Transcripts For CSPAN Lawmakers 20240703

This is just under two hours. Cooks healthcare issues that must be addressed. First, the major need for more black latino native american and secondly the alarming rate of Maternal Deaths in america thats disproportionately impacting black latino native american women. They are in the midst of a Healthcare System that in my view is largely broken and dysfunctional. Where we spent almost twice as much per capita on healthcare as the people in any other country. A 5 million americans today are uninsured or underinsured. We dont have enough doctors, nurses, Mental Health specialist, or pharmacist we have another crisis on top of all of that. That is, that problem lack of medical personnel is extremely, especially acute in latino and native american commutes which is the subject of the hearing today. Despite making up almost 14 of our population just 5 of all doctors in our country are black. Less than 4 of all dentists to default nurses in america are africanamerican. Despite making up over 19 of our population just 6 makes up 1. 3 just three tens of 1 about in our country why is this an important issue that weve got to address . Native american doctors their Health Outcomes substantially improve. Theyre more likely to prevent preventative services. They are more likely to live longer and happier lives. In my view it is unacceptable that Life Expectancy on average. Rate which is low in American General is about five years lower for black americans and 11 years lower than native americans for. Black americans are more likely to die of Heart Disease in the highest rates of cancer of any group in america. Its unacceptable black americans are more than we are doing with right now. Major epidemic in america, twice assigned black community and White Community but one of the most alarming and Troubling Health disparities in america is the Maternal Mortality rate. The other major focus will be talking about in the highest infant mortality rate facts the Maternal Mortality rate is 19 times higher than norway. Four times are than france appeared incredibly according to the cdc women in america are twice as likely to die from childbirth than their mothers. And, as bad as the crisis is, it is much much worse for black women and infants for it America Today black women are nearly three times more likely to die from pregnancy related complications and their white counterparts. The crisis is also getting significantly worse for latino women. Fertility rates skyrocketed by 44 in just one year. Maine wont black infants it america almost four times more likely to die from complications due to low birth weight. The question then becomes given that reality what we can do about it . How are we going to address what is obviously a major healthcare crisis in america . That is what we will be discussing this morning. Just a few things i think weve got to do but when she substantially increase the class sizes of historically black colleges and universities. We need to pass the black maternal act introduced by senator booker. Senator beutler will be talked about that today. We need to substantially increase funding for women, infant, Childrens Program privilege substantial increase funding for Health Services or in my view we need to cancel student debt make all public and College Universities tuition free people of all regardless of background income will get the education they need include going to medical school for the good news is make tuition free is a growing idea. In fact fort medical schools in america including the New York University school of medicine are currently tuition free while five others have made tuition temporarily free or offering free tuition to workingclass students. So, we have a lot to talk about today. I look forward to a serious discussion about a serious issue. I thank our panelists who are here with us. Thank you chair at sanders for this guy received shortage of positions other healthcare workers extensively. Shortages or deliver healthcare in all communities. Home state of louisiana projected to have the third wart shortage of the state by 2030. We need more doctors appear particularly in the underserved areas lacking sufficient healthcare resources. My practice is a position was for 25 years on a hospital serving the uninsured and poorly insured which is to state medicaid. This is something i spent my professional life attempting to address. Underrepresented in the healthcaresystem. For example africanamerican account for only 8 of all physicians despite comprising 13. 6 of the population. Now, if youre listening carefully you will note my statistics are different than the chairs. His is 5 . Minus 8 paid my data in the area of medical colleges 2019 data. I am using bureau of labor statistics which is 2022 data. That is important. 2019, 2022. Government data a little more uptodate, little more valid. Maybe there is progress being made. As we look at something which needs to be addressed we can also say if we have gone from five 8 there may be progress being made and that is a good thing. But it is interesting to note this disparities that felt across all minorities. Agent doctors account for 22 of all physicians but are only 6. 