to arbitrary forms a police power. if we have a real conversation about race, we have to be honest about it on all sides.

it took the president of the united states of america and a professor of harvard pedigree just to argue against the word of a white policeman who was a sergeant in cambridge. what that says to me is that the every day, ordinary, average person subjected to these kinds of business forces may not actually be talked about. what we have to do is read but as the conversation between putting a personal face on a structural problem. it can do little more than change the deck chairs on the titanic. >> is a symbolic or is it structural? potentially. >> i think it is structural only because the goal is to move us back to a policy conversation and not a conversation about dates and the cambridge police. -- gates and the cambridge

police. i think it is symbolic in the ways that the professor has suggested it is also a two powerful black man and a less powerful white man, based on rank. and yet as professor has suggested, it takes the enormity of power, the most important structurally important black professor and the country and the president of united states against the sergeant, and it is interesting that the meeting is in fact -- when we think about community policing, normally a room full of white and black police officers, and a few community faults who were deeply disempowered in a conversation. in this case, the question of race and power is more public family might normally think about it. but to the extent that it is structural, only in an attempt to move us back to a conversation about health care. that question came at the end of an hour-long conversation about

health care reform, and immediately hijacked it said that none of us are talking about what the boy died -- a blue dog democrats are doing to hold up health care reform. we're talking about a beer at the white house. >> i think that this might be -- as meeting will be interesting for a lot of reasons. skip gates is going have red stripe for the first time ever. i hope he enjoys it very much. one of the important things that really needs to come out of this meeting between the three today is an understanding of where each person was coming from. that is what is missing in the debate. we keep hearing that skip gates was either crazy or a subject of profiling. or that he may be racially profiling against the police

officer. what the immediate needs that i thought of and the first conclusion i'd jump to, and regretted it, it that i thought thatskip gates was being racially profile. i firmly believe that he should not have been arrested in his own home. but what we're not hearing enough conversation is why is this something that happens to black males? particularly black males of a certain age group. what psychologically caused skip gates to open a door -- if i have the facts straight, i don't think we have the facts -- and say are you asking me for my ided because i am a black man in america? what we've done to the conclusion that we are being persecuted? i don't think other races have a fundamental understanding of why sometimes we feel the way that we do. we also don't have a fundamental understanding of why somebody in

the position of sergeant crowley did what he did. some of it is because we do not have all the facts and i don't think we will get all the facts. but if we're going to talk about an "post-racial america was " and i do not know what that means, this discussion about what it means after our first african-american president, it is not talking about history by talking about what it is that people feel. when a white man says up to your door and you have worked very hard to get to where you are, and they say, showed me your i.d., what was skip gates thinking? >> one of the things that was interesting to me is that crowley, one of the things that he said, he could not understand why professor gates would be so angry. he did not seem grateful that i was there. >> exactly. >> and this is a man that is an

expert and racial profiling. the first thing he said was that he did not understand why he was so angry. no. 2, he did not seem grateful that the police had come to his home. i can come up from the guy that is the expert and racial profiling. where does this conversation had to go? i see you laughing in the first couple of rows. but i am completely serious. where does the conversation had to go that you have the expert in the history of african- american culture, and the guy who is the expert in racial profiling for the police department, and they are not completely at odds with each other? >> i want to answer your question but i want to speak to miss bernard. i'll tell you what sets the predicate for the assumption that this could be something amiss.

after shawn bell, and let me say this, and we get and 50 or 70 other names, the man begging for his life in oakland, calif., i have a child, please don't kill me. a police without provocation raised up and dislodged a bullet in his back and murdered him and brought light where everybody saw it. the history of brutal relationships between police people and black communities is what is the predicate. i think a professor wells said, we cannot miss the structural reality here. it is not gates versus crowley. i am saying that the reality is that the atmosphere that has been set in this country should be known by a man who teaches racial profiling as a cop. is it not that black people

stand to be sensitive to to the assertion of police power in the face of obvious innocence. professor gates is at his crib. he says that i am here. this man is affiliated with harvard. send harvard police. intellectually, so really, it is the illogically, if you know that he is connected to harvard. but you call this cane-wielding black man -- it is a professor gates to broke the silence, that you do not speak back to police people? i disagree with colin powell's and even the present his said that professor gates oliver responded. white men do not have to police themselves in the same way. i have seen white men get out of the car, cost the police out, and get back in the car. i am running for cover.

i think that says the background. it does not mean every example of black people actually misbehaving should be excused. it does suggest that if you are living in an era where you now that -- brutality has existed, where stereotyping had prevailed, if you are i have less of this to get a police person, you understand that. his inability to comprehend that says more about the police force and its inability to understand where black man in the other way round. that is what we have to come to grips with ultimately. >> i will disagree with the idea that we may not know what is going on in sgt crowley's mine. we know specifically at harvard. that is the brain trust for a project called project in pleasant. you can find it on the web site. -- project implicit.

you can find it on the web site. he cannot be a racist because he has never shown any explicit late-racial opinions. he gave malcolm out to a black person. -- he even gave mouth to mouth to a black person. [laughter] bill actually note, -- we know quite well that what happened is a set of opinions and understandings about race that operate at a preconscious level. for most of us, that does not matter most of the time because we do not have to make decisions in a preconscious moment. we don't make relationship decisions or grade student paper any preconscious moment. where it matters a lot is with police. police to make choices, split- second choice iss, it tells is t

is going on in crowley's mind. that history should set the stage for crowley and probably better inform gates who is also surprised that this happened. i said at some point, had you called me and said that [unintelligible] >> absolutely. >> we now prof. -- know professor gates well enough. president obama and profs gaessr gates know this way more than

the rest of us. we're giving it the best that we have. it is like the very best that we have, both intellectually in their sense of wanting to bridge socially and personally and intellectually. so please, if you reject them, if they get ridiculed as militant or as radical or is racist? >> right. but what is interesting, what i know from detroit is that i knew my roll band. when i am at the crib, yes, sir, no, sir. now i am raising -- i understand that you have to share your gun gets not at behave the way that professors gates did.

let's be real bad. you do not have barack obama as your friend. you be quiet and silent until such time that you can insert your manhood later on. that is what i -- assert your manhood later on. that is what i've known. >> we're trying to look at a macro sister was informed micro situation. yes, professor knew that it was a man's world. you're going to talk about somebody's mamma, you are going that provoke response. the sergeant should have at least ask a question, what is disorderly contact? he is see a threat to anyone and why am i arresting him? we still have to deal with the racial profiling is you. when you look at wanted to data, there is that consistent trend of the incarceration until you get to 1980. what happened in 1980?

if you lose -- if you use the micro analogy, the black man made a decision that they would react differently to the police department. that did not happen. in 1980, the reagan administration institutionalized new criminal justice policies where you begin to see a 70% spike in the incarceration of black males. we cannot have this conversation without talking about these practices. you're not going to solve that macro challenge by just sitting back a few beers at the white house. >> there was a boston police officer responding to what he had been reading in the paper who said this. a call professor gates of banana 18 jumbo monte a number of times. -- a banana-eating jungle monkey a number of times.

his lawyer said he was taken out context. [laughter] he also said that he is not racist. my question to you is this. is this debate, this conversation, the additional boys is that continued to weigh in, does this signify progress because a lot of people know about racial profiling and a bunch of people seem to be learning about it, or is that highlighting all lack of progress? >> i think it is highlighting the fact that we have lied about progress. it highlights the need have discussions, that we continue to not to want have. i'm offended by the discussion at the white house. i am offended by it because if we were serious about dealing with the issue, gates and crowley would be there, but so

would so many who had bu dealt with the same psychosis from the police officers. we have failed to deal with the micro levels and we are only dealing with the personalities as opposed to the realistic. what is happening is that we are seeing the issues that continue to throw back in our face that we are hypocrites about progress, and the name of being comfortable. i wish that people would say i am races. i don't like black people. i have some less more respect for them then. he was taken out of context because the mexican gas heating and not banana-eating. -- the mets chicken-eating and not a banana-eating. that is what he meant. these police officers are experts in what john was talking

about, which is police departments being talked out to continue to disenfranchise as a modus operandi and in claiming that this is about a decrease in crime. he is an expert in manipulating the process of policing to beat down on one group which would allow another to get away with. in closing, at the end of the day, if we are going to be serious, it is not president obama's job. it is the job of organizations like the urban league, but like the naacp, those who been doing work around police brutality and pries profiling for decades, but have not gotten the proper resources, the proper support. until we begin to shift this to a local conversation for people who have been doing the work that are challenging police departments, i love this the

present obama talk about the only way that you change a history of police brutality is by holding accountable to fellow oral tolerance -- through federal dollars police department's that had a history of this type of activity. they're going to be people that do not understand what it means to be a person of color. they are going to be people that do not like people what country -- of color. i did not care if you are racist or not. i have no concern about how you feel about me as a black person. i'm concerned about how do you job -- how you do your job. you take into consideration my rights. and if you present that racism and use that power to discriminate against me, i wanna make sure that your department is held accountable through federal dollars. i want to make sure that there are civilian review -- review boards that have subpoena power said that we don't have these internal review committees that

slap people on the back and get them paid leave for doing what they were trained to do anyway. and that's not the conversation that we were having, up from your initial -- from your initial question. >> are you going to get me at three. answer for my one. question? >> will i know that i will be able to speak anymore with the professor on the stage. >> i yield back the balance of my time. >> so often we talk about the institutions that are pressing us and the need for groups that all of us appreciate, like the national urban league. but we fail to deal with african americans to talk about the need for us as individuals, not just rely on the national urban league are that naacp or any other group out there, but be out there as individuals raising hell. when you say that someone is

