more money, when you make a budget request, we need to make certain this is not about standing the number of people. i am told within the headquarters, there were 800 people in 1990 and now it is 11,000. the focus has to be on the people who provide patient care, not the folks who get into the way of that patient care. i indicated to you in our commerce station that i am looking forward to somebody who can rebuild the trust that i want and the department of veterans affairs and what our veterans deserve to have in the department for their benefit. i look forward to working with you to accomplish that. i want to highlight for you how rural our state is. i served in the house of

representatives for a district that is larger than the state of illinois. we need to continue to work to provide services to folks who do not happen to live any place close to where there is a v.a. hospital. over the course of my time in congress, working with the department of veterans affairs, we have had outpatient clinics that has helped. if you lived four or five hours from a v.a. hospital, how do you get there, particularly if you are 92-year-old world war ii veteran? if you are 92 when you live 2.5 hours from the outpatient clinic, it doesn't make that much difference that you are two hours closer to a facility if you cannot get there nyway. one of the things i am pleased about and the legislation that

is pending that i hope the conference committee reaches a result when we come back and vote about it, the idea if you live long distances from ava facility that the v.a. will provide care for you. the v.a. today has the ability to do that. they have the ability to pay for outside services. they are seemingly reluctant and often unwilling to do so. you need to understand that when the v.a. fails to provide those services to those veterans, most likely what happens is that better and no service at all. in fact, in my hometown -- we were successful in opening an outpatient clinic. 1100 veterans of northwest kansas was able to access care. that 1100 making their way to wichita, this would be closer. the amount doubled because prior to that those veterans were not receiving care. i look forward to my opportunity with you. i want to help explain the challenges that we face in a

state like ours. one of the ongoing complaint i will like you to solve is we have an outpatient clinic in kansas that has not had a physician for more than three years. while i have raised this issue with the department of veterans affairs, over that time, the problem i had is that -- i understand it is difficult to recruit and retain physicians, there is been no plan to fix the problem. we need to help you implement it. all want to bring home to you the unique natures of places like my state. thank you. >> as you said, i think it is all about the mission which is care for the veterans. we have to look at all these

decisions through that lens and tried to get access for the people in rural america. >> thank you, senator moran. >> you have done a terrific job here today. you have a variety of tests that have not surfaced at this point within the workings of the congress and united states government. it is always a has been that when you give testimony, it is different. when you give testimony or your people at a higher level give testimony to this committee or any other committee in congress, it has to be approved before it can be given by the office. that is a restraint because the

white house is saying to you that you can say what you want but it has to be within our parameters. i do not have any fear in your case because the veterans administration's deficiencies and the need for money is so apparent that i think your road will be easier. that is a restraint. it is an unknown restraint for most of the american people. secondly, you will find that we in the congress are terrifically skillful at finding problems, things we think have gone wrong in your agency. then, we want those problems fixed. there you are sitting. the press is always available and people use the press very liberally often to make criticisms which they themselves are not willing to step up to the plate to solve. do it talk a lot here about accountability. i think it is part of your responsibility -- and i am not sure what i mean when i say

this because i am not sure how you do it -- you can find ways. people here say well, let's not throw more money. there are plenty of resources. you have talked about that -- putting the i.t. people on other positions. the fact of the matter is the problems of the enormous boundary and growth is yet to be seen. eople who were seeking help at the v.a., the whole series of new problems to the v.a. system. part of the accountability is you being frank with us when we are not giving you what you eed to do the job. you cannot allow us to sit here and say that there is plenty of money available when you know perfectly well you are going to go out and hire the right kind

of nurses and doctors which has profound the dsp solutions -- ptsd solutions. all of that costs money. this congress is divided from the people who want to spend money and think you need to spend money when you of a particular problem. and those who would say there is no problem with veterans but hey do not want to spend money to do anything about it. maybe it is ideology or fear or leadership or whatever. oy, does that hit you in the face. the v.a. has done better than any other institution in

getting money. that is still not saying much. we have shut the government down, we have sequestration. don't spend, it if you will you will be labeled a big spender and you will lose the next election. i am just saying as a friend to you, when people say they will be your ally, make sure they really are and make sure they are doing for you what they should be doing for you. that is the accountability we oh on ourselves and we hope you will do for us. we are not an easy group to deal with. it is easy to talk and complain but it is hard to solve problems. i think you will be a superb the secretary. to be frank with us. >> i do when on it being a two-way partnership and want to give you my cell phone number and i want yours at the same time. [laughter]

>> thank you. senator blumenthal. >> you can have my cell phone number for what it's worth. it is not worth as much a senator rockefeller's. thank you for being here and thanks for answering all of our questions as well as you have. in my initial statement, i aised a spector of the v.a. as comparable to a bankrupt orporation unlike a lot of bankrupt corporations or at least corporations that fold. the v.a. has a lot of assets. one of its very distinct asset is its very dedicated people. its trained professionals who do such great work day in and day out regardless of the headlines in the paper and the disparagement they may see in

the congress. we see it in connecticut. we have a lot of great docs and medical care in connecticut. most especially at the west haven v.a. facility which is our main hospital. my question is -- what can we do to attract more of those trained professionals to the v.a. facility in connecticut and others around the country which really provide the day-to-day care for our nation's heroes? >> i think that is a great question. i have been thinking a lot about this. knowing the shortage we have. and also the more relatively organization -- morale of the organization. it dawns on me that health care professionals want to make a inference in the lives of others. they want to be on the cutting edge. we are going to start correlating ptsd with events

that occurred during the military experience, that is cutting-edge stuff. stuff that no one has done before. that is the kind of thing that i would think health care professionals would want to be a part of. we should tell that ability and use it to recruit the best people who want to make a difference in others' lives. >> when we met, i have asked or sites pacific information related to the audit that was done here. asking general's shinseki for site-specific information. i am referring to the audit that was done in the spring. i would like a commitment that i will receive a response to that letter.

>> we will respond to the etter. >> i would like your commitment that you will -- asking for an pparent tripling in the wait times. it seemed to have tripled in connecticut. will you commit to me that you will provided response to hat? > if confirmed, i will provide a response. >> i'm hoping that response. >> that is my hope as well.

>> the other area that is of grave concern to me is care for women veterans. 's -- >> is a growing priority the number of women going into combat is growing. this is something we have to et ahead of. >> relating to connecticut, a reat deal of our veterans have been victims of purgatory -- predatory schemes or practices on the part of for-profit colleges or others related to educational benefits. ultimately the victims are not just the veterans but also taxpayers. it is taxpayer money that is ost.