8 of the population. This is an important nuance as we address the situation. It is also important to note is the chair notes we have a limited number of residency slots to train doctors. These residency positions are not allocated or disbursed to reflect where underserved communities are. Unfortunate this topic is under finance jurisdiction. But it is an important context and needs to be considered in any conversation about addressing Healthcare Workforce shortage. It is a truism practice within work she or he does the residency. At the residency spot is not in an underserved area is not going to be within the 100 miles. Access to opportunity is crucial. I want to highlight, brag on Xavier University in my state of louisiana this week they announced an agreement with oxnard health to open a medical school in new orleans at xavier but many of the doctors trained in xavier which is not a Traditional Mission to serve the underserved and provides opportunity for minorities. They will stay in louisiana go elsewhere to serve the population. I am proud of xavier look forward to continuing to support their effort. As a doctor i am so aware and desire to support those nurses who have claimed the career ladder by building credentials over time through upscaling. Despite benefiting the individual it benefits the capabilities of the workforce. It also benefits their family as their child sees the impact of the mother or father seeking through education and delayed gratification greater opportunity that results in more prosperity. There is a woman i worked with name all lived he would permit nurses assistant to lpn to an rn, to a nurse manager. The clinic she was formerly the na and being the manager of. Incredible story will have someone with a similar story. Doctor jonas will tell us how she has done that in her career. That is something we need to think how to enable bird we should also look at other challenges to ensure our Healthcare System meet the need of all. Especially underserved. Making sure patients from all walks of life can participate in Clinical Trials. Which often times gives the most advanced treatment to those who have the most advanced disease. And, as i mentioned for my career making sure all have high quality medical treatment is something i am passionate about. One of her Witnesses Today will tell us how he is trying to address these issues in his community. The committee will also discuss Maternal Mortality per topic incredibly important that its been a priority of mine in congress. It is important to acknowledge it disproportionately affects african americans. As a doctor worked in Louisiana Charity Hospital System i note this community for my practice i note in this community is at high risk. Thats when please have u. S. Representative doctor Michael Burgess testified by ob gyn who stated many nights delivering medical care to pregnant moms and their babies in an underserved population of dallas. Now that legislator is a leader in addressing Racial Disparities in healthcare its been an honor to work with him on legislation specifically tackling Maternal Mortality. We are unaware we were having a members of Congress Panel until sunday so we greatly appreciate him joining us on short notice when they were adjourned at last night for his participation helps makes clear congress understands the severity of the issue and is working to address. Im also proud to have led several bipartisan legislative efforts to improve Maternal Mortality reduce healthcare disparities. In 2022 Congress Passed the Maternal Health Quality Improvement act which helps address Maternal Mortality particulates that disparaging with an african americans. It supports Research Examining the best practices to reduce and prevent Racial Discrimination in the american Healthcare System. The same year Congress Passed my legislation john lewis at National Institute of minority Health Disparities Research Endowment revitalization act, its a mouthful but a good piece of legislation provided funding to institutions including the savior to conduct research and address minority Health Disparities. Last year end this committee we passed preventing Maternal Deaths reauthorization act. The legislation led in the house by doctor burgess the bill directs cdc to provide hospitals and other providers information on best practices to prevent Maternal Mortality. This is not yet become law we are pushing for passage with congress. All this shows bipartisan commitment to address the Health Disparities among online Monitoring Systems center in beutlers about to promote or demote you which i introduced with the senator of New Hampshire in this committee promotes medicaid coverage Remote Monitoring technologies for those who are pregnant at higher risk of complications. The need for moms and underserved rural areas of travel sometimes hours on Public Transportation to a Doctors Office could be a major impediment to care. This legislation allows a physician to remotely monitor her health watching for indicators crucial healthcare for moms and Maternal Deaths. On how we can continue to make progress in how we address these important issues. The senator from california opportunities for students from underrepresented and disadvantaged backgrounds of the health profession. She is also a strong advocate for reducing Maternal Health disparaging in the black Maternal Health Crisis Center beutler thank you for being here. Rex thank you chairman sanders. And Ranking Member at cassidy for the hearing today. Thank you to other members of the committee for joining your leadership on this issue is demonstrable. Thank you for having me. Its an honor truly to sit before todays committee to bring added