racist, well, yes. but saying that someone is racist is not going to get shaniqua or anybody else out of poverty. what is going to do that is black people taking on one themselves every single person in this room -- they should be out on the streets demanding your tax dollar? -- your tax dollars back from police departments that do not police, from education departments that do not teach your children the fundamentals that they need to become barack obama or like anybody else in this room. get your money back. >> you have listed a number of issues. the topic is the state of black america. racial profiling is one of those issues. education, police protection, financial where it all. what is number one, the most important issue? people have to go work. what is the is it a focus on

first and foremost? >> education. i am working on a project where i have been going out in some of the poorest neighborhoods in washington, d.c. and interviewing people about -- what do you see every day? when you cut to the barber shop, when you get on the matter, if you take the bus, what do you say? what do you need? it has been disheartening. a lot of boston not like to talk about the trick but this is what we are witnessing in a housing project called barry farms. there are women everywhere but there are no men. that is the truth. they are gone. i have interviewed women -- one said, have you ever heard about the women who kill their children? and i thought i was going to pass out. i said, i have a. d you feel like you would do that? >she said, no, but they do it

because they do not want their children to suffer. they cannot get a proper education and the district of columbia, that cannot get help for special needs kids, every single person i have talked to who has said that all they want is for their children to get a proper education. i believe that education is the great equalizer and it is one of the things that we should be beating the streets for and demanding. >> let me go to stephanie. editor in chief of the state of a black america report. what is the number one issue? >> i don't think we can say that there is one number one issue. some of these are related. education is directly tied in with economics, which is tied in with health, and the criminal justice system. all these things have to be dealt with in a comprehensive way. that is what is overwhelming people. want to think of one thing to focus on. and there is not. i agree with michelle that we

all have to be out there pushing on these issues. when every ec you think is most important to you should be what you should be fighting for, and not get overwhelmed. so much of this -- we see it is bigger than we can handle. we can fight it ala. but we can make a difference. what you doing with the education work if you're doing, what everybody in this panel and in this room is doing, it makes a difference at chipping away at this. but when you talk about pushing on these issues and going out and making your voice is heard, the media plays a big role on that. i am glad there are so many media people on this panel. you are already doing this. it is something that we want but we don't have much say in it. but some much of what we're talking about, so many of the misapprehensions are based on a distortion in the media. i think it is us for anything

that we watch and see is not right, we need to make an impression on local media outlets, whatever, because they are helping to bring the stories. we're so glad about your special. [applause] it takes someone who is high- profile to frame this issue so that people start talking about them. >> an interesting thing -- after we did the first black in america, where reported on the terrible dropout figures, the graduation rates for black men. i people call me and say why would you want to show that? but something positive on. you should not talk about it. my feeling was, you are welcome to call me but you should also go and march in front of that school or 29% of african- american boys are right to waiting. that is insane. when you get pushed back like

that, i have a thick skin and it rolls off, but people get very angry. i agree with you. anyone in the media will say, we did a story on the brother who is in prison. what would you want to sell all black man in prison? it is an interesting -- what would you want to show a black man in prison remarque it is an interesting question? -- a black man in prison? . it is an interesting question. >> there are positive images. >> no question. there is a balance. >> we have seen a lot of ways that these issues are portrayed. there is also equivalency presented and the notion that we're in this balance do we even began to pick to build this paradigm? going back to a gates case, what

constitutes disorderly? that is a narrow perspective. there is a false equivalency between gates and officer crowley. gates at fault are was often serve crowley at all? it is the recognize that often serve crowley is a police officer with a gun and badge and power. professor gates, while it may seem that he is bigger than life, he is an ordinary man who was standing in as house with a police officer in his house. there is not an equivalency there to start with. .

>> everybody is jumping on surgeon crowley, but there was a black officer. >> one of his concerns was that he was a police officer responding with no backup >> i really appreciate the point you just made about crowley engaged. it goes to mitchell's point about everyone standing up and taking to the streets and that

this is the complete keep. pushing back in part to this respectability idea, somehow, if we would all just be sufficiently respectable, pull up your pants, naming your kids and tina instead of tenisha, then you are safe. we can all achieve equality. then you can stop squandering the work of the civil rights organization with of the mass of the hip-hop generation. if it does nothing yelled, what the kaitz arrest does -- what the superdelegates arrested does is disproves the cosby theory. there is no question that the outcome was fundamentally different than the outcome for someone who is structurally

positioned or in a position of economic inequality. but the point is not the level of respectability of the individual with a black body, but the way the -- but the black body within the larger system. i am not sure this is taking it to the streets is as effective as it once was. i am concerned about ordinary citizens to serve in the military and fulfill the responsibilities of citizenship that there's this other blackness' burden, who don't get their education that our taxes pay for and the police that our tax is paid for and the national security that are taxes paid for it. if obama ought to represent

anything, it should be the fulfillment of the black citizenship reality. it is the question if a black man could even be a citizen. when they ask whether obama is truly a citizen, they are saying that no black can truly be a citizen. [applause] >> i am not sure that the argument is that deep. i think it has undertones and it takes is off topic. right over here. >> good afternoon. how do we avoid what is going on in washington, the beer and so forth, and how do we make it real? we had a similar situation in chicago. we had rev. james meet as a

state senator. he was the pastor of one of the largest churches. the car made a wrong stop. he got out. the surgeon to new who he was. the sergeant and drew his weapon end told the rev. to get the f back in the car. the following sunday, the police superintendent came to the church and hugged him, but nothing changed. how do systemically fix the issue? >> -- how do we systemically fix the issue? >> that is a good question. >> you could reduce it to what michelle bernard said about the individual. you can have one of the biggest churches here and demobilize a lot of the critical urgency in

his conversation to speak out against it. i think that response is critical, but this is a collective problem. it is not an individual problem. a black people then decide, being andpoorer and less educated, they don't do what it more educated people do every day. we have to articulate a conception of legitimate american identity. even if it does not intentional that everybody was implicated -- which is trying to say is that it isn't bad d. -- that the deep. there is this sensual the white supremacist ideology -- there

is this white supremacist ideology. this is the machinery that is a raid against it after gannett -- african-american people and latino people. if you do the right thing -- he has never done the right thing. you are not an exception. do not buy the mythology that your education or pedigree, the herd or the white house, that will save you from being treated like a nigger. [applause] howl middle-class educated elite must never think that there never implicated in gshin iqua or muhammed.

that is your black ass, too. get your black but on your board and talk to the teachers of your children and elect state set -- state representative who will represent your interests. by the way, president obama, even the white house, you need to talk more about race and not less about race and you need to educate us. [applause] >> that was very rousing. but we have eight minutes. so here's what we're going to do. we're going to take care next question from over here. we're going to take it very tight.

whoever is delivered to on the panel, is going to remain very tight. got it? rousing, but short. >> my question is how does racial profiling the predominantly affected black man -- how does that affect our conversation when predominantly black officers are harassing our black men? is it appropriate to only focus on what officers? i think that is a serious issue, but, in the neighborhood -- >> at the end of the day, we do not need to do with personalities of the officers, no matter what color they are. we need to deal with the department and the legislature. >> when we talk about dealing with the policies and the structures that persist in the area of racial profiling, we

need to challenge your state and government and your attorney generals to hold local police agencies accountable for their reporting they need to have uniform reporting in order to track who is profiling so that you can hold them accountable when it comes to funding from the federal level. if you do not have documentation that they are actually profiling the way we collected data nationally, it is very difficult to put forth sanctions against those various jurisdictions. you have the power to go to those jurisdictions and demand uniform reporting guidelines so that every police jurisdiction is collecting the same data. then you know they are profiling and then you can begin to withhold funding. >> the next question, right over here. >> i would like to have them

address legal discrimination. when they come out of jail and they go to a restaurant -- i do not want to hire any ex-robbers. but how you handle the devastation of someone who cannot get a job when they want to turn their life around? >> there are federal areas of legal discrimination. president obama has been particularly awful on the legal discrimination against gays and lesbians, both in the armed services, said he could get addressed on day one, and is hedging on the marriage equality. in many states, gays and lesbians can be kicked out of their housing. they can lose their jobs. they can lose the custody of their children, simply because of their identity. that is mass bigotry.

because president obama has not been strong enough on a policy level. you serve time under a new criminal justice system, which actually move to the law that is crime. i can make a million more criminals tomorrow for a million fewer criminals tamara. in the 1980's and under the 1990's, under the democratic presidents, we increased the group of criminals by making more activities criminalize. it is not just about a black man in black women is the fastest- growing of newly incarcerated people. when women go to jail, their children go into the system, not another custodial parent. the effect is multiplicative.

they lose their right to vote and their rights as citizens, their ability to get housing, to get a job. we have expanded the number of people who are criminals. when they are highly identifiable by race and economic circumstances, we are generating a permanent underclass that we will then need to police by providing jobs for a different part of the underclass, the working-class, and it is deliberate and it is policy-oriented and it is addressed through legislative action and to the action of the president. it ought to be, without question [applause] . [applause] >> we have heard about post- racial america. if we look at where this occurred, a cambridge, harvard. there's nothing that racial about that area of the country.