will you commit to make correction of those kinds of abuses? >> i have read some of the newspaper articles and reports on that. we will get into that and understand it. it is unconscionable that somebody would take advantage of our veterans. >> with regard to the criminal investigation that is ongoing which i asked the department of justice to begin, i would like your commitment that you will assist and support that investigation to hold accountable anybody who has committed fraud awardees were documents. you legally manipulated -- committed fraud or destroyed documents. illegal many -- illegally destroyed or manipulated things. >> the number one value of the

organization is integrity. >> thank you. >> thank you for being ere. i would be remiss if i did not first to brag about my state and invite you to it. as the senator from alaska, we have attempted to look at this problem in a very complex way. it's not only a health care delivery system, g.i. benefits, a laundry list of services. as i said earlier in my comments in the opening -- we now have in alaska 26 agreements with tribes that deliver health care. e didn't need legislation. we offered it to read we work

with the administration to figure it out. the former secretary was bold and went on the cutting-edge. i think we are starting to do some incredible things that are delivering services wherever veterans are in uva -- and the v.a. reimburses with regards to the services. in both of these, when we are partnering in anchorage, the delivery system -- if you are a veteran, you will get same-day care. that is a pretty -- that should be the goal. when you walk in as a veteran, you should get care. we're getting 70 to 80 folks a week signing up. many are signing up to be -- we have an incredible delivery ystem. what i mean by that, not just a mechanism but the kind of care we deliver. a holistic view of medicine. not just that you come in with

one ailment. we try to look at the whole system. we have a team that works with you. the idea is that the outcome of the health care is better than just a process they are going through. i would hope that you would be willing to consider looking at that. i know dba -- the v.a. has been looking at this as a model in some cases. we dropped emergency care cases by changing once a both thing. would you commit -- you mentioned you were going through go around. we have a clinic and a unique delivery system. to come to alaska and see what we are doing? >> certainly, i would like to go to alaska again. i have been there many times and have always enjoyed it. what you described is trying to

prevent the ole miss. trying to prevent the problem not just treating it once it occurs. the work we have done at procter & gamble with our health care business has always been about preventing the illness from occurring. >> for a good. >> in order to keep people healthy hunger. >> -- very good. >> in order to keep people healthy longer. >> i wanted to echo what senator blumenthal mentioned about the eva -- growing population of women in the va system. some of our systems were not designed for the needs of women. i want to hear you say it again.

your commitment to make sure the women who are veterans who will get equal treatment as you are looking at and in proving nd reforming the system. >> yes or. >> -- yes, sir. >> here is what is going to appen. you will have all these wonderful ideas. hich we are anxious for. you will be told, you don't have enough money. are you willing to buck the system to say, here is what we need if we are serious about dealing with our veterans? which may mean you have to say something -- no disrespect to my friends at omb -- they are my friends -- are you willing to push to be the advocate for the veterans when the system says, you we cannot do it? >> my intention is to meet with members of the opposite --

office of management and budget meet with -- once a week or o. they are a constituency and they are going to be helpful. a partner ship with them is critically important. just as a partnership with that organization and the private sector would be as well. >> less question -- last question. we have seen this play before with dod. i have seen it on the ppropriations committee. e brought v.a., da, an irs ogether to figure this out. when they say, it is not our problem. when you stand tall and say, we are going to have these integrated systems that are clean? that the veteran does not have to worry about. we as agent she should worry about a boat -- worry about but we should never worry about

it. i am anxious for your -- >> the pentagon may be big but secretary hagel and i are small. we can work together on these kinds of things. i do plan to let him know what our needs are. hope in return he will let me know what his needs are. at the effect that he reached out to me is a great sign. -- i think the fact that he reached out to meet is a great sign. >> thank you very much. i was a bit more questions. i appreciate your willingness to be here. >> we are coming to a close. let me thank you, mr. mcdonald, for your willingness to serve. what we are going to try to do -- i hope and believe we can --

is have a vote on your confirmation tomorrow. i believe based on what i heard, you are going to be confirmed. i hope that is the case. the other thing i would say, and the senator raised, is there is a conference committee report out there. my only disagreement is there is also a house of representatives, not just the senate. both bodies are going to have to work together. i hope we will be able to do that before we leave here. i hope we will be able to provide you with the emergency hope -- hope you need. i hope also we will give you the resources you need to get the doctors and nurses and other personnel you need so we don't have this crisis. let me conclude by saying you have heard -- and i know you are aware -- of the significant roblems facing the v.a.. in addition to everything else,

we have 2 million veterans that have come into the system in recent years. you will be dealing with a crisis of 500,000 men and women dealing with ptsd and tbi. accountability issues. the need to develop a new culture at the eva. -- at the v.a.. what you have going for you is the american people feel very strongly about the need to provide for and take care of those who have sacrificed so much. i think they will support you. i thank you very much for being here. this hearing is adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014]

>> you can join the conversation on facebook and twitter. we're asking our viewers, do

you think robert mcdonald can fix the veterans affairs department? maureen writes on facebook, he may be able to do so, but he needs to change the government mentality mindset or culture of the v.a. employees. and this from jay, no, not unless he goes in and cleans house. the major problem with the v.a. is a bloated management. post your comments go, to acebook.com/cspan. >> 40 years ago, the watergate scandal led to the only resignation of an american president. we revisit 1974 and the final weeks of the nixon administration. this weekend the house judiciary committee considers impeachment of the president and the charge after buss of power. >> what you have here are questions about what the framers had in mind, questions about whether the activities that had been found out by the committee and by the watergate

committee were indeed impeachable, and thirdly, can we prove that richard nixon knew about them and even authorized them? >> watergate, 40 years later, sunday night at 8:00 eastern on merican history tv on c-span3. >> president obama signed the workforce innovation act which invests in job training. the president, who was joined by vice president biden, spoke about jobs and the economy. his is 30 minutes. >> ladies and gentlemen, the vice president of the united tates. >> good afternoon, everyone.

great to be here. please, thank you very much. thank you. distinguished members of congress, members of labor and business and the community, today as the president signs the workforce innovation and opportunity act, we're using this occasion also to present to the president a road map he asked and requested in the state of the union message, how too keep and maintain the highest skilled workforce in the world. i had the best partners i could ask for. i talked to governors, mayors, industry leaders, presidents of community colleges and colleges, unions, and a lot of members of congress, many of

whom are here. i have to knowledge at the outfront -- at the outset that my wife, jill has been an incredible advocate for community college and the role they play in training the workforce. most importantly, i spoke with a lot of americans who were hit exceedingly hard by the great recession. they are doing everything they possibly can to find a job. they are willing to learn new skills in order to have a decent middle-class job. one thing i hope we can put to rest -- americans want to work. they want to do anything to get decent job. they show us that are saying his greatest resource -- and is not hyperbole -- is our workers. they are in the best position to learn the skills of the 21st

century that the workforce requires. the phrase, all has changed has changed utterly. all has changed. it is a different world in which people are competing to get the jobs they need. whether it is in clean energy or information technology, all areas that booming. how do you connect? how do you connect these workers who desperately want a job, who will do all they need to do to qualify? how do you connect them with jobs? how do americans know what skills employers need? it sounds like a silly question. how do they know? how do they get these skills once they know what skills are needed for the job? where? where did they go to get those jobs. this report is designed to help answer those practical

questions. it includes 50 actions of the federal government and outside partners are taking now to help fill this skills gap. there is this new strategy that we think will lead directly to more middle-class jobs. these actions will help promote partnerships between educational institutions and workforce institutions. they will increase apprenticeships which will allow folks to earn and learn and earn while they learn. it will empower job seekers and employers with better data on what jobs are available and what skills are needed to fill those jobs. let me tell you a story. i have been looking at programs you have that are similar to what he are proposing today. i was recently in detroit just last week. i met with an incredible

group. all these people came from hardscrabble groups in detroit. it was all women. it was coincidence. they all made it through high school. they ranged in age from 25 to their mid-50's. they all got a high school education and they were determined to do more to provide for themselves and their families. through word of mouth, they heard about eight coding boot camp. it is called set it up america. it was a partnership between

wayne county community college and a company called ust global. it is an intensive four-month, eight hour a day -- i think. it is almost the whole day. don't hold me to the exact number of hours. it is an intensive training program where these women -- as i said, there were about a dozen and a half women -- learned i.t. skills needed to fill jobs at ust global. they represent a lot of i.t. companies as well. knowing vacancies exist, they estimate over 1000 vacancies in the greater detroit area. upon completion of this rogram, ust global hires the students and the lowest starting job is at 45,000 a ear and the highest is $70,000 a year. these are computer programmers.

