INVESTIGATION INTO HEALTH CARE DISPARITIES OF U.S. PACIFIC ISLAND TERRITORIES HEARING BEFORE THE SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS OF THE COMMITTEE ON GOVERNMENT REFORM HOUSE OF REPRESENTATIVES ONE HUNDRED EIGHTH CONGRESS SECOND SESSION FEBRUARY 25, 2004 Serial No. 108–160 Printed for the use of the Committee on Government Reform ( Available via the World Wide Web: http://www.gpo.gov/congress/house http://www.house.gov/reform U.S. GOVERNMENT PRINTING OFFICE 94–494 PDF WASHINGTON : 2004 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 VerDate 11-MAY-2000 11:19 Jul 15, 2004 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 D:\DOCS\94494.TXT HGOVREF1 PsN: HGOVREF1 COMMITTEE ON GOVERNMENT REFORM TOM DAVIS, Virginia, Chairman DAN BURTON, Indiana HENRY A. WAXMAN, California CHRISTOPHER SHAYS, Connecticut TOM LANTOS, California ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York JOHN M. MCHUGH, New York EDOLPHUS TOWNS, New York JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania MARK E. SOUDER, Indiana CAROLYN B. MALONEY, New York STEVEN C. LATOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland DOUG OSE, California DENNIS J. KUCINICH, Ohio RON LEWIS, Kentucky DANNY K. DAVIS, Illinois JO ANN DAVIS, Virginia JOHN F. TIERNEY, Massachusetts TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri CHRIS CANNON, Utah DIANE E. WATSON, California ADAM H. PUTNAM, Florida STEPHEN F. LYNCH, Massachusetts EDWARD L. SCHROCK, Virginia CHRIS VAN HOLLEN, Maryland JOHN J. DUNCAN, JR., Tennessee LINDA T. SANCHEZ, California NATHAN DEAL, Georgia C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland CANDICE S. MILLER, Michigan ELEANOR HOLMES NORTON, District of TIM MURPHY, Pennsylvania Columbia MICHAEL R. TURNER, Ohio JIM COOPER, Tennessee JOHN R. CARTER, Texas ——— ——— MARSHA BLACKBURN, Tennessee ——— ——— ——— BERNARD SANDERS, Vermont ——— ——— (Independent) MELISSA WOJCIAK, Staff Director DAVID MARIN, Deputy Staff Director/Communications Director ROB BORDEN, Parliamentarian TERESA AUSTIN, Chief Clerk PHIL BARNET, Minority Chief of Staff/Chief Counsel SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS DAN BURTON, Indiana, Chairman CHRIS CANNON, Utah DIANE E. WATSON, California CHRISTOPHER SHAYS, Connecticut BERNARD SANDERS, Vermont ILEANA ROS-LEHTINEN, Florida (Independent) ELIJAH E. CUMMINGS, Maryland EX OFFICIO TOM DAVIS, Virginia HENRY A. WAXMAN, California MARK WALKER, Chief of Staff MINDI WALKER, Professional Staff Member DANIELLE PERRAUT, Clerk RICHARD BUTCHER, Minority Professional Staff Member (II) VerDate 11-MAY-2000 11:19 Jul 15, 2004 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 D:\DOCS\94494.TXT HGOVREF1 PsN: HGOVREF1 C O N T E N T S Page Hearing held on February 25, 2004 ....................................................................... 1 Statement of: Camacho, Felix Perez, Governor of U.S. Territory of Guam; Juan Babauta, Governor, Commonwealth of the Northern Mariana Islands, accompanied by Dr. James U. Hofschneider, Secretary of Health; Togiola Tulafono, Governor, American Samoa; Jefferson Benjamin, Sec- retary of Health, Department of Health, Education, and Social Affairs, Federated States of Micronesia, Pacific Island Health Officers Associa- tion; and Dr. William McMillan, administrator, Guam Memorial Hos- pital Authority ............................................................................................... 76 Cohen, David, Deputy Assistant Secretary, Office of Insular Affairs, U.S. Department of Interior; and Nathan Stinson, Jr., Deputy Assistant Secretary, Office of Minority Health, U.S. Department of Health and Human Services ............................................................................................ 21 Letters, statements, etc., submitted for the record by: Babauta, Juan, Governor, Commonwealth of the Northern Mariana Is- lands, prepared statement of ....................................................................... 91 Benjamin, Jefferson, Secretary of Health, Department of Health, Edu- cation, and Social Affairs, Federated States of Micronesia, Pacific Is- land Health Officers Association, prepared statement of .......................... 124 Bordallo, Madeleine Z., a Delegate in Congress from American Samoa, letter dated February 25, 2004 .................................................................... 14 Burton, Hon. Dan, a Representative in Congress from the State of Indi- ana, prepared statement of .......................................................................... 5 Camacho, Felix Perez, Governor of U.S. Territory of Guam, prepared statement of ................................................................................................... 