i went to boston university and a felt like i was in south africa. no one in the media has broached that. it has a lot to do with where you are, depending on what you look like. you are still going to be considered less than. nobody has really addressed to that. would anybody like to? >> is there a poster-racial america? >> it is not posted-raci-racial. >> let's keep i am not that comfortable in some of the so- called -- let's keep it wheel. i'm not a comfortable and some of these so-called chocolate cities in america. let's have the real conversation. the real conversation is let's be honest about the fact that how does racism manifest itself

in people's power to push that racism onto someone threw their job? those are the conversations we need to be headihaving. [unintelligible] we have to talk about this issue about how do we shifted the reason incarcerated person. there are rules that each of us has to play. we keep playing checkers instead of chess. i want my organization to get to the [unintelligible] we just slide across the board as keynes, not making any real impact. -- as kings, not making any real impact. play that role and understand that i'm a move that look differently than the other pieces, but there connected to those who are in the criminal

justice and two policy. [unintelligible] then we begin to create impact and symmetry across the board as opposed to having the smallest trees that some cases stand in the way of the people who are fighting with us. >> thank you. we have time for one more question. >> i want to start off by answering your question. discriminatory practices by the housing authority that encourages women to not allow their sons or husbands on to the leases, that is why we are absent in public housing. i acknowledge the civil rights movement and everything that everybody did. i do human rights.

when everybody starts to recognizer buddy as human beings first -- recognize everybody as human beings first, i think brother martin luther king jr. and brother malcolm x will stop turning over in their graves. they have this movement that started in the 1960's and then kind of slowdown appeare. he wondered how the world perceives racism in america after barack obama is elected. this was in may of 2008, before the election. until we enforce the right to be recognized as human beings, there will never be nothing

subtle about us and we will never get the civil rights that we are aspiring for. [applause] >> i will be very brief. malcolm x face the united nations. the movement did not starred in the 1960's. but that stuff goes way, way back. as far as recognition of each other, we have to do that in our own communities. the sulfate that we have for their refusal to recognize -- the self hate that we have or the refusal to recognize a brother or sister and the like. we want to be done with the negro business and all of that. we elected barack obama. the problem with that is that your present and mine -- i was on the front lines.

i am a hater and a lover. you have to call them on the stuff he is not doing right. he chose not to go to the u.n. conference on racism. we had a hissy fit. barack obama said that we give him a pass. you should expect more for him because he is the presence of the united states. but you should not expect less of him because he is black. he has an incredibly important job. we cannot put everything on his back. he is one dude. he is in public housing in washington d., d.c. what to do to not put everything on him? how do get grass-roots to talk to power, including barack obama. you need a profit to speak to

the president. that is why we need preachers and activists and social critics on the one side speaking truth to what barack obama and his administration represent. eric holder talked-about risen during h-- eric holder talked at racism in. he culmination of cowards. [unintelligible] human rights are critical, but black people have always been interested in this human rights of all people. we have to stop homophobia. i have not seen a black person said that i will not take money from gay and lesbian people. [applause] that is human rights right here. >> thank you for being briefed.

-- for being brief. >> we need organizations like the arab league to get away from -- like the urban league to get away from [unintelligible] in chicago, 37% of black males are graduating. you have a black man on the mountaintop " people are still living in the valley. that is not success. we perpetuate that. throughout the speech, he get the most applause when he said that black males need to pull up their pants. yes, that is important. but after they put their plans, we send them to schools where they're less likely to get access to higher education, less likely to have highly effective teachers. we have schools that are potlines -- are pipelines to

prisons. [unintelligible] we have to begin to deal with success that involves legislation and even sometimes involves agitation. there is a 19% graduation rate in indianapolis. we have to be willing to elevate her game with legislation and education. >> that is their final word. thank you for joining us this afternoon. ♪

>> once the, on washington journal, we have a look at the economy. senator patrick leahy will stop by to talk on the work in the senate. later, doncaster lani doncasterjohn castellani talks about -- john castellani talks about health care from a business owner's perspective. >> we have a senate hearing on the needs of children before, during command after a disaster. witnesses include craig fugate.

good morning. i >> i think the staff for helping prepare the meeting this and ng happy to chair. i thank the staff for helping prepare the meeting this morning. today's hearing is entitled focusing on children in disasters. the committee's objective today is to evaluate the very special needs of children during the preparedness response and recovery phases of disaster, and the extent to which our current planning and programs either meets or fails to meet these special needs. we're focusing on children and their needs for several reasons. first, children in most families are the focal point and parents

who cannot find an available school or day care center or access health care for their children may be forced to relocate after a disaster or worse, in some yk,@@@@@@@@ @ @ so getting your work force back to work after a disaster is one of our primary goals. it seems to me to be very difficult if we're not doing our best to provide them help and support with proper placement during those daylight hours for their children, either in schools or day care, and provide

the mental health counseling that children need and families need to sustain themselves. so we must be mindful of the fact that people cannot return to work or begin rebuilding until they locate a safe and productive environment. these parents, i may remind everyone, are the nurses, the doctors, the first responders, the police officers, the grocery store owners, the gas station operators, the electric line repairmen or other citizens who play an important role in the communities' return. that means the provision of child care and reopening of schools must be a top priority. i would like to show a chart of the number of day care centers that were operating and ben, why don't you stand up there and show this chart. you all have it in your documents. but in august of '05, the purple line shows how many day care centers were open and of course, you can see the dramatic fall-off over time.

the second reason we're focusing on children here today is that children are a vulnerable population with unique needs that require special planning to address, but in my view, they have not received the same level of attention that some other populations, whether it be the adult homeless or the disabled or the elderly generally. a broader goal of this hearing is to encourage the nation to consider the mental wellbeing of a community as a key indicator of recovery, every bit as important as the restoration of infrastructure, housing and the return of the economic tax base. i would like to take a moment to commend the "washington times" for their particularly insightful articles, actually the last couple of days. it was a coincidence that they were running these in line with our hearing. and wanted just to quote from one of the articles that was august 3rd. says almost four years after the massive hurricanes inundated

much of new orleans that killed about 1800 people, millions of words have been written about the devastating physical damage to the city, and hundreds of millions of dollars have been spent on fitful efforts at reconstruction, but almost nothing is said and relatively little has been spent on the more silent wreckage, health of new orleans residents who were pushed over the edge by terror and turmoil of the storm and have been unable to recover emotionally or mentally. when i say new orleans, i mean the greater new orleans area and in large measure, you could almost substitute the gulf coast for new orleans. local response plans must be provided for evacuation, sheltering and continued care of children from facilities where they are likely to be clustered at the time of the disaster, or called for evacuation either at day care centers, schools, hospitals, including the

neonatal wards and maternity wards. katrina showed us the impact of failing to include nursing home sector in our evacuation plans and we must ensure in the future that facilities which house other vulnerable members of our society are included fully in these planning processes. save the children issued a report last month called the disaster decade, indicating shockingly that only seven states currently require schools and day care centers to develop a comprehensive evacuation and reunification plan. those states are alabama, arkansas, hawaii, new hampshire, maryland, massachusetts and vermont. the other states have virtually no plans. local emergency managers and facility owners can do more to expand planning efforts, states with planning gaps may consider requiring these facilities to develop plans as some states have already done and obviously, the federal government has a role to play. another concern raised by the

report is the fact that child care is not eligible for funding under the stafford act as an essential service. i would like to ask and plan to ask our fema director, craig fugate, who's here, to address this in his testimony and i understand that he will. in addition to schools and day care centers, we will also consider newborn infants and mothers who may be in hospital wards when disasters strike. according to hhs, an average of 36 babies are born each day@@@@, the senate version including monitoring tracking and care for neonatal and obstetric patients.

they excluded -- they executed the function for the state during the response of hurricanes katrina and rita. my statement is much longer. i am going to shorten it. that's me say just a few more things. after the hurricane, the demand for mental health services spiked. the hurricanes, a demand for mental health services spiked due to an increased trauma, depression and substance abuse. that was combined with the loss of in-patient beds and work force capability which created a severe gap and strained medical workers and facilities, host communities and first responders. it's startling to know that the lsu department of psychiatry screened 12,000 children and schools in louisiana during the 2005-06 year. 18% of them had a family member who was killed in a hurricane.

49% of them have met the threshold for mental health referral. one year later, the rate was lower but it was still 30%. 28% of displaced children in louisiana are still suffering from depression or anxiety. the suicide and attempted suicide rates for adults are startling. i'm going to include those in the record but some are reporting that the suicide rates are three times higher than the national average but what struck me was not just the high -- height of the suicide rates, but the number of people who had attempted suicide but failed was startling. it was something like, if i remember, 116 people had committed suicide in one year but 750 had attempted suicide. the crisis counseling assistance and training program is jointly administered by fema and samsa. it is intended to counsel survivors, to teach them coping

skills. we obviously need to do a great deal more. there's a chart that shows, if you will put up the confusing overlap of the number of federal programs that are available but they are very stovepiped there's the other one. the number of programs that are available, this graph shows it a little bit better. the number of programs that are stovepiped. some have eligibility requirements and some don't. i know this print is small but basically it's a list of all the different programs offered through federal government grant programs, et cetera. but there is no sort of comprehensive community delivery system in my view in place right now to cover the extraordinary needs after a catastrophic

disaster that affects a community the way it did to the greater new orleans area and in large swaths of the gulf coast. so in conclusion of this statement, i would just like to -- i'm sorry, there are 21 different federal programs, as i indicated, and three of the 22 medicaid, schip and head start, have income eligibility requirements that limit their ability to provide services in a seamless way after a disaster. the consolidated appropriations act of 2008 established the national commission on children and disasters to conduct a comprehensive study and examine children's needs. mr. shriver and dr. redlener are members of the commission and we are pleased to have them with us to talk about their recommendations in their testimony later. finally, i would like to conclude with a quote from chris rose, who is a columnist in the "times picayune" that probably wrote more extensively on a

daily basis about this than any person in the country. he gave the commencement address to my alma mater high school that's been in new orleans for 275 years. he spoke the year of the storm and he said there was a hurricane, he said his daughter wrote, he's saying my durt was asked to write about her experiences over the past year when she came back to new orleans. this is what she wrote. there was a hurricane. some people died. some of them were kids. my daughter, he says, was 6 when she wrote that. it just doesn't strike me as what you would wish for your child to write in her first grade journal. but there it is. you, all of us are marked for life for what's. like it or not, this storm and its circumstances have marked you. this was part of chris rose's comments to the graduating class, we call them the katrina class that graduated because it will be four years this august, that graduated in may.