u.s. global does not train these women out of a sense of charity. they do it because it is a very smart business decision. there is an overwhelming need for more computer coders. not just ust global, but the entire industry. by 2020, our research shows there will be one point or million new i.t. jobs all across this country. the pay is in the $70,000 range. i was so proud of these women. as i said, my wife teach at a community college. her average class age is 28-30 years old. just think of yourself what courage it takes. you are out of high school. you have graduated. you have been in a job trying to make it. you have been out 10, 15 years. someone says there is an opportunity to take this program, to learn java, to

learn to operate a computer in which you can code it. it takes a lot of courage to step up. it takes a willingness to be able to fail. these women were remarkable. not just of these women. they write code. they were not out there. they knew someone who had gotten a job because of the program and they thought they could do it. they learned an entire new language and they displayed an initiative that was remarkable to see. they showed up. they worked hard. because they want a good-paying job. they want to make a decent living. they want to take care of themselves and their families. folks, as i know all of my colleagues believe, this is what it is all about. it is not just information technology. manufacturing. 100,000 high-tech manufacturing obs available today in the united states because the employers cannot find workers with the right skills. that number of highly skilled

manufacturing jobs is going to grow to 875,000 by 2020. folks, you know i was recently up in michigan. dow coco has a plant there. they could not find someone who knows how to run the machines. the community college and business role be machines into the community college. these are good paying jobs. in energy, 26% more jobs for petroleum engineers. average salary, $130,000 a year. 25% more jobs for solar panel installers. $38,000 a year. more electricians are needed earning $50,000 a year. these are real jobs. health care. there are 20% more jobs. 526,000 more that are needed in the health care industry. registered nurses, jobs that pay 65,000 bucks a year. there are training programs in your districts when while you are out there and a practical urse, you can still be working and be essentially apprenticed while you are learning how to become a registered nurse. physicians assistants badly needed as the call for health care increases.

what is the number, tom? 130,000 a year, roughly? these are jobs all within the grasp of the american people if we give them a shot. if we show them away, let them know how they can possibly pay for it while they are raising a family, and they will do the ays. to maintain our place in the

world, we need to maintain the world's most skilled workforce and to give hard-working americans a chance at the good middle-class job that can raise a family. the actions in this report are ust a beginning. so many have fallen out of the middle class and many need to ind a path back. there is a path back if we all do our jobs. from union leaders to congress to the federal government. the mission is very simple. it goes back to central economic vision. this guy that most of us -- i can speak for the president and i -- from the day we got here. the mission is to widen the aperture to be able to get into the middle class. to be able to get into the middle class by expanding opportunity. no guarantees, just expanding opportunity.

men and women who represent the backbone of the most dynamic, thriving economy in the world. that is a fact. we are the most dynamic, thriving economy in the world. in order to thrive, education and training has to be just as dynamic and adaptable as our economy is. folks, america is in a better position today than we have ever been. we are the most attractive place in the world for foreign investment by a long shot. since the survey says the gap between number one and number two is wider than it has ever been. manufacturing is back. instead of hearing about outsourcing, what are you hearing now? you are hearing about in sourcing.

companies are coming back. we take note direct credit for. we are in the midst of an energy boom. united states of america, mexico, and canada. we remain the leader in nnovation. we have the greatest research universities in the world. we have the most adaptive, most adaptive financing systems in the world to go out and take chances on new startups. american workers are the most productive in the world. they want to work. to seize this moment, we need to keep the world's most skilled workforce here in america. i think with this bipartisan group, we are ready. the american people are ready. i know the man i'm about to introduce is ready. he wakes up every morning trying to figure out -- how do we give ordinary americans an opportunity?

this is just about opportunity, man. imple opportunity. how do we give them? they are so exceptional. ladies and gentlemen, i think everyone in this room shares that goal, providing for opportunity. the man i am about to introduce, that is all he talks about when he talks to me. ladies and gentlemen, the president of the united states, barack obama. [applause] >> thank you. thank you so much. everybody, please be seated. welcome to the white house. i want to thank joe for the generous introduction but more importantly for everything he does on behalf of american workers. i want to thank the members of congress who are here from both parties who led the effort to reauthorize the work worse investment act. when president clinton signed the original work or investment act back in 1998, he said it

was a big step forward to making sure that every adult can keep on learning for a lifetime. he was right. the law became a pillar of american job-training programs. it has helped millions of americans learn the skills they need to a new job or find a better-paying job. even in 1998, our economy was changing. the notion that a high school education could get you a good job and you keep that job until retirement was not a reality or the majority of people. advances in technology made ssome jobs obsolete. global competition sent other jobs overseas. as we were coming into office, the great recession pulled the rug out from millions of hard-working families. the good news is that today, nearly six years after the financial crisis, our business has added nearly 10,000 new

jobs over the past 52 months. manufacturing is adding jobs for the first time since the 1990's. the unemployment rate is at its lowest since september of 2008. it is the fastest drop in one year in nearly 30 years. there are more job openings at any time since 2007, pre-recession. for the first time in a decade, business leaders around the world have declared that the number one place to do business, the number one place to invest is not china, it is the united states of america. thanks to the hard work of the american people and some decent policies, our economy has recovered faster and gone farther than most advanced nations. as joe says, we have the best cars. now we emerge more companies to join the trend and bring it jobs on. to make sure that the gains are

not just for the very top but that the economy works for every single american. you are working hard. you should be able to get a job. that job should pay well. you should be able to move forward and look after your family. opportunity for all. that means that even if you are creating jobs in the new economy, you have to make sure that every american has the skills to fill those jobs. keep in mind, not every job needs a four-year degree. the ones that do not need a college degree generally need specialized training. last month, i met a wonderful young woman named rebecca in minnesota. a few years ago, she was waiting tables. her husband lost his job. he was a carpenter doing construction work.

he had to figure out how to scramble. she got enrolled in community college and retrain for a new career. not only is her husband back in construction, but she loves her job as an accountant. started a whole new career. the question then is how do we give more workers that chance? to adapt, to revamp, to retool so that they can move forward in this new economy. n 2011, i called on congress to reauthorize the workforce investment act updated for the 21st century and i want to thank every maker who was here, from both parties, who answered that call. it took from compromising, but you know what? it turns out sometimes that compromise is ok. folks in congress got past the differences. they got a bill to my desk. this is not a win for democrats or republicans. it is a win for american workers. it is a win for the middle

class. it is a win for everyone fighting to make their way into the middle class. the bill i am about to site will give committees more certainty for job training programs in the long run, it will help us remove programs into the 21st century why building on what we know works based on evidence, based on tracking what actually delivers on behalf of folks who enrolled in these programs. more partnerships with employers, more tools to measure performance, more flexibility for states and cities to innovate and to run their workforce programs in ways that are best suited for their particular demographic, their particular industries. as we approach the 24th anniversary of the ada, this bill takes new steps to support americans with disabilities want to live and work independently. there is a lot of good stuff in

here. as joe said, there is still more we can do. that is why we have rallied employers to give long-term unemployed a fair shot. that is why we are using $600 million in federal grants to encourage companies to offer apprenticeships and work directly with community colleges. it is why in my state of the union address, i asked joe to lead an across-the-board review of america posturing programs to and match them with good obs right now. today, i direct my cabinet to implement some of the recommendations. we are going to use the funds and programs that we already have in a better way. we have been working on an pproach.