amplification to the lack of diversity within our nations Healthcare System you both have outlined so clearly. In addition the worsening Maternal Health crisis. Before i begin my testimony i would like to acknowledge those leaders who have been champing this issue prior to my arrival in the United States senate. It is leaders like representative lauren underwood. Our colleague senator booker who introduced black maternal omnibus in the Senate Representative adams for their leadership and developing black Maternal Health caucus. And the leadership. I also cannot sit here Vice President harris who introduced the first version while serving in the senate. She continues to lead the Biden Harris Administration effort to improve maternal Health Outcomes. These are champions i am proud to stand alongside. Want to take a brief moment to highlight was a witness in todays hearing. Let resident of california. One of my constituents. He is a Board Certified plastic and reconstructive surgeon. Specializing in pediatric hand surgery in valid Childrens Hospital in california pretty cocreated National Latino physician day to bring attention to the fact that while latinos make up 19 of the population, they account for only six 7 of the Physician Workforce. Thank you for being here today. Our Healthcare System and the state of Maternal Health in this country is at an Inflection Point that requires the urgent attention of this committee. The numbers should alarm all of us. The United States has the highest rate of Maternal Mortality among high income nations. Within recent years thousands of womens have a loss of their lives due to pregnancy related causes. Over the past decade, the birthrate in this country has declined by roughly 20 , Maternal Mortality rates have steadily risen. The crisis is exacerbated in committees grappling with the lack of access to central Maternal Health care according to a report produced by the march of dimes one third of counties in the United States are considered Maternity Care deserts. There are no hospitals no obstetric providers. Think about that. Imagine your loved and preparing to give birth to bring new life into your family and having no choice but to drive hours away from home to seek the care they need. We know from that research on the numbers this a crisis has not been felt equally among a black and native indigenous Maternal Mortality rates are twr compared to those. Two four times higher on black and native american women more likely to die. In a pregnant sleep related deaths. Black and brown communities experience highest rates of mortality and morbidity populations also remain historically underrepresented within the healthcare field. While an estimated 13 of our countrys population identifies as black, only about 5 are physicians in the United States are black. Research suggests under the care of black physicians the mortality rate decreases. By over 50 . Which is why i applaud and urge the committee both through the Healthcare Workforce but use every tool to ensure that workforce is diverse and equipped to provide unbiased culturally competent care. Only then can we begin to change the course of our nation current Healthcare System. We know this must not mean focusing exclusively but families, mothers and babies this means do listen nurse midwives, nutritionists and the full spectrum of Reproductive Health care professionals. Health, wellbeing and birthing experience. Have competence of care team can make a world of difference for families. I saw firsthand how to do lives integrate into their overall Maternal Health care model to ensure birthing mothers receive the highest quality, most competence of care. The leadership of doctor elaine batchelors made a significant difference for even as we have existing models we consider other proposed solutions to this crisis i implore this committee to advance the black maternal act led by senator booker. It is comprised 13 individual bills that would come about the black Maternal Health crisis make historic investments to address comprehensively every driver of Maternal Mortality morbidity and disparities in the United States. Its is not just about the life and death of black women. Its enactment will improve birthing outcomes for all women. Includes bills such as the secured johnson act make necessary investments in Community Based organizations that are leading the charge of o protect mothers and support culturally competent training within Maternity Care settings. This bill is named after curate johnson a black mother who in 2016 checked into a hospital with her husband charles to give birth to their second child, langston. Despite being in Excellent Health she died from a hemorrhage in the hours after delivering young langston. Keira should be here today. The lives of her husband and sons have forever been changed. The Johnson Family tragic experience and that of so many other families should be a wakeup call for us to act with urgency. To address the need of unbiased patient centered care. Todays hearing is an important step in the right direction. I urge this committee to hold the additional sessions, focus on the black Maternal Health crisis and important legislation my colleagues and other advocates of introduced in research. This committee which will see primary jurisdiction for the black Maternal Health and so many other Maternal Health policy solutions is having has not had a recent hearing on the topic. Last month, during black Maternal