these were the freshmen in high school and freshmen in college when the storm hit and the kids that were in kindergarten are in now fourth grade, so they know themselves as the katrina class. and i think this is a good place to start this hearing because these are real results from a terrible catastrophe that happened. we're still struggling with how to respond better, how to plan, how to recover, how to respond, and the needs of children are of primary interest to me and particularly the mental and emotional needs of the community at large as we seek to build a better and stronger community. so with that, let me submit the rest of my statement to the record and i would like to introduce the first panel. we have craig fugate, administrator of fema, who has been on the job now for about two months. two months.

and is already making some very positive changes. we have rear admiral nicole lurie from the assistant secretary for preparedness, u.s. public health, department of health and human services. we're happy to have you, admiral. and cynthia bascetta, director of u.s. government accountability office. they have issued a recent report and we are interested in hearing about that report relative to the subject. i will then introduce the second panel at the appointed time but mr. fugate, let's begin with you. thank you for being here this morning. >> well, good morning, chairwoman landrieu. i have submitted my written testimony. i would ask that be entered in the record as i have some opening remarks, if that's okay with you. >> that's fine. thank you. >> as a paramedic, one of the things i was taught early on in dealing with medical emergencies was that children are not small

adults. that may seem like duh, but it points out that not only are the pharmacological needs of children different, it goes to the whole aspect an adult, you don't just size down to a child and get the same outcome. you really have to focus on children, their brain development, their mental capabilities and their physiology are vastly different from adults so your treatment approach has to be geared towards a child, not merely taking what you would normally do for an adult and make it smaller. i think that's one of the challenges we have when we look at planning. historically, when we look at communities and we write planning documents, my observation, i've been doing this for awhile, is we tend to write plans for us, adults, the people that have high school education, they speak english or have more education, they have a car, they drive, they have resources and they can pretty well take care of much of their needs, so we tend to write a plan for that population. then we'll go back and go well, now we got this other group,

they have different challenges, we need to write a plan for those, we'll come up with a second plan and third plan and fourth plan. that's been our approach. we're going to try something different and based upon the concerns that have been raised by the commission on children and disasters and the gao reports and the issues youe raised, we've decided to take a different approach in fema and instead of writing our plan for the adults and then try to figure out how we deal with everything else, let's write plans that actually reflect the communities we live in. they have children. there is people with disabilities. there is frail elderly. but let's quit putting all these populations in a special box that we'll get to after we get the plan written and let's do this from the beginning. so we're going to start with children. as you point out, there are cross-cutting issues not only when we talk about disasters but just in the daily delivery of service programs that oftentimes we do not take advantage of when disaster strikes. there are many things that i think if we looked at children up front at the beginning, across all the areas, and we're

starting internally with fema but we also want to look at and work with our partners because again, as we continue this journey as i completed my second month and looking forward to completing my third, i hope, is fema's not the team. fema is part of a team. i think we have to do a better partnership with our federal partners where they have the expertise in how these programs need to be delivered, the needs that we're going to face, particularly when talking about this hearing, children, both from their physical needs as well as dealing with emotional and mental support so that we reduce that trauma. we know that historically in disasters, that in high stress and the events that children face, the quicker we are able to get to a sense of providing routine, to intervene early, the better the long term outcome is for those children. well, that means you cannot just look at what fema may be able to bring, but look at how do we take existing programs that are already every day in the community and leverage that and

particularly when we look to our federal partners, their expertise, in helping us design programs that achieve a change in outcome. not just merely look at an administration of a grant program and hope we get where we need to go but really get our partners to drive that process of how we need to structure and put together these programs so we effect real change. so we have put together and have worked with secretary napolitano to form within fema a working group whose sole focus is to make sure that throughout fema, we are addressing children issues from preparedness grants, training, exercising, all the way through our response recovery activities. and again, we continue to work on these issues everything from some of the issues we ran into, unaccompanied children, working with the center for missing and exploited children, to establish a child locator center. working with some of our programs like citizen corps, where we have the community emergency response team that now has programs designed for

teenagers to become involved in that. also working in looking at how we incorporate this across with our state and local partners. the day care centers, particularly are a challenge because in a hurricane, these are going to be part of the overall, they're closed down as children are reunited with their parents before evacuation orders are issued, but an earthquake would happen during those time frames. we have seen other incidents that have occurred when children are in school and we know that if people don't have good family communication plans, they don't know what the day care centers and schools are doing, it can cause a lot of trauma and stress to families as they try to unite after disaster. so with that, i will conclude my opening remarks and look forward to the questions, ma'am. >> thank you. admiral? >> good morning, madam chairwoman. thank you first for your continued interest in and support of the issues that we're here to talk about today. as we are coming up on the

anniversary of hurricane katrina and reflect on it, it's been a really good time for us again to reflect on both the strengths and the gaps that remain in our national emergency preparedness response and recovery efforts. we all know that throughout this, you have played it out and mr. fugate has, that children and their families are often the most impacted and bear the most long-lasting scars of this. let me say first, having spent now a lot of time in new orleans, my heart goes out to all of those who continue to suffer throughout this. what i want to do is talk to you today briefly about hhs' efforts in the last four years to address particularly the needs of children, with the focus as you requested on evacuation, particularly of neonates and obstetrical patients and mental health. we all know preparedness is a critical part of what we do. we are completely in sync with mr. fugate about the need to plan for the entire community

and a community as it is, and communities are different. we need to plan to their needs. for that reason now, my office has now more than 30 regional emergency coordinators who are actually on the ground in communities, sort of the eyes and ears to really know how to plan exactly for those needs. we know that in the long run, this preparedness and planning promotes resilience and enables communities to cope with the emergencies that come upon them so building community resilience is a really important part of what we do. by way of example, one of the important programs that we've gotten under way over the last couple years are partnerships to really look across the population spectrum as we just heard about, and to integrate really at the front end all of the groups that might be considered in the vulnerable category because when you add them all up, there's an awful lot of the population that's vulnerable but kids and pediatric populations often very much rise to the top of the

list. other kinds of programs that we have developed in response to this include training curriculum for school crisis teams, disaster communication messaging and a lot of work to develop programs in emotional first aid to early on, address those emotional and mental health needs of children. it's important as we just heard to do that at a developmentally appropriate level and that means across the whole age range of kids as well as adults. the national child traumatic stress network has been really instrumental in this regard and launched the@@@@@ @ @ r@ @ @ @ r >> it is critical to support the state efforts to provide quick and competent assistance to everybody, and children being no exception. as in no, dms is the primary

federal program that provides transfer for the evacuation of patients. it has both pediatric and obstetric capacity. it has worked really hard to upgrade its training, it's material, and its transportation capacity in this regard. hard to upgrade its training, its material and its transportation capacity in this regard. so this ranges from specialized equipment to transport teams who are really specially trained and capable and to be sure that all of our teams now have those special capabilities involved in them. in addition, as i think you know, the pediatric disaster coalition was formed by advocates and planning region six which includes new orleans and the gulf coast andts goals have also been focused on not only getting people out but identifying the appropriate receiving facilities for these children and their families and

anyone else and being sure that everybody knows about them and that that planning is integrated into community operations plans at every level. mental health needs can't be separated from the rest of other children's response needs, and how we respond early on is going to really impact the mental health of children and their families going forward. the crisis counseling assistance program as you know is an example of collaboration between hhs and fema, as this is administered by the substance abuse and mental health administration, and has crisis counselors routinely working at all of the places where children congregate. as a complement, the national child traumatic stress network also has a cadre of rapid response teams that can be mobilized after a presidential directive. recovery is really complex and i think as we all appreciate, it's been really sort of

underattended to until this storm. for this reason, we are very excited about the new directions that fema is taking and are looking forward to working on the children's discovery efforts that have just been described. hhs also started its own recovery coordination effort and now has recovery coordinators identified in each district and a concept of operations that integrate many of these stovepipe programs, particularly within the hhs family, and we're continuing to work on building that out. i think that we've made a great deal of progress in addressing the needs of children in disasters in the last four years. we also have a long way to go. and i think we would be the first to tell you that. as we look forward to the future, we have a lot of planning and preparedness efforts under way. there's terrific research that's gotten started over the last four years. the challenge now is to take what we learn from that research

and translate it into practice and best practices that are going to help communities all over the country, and on the ground. we are committed to the highest level of planning response and assistance to recovery for children in emergency events. we are most appreciative of the important work that the national committee on children and disasters has done to highlight these important efforts. i also want to call out the work of the national biodefense science board, which had a work group focused very specifically and make recommendations for us on the important needs and mental health needs of children and their families going forward, and we are now moving forward to integrate a number of those efforts and i think during the q & a, we will probably have an opportunity -- >> if you could wrap up. >> -- to tell you more about those things. so thank you very much. >> thank you.