a lot of you know what that means. hey enroll, they get trained for something, and they are not sure if the job is out there. all they are doing is saddling themselves with debt and putting themselves in a worse position. we want to make sure that you train the workers first, based on what employers are telling you they are hiring for. help business design the training programs. so, we are creating a pipeline in jobs that are out there. number two, training programs that use federal money will be required to make public how many graduates find jobs. workers, as they are shopping around, no if they can expect a good return on their investment. every job seeker should have all of the tools they need to take their career into their hands. we are investing in new

strategies that keep pace with the economy. we are testing faster ways of teaching skills and giving at risk youth the chance to learn on the job. we will keep making sure that americans have the chance to build their careers throughout a lifetime of hard work. the bill i am signing today and the actions i am taking today will connect more americans with ready to be filled jobs. there is so much more we can do and i look forward to engaging all members of congress and all businesses and not-for-profits ho worked on this issue to see what else we can get going. i will give you a couple of examples. ur high school graduation rate

is the highest on record. more are earning college degrees than before. we can still do more to make college more affordable and lift the burden of student loan debt. i acted to give millions of americans the opportunity to cap their student loans by 10% of their income. congress could help do ore. minimum wage, you know, this week marked five years since the last increase. more and more businesses are raising wages. i would like to work with congress to see if we can do the same for 28 million americans. give americans a raise right now. fair pay. let's make sure the next generation of women are getting

a fair deal. let's make sure that the next generation of good manufacturing jobs are in america and let's make it easier and not harder to bring the jobs back home. we will get to vote on the "bring jobs home" act. there are companies moving profits offshore. let's encourage those companies. let's build on what parties have already done on many of these issues and see if we can come together. while we're at it, let's fix the immigration system that is currently broken in a way that strengthens the borders and we know will be good for business. we know it will increase gdp and drive down the deficit. so, i want to thank all democrats and republicans today for getting this done. it is a big bil.

i invite you back. let's do this more often. this is so much fun. let's pass more good bills. look at everybody. everybody is smiling. everybody feels good. we could be doing this all the time. our work to make real differences in the lives of americans. that is why we are here. more job satisfaction. the american people are customers and they will feel ettore about the product we produce. in 1998, when president clinton signed -- into law, he had a man from pennsylvania who spoke about how he had been laid off in 1995 at age 49 with two kids and no college degree.

with the help of jobs training programs, he was able. he earned his bachelor's degree in computer science, found a new job. today i and his wife still live there. for the past 16 years, he has been employed as a programmer and worked his way up from contractor to full-time employee in a few months. he plans on retiring after a lifetime of work. the program made a difference in his life. what he is thinking about doing is teaching computer science and helping a new generation learned skills that lead to a ob like he had the opportunity to. i ran for president because, even in a changing economy and a changing world, stories like jim's should be the norm. i know that america is full of men and women who work very

hard and little to the responsibility. all they want is to see hard work pay off. that responsibility rewarded. they are not greedy. they are not looking for the moon. they want to know if they work hard, they can retire. they are not going to go bankrupt when they get sick. maybe take a vacation once in a while. nothing fancy. that is what they are looking for. what is important is family, community, and relationships. that is possible. that is what america is supposed to be about. that is what i'm fighting for every single day as president. this bill will help move us along this path. we need to do it more. let's get together and work together to restore opportunity for every single americans.

i want to invite some of the people in the audio to help make this happen. i am going to sign this bill with all of those pens. thank you, everybody. [applause] >> all right.

>> all right, everybody. [applause] >> great job. > good work. >> all right. thank you, everybody. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> the head for the centers of disease control and prevention

says the government needs to take steps so that life-saving bibets don't become ineffective. those remarks are next. topics on this morning's "washington journal" include reforming the veterans affairs department and the chemical weapons program. "washington journal" is live at 7:00 eastern here on c-span. app 40 years ago, the watergate scandal led to the only resignation of an american president. american history tv revisits 1974 and the final weeks of the nixon administration. this weekend the house judiciary committee as it considers impeachment of the president and the charge of abuse of power. >> what you have here are questions about what the framers had in mind, questions about whether the activities that had been found out by the committee and by the senate, watergate committee, were indeed impeachable, and thirdly, can we prove that

richard nixon knew about them and even authorized them? >> watergate, 40 years later, sunday night at 8:00 eastern on merican history tv on c-span3. >> the head of the centers for disease control and prevention spoke about public safety issues, including antibiotic resistance. dr. tom frieden also took questions at the national press club. this is an hour. >> good afternoon and welcome. i'm an adjunct professor at the george washington university school of media and public

affairs, former international bureau chief with the associated press, and the 107th president of the national press club is theional press world's leading professional organization for journalists committed to our profession's future through our programming with events such as this while fostering a free press worldwide. or more information on the please visit our website. on behalf of our members worldwide, i would like to welcome our speaker and those of you attending today's event. our head table include tests of the speaker, as well as working journalists who are club members. if you hear applause in the audience, i know members of the general public are attending so not necessarily evidence of the lack of journalistic object to the. i would also like to welcome c-span and public radio audiences. follow the action on twitter.

guest speech concludes, we will have a question and answer time. i will ask as many questions as time permits. headt is time to introduce speaker guest and i would ask briefly.ou to rise charles schneiderman. m.d., phd, audiovideo news. editor, pierce medical devices and pierced drug delivery. come a world prevention alliance. ruth catch, director of the health come a medicine and society program of the aspen institute and member of the cdc foundation board of. ,nna miller, associate editor monitor on psychology magazine.

liles, cofounder and executive director of the peggy liles memorial foundation. donna lane well. vice chair of the national press club speakers committee and former president of the national press club. skipping over the speaker, resident of editorial associates and national press club speaker committee member or organized today's luncheon. thank you. faith mitchell, president and ceo of brad makers and health and guest. correspondent for reuters. carolyn block, publisher and editor, federal telemedicine news. washington bureau chief. week dr. tomt friedan was busy cramming for his july 16 appearance before

the house committee on energy and commerce. the director of the centers for hadase control, dr. friedan been summoned to washington to theer questions about starkly and potentially dangerous latter errors at the cdc. while that topic is likely to come up again today, dr. friedman joins us to explore a much bigger and broader issue, looming worldwide health threats, including the pathogens that put modern edison at risk. he will discuss what can be done about the middle east syndrome corona virus or mears, a disease that has no known cure and recently emigrated to our country. it haunts the arabian peninsula come and is now showing up in other destinations faraway. the virus recent arrival in the united states sent hundreds of

staff into emergency mode. some now referred to the illness as public enemy number one. other key issues dr. friedan will tackle include the dramatic increase in the number of measles cases in america and the pathogens pose to world health. they can crisscross rides -- they can take rising crisscross countries in a matter of days. tillers, microbes jumped from animals to humans and the growing number are resistant to all currently known drug treatments. director ofhas been the cdc since june 2009. a physician with training in internal medicine, infectious diseases, public health and epidemiology, known for his

tuberculosis control. from 1990 to 2002, dr. friedan worked for the cdc, starting at the epidemic intelligence service officer at the new york city health department. spanish, a graduate of oberlin college and received his medical degree and masters of public health degree from columbia university. he completed infectious disease training at yield. dr. friedan has won many awards and honors and has published more than 200 scientific article. mers, public enemy number one? . ladies and gentlemen, please join me in welcoming back to the national press club, dr. tom frieden, director for the centers of disease control and prevention. [applause]