81 Cohen, David, Deputy Assistant Secretary, Office of Insular Affairs, U.S. Department of Interior, prepared statement of .......................................... 23 Cumings, Hon. Elijah E. Cummings, a Representative in Congress from the State of Maryland, prepared statement of ........................................... 150 McMillan, Dr. William, administrator, Guam Memorial Hospital Author- ity, prepared statement of ............................................................................ 144 Stinson, Nathan, Jr., Deputy Assistant Secretary, Office of Minority Health, U.S. Department of Health and Human Services, prepared statement of ................................................................................................... 32 Tulafono, Togiola, Governor, American Samoa, prepared statement of ...... 113 (III) VerDate 11-MAY-2000 11:19 Jul 15, 2004 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 D:\DOCS\94494.TXT HGOVREF1 PsN: HGOVREF1 VerDate 11-MAY-2000 11:19 Jul 15, 2004 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 D:\DOCS\94494.TXT HGOVREF1 PsN: HGOVREF1 INVESTIGATION INTO HEALTH CARE DIS- PARITIES OF U.S. PACIFIC ISLAND TERRI- TORIES WEDNESDAY, FEBRUARY 25, 2004 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS, COMMITTEE ON GOVERNMENT REFORM, Washington, DC. The subcommittee met, pursuant to notice, at 2:05 p.m., in room 2154, Rayburn House Office Building, Hon. Dan Burton (chairman of the subcommittee) presiding. Present: Representatives Burton, Watson, and Cummings, and Delegates Faleomavaega and Bordallo. Staff present: Mark Walker, chief of staff; Mindi Walker and Brian Fauls, professional staff members; Nick Mutton, press sec- retary; Danielle Perraut, clerk; Richard Butcher, minority profes- sional staff member; and Cecelia Morton, minority office manager. Mr. BURTON. Good afternoon. A quorum being present, the Sub- committee on Human Rights and Wellness will come to order. I ask unanimous consent that all Members’ and witnesses’ written and opening statement be included in the record. Without objection, so ordered. I ask unanimous consent that all articles, exhibits and extra- neous or tabular material referred to be included in the record. Without objection, so ordered. Today the subcommittee has the honor of being joined on the dais by my esteemed colleagues, the Honorable Madeleine Bordallo, the Delegate to Congress from Guam, whom I had not had an op- portunity to talk to when I was over there, but I’m glad she’s with us today. And the Honorable Eni Faleomavaega, who’s the Dele- gate to Congress from American Samoa, and a good golfing buddy of mine when we have a chance to get out and play. In the event of other Members of Congress joining us at today’s hearing, I ask unanimous consent that they be permitted to serve as a member of the subcommittee for the day. Without objection, so ordered. I’d also like to take this opportunity to recognize a good friend of mine, the Honorable Pete Tonorrio, Representative of the United States from the Commonwealth of the Northern Mariana Islands. He’s doing a wonderful job for the people of the CNMI here in Washington, and I hope 1 day to welcome him as a friend and duly constituted colleague here in the Congress. (1) VerDate 11-MAY-2000 11:19 Jul 15, 2004 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 D:\DOCS\94494.TXT HGOVREF1 PsN: HGOVREF1 2 The subcommittee is convening today to examine disparities in the quality and access to health care experienced by the people of the U.S. Pacific Island Territories. We’ll be discussing possible solu- tions that the Federal Government should seriously consider in order to alleviate these health burdens. The medical system in the Continental United States prides itself on the quality of medical services supplied to the millions of Americans under its care. Unfortunately, there are populations of underserved American citizens and nationals who do not have the same access to adequate and proper medical care in other regions of the world. These are the citizens of the U.S. Pacific Island Territories; namely the residents of Guam, American Samoa, the Common- wealth of the Northern Mariana Islands. In a post-September 11th society, many foreign nationals have been hesitant to travel to the Pacific Islands, which regrettably has taken a great toll on the economies of Guam, CNMI and the Amer- ican Samoas. As a result, this has drastically increased rates of un- employment on the islands, and consequently has left tens of thou- sands of men, women and children without proper health insurance or the means for medical care. Due to these times of economic hardship, coupled with the caps placed on Federal Government services such as Medicaid, terri- torial governments