miss bascetta? >> madam chairwoman, thank you for inviting me to testify about our recent report on barriers to mental health services for children in greater new orleans and to update you on our recommendations to fema in its efforts to support states faced with the mental health consequences of catastrophic disasters. my remarks will be a reminder of why fema's commitment to children is so very important. as you know, the psychological trauma experienced by so many children in the aftermath of hurricane katrina increased the incidence of depression, ptsd, risk taking behavior and other potentially long-lasting behavioral and emotional effects. it is well known that children who grow up in poverty may be at even greater risk of developing mental health disorders and in new orleans, the slow pace of recovery and the recurring threat of hurricanes may further exacerbate their trauma.

against this backdrop, we found persistent barriers to providing and obtaining mental health services, although federal grants are helping to address them. lack of mental health providers was identified as the number one barrier to providing services. the designation of the parrishes in the greater new orleans area as mental health professional shortage areas underscored this barrier and state data showed a large decrease in the number of psychiatrists and clinical social workers who received medicaid and c.h.i.p. reimbursement. to help address this shortage, funding from hersa and cmf provided incentives to almost 90 mental health professionals who either relocated to or decided to stay in new orleans. the second most frequently identified barrier was sustainability of funding. we found that although most of the federal grants we identified existed before katrina, the hurricane related programs has

been a key source of support for mental health services for children. much of this funding is temporary and it is too early to know whether sustainability can be achieved by these programs. we also reported on barriers to obtaining services for children and the top three were a lack of transportation, competing family priorities and concern about stigma. officials told us that funding from several programs had been used to provide children with transportation to mental health services, although none of the programs were designed solely for that purpose. examples include medicaid, the community mental health services block grant and the social services block grant, as well as samsa funding. similarly, block grants and disaster housing assistance program funds were used to help families struggling with housing, unemployment and other expenses. there was also federal support for case management and referral services designed to help

families locate and obtain mental health services for their children, although we found a lack of continuous and reliable funding for case management. stigma as well as transportation and competing family priorities was addressed by the use of federal funds to support services delivered in schools. during the 2007-2008 school year, nine school-based health centers were operating and at least four more were in the planning stages. the advantages of the school settings are that first, it's not obvious that students are receiving mental health services. second, the transportation problem is solved. and third, the financial burden on the family is reduced because parents don't have to take time off from work and the services are offered at low or no cost. stigma can also be reduced by media campaigns, including the one run by fema and samsus crisis counseling program. we made recommendations to fema in february 2008 to improve this

program by revising its reimbursement policy to pay for indirect costs as it does for other post-disaster response grant programs, and by determining what types of expanded crisis counseling services should be incorporated into ccp. expanded services would provide more intensive services, especially in the aftermath of a disaster when provider availability can be limited. and fema and samsa have allowed the states to develop pilot programs along these lines. the department concurred with our recommendations but has not yet implemented them. fema also recently concurred with additional recommendations we made to expedite and improve the effectiveness of its case management services. taking these actions expeditiously before the next disaster would improve services for children and their families as well as for all adults. that concludes my remarks. >> thank you very much. i would like to call attention

before i get into the questions to two charts that i think are very telling. first is to my left, your right, and you'll see the green lines or bars are mental health resources in new orleans in august of 2005. so starting from the left, emergency rooms in new orleans, nine, psychiatric beds in new orleans, 350, psychiatric beds in greater new orleans, 668, and then physicians in new orleans, 617, psychiatrists in new orleans is the next bar, 196, and number of doctors, new orleans doctors participating in medicaid, 400. now, when you go to the orange, which is two years after the storm, two years, you would think you would be sort of well

on your way to recovery, two years after the storm. we are going into the fourth year but in two years, in 2007, instead of having 350 psychiatric beds, we had 77. instead of 617 physicians in new orleans, we had 140. instead of 196 psychiatrists, we had 22. and instead of 400 doctors participating in medicaid, we had 100. now, just this one chart shows that there's something terribly wrong with the system of support at either the state, the state and the federal level for shoring up the core of mental health stability in a community.

it's one thing to talk about you don't have access to mental health because of lack of funding. if you don't have the professionals to deliver the services, you could just start with this chart and work backwards from there. you don't have enough physical beds, you don't have enough professionals, et cetera, et cetera. this is two years after the storm, when you would think that people would be really trying to return after a catastrophe. this isn't four years. this is two years. and the trauma that occurs in a community struggling with limited services. i want to call your attention to this next chart i would like you all to put up, this one here. this is the child care center situation as of august 2007. and there are a couple of pretty startling graphs here. again, this is two years after the storm. now, this is two years.

people have hundreds of thousands of people have fled to houston, atlanta, they're trying to get back. the year has passed, their neighborhood has finally been cleared of environmental concerns, they're coming back to try to build their life and this is what they find two years after the storm. the blue graph is the number of child care centers in the greater new orleans area that were open before katrina, 275. the green is the marker of august '07, is 100. in jefferson parrish that wasn't as affected, it was 197 and then it was i think down to 170. but this is interesting, very interesting to me, in st. bernard, which is the small little bars on the side. st. bernard was the parrish of 67,000 people that was virtually

completely destroyed, only five homes survived in the whole entire parrish. before the storm, there were 26 day care centers in st. bernard parrish, very tight-knit middle class, working cla community. in two years later, after all of our combined efforts, which obviously weren't enough, they only had two day care centers open. two. in a parrish that was completely destroyed. now, my question would be if we're asking parents to return and rebuild their communities, how is it possible for parents to do that if they do they bring their children in and let them sit in-home while their parents get their homes and they can play in the dirt? i am not understanding how we think that the system that we have is appropriate in any way, shape, or form.

i can assure you the statistics for years out from a storm. but this really grab me when i saw that, after two years of all of our efforts, their word to date can it -- there were two day care centers open. so my question to you is what is fema focused on in providing safe places for children, whether it is food, day care opportunities, while parents are struggling to rebuild their communities after a catastrophic disaster and what would some of your comments be about what you heard this morning? >> mark shriver, who chaired and currently chairs the commission on children, it was one of my first meetings when i was sworn in. we let out the concerns and issues, many of the ones you have laid out and passed the same questions about what was going to be done about it.

the easy answers to put another box in there and that would satisfy of his concerns. however, i did not think it would be real change. . however, i didn't think that was going to be real change. so as we talked with mark and we talked with members of the commission and we had an opportunity to go to one of the commission meetings, i kept asking, you know, we have historically looked at special populations as an afterthought. i said let's try something different. why don't we write plans for the why don't we write plans for the riting plans for just one part of the community, the people that can pretty well take care of themselves and really look at what the needs of the community. as you point out, my experiences with the hurricanes, one of the first things we really pushed hard to do was to get things like the pre-k and schools open, and there were several reasons for that. one is we recognized distressed

children were going and that we did not have the resiliency in the mental health community because they were impacted like the rest of the facilities. all three hospitals in charlotte county were shut down. we knew if we could get schools open, we could bring counselors to the schools and start working with children. it wasn't that we wanted schools back to normal. we just wanted to get them open to get children back into an environment that would get them into a routine that would both get them a chance to start dealing with this but also give their parents a chance to deal with what had happened, with their children somewhere safe. the challenge has always been when you get to day care that it depends upon states and localities but that can be a quasi state function, local function or private investor owned and the stafford act again historically has been looking at what government's responsibilities have been when you look at reimbursement programs. so we're working with the commission and their report, we're seeing we don't have time for the report. as soon as you guys have identified this, how do we go back in fema and look at stafford act, look at grants,

look at program guidance, look at training, to start encouraging and recognizing that children from in the home as we look at, again, you cannot just do one for all children. you have to really look at them developmentally from infants up through a certain age and different grades, how do we change what we've been doing so that if disaster strikes in the future, we're addressing these issues. >> i appreciate that comprehensive look and i think it's important, but issues, it brings me to your other point when you said fema is a partner in this effort. yes, i do believe that fema is a partner but i would say that fema is the leader. fema should be the experts on disaster, with your federal -- other federal partners. fema should be the driver. fema should be the motivator, the communicator. i look at fema and homeland security as not being the only entity that responds after a disaster but being the lead

entity that helps to coordinate and manage your other federal partners, gives guidance to your state and local partners, provides technical assistance and support to the private sector, but i wouldn't just say that fema is just any old partner. fema is the lead. number two, when we talk about day care centers, part of this is you're right, some of them are nonprofit, some of them are government operated and run, some of them are nonprofit, and some of them are for-profit but a good plan that would make sure that head start teachers and early childhood education teachers and counselors are part of that first responder team coming back for rebuilding, loans from the small business administration to make sure that these day care centers can get the loans they need, and think

about how difficult it is for a for-profit day care center operator under our current laws and current requirements to get a $200,000 loan to reopen a day care center. any bank or even under any regular system would look at her and say why are you opening a day care center, there are no children in your parrish. she says well, we will never have children in my parrish unless i open and provide a space for them. but she's not or he's not, whoever's running the center, not deemed credit-worthy or their business plan is quote, not viable. well, that is true on its face but that is where the federal government has to step up and say under normal circumstances, you wouldn't lend this person $200,000 to open a day care center where there are no children, but under this plan, under a disaster response plan, we are going to require you basically to lend the money at a lower interest rate and extend out the repayment, or if you

don't get a day care center back in this parrish, you're not going to have a parrish back because there has to be safe places for children in order for parents to return. i will submit another thing that's all interconnected. i think, mr. fugate, you hit the nail on the head, but when we're trying to encourage doctors to come back, we have lost many doctors. we think of them as doctors. we don't think of them as parents. most of them are probably parents with children. they can't come back if there's not a day care center or school for their children. so all of our efforts to rebuild our community are really spinning our wheels if that plan as you said, mr. fugate, doesn't have at its essence rebuilding safe places for children, which represent not only a special population but a central population to the families that we need to rebuild. i guess is my point. and i just think that has really been overlooked.

i've got, they said there's been a vote that's called and unfortunately, because i'm here, by myself, i'm going to need to probably call a two-minute recess and come back. but if the committee will stand just at recess for two minutes, i'm going to go vote, we'll come back. i have a few more questions for the final panelist a hearing now on children and disasters after a senate floor votes. live coverage on c-span 3.