>> thank you very much. great to be here. thank you so much to the national press club. thank you so much for the invitation and arranging it and all of you for your interest in health. what i would like to do is talk about some of the biggest threats facing us today. some of you may have heard about problems at the laboratory where we have had to safety lapses in recent months. these lapses should never have been -- happened. these are some of the best scientifically in the world and now we are taking rapid and decisive action to make sure they are also some of the safest laboratories anywhere in the world. i will be happy to talk about that later, but right now i want to talk more about the challenges that we face. sometimes problems like the ones that have come to light recently

oh kerr because people are so used to working with dangers -- danger. we are currently mounting a substantial response in west africa where three countries are battling evil like. more than 1000 cases and more than 600 deaths in the ebola virus. recently i walked through the unit to talk to people who were deploying to west africa and we shared some common experiences. i had been at the place called python cave in uganda, which is as you might imagine, a cave with a very large python in it, 15 feet large and 10,000 bats. the bats it turns out have about a five percent infection rate with a virus. marburg has not had a movie made after it that is just like able like. similarly fatal. there were two infections, one fatal one not.

understanding how the bats were moving around the region and what might be done to control it there. i asked them, weren't you scared to go into the cave that had 10,000 bats, lots of them was marburg, an often fatal virus in this enormous price on? they said the python did not worry us in the bats did not worry us because we were wearing the moon suit. did not worry us because we have the protective equipment on. the cobras worried us. underneath the moon suits they had to wear leather chaps so if they had a cobra strike it would not be killed by it. sometime that kind of experience makes people to used to risk. we have to always remember that above all do no harm needs to be war than a motto, an organizing

principle for all of our work. like other health-care workers, i have my personal experiences with risk. sometimes that -- sometime back i was working in wirral latin didica and communities that not have great sanitation. i became extremely ill. time between brief medical school and starting internship and residency. i have learned in medical school reichard was.-- it is a vibrant checking the shaking chill the violent it shakes. it is gram-negative bacteria in your blood. i became white ill and returned to the u.s. a little better to start my internship and was tested and found to have an organism, from poor sanitation.

with it.y ill highly infectious. 10 or 20 organisms can in fact another person. just to give you a sense of scale, you can fit a mega -- million organisms on the head of the pen. hen i went in for testing said it is resistant to every in a biotic known. i said i have to start my internship. the infectious disease attending said you need to go home. but we always want to be part of the solution. and health second sometimes be part of the problem. a footnote to that story, that episode of illness is limiting. i did eventually get better. i recovered completely. the belowar later

baucas came onto the -- cipro fraxin came onto the market. took two years to have a wonderful medicine that has an important role rightly -- widely overused. whathave a quiz for you, did the six organisms all have in common, besides the fact they're all infectious diseases? mers, ebola, measles, multi-drug-resistant tuberculosis, see this -- cdif, guesses? >> they are preventable. that is one thing they have in common. how about how they spread? is there something, and?

some are airborne, some are not. three quarters of the new infections we face are zero not a. not all. they are allsses? very importantly spread in hospitals. we can be part of the problem if we are not careful. all of them. i will talk more about that. to medical school the comity is use really fancy words. we do not say we give it to them in a hospital. we say it is [inaudible] that is much more polite. we also do not say the dr. made them sick. avoid theord we will uncomfortable truth.

my most favorite of all, we know exactly the cause of his illness, idiopathic. idiopathic means we do not know what causes it. another definition is the patient is sick and the doctor is it -- is an idiot. mers is very concerning because it has a high case the talent he rate. maybe as high as 30%. cause significant not only illness but economic dislocation. sars cost the world $30 billion in just three or four months. we are learning more about mers. the quiz earlier was the key lesson we have learned as we have worked closely with the saudis and now working very closely with them on a variety of investigations and control measures. we have found the overwhelming

have beenn mers cases associated with hospitals. they have been spread in hospitals. patients, staff, visitors. that is bad news and good news. bad news because it should not have happened but good news because we know how to protect health care workers and others through infection control measures and i received an e-mail last week from the saudi minister of health who reported in the past 10 weeks they have not had a single case of murders and a health-care worker doubt that they have implemented stringent infection control measures. when you know how something is spreading, you can stop it. there is still more you do not -- we do not know. we do not know how it has jumped from animals to people. heroes seem campbell's have haps been infected by bats and

perhaps something like mers, whether it is direct contact with camels or camel products, we do not know. we are undertaking studies to prevent it. the better we understand it, the more we can prevent it. the next pandemic is not likely to be murders, unless it mutates. mers. likely to be may not be a pandemic like in china couple years ago. maybe the thing we are most at wek for is not the thing don't know but something hiding in plain sight. any ofng that could kill us, something that could undermine the ability to practice modern medicine,

something that could devastate our economy, and something that could sicken or kill millions. ,ow, someone here in this room christian lowe lists,this problem. christian's mother was a beloved kindergarten teacher. she went in for a routine root canal procedure. sepsisa week she had from and -- an infection from the bloodstream. tragically at the age of 56, she died. christian and others have carried the standard to make human faceis the behind the tragedies we read about? in public health we are at our best when we see and help others see the faces and lives behind the numbers. i think of the 13-year-old who

loved music, had a congenital , malformation not major and went in for a routine checkup. two days later had a resistant bacteria pneumonia and i used her weekend. i think of a young man from old who lovesars skydiving. had an injury from skydiving and got infected began to recover and then develop highly resistant organism and died at the age of 27. mother has been an advocate for improving the way we address infections in the country. antibiotic resistance could affect any of us. , 2 million americans get resistant infected infections each year. another 14,000 americans have

.ust like christians mother i am an infectious disease position. -- position. i have treated patients for many infections and treated patients for whom there were no antibiotics left. i felt like a time traveler going back to an era before antibiotics. we talk about pre-antibiotic area -- era and post-antibiotic era. for some patience and pathogens, we are already there. antimicrobial resistance is a big problem and getting worse. cost us at least $20 billion per year in health care costs alone. it creates two problems that are worth inking of a little separately. one of them are the things you think of as infectious. urinary tract infections, wound

and things we think of as infectious diseases. -- things we would think of as infectious. a second problem we may not think of naturally, and that is how important the control of infections is to the practice of modern edison. 600,000 americans per year get cancer chemotherapy. we drive down all of the body's defenses. puke -- patients get beavers and serious infections and are able to keep them in check until the body's resistance am stock the cuts we have antibiotics that work. cancer chemotherapy may be at risk. more than 400,000 americans who are on dialysis. infections commonly complicate dialysis if we lose the ability to treat infections it will make dialysis much more difficult. and modern treatments from

everything from arthritis to asthma suppress the immune system because they are partly autoimmune diseases and our ability to get the cutting edge treatments is at risk to kiss of the spread of drug resistance. treatment is at risk because of the spread of drug resistance. every day we delay means it will be harder to treat tomorrow. bacteria are evolving very quickly. we need to move quickly to get ahead, catch up, and control it. resistantible to keep bacteria from spreading. it is possible for some pathogens to reverse the level of drug resistance, but only if we act now and act decisively. what we have seen in some , a highlyfrom resistant organism that can be that they canis start in the hospital, and are

most resistant organism start in the hospital. if andd to be all of cd was in the hospital but now we've seen it in the community. the most common pathogens recovered from patients with then -- with infections in the emergency department is a resistant organisms that it is not too late. we know we are still largely dealing with the hospital infection. we can keep it in the hospital and shrink the numbers and control it. don't than common and infections may be very difficult us, where i many of have looked at a time machine before antibiotics. to stop drug resistance, we need fundamentally to do four things. first, we need better detection.