>> you heard the gao recommendation recommendations for fema to modify program rules to allow reimbursement of costs when it comes to mental health counseling. how did you receive this recommendation? how do you plan to implement it? if not what dlou as an alternative? >> senator we received them favorably this is part of my rival. we have been working with hhs to go through the um mrementtation. we are getting to the point of finalizing those and sending those back out for final comment so we can go forward. we did receive these recommendations favorably. we are working to achieve that. and those are things that are still in process. but i think it goes back to earlier when i said we are part of the team. on behalf of the secretary and president, my job is to coordinate all the federal family when a governor request

and receives disaster assistance, part of that is recognizing that subject matter expertise has to be a part of that response. that's what i was referring to. i don't think fema has done a good job of understanding and working with partner agencies to leverage all their programs and we defaulted often times to the stafford act, which may be appropriate in some cases but does not build upon the existing expertise and programs already in the community. that's why we will use this children's working group to step back from our traditional fema-centric approach and look at all the fall family has and do a better john of leveraging those resources as a team so we know where the expertise is. where core competencies exist and with the program swres dealing with mental health issues, how we leverage the stafford act, so we are not having the locals and have go through and filling out who has

got what but present a program that focuses on outcomes, particularly on the outcomes from children as the federal family working under that authority that the president has invested in fema to support a governor in those jurisdictions. >> i agree with that. i think your analysis that it's ban fema-centric approach and has to change to fema leading the team, coordinating, being the link, and designing the programs not necessarily assuming responsibility to deliver them all, but to have them delivered through partnerships. one more question, then i have a few others. in november of 2005 i led the effort along with senator kennedy and senator enzi, and without the support of these two senators, i have to say publicly it never would have happened. but senator kennedy and senator enzi led a one-time

unprecedented effort to establish a base -- basically a plan for the 300,000 children that had been displaced from the storm in the week of august 29th which is approaching soon to try to find them a school somewhere in america where they could start school on a monday, the following monday because children that are out of school for two, three weeks sometimes have to skip a whole year. and under their extraordinary leadership this plan was implemented and basically provided vouchers for up to 300,000 children to attend school for that year. as a result, the katrina class graduated, many of them. this was one time, though. my question, mr. fugate, are you going to recommend a continuation of this plan? if so, how? if not, what plan is going to be put in place the next time a catastrophic disaster happens? >> again, that's some of the

issues we want to raise with the children's working group. in florida, our experience was, we ended up with about 25,000 families that had come to florida. they weren't part of any directed evacuation, either through churches or family associations or just coming to florida. we were able to make the decision in florida as a matter of factually that any of these children that had children that were school-aged that wanted them to go to school would enroll. we did this across the board. realizing that at some point we would have to look at how we would come back to our federal partner agencies that provided funding and get funding. we didn't want to make money away from the state of louisiana but recognized many of these would-be additional burdens for our local tax authorities and how we do that. that's one thing we want to come back and go what is the mes mechanism, so if a state has children coming into their state or a jurisdiction has children

coming in, how do we provide that assistance without -- >> i would suggest, respectfully suggest that you look at this program that seemed to work amazingly well. again it was a very simple voucher program, up to $7,500, as i recall, where the cost of a catholic school tuition, whether children left a private school to go to public or public school to private or catholic because you have to have a program that snaps into place within the first week of the disaster, if it's a catastrophic disaster. it's obvious after a few days of analysis that there are no schools to come back to. you've got to have a button you press and this program operates. right now, as i understand it, though senator kennedy and senator enzi put this in place for katrina and rita, it was one time. and it's not in place today. so if another catastrophic disaster happens this summer in

either texas, mississippi, alabama is hit and hundreds of thousands of children are displaced, we have to start all over again and get an active congress to give people confidence that there is a back-up plan in the event that their school is destroyed. so i only raise this to say, in what while we have done a lot of talk and had some actions, there's so many other steps that need to be taken. one more question to goa, let me see here. the goa recently released another report, as you mentioned, on disaster case management programs. case managers are meant to help clients find job training, permanent housing, relief supplies, access to critical services, particularly after a disaster. case managers can be extremely helpful in trying to make sense of things, trying to identify the programs that are still

operating and out there and making them real for clients. what, in your study, could you share with us about the need for case managers? did we have enough on the ground? how did the case management program work generally? i think you tt%%b@ n @ @ @ @ @ all they can put together the package of services that they need. to a crane their self- sufficiency. we have had two major findings. as we found in the mental health area, there was a significant lack of case management providers. there were limited referral services. this goes back to the fact that they are under and the providers, there is nobody to

refer people to. the other major concern was sustainability in funding and breaks in funding. there is one situation which a federal program was about to make a handoff to the state. situation in which a federal program was about to make a handoff to the state. the state program wasn't up and running yet so there's about a two-month gap in case management services when families were unable to access anything at all. >> whatsoever. >> that's correct. >> i also understand that catholic charities stepped forward which is a reputable and capable non-profit and provided case management but under the current law they were not allowed to recoup indirect costs. so as a result they were basically losing money as a non-profit trying to deliver services for the federal and state government. is that your understanding? >> i'm not sure i have the

details of the situation you're describing. i do know that catholic charities had dropped out as a provider for crisis counseling services because they were not able to recoup indirect costs. this was part of the basis for our regulation to expedite that reimbursement under fema's rules. >> okay. thank you all very much. i'm going to ask the second panel to come forward. i really appreciate your participation this morning and look forward to continuing to work with you. as the second panel comes forward to save time, let me begin to introduce them. our first witness will be mr. mark shriver who served as the first chair on the national commission of children and dasters das disasters in 2008. the commission is asked to examine childrens needs as they

relate to all hazards and evaluate existing laws, regulations, policies and programs relevant to the needs of children during and after a disaster. he's also vice president and managing director for u.s. programs save the children. he served as a member of the maryland house of delegates a is not new to this subject or to his leadership. we're pleased and honored to have mr. shriver with us today. dr. redlinger is a president and co-founder of the children's health fund, which works to educate the general public about the needs and barriers to health care. i want to say on a personal note he really stepped up after katrina and rita working through senator clinton's office at the time to give support and encouragement to us along the gulf coast. we're grateful, doctor for your help and support. finally, ms. terry fontenot of

women's hospital in baton rouge. she assumed the position in 1996 after serving as health care finance operations executive in louisiana and florida. she chairs the louisiana hospital association professional and general liability trust and is leading one of the finest hops in my view in louisiana that serves as a expertise in birthing and maternity for 8,500 children every year and is the designated hospital in louisiana to be the leader in disaster preparedness and response for this neonate group which is a very special group of infants that we need to keep our attention to during a disaster. let's start, mr. shriver with you. thank you very much. >> thank you very much, madam chair, for hosting this hearing and for your interest in this

issue. i submitted a longer report, frankly you said most of the things i was interested in saying and points to try to get across. just for the record, i'm mark shriv shriver, vice president and managing director for save the children. i want to summarize and say a couple quick facts. the bottom line is children are 25% of the population. yet this federal government and state governments and really all across the board we have spent more time and energy and money focusing on the needs of pets in disaster planning, response than we have on kids. 25% of the population received less time and focus and resources than pets. i think that for this country n this situation, that's absolutely outrageous. kids, as we all know and as you have eloquently said are lumped

under at risk and special needs populations. as mr. fugate just said what he is proposing to do at fema through the efforts over there are an exciting first step in the right direction to address children's needs in a comprehensive and effective manner rather than just creating window dressing, as he already said. a little background on the commission. we had our first meeting last year, our interim report is due in october of this year. final report is due to the congress and president in 2010. we had a field hearing in baton rouge where dr. redlinger joined me down there. we engaged a large community of entities to gather information, try to assess whether there are gaps in services, and those folks are not just federal government or state and local government but non-profits as well. i do want to comment again, what administrator fugate started at fema is very excited.

i want to say a couple quick words on child care. you have already had the save the children report up. there but the issues critically important not just from a kid's perspective, which, obviously, i think is paramount but the fact is that following a disaster, if you don't have child care facilities you have a loss of economic opportunity as you eloquently stated it. save the children's disaster decade report which is up there, shows only 7 states meet the basic requirements for licensed child care providers to have basic written emergency plans in place addressing evacuation and accommodating children with special needs. seven states in this country have the basic minimums in place. that, too, i think is absolutely outrageous and should be addressed and can be addressed through federal legislation. some steps we are proposing are in my written statement,ed in dam chair. i will just highlight a couple of them. mr. fugate talked about the

stafford act and saying child care can be deemed an essential service. we are supportive of this concept. we think that funding is necessary for the establishment of temporary emergency child care and recovery of child care infrastructure. the child care development books are being authorized. we propose during that reauthorization that state child care plans have guidelines for state operating child care after a disaster, and that states also are required to have child care providers with comprehensive all-hazard plans that incorporate shelter in place, evacuation relocation, family reunification, staff training, continuity of services and accommodation of children with special needs. the federal government has the responsibility to put these into place and we encourage to you