better control, third, better prevention and forth, more innovation. on detection he needs real-time systems to find out what is happening around the country. this week cdc will launch for the first time a system that will allow any hospital in the electronically, automatically with no extra work after the initial uploading work , all with the antibiotics dispensed in a hospital and all of the is a biotic resistance patterns of patients who have infections. that will allow doctors to be empowered with the right information at the right time to make the right decision so they can give information needed. is the firstion step in controlling drug-resistant organisms to allow us to improve prescribing practices. to figure out if the outbreak

control measures are working. the second key step has to do with control. earlier, muchiz of this is in no -- no michael nomicusioul problem. too many patients are coming in with one problem and leaving with an infection they did not come in with. prevention requires work across many facilities. even the best hospitals cannot do it alone. they need to intercept with the nursing homes, outpatient providers and other facilities in the community and that can best be done if public health convening, serving a collaborating and facilitating role. state health departments will be key to reversing drug resistance and key to reversing the hospital spread of infections. many of them are doing it and doing a wonderful job but we have much more that we need to do. third is prevention.

of fact is, the quality treatment for many conditions is nowhere near what we would like it to be. cardiologist and he used to say when you see how other top or spark us medicine, you raise -- realize how resilient the human body is. [laughter] improving, prescribing practices in all sectors is crucially important. we recommend that everything a hospital in the country has an stewardship program. it means antibiotics are looked at carefully, the data from the hospital, resistance patterns and prescribing patterns tracked regularly and if there are aberrations, things that are not right they are improved. we have done a study that suggest about a third of antibiotics are either unnecessary or inappropriate. enormous differences between one region of the country and the

other is they do not reflect undertreatment. we know team-based care, checklist, reporting, feedback and accountability are simple management tools that need to be applied systematically to prevent drug resistance and we know many antibiotics being used are not necessary. with every medication, whether infectious disease or other, we need to think about the risk-benefit ratio and always think about that ratio. there is no medicine without risk. we have to balance that ratio. that may include drug resistance. it may even include the case of contributing to the old the city epidemic. that is a hypothesis for some data. there is lots of data about lots of hypothesis on what is contributing to the obesity epidemic. another area we have seen the

risk-benefit occupation is with chris -- prescription opioids, which turn out to be extremely deadly.e and for all of the medicines we use, we have to keep track of the risk-benefit ratio. ironically, we underutilize a lot of medications that have a very favorable risk-benefit ratio for people of high risk of aart attack or who have had heart attack or stroke, aspirin only use half the time. half pressure used about -- controlled about half the time. so we have to get the risk-benefit ratio to make sure we are above all doing no harm and doing as much good as possible. the fourth is innovation. you need to come up with new tools. while we need drugs and new in a biotic but they are at least five or 10 months away -- 10

years away. or slowlyan stop perverse must shout the reversing trend. also innovation needed in tracking resistance, understanding better, figuring out what works to reverse it. in the president's budget for 2015 there is an initiative that would be the first of the five-year initiative that would allow us to build five regional centers of excellence around the country so we can help. her's understand whether patients have resistance faster and whether their outbreaks and how we can stop them. it would help us develop a bank of resistant organisms that pharmaceutical companies and others could use to come up with diagnostics or better ways to treat them and what allow us to scale up hospital stewardship programs and improve on in a biotic prescribing. we project is funded we would be not only able to save money but

save lives. we project based on real data that with the initiative over five years we would be able to cut the two deadliest threats and half. bacteria the nightmare spreading in intensive care units, and cdif . we could make this succeed across the country but only with investment. in fact, over five years we project we could reduce by 600,000 the number of resistant and by $7.7y 27,000 billion to health care costs from public -- from this. a best buy buts we have to act now. antimicrobial resistance has the potential to harm or kill anyone in the country, to undermine modern medicine, devastate the economy and to make the health care system less stable.

confronting this has the ability to protect americans from the moment they're born and throughout their lives. gets day that we delay it harder and more expensive to reverse it. for peggy, nile, josh and 23,000 people who died died thisar -- who year from infections that might have been able to be prevented if we had taken these actions before and although the problem is big and getting worse, it is not too big to reverse it. by taking the feist -- decisive action now, we can reverse it and protect antibiotics. the concept of stewardship is an important concept. we are protecting them not only for ourselves come up protecting them for our families, children and for our children's children. thank you very much. [applause]

>> thank you, dr. frieden. according to a recent report by the f.d.a., 80% of all anti-bibets used in the united states are fed to farm animals. this means that only 20% of anti-buy octobers, which were originally developed to protect human health, are actually used to treat infections in people. what is being done to address this issue? >> we want to see rational anti-bibet use wherever anti-bibets are used, and i think that means, for example, in farm animals or feed animals, that if animals are ill, they should be treated. using antibiotics that are of importance to humans for growth promotion is clearly something that we, the f.d.a., the usda, and the food industry is concerned about. i think that's something that we'll see progress on in the

coming months and years. it's more of an f.d.a., usda issue than it is a seeding issue. but we do recognize at c.d.c. that some of the more resistant organizations we're seeing, like c.r.e., which is a night marr bacteria. it's resistant to virtually all antibiotics, and it covers multiple different organizisms that have a fatality rate as high as 50% in the hospital. some of our most serious resistant organisms are in the healthcare system, particularly in hospitals. but we want to see rational prescribing everywhere ntibiotics are prescribed. >> antibiotic development is not as profitable for drug companies as drugs such as statins and viagra. do we do he courage pharmaceutical companies to develop new antibiotic to treat

the infections? >> we do really have a problem with the incentives. one of the -- from a strictly business standpoint, a terrible thing about antibiotics is that they cure people, and then you can stop taking them. that's not a model for a highly lucrative pharmaceutical product. you want a product that's going to be taken for a long, long time. and that's not what we want with antibiotics. we have to figure out a way for government and industry to work together so that the incentives for antibiotic production and antibiotic development match the need and there have been important steps taken by , ngress in the past few years new laws in place that improve those incentives, but it's going to require creativity. it's going to require innovation. it's going to require a dialogue between government and industry, thinking about ways to reduce the risk for developers to improve the

benefit and to ensure that there's reasonable profit without excessive profit that might result in a backlash. so these are tough issues, but they're important to address. we do want new antibiotics. they're important. we also have to recognize that we may or may not succeed. we don't know why the antibiotic pipeline has thinned out in recent years, but it has. is that because of less investment? maybe. is it because the low-hanging fruit has all been plucked and it's going to be harder to make antibiotics in the future? maybe. we don't know. we can't assume that we're going to develop new drugs to get ourselves out of this mess. we have to assume that we have to make rapid progress with the tools we have and preserve the antibiotics we have while at the same time we promote development of new antibiotics as well. >> is c.d.c. lacking into natural cures in addition to prescriptions? >> there's some really interesting developments in a

variety of ways to reduce infection. we know that lots of things will reduce your success he wantibility to infection, or improve your success he wantibility to infection. if you're healthier, if you're physically fit, if you get enough sleep, this improves your overall immune system. and there's some intriguing new data coming out on the micro iom. we sometimes think of ourselves at war with my brokes. we try to keep them out. actually we've got trillions of microbes in us, and they're important for our health. we're just beginning to understand that. some of the new tools, some of which congress funded c.d.c. to expand the use of called advanced monthly he can collar detection, allows us to sequence the genomes of microbes in real time. they're teaching us new things about the microbes that are helpful, as well as harmful. in fact, there are new treatments that involve

providing microbes that fight against cdif as a way of battling microbes with microbes. after all, if you go back to the first drug developed against tuberculosis, sheldon waxman and his graduate student figured out that there had to be things in nature that fought tuberculosis, otherwise you'd have to tuberculosis everywhere. so they went into the soil of statin island, and they figured out that there were bacteria there that produced chemicals that killed the tuberculosis bacteria. so there are ways that we can use fire to fight fire, if you will. >> can the c.d.c. or the h.h.s. take any regulatory steps to enforce responsible use of antibiotics in hospitals? >> we have to work in collaboration with the healthcare system. one of the biggest challenges for public health in the coming years is that integration of public health and clinical