look into that. i know time is of the essence, so i will just wrap up by saying that a lot of the ideas that you and your staff have been working on and mentioned today are critically important. i would only encourage you as the chair of this commission and as a member of the non-profit community to follow up, follow up, and follow up again. you don't hold everyone's feet to the fire. kids because they don't vote and particularly poor kids are not actively engaged in the political process. you are their voice. if you do not stand up and your staff doesn't follow up diligently with all levels of the government they l unfortunately, suffer from benign negligent, which david paulson has told me is the modus operandi in the past. and i don't think that's the way this country should be reacting to poor children across the country. >> thank you, appreciate it i want to note for the record that commissioner fugate, administrator fugate has stayed

for the second panel. i would like that to be noted. it's important to me that he didn't testify and leave but is testifying to stay and hear these comments. doctor? >> thanks, madam chair. i want to echo our great appreciation for you holding these hearings and learning more about this terribly difficult problem we're facing. i'm a pediatrician. president of the children's health fund but also director of the national center for disaster preparedness at columbia university and have the honor of serving on the national commission, chair there the subcommittee on human services recovery. by way of background, shortly after hurricane katrina and working with local officials, we dispatched seven mobile pediatric clinics and teams to the gulf to provide acute medical and mental health care for those people and those are still there, affiliated with

tulane and other institutions. to date, we have seen over 60,000 health and mental health encounters in children. in addition to that, the national center, my center has conducted long-term periodic interviews with a cohort of 1,000 families. i want to summarize a couple key points out of many, many that i think are germane to discussions today. this comes from our clinical information and studies. more than 3 in 5 parents have feld over time that their general situation currently is either uncertain or significantly worse than it was before katrina. secondly, approximately one-third of this displaced children are at least one year older than appropriate for their grade level in school. third, according to interviewed parents, more than two-thirds of children displaced by the hurricanes are experiencing emotional or behavioral problems as we speak. in a study last fall of our program in baton rouge, 41% of children were found to have iron deaf fish shentcy ameanya, and

55% reported to have behavior or learning difficulties. as far as the overall learning situation for children, the number of disaster-related excessively vulnerable children now four years after katrina's landfall is unacceptably high with some 17 thoushlg at the minimum to, in my opinion, over 30,000 children still in limbo and at risk. many children who are now developing chronic emotional problems or who are failing in school will not easily recover. we are undermining not just their current well-being but future potential as well in my opinion, the overall management of the recovery process from the hurricanes in the gulf while less visible than the images seen around the world of people waiting on their rooftops for rescue has been more mishandled than the initial response to the disaster. the persistence of trauma and

profound disruption to children have been far more insidious and invisible. the failures of recovery have lost the attention of the media, for the most part the public and i'm sorry to say perhaps many in government as well. the basic concept of long-term recovery is fraught with confusion and lack of leadership on every level. there's a lack of clarity by what we mean by the term recovery. ma that is are we talking about rebuilding physical environment other working to help families reestablish conditions of normal life? though a national disaster recovery strategy was mandated under the post-katrina emergency management reform act of 2006 that strategy has yet to appear that said i believe that under new and highly motivated and capability leadership at dhs, fema and hhs, we are hopeful we may soon see the emergence of this critical road map. there's been no apparent recognition that the needs of children must be understood and

absorbed in this response planning, mitigation and recovery. we think this is changing as mark was pointing out. perhaps most egregious of all, there's a growing sense, and i consider it a monumental misunderstanding, that recovery from large-scale disasters is a local problem to be solved and managed by states and local jurisdictions. but the destruction we saw in the gulf and the flooding of new orleans was and remains a national problem. the well-being of the effected states is highly material to the well-being, economy and security of the united states. so i want t let me just his three of these. >> take another minute or two. >> the recovery strategy must be completed as fast as possible. i would ask for the by the end of the calendar year. there is no reason it needs to be delayed.

if we do not have that, we will be flailing around to figure out who is doing what for whom. i would strongly recommend a high level directory reporting to the president to oversee all assets. rebuilding and revitalizing the needs of children and families during this terrible transition is needed recovery must be seen as responding to every needed during the transition. we would like to see how the special recovery strategy actually addresses that. some of the other issues around children, which are representing the most dangerous problem right now. around children, which are -- which represent, to me, the most dangerous problem that we're facing now, because, as i

said before, the problems will not be sometimes at all reversible. children lose a year or two at school cannot be recaptured in terms of their economic success. emotional problems rooted in four years of trauma -- we think it will take another two years to get everybody housed if we have housing available, those children we ignore at their peril and our peril. so i have been thrilled to be on the national commission with mark. and here's a couple things i would point out. the national recovery strategy, when it develops should have an emphases on safe guarding the health, mental health and academic success of displaced children this addresses the point is, you raised before. it cannot be ad hoc it has to be part of our basic understanding about how we deal with recovery. for this disaster and anything else that happens in the future. maybe a storm in the gulf it could be terrorism in new york. it could be an earthquake in san francisco. we don't want to be redoing this. we need that road map.

secondly, the federal government must ensure -- assure a robust uniform and accountable case management program for every child displaced by a major disaster. i don't have time to go into it, but i had to medicate myself just to absorb the complexity and dysfunctionality of what our country called the case management in the aftermath of this disaster. it's shameful. thirdly i would say the health, dental and mental health service force every displaced child should be assured under a medical home comprehensive care model this is because somebody has to take responsibility for not permitting children to fall through the cracks. they can't afford the delays and interrep shuns in their safety net. i think i'll leave it at that and respond to any questions. burr our profound gratitude to you, senator, for taking and keeping the leadership on this vital issue. >> thank you, dr. ms. fontenot?

>> it's a privilege toe come before you today to describe our hospital's response to the evacuation of critically ill patients in the aftermath of katrina, our preparations for reit tax gustav and ike, the important lessons learned and our recommendations. women's hospital is 70 miles northwest of new orleans and a two-hour drive from the gulf coast. hospitals are usually a place of refuge rather than a complex evacuation site, so the need to evacuate one or a whole city had not been considered. but in katrina, women's hospital did just that. working with our colleagues in new orleans under unfathomable conditions, not one transferred baby or mother died. unquestionably this remarkable hievement was the result of dedication and hard work by thousands of people, not because of carefully crafted and effective planning. blackhawk helicopters brought

men, women and children day and night to our hospital. we received, stabilized and transferred many patients to other facilities. the most critically ill infants and women remained. for a month after katrina we cared for twice the number of critically ill infants and delivered 150 babies. for several day there's were 125 infants in our 82 bassinet and neonatal care unit. we provided care for over 1,100 patients and provided shelters for 110 newly delivered mothers and families because they were rejected at government-run and red cross shelters. what began as a rescue became a response to their overwhelming needs beyond medical care. this feat was successful because of our incredibly dedicated staff, an expansion to our neonatal care unit completed just weeks before katrina, and a drill held in 2005 that yielded valuable information. the rescue was adequate, the

coordinated planning by all agencies involved could have vastly improved their response. hurricane rita came three weeks after katrina. for rita and each storm since that time, flee neonates and high-risk women were evacuated before the storm. a plan was produced for emergency management of neonates. we contacted neighboring states to discuss evacuation, especially if baton rouge became a disaster site since no other hospital in our state has the capacity to take a large number of patients. we took part in research with tulane university to study the effects of the storms, and we are the officially designated provider for louisiana medical institution evacuation plan. we are committed to anything and everything that will prevent the chaos of katrina. hospitals in louisiana strengthened their infrastructure and plan to shelter and place with the notable exception of especially

fragile patients, those hospitals depend on us to transport and care for patients. women's hospital performance after katrina demonstrate an expert organization with adequate capacity is critical for the emergency management of certain populations of fragile patients. the expert hospital is the coordinator of care and has capacity to care for displaced infants. named operation smart move it's an initiative to ensure infants and mothers have a safe place as well as network of care and services. a remarkable opportunity exists to further implement these concepts as we build replacement hospital. search capability was included but was removed due to the high interest rates on tax-exempt debt and deep medicaid cuts to hospitals. search capacity is now unaffordable for us and most hospitals even though the hospitals in louisiana counted on us three times in four years

to fulfill this need. the cost for hospitals to be ready at all times is critical. the relocation of our hospital to a new campus will provide a unique learning opportunity. representatives from hospitals like women's from across the nation will participate in a real time evacuation drill as our nic unit is moved from one campus to the other. private organizations will qualify for associated costs of that evacuation. your concern about the impact of disasters on children is appropriate and important. on behalf of the staff of women's hospital we are excited to share our experience and knowledge in response to the care of our most vulnerable citizens. thachg you for your ongoing support and the opportunity to speak today. i look forward to answering any questions.

thank you. >> thank you very much. terry, we appreciate your leadership. you continue to make this senator very proud of the work that you're doing. we'll only have one question for each of you because of our time limitations. let me, ms. fontenot start with you. if you could restate two points for the record. one, despite the fact that your hospital did such extraordinary work in the storm, could you say again for the record what the current law allows you to get in terms of reimbursement? i understand you're a private facility so therefore basically out of -- while the government depended on to you help in so many ways, through not in line for any reimbursement for. you could explain that. >> my understanding is because we are not a governmental agency, that we are not able to receive funds directly from fema, that we have to have a contract with the state for any type of service that we provide

and it goes through state as fiscal intermediary. >> okay. could you say -- talk a minute about the surge ka passcy issue? as we debate the health care bill and how we may reshape the health care delivery system for the country, i think this would be important. so, again, if you could comment about the lack of surge capacity. >> thank you. most hospitals are faced with cuts because of inadequate reimbursement, particularly medicaid, that is the primary payer for children, particularly infants. 60% of the babies in our nicu are covered by medicaid, two-thirds of the deliveries in our state are covered by medicaid. whenever there are medicaid cuts as there have been just announced this week in louisiana, hospitals are not able to provide the financial support for additional bedses to be on stand by or equipment or supplies or planning or any of those things. any reimburse.

they receive has to go directly for the core medical services, that's taking care of those babies that are in the hospital that day without being able to have anything on the side so that we acan -- it's very expensive to have the planning and drills and that sort of thing. >> thank you very much. mr. shriver, let me ask you, if you could sum up, besides your excellent recommendation that a strategy be enacted by the end of the year and a requirement put down to receive that strategy, and that the child block grants not be reinstated without the requirement that states step up to at least have evacuation reunification, special needs and written procedure force disaster planning, are there one or two other specific suggestions that you would like to mention that you think from your study and review should be really at the top of our list to address in the next few weeks and months?

>> i think, as dr. redrener mentioned, coming up with a national framework for recovery is important. i think, honestly, senator, if you look at the child care development block grant and can put those requirements in there you come up with a recovery framework within the next five and a half months, and you have all child care facilities in this country looking at the issue of reunification, evacuation plan, making sure the children with special needs, their needs are incorporated into their planning, that that is tied in with the local emergency management community, i would consider that a hugely successful 5 1/2 ponts. i think that would be fantastic. i think the issue of -- that administrator fugate talked about, regarding the stafford act and having those child care facilities be reimbursed, i

knows there some int tra kacys involved in that, if you can address that issue and come up with recommendations and funding for that, i think that would be hugely successful. i think frankly if you could have another hearing to make sure we are all doing what we are supposed to be doing, that would make the next 5 1/2 months extremely successful. the first meeting we had with director fugate, he said what do you need? we rattled off a few things we said here, and he has set up meetings every 30 days to gauge progress or lack thereof. so if you and this subcommittee could look at and have another hearing and hold our feet to the fire and the executive branch's feet to the fire that would make the next 5 1/2 to 6 months highly successful as well. >> thank you very much. we will do so. doctor, you said that the case management was -- i think you

would say, i'm putting these words in your mouth, you would hardly call it case management. it was not really managing much of anything. so fragmented, unable to deliver in a timely, appropriate way. when we think about creating a new kind of system, i've read in some of your testimony and other recommendations that part of the delivery system might be done through the schools as they start up in terms of school-based counseling services. do you want to comment about the preference for that? or should there be opportunities community-wide? what is it about school-based counseling that you think is particularly desirable? >> well, first of all, we have to have a system that makes sure every child who is school-aged is in school and kids in pre-school age are in appropriate day care facilities. so the school can be -- and the related institutions could become the basis of stability for lots of families, especially

lots of children. from that point of view, if we could have services emulating out of that model, so every child is in school, every child has a family and that it's possible to think about a system that would mandate not only the kids being in school but that appropriate safety net programs and assistance for the families be generated by that the other organizations that are down there. the problem is that it is so fragmented and disorganized many families are just looking to the effect -- through the cracks. i want to clarify that a lot of good work was done. we do not know how many. getting the numbers was one of the most difficult challenges i have had in research in 20 years, because there is not a

single agency that feels it is responsible for tracking these families who have been displaced. if we start with that, we have an inability to know how many or where they are. we begged them, fema and the state, to make sure no families were discharged from those tree the parks before we knew who they were where they were going so we could provide services. all sorts of snafus between the federal government and state governments and private agencies yielded that one of the largest programs never got implemented. not one dime was spent until very recently. we cannot track families. we had no idea where they are. i have no idea where those children are. i would challenge the federal government to try to figure out where they are. how many are in houston or

alabama and how many are still struggling in limbo? how many are in houston mobile, alabama, so forth? how many are still struggling in limbo in displacement conditions that are really, really hurting these children and their opportunity for success. >> thank you so much. i would like to close with a couple of comments. one, the louisiana family corporation, recovery corporation, i understand delivered some very good work. >> they did. >> unfortunately their contract was not able to be renewed, and i hope that they can be called in for comments as we try to come up with a better system. my final comment is my own personal experience, not only in my own family experience recovering from the disaster as you all know i'm one of nine siblings, and four of my brothers and sisters lost their homes, their children were displaced. watching it up close and

personal within my own family, and then expanding that out to our own neighborhood, broadmor, which was destroyed, out to the community. i have concluded one thing that i know without reading one report -- that schools became the center of life when those neighborhoods were struggling to come back. whether it was st. dominic's or holy cross or wilson public school that is getting ready to open or lusher that opened, it became the only stable place, building, in a anybodihood completely destroyed. the government at its own peril fails to recognize the importance of these schools. it brought stability to the life of parents that otherwise had no stability. they needed to turn from just schools to community centers that provide counseling, medical support, particularly when your hospitals are closed, getting

your schools open, getting children back in touch with their teachers, which is a familiar face at that moment is very significant to children that have had such trauma. i can't overestimate and overstate how important this is. and the federal government that doesn't recognize the importance of schools, be they public, private, catholic or independent, and the ability of schools to be sort of step in the gap until the rest of the community comes back, i think is kind of the model that i see. and the celebration of joy that when a school would open in a neighborhood, what it meant to that community cannot be overestimated. so i'd like to end with that. we have a great of deal before us. this record will stay open for 15 days. please, anyone can submit to the

[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> tonight a hearing on defective medical devices and the cost to patients. starting at 11:00 p.m. eastern on c-span2. quit>> before it was decided, te device manufacturers were subject to loss. there are many of them. it does not until the real decision that the door shut. and i not correct in that? >> no sir.

>> they were certainly subject. >> they did not know if they would win or lose in a court room. the best year before the decision before the top 25 medical device companies had a net profit of $173 billion. that is net profit. they were doing quite well. they were coming up with new devices all the time even though they did know it will be set to record claim or not. it does not seem like innovation is stifled. regardless of the difference between drugs and devices we are getting new drugs on the market all the time.

they are not preempted from court claims. is it not true that after medtronic received reports of these manufacturers, you state that within months of initial market release they did not recall it until three years later an fda report said there was "objectionable conditions" related to the company investigation of the product anomaly. do you believe the fda approval process is so good that manufacturers of these devices should receive immunity when there faulting or cause injuries? you have been there. tell us about their.

>> efta has done an exceptional job evaluating devices. they are thorough. the issue i have is the concept that manufacturer liability stops that device approval. i tried to outline all the responsibilities of the manufacturer after the fda approves the device. they have to ensure stability. there are many compliance guidelines that they need to follow. it is simply impossible for the fda to monitor individual companies when there are 50,000 manufacturers and 100,000 devices such being produced. the idea that only those companies that get caught by the fda for the one sector going to be held liable is bad policy. -- are the ones that your going to be held liable is the policy. there is a report in 2006 that noted the decline in enforcement

reports and activity of the fda. a number of warning letters declined 50% between 2000 and 2005. they have the largest decline in issues. the concept we will rely on them catching manufacturers doing something wrong in order to support consumer liability is just a bad policy. >> they say want to make a device -- i guess you can change the device, you can change it. if they make a change on the device does have to go all the way back to the beginning in go through free market approval? >> manufacturers can make modifications for their device and they need to let the fda know about it and submit supplements to their application. >> it does not go right back? >> that is an excellent point.

the of the trumbull different later was actually a supplement -- the electronic defibrillator was at a supplement application. it had no human clinical data. they made a modification to their lead. it was never an implanted in a human before it was approved -- no human data was submitted to the fda for approval. it is approved on the basis of bench testing and then it goes into record -- into roughly 300,000 patients. why are we here? it is obvious. it to be inevitable that something like this would happen. >> used to miss a thing i did not know. you are saying the device when it went through the whole free markell approval -- pre-market approval, later on they made a change clinton and have to go back and be approved and they did no human trials? >

each of the supplements go back to the fda consideration. supplements often do not require human clinical testing. you are now looking at at least 15 years removed from the are original. there is not a lot of clinical data that was submitted. the idea it will function perfectly well and the manufacturer will not be liable is an interesting policy. >> thank you. >> do you have any comment about anything similar? >> it supplemental pma required for any change of any kind and is required to be approved by fda using the same standards of

safety and effectiveness as the original pma > i do not want there to be any confusion about theiat. they look at the entire document. there is no distinction between the original and the supplemental pma. the fda in this instance, perhaps incorrectly, what they did was look at all the data on safety and effectiveness in humans. they concluded that the new lead did not require additional human data. i am not a scientist. i cannot say they were right or they were wrong. the doctors more qualified than i to make that judgment. i do not want there to be any

confusion about what the process was. >> did you sue because of the difficulties you went through? did you intend to sue? >> when it first happened, i did not intend to sue. i liked my doctors. i did not know there have been a problem with leaves. i was not told the. in october of the year i had my problem, for five months later, a friend called me and said did you see the products? i said i had not. i looked edit and my wife and i discussed it. i did not do anything for a good long time. it was the ende jan. -- the end of january before a contacted the firm. >> i understand you'll be going

right from this hearing of to the salt flats in utah. you try to set your fifth record. is that right? >> that is right. but i do not want to call you nuts, but we are very proud of that. >> thank you very much. >> it is a great opportunity that the family has been given. we have the wounded warrior project on board. , to be flat with us -- you can come up to the flats with us burda we will take the u.s. -- flats with us. we will take the u.s. military with us. but you said that the first stimulator did not work and the technology from the second push the envelope and was risky.

after considering those factors, can you explain what made you decide to get the second device? but have you any regrets and to have received the second device? >> family. i want to my family back. i wanted a chance that a normal life. the original did not go well. it was like being electrocuted. it fell to predict it felt like counting. five years later it is now up to three and a milligrams a month. -- 300 milligrams a month. i had suicidal thoughts. for me it was desperation. during that time the technology have changed. it was night and day when they turn the system on.