medicine. at c.d.c., we've been delighted to have a very positive, constructive partnership with the center for medicare and medicaid services. as an example, we, for many years, have run something called the national healthcare safety network, and we had many hospitals involved, and then they had, oh, by the way, if you want to get 100% of your reimbursement, you must participate, and suddenly we have 14,000 facilities participating, and they benefit from that. they are given information that they can act on to improve their care. just yesterday, the person who's leading much of our work here met with eight defrpblt healthcare systems to figure out how can we sustainablely achieve the kind of hospital stewardship programs? it's not so much a question of mandating and forcing as figuring out together what's needed and then making sure that we have a level playing field so that that gets done, and tools like the national healthcare safety network provide tools to hospitals to improve the quality of their

care. >> it's september 2013, c.d.c. put out a report, resistance in which the agency identified new drug development as a pillar of a strategy to combat a.m.r. congress is currently considering legislation to facilitate drug development by creating a new approval pathway for drugs to treat serious and life-threatening infections for which there are few or no treatments. from c.d.c.'s perspective, which are the infections for which we most need new drugs? >> well, we have one success story. there's a new drug that's useful for multidrug resistant tuberculosis, and the f.d.a. was able to approve that rapidly. there was some controversy about that, but the data was strong, and c.d.c. recommended it, and c.d.c. is in support of that decision. we need to lack at the organizisms for which we have the greatest risk.

that includes the whole spectrum. it includes the negative rods, which are deadly, things like e. coli in our intensive care units, but also the grand positive organisms like staff, where we have mrsa. so there are a range of organisms for which we need better treatment, and we also need to understand them better. the tools that we're now using of advanced detection are fascinating. we're learning that many of our assumptions were real simple, that if you have an infection, it may include a broad range within that species, what is sometimes called quasi species, and how we measure that in the laboratory may be different from what's actually happening and causing illness in people. so there's a lot we need to learn about the patterns of disease, not only within the population, but within individual people, so we can innovate and target our

innovations most effectively. >> perhaps the battle between resistance to drugs will have to be fought genetically at the molecular level. can you address some of the steps in this direction that are being taken at the molecular or nano level? >> well, i've mentioned c.r.e. a couple of times. let me give you more detail, because i think this illustrates the answer to this question. r.e., you'll be quizzed on that if you want to have a second cupcake, which i recommend. but the c.r.e. is something that we really have not seen before. it is a jumping gene, a plasmid, a part of the genome, a part of d.n.a. sequence that can move not only between one organism and another, but between one species and another, and not only can it move between species, but it

can encode for resistance to an entire class of antibiotics, all to the penicillin and penicillin-like antibiotics, first generation, second generation, third generation. these are our big guns. this is what we've got to protect people. and this organism can spread its resistance to multiple species and multiple antibiotics. and we've seen a couple of different ways it can be spread. there's a dominant one in this country and a secondary one in this country, and that's an area where we need to do more research, to understand, all right, if that's what the jumping gene is doing, if that's what it's causing, that's what's driving the resistance to our biggest gun antibiotics. what can we do to counteract that across multiple species to multiple antibiotics? >> have you seen the latest mrse study saying it may be airborne and your thoughts,

please. >> we're working very closely with the saudis and with other countries in the region to better understand and control mrsa. we did a study that was fascinating. it showed that if there were lapses in infection control, you had a lot of spread in the healthcare facility. but if you had good infection control, just standard infection control, even if you had several infectious patients and loss of exposure, you had essentially no spread, as confirmed by checking healthcare workers. we're still understanding how it jumps the species barrier, how it is continuing to seed cases, but from everything we've seen, it's largely been spread in hospital, and that's largely controllable by rigorous infection control, and that's good news. that doesn't mean it won't

change in the future, but at least that's where we are now with it. >> you have called the bird flu safety breaches to you the most distressing of all breaches. why is that breach most troublely to you? >> we had two laboratory breaches at c.d.c. one was anthrax, where there was potential, probably not, but potential exposure of workers at c.d.c. to infectious anthrax. what happened basically was that laboratories thought they had killed the anthrax, but subsequently it was not clear this they had. we've been studies which suggest it's not impossible that some of the anthrax may have exposed other people at c.d.c. it's extremely unlikely. but still, that was a reflection of a set of policy and procedural lapses that should never have occurred, and we're now taking active measures to make sure that we do everything we can to make sure that the risk of that is

minimized. the h5n1 situation was rather different. through means we're still not sure of, in our laboratory, a nonharmful bird flu was mixed up with a harmful bird flu and then sent to the u.s. department of agriculture laboratory. all of this work was done in enhanced laboratories. very, very highly contained people wearing what are called packers, very fancy respirators, so they don't get infect, people who shower out when they come out. so there was no risk at any point of a release of this into the community, but the fact that we were dealing with such a deadly virus that could have big impact on agriculture and that there was a six-week delay between people at c.d.c. being notified about this and it being notified up the chain at c.d.c. made me very concerned that we need to do a better job of encouraging a culture of safety, of encouraging people

to report problems or potential problems if they have the slightest concern that there may be a problem. and whatever the reason, we're still investigating that second incident. whatever the reason, the fact that, first off, it happened in our flu lab, and without exaggerating, i can say that our flu lab is as good as any in the world. it's a phenomenal laboratory. so that made me really stunned that if this could happen at the c.d.c. flu lab, where else could something like this happen? second, i was deeply disappointed that it took so long to notify, and we're still understanding the reasons for that. what we've done since then is really take decisive action. we've stopped all shipments of all biological materials from all of our high-containment laboratories until i personally review and approve the inactivation procedures laboratory by laboratory. we've appointed a single senior scientist at c.d.c. to review the protocols with the help of

a working group and strengthen them before they come to my review. we have also ensure that had we're going to take a look at every aspect of our safety to improve the culture there and improve that, again, as i said in the beginning, we have want only some of the scientifically most advanced laboratories in the world, but also some of the safest laboratories in the world. >> this touches on your previous comments, but let me ask, in a recent hearing you told congress that you recognized the pattern of weaknesses within the culture of safety. how were those weaknesses allowed to develop? >> when we look back at the last few years, we see that there have been isolated incidents, and i believe in each of those isolated incidents, the staff at c.d.c. and i took responsible behavior to address the concern that was raised. and what i missed and what i think our staff missed was that these isolated incidents did reflect a pattern, and it was a pattern of insufficient

attention to safety in our laboratories, and that's what we're addressing now. and i think you can hypothesize about the story is likely to be part of it. if you work with dangerous organisms day after day, month after month, year after year, sometimes there is a tendency to get lax. what we have to ensure is that though human error may be inevitable, human harm shouldn't be. we should do everything in our power to ensure that we -- and we will do everything our power to ensure that there are redundant systems in place so that if there is human error, there will not be human harm. i think the broader lesson is that it's possible to minimize the risk of many things, but it may be not possible to achieve zero risk, and that has a lot of us thinking hard about what makes sense to do in that

risk-benefit ratio. if we're balancing a minimal but nonzero risk against a potential benefit, we'd better be very sure both that we make that risk as low as possible and that we have a reasonable expectation there will be a benefit. >> can you describe the sweeping changes that you have initiated at the c.d.c.? i realize you touched on some of them. you might want to expand. >> we have done a series of things. we have -- i've issued a moratorium on transfer of all biological materials out of high containment laboratories. we've closed the two laboratories where these incidents occurred, and we will not reopen them until we're ensure that had they can open safely. i've appointed a single point of accountability to oversee laboratory safety throughout c.d.c., and he and his group, dr. michael bell, will reviewing first and foremost those applications to lift the

moratorium lab by lab. they will work not just as an individual group, but throughout every part of c.d.c. to promote that culture of safety, which has to be every lab worker, every supervisor, every lab branch team and team lead. we will also take disciplinary action as appropriate. we have convened, and i've invited an external advisory group of all people who never worked here before, to give us a fresh look, tell us what we can do different or better to improve safety. we're investigating the incident with flu that's not completed yet, and we're looking at our function as a regulatory agency. we have something called the division of select agents and toxins to regulate over 300 other entity that is work with dangerous organisms, and that are the lessons from our experience to make sure that we do that regulation effectively. >> do i hear that -- are you

advocating for harsh punishment against those who breach safety in labs, and what can congress do to improve lab safety? >> it's really important to balance two competely visions of how you deal with an incident like this. in one vision, you find the culprits and you punish them. in another vision, you fix the culture and you fix the policies and procedures. i don't think either of those on its own is the right way to move forward. on the one hand, you have to ensure that you have policies and procedures and a culture that promotes safety continuously, that recognizes that risks are serious and nonminimal and does everything to analyze what are ways to reduce that risk. at the same time, you look at individual incidents, and if there is negligence, if there is a failure to report, then you have to take appropriate action. i think those aren't either/or. that's a combined approach. in terms of congressional action, there are observers who have said perhaps there should

be a different entity to look at these dangerous pathogens, and i think that's certainly an idea worth exploring. it's complicated to investigate these laboratories, to inspect them, to ensure that they do a good job. we do as good a job as we can with the division of select agents and toxins. we're going to see if there are ways to do that better. several years ago, because of the -- because of my concern that it would look like a conflict of interest, i asked the agriculture department, which also inspects such laboratories, to inspect the c.d.c.'s lab so we wouldn't be one part of c.d.c. inspecting another. but we're anticipate to all ideas how to improve safety in these laboratories. more broadly, i think we have to look at, do we have the right number of laboratories? do we have the right risk-beneficiary ratio calculations for some of the research that's going on? >> you faced tough questions during last week's house hearing. >> i noticed.

>> what was your takeway from what you heard from the committee members? >> i think the committee very appropriately had concerns, that if something like this can happen at c.d.c., first off, how did it happen? are you going to fix it and hat's happening elsewhere? i think the questions were tough but fair, and the approach i'm taking with my staff and that i encouraged congress to take is very much a trust but verify approach. we're going to do things to improve safety, but don't take us at our word. we will review and share the results of that and ensure that what we do, we do transparently, openly, clearly. we always find that it's much better to be clear and open about a problem than otherwise. and i think we have been about these problems from the moment we learned about them, and that will be our way going forward as well, to say here's what we've done, here's what's achieved and not achieved. i would be disappointed, but

not surprised if we identified other incidents in the past or other things happening in the future, and that may well be a reflection that we're improving that culture of safety and that willingness to report problems rather than failing to correct what is an important issue to address. so i think the questions were tough but fair, and we will continue to provide information , because we have such important work to do. this work has not done out of idle curiosity. this work is done because anthrax continues to kill people around the world, because anthrax has been used as a biological weapon, because these select or dangerous agents, organisms, are still both spreading in nature and potentially could be used in a ioterrorist event. >> we have some media-related questions. what is your reaction to the media coverage of recent incidents involving laboratory safety at c.d.c.? >> i generally think the media

has been responsible in their coverage. i sometimes wish it would be a little different, but i don't think that's something that anyone wouldn't say at some point or another. i think the smallpox discovery on the n.i.h. campus how has gotten conflated in some of the reports. what happened there was a researcher, probably in the 1960's, before there was smallpox eradication, put aside her medically sealed vials. it was a different era. it was not done out of malice. and it was kept in a cold room for decades apparently undisturbed, untouched. and the moment it was touched, the f.d.a. appropriately informed n.i.h., they appropriately immediately informed us, and we mobilized over the july fourth weekend actually to make sure that along with law enforcement we were able to go in safely and securely, secure the materials, make sure they were secure at all times, transport them securely back to c.d.c., then

in a controlled environment, in the only laboratory outside -- there are two laboratories until world that are allowed to have smallpox, one is ours, one in russia, with the worker who is the most experienced in the world at working with historical collections of smallpox safely open it, analyze it, test it, and determine that, in fact, it was still viable smallpox. what we will do with that, as we said from the very first moment it became apparent, is we will fully analyze the genome, and once that genome is sequenced and analyzed, we will then invite the world health organization observers in, and we will destroy the strains and all of the biologically viable materials associated with the strain much that's one part of the study that sometimes is the story that i think sometimes has been confused with the other parts that are going on. it really shows c.d.c. staff working 24/7 to protect people and make sure that we can understand and control what turned out to be not a risk,

but that requires a very active response and got that response. >> media-related question on behalf some of journalists, why does c.d.c. now prohibit staff members from speaking to reporters without public affairs office oversight, despite the fact that in previous times there were no such restraints? >> as far as i'm aware, the c.d.c. does not prohibit staff from talking to reporters, we do, without media staff present, we do like to have media staff present so we can follow up on any questions and make sure that you're talking to the right people. sometimes a reporter might ask a question of one part of c.d.c. that might be best answered by another part, so we try to facilitate that. but we do like to be quite open, and the more information there is out there about what c.d.c. does in this country and around the world 24/7 to protect people is challenge that we have, as well as the programs that we're mplementing, the better.

>> we are almost out of time, but before asking the last question, we have a couple of housekeeping matters to take care of. first of all, i'd like to remind about you our upcoming speaks and speakers. on august 1, his excellence a, president of the republic of congo, will discuss peace, security, and stability of the central african region and oil investments in his country. and on august 4, we've just announced that his excellence a, jacob zuma, president of south africa, will speak at the national press club on the eve of the u.s.-africa leaders summit. next, i'd like to present our guest with a traditional national press club mug. you can add this to your collection. and the traditional last question, how does your experience appearing before the national press club compare to your experiences last week before congress?

>> the food was much better here. it's a pleasure to be with you. it's a pleasure to share with you what c.d.c. does. despite the recent incidents, the fact is that c.d.c. has more than 15,000 staff. we work in over 50 countries, and every state in the u.s., we provide 2/3 of our resource at the state and local entities, and we're there 24/7 to protect people from threats, whether they're infectious disease, environmental threats, chronic diseases, cancer, heart disease, whether they're intentionally create, manmade or naturally occurring, whether they're in this country or anywhere in the world. we do see the press as a vital partner in providing information and shedding light on the important health challenges that we face, so thank you all so much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> >> thank you all for coming

today. i'd like to thank the broadcast center for helping to organize today's event. finally, you can find more information about the national press club on our website, also if you'd like a copy of today's program, please check out our website at press.org. thank you, and we are adjourned. >> the militant islamist group i si s has been fighting against iraqi forces for control of major cities across that country. state and defense department officials will test testify this morning about the escalating violence in iraq. live coverage from the house foreign affairs committee starts at 10:00 a.m. eastern on

c-span3. later in the day, a member of the international cruise victims association will talk about passenger safety on cruise ships at a senate hearing. we'll also hear from a woman whose mother got sick on board a carnival cruise and later died. our live coverage starts at 2:30 eastern, also on c-span3. coming up this hour, we'll talk to house intelligence committee member jim himes about some of the challenges facing the u.s. then we'll discuss v.a. reform and president obama's pick to head up the v.a., robert mcdonald. .

we'll break down the rulings and get your thoughts on the law.