Health week i convened a roundtable of prominent Maternal Health leaders experts for discussion on how we can Work Together to carve up the Maternal Health crisis we discussed the hurdles that lie ahead in advancing similar legislation those advocate shared with me they believe they would have to remove the word black from the title of. Only then with the legislation likely gain the necessary support for passage. After spending some time with my colleagues in the senate, spending time with many of you i do not believe that to be true. I know this committee is filled with centers Public Servants who represent black women living in each of their states. I am here to stand with you in every american watching Civic Leaders on this committee who together demonstrate our commitment to the black and brown women and their families have suffered the most in our Healthcare System. We have solutions at the ready. I know as a black sentiment will not serve as a barrier towards progress. Served in this chamber will continue to stand with all of you loudly and proudly in the investments required for caregivers, healthcare personnel, mothers and families in california reported to work with this committee may mycolleagues in both chambers. Every level to prevent Maternal Death in this country. Thank you. Thank you very much senator. Our next witness will be congressman Michael Burgess i think senator cassidy wants interest the congressman for. Its a pleasure to introduce a friend. An ob gyn. The 26th district of texas he is a chair the chair of the rules committee. He serves on energy and commerce. Used his wealth of knowledge Maternal Health to advance key pieces of legislation addressing these issues. As you might guess he has a unique perspective as both a policymaker and as a practitioner. Thank you for being here. Rex thank you doctor cassidy. Chairman sanders got members of the committee thank you for allowing me the opportunity of testifying here this morning. I represent the 26th district in the state of texas. In the house of congressional districts for thus the area of the dallasfort worth airport. Just to locate it for you. Before coming to congress i spent nearly three decades practicing medicine in that area. I chose obstetrics through attention to details they spent time at residency as an ob gyn at parkland hospital. Due to its emphasis on proper care and attention to detail. When i started my residence at member doctor Jack Pritchard who was the leader of the department of obstetrics and gynecology and practicing ob you are unique in medicine. Those are privileged enough to continue are going to be charged with taking care the simultaneous care to patients with the Life Expectancy of 100 years. Nowhere else in medicine does not occur. The Patient Population for parkland and Dallas County hospital district serves both rural is multiethnic. Almost completely uninsured or underinsured. But again, this of the best statistics in the country. The lesson for me there always was it does not have to be this way. You can do better. I would like for us to focus on that with whatever our Public Policies are going forward. For myself i delivered in private practice over 3000 babies. Treated patients who suffered from miscarriage, stillbirths and other conditions. With my response was to step in and deliver a baby or save a life i did it without hesitation. For this reason i spent my career trying to increase access to quality healthcare for patients. Both of my experience as a physician and legislator bread and 2005, there what i describe is the miracle of redistricting i picked up an area of the east esite of the city of fort worth. Highest infant mortality rates in the country. Despite the challenges and figures of concerted efforts. Eventually i was successful in getting a federally qualified Health Center with the pediatric unit in that part of fort worth. Collaboration with the democratic county commissioner roy brooks. The mayor of fort worth who is a prior Democratic State senator. It was through that joint effort the experience and expertise and the passion that led us to champing those issues. In congress i continued that as well as other healthcare issues improving the health of the nation. The alarming trend of our greater mortality first came to my attention september 2018 and my copy of the green journal a journal of obstetrics and gynecology. The original research cited in the journal stated the Maternal Mortality rates increased in texas between 2011 and 2012. But a new study found a number of Maternal Deaths in texas in 2012 was actually cap a number of previously reported. In other words there was a mistake in the arithmetic. Because of that the focus became on how things were counted on rather than how do we prevent these bad things from happening. The study was retracted. Again the discussion came about the numbers not about the patients parade that was unfortunate. I personally believe one Maternal Death is too many. It is important to capture these deaths actually tortoise and the scope of Maternal Mortality in the United States in my state of texas. We have a better understanding of how to address them. In combination we cannot legislate good practice. We can provide the tools to be able to come up with the best practices and increase access to maturity care. This critical points of influence by policy work. Their tangible results from them. Because of preventing Maternal Deaths act in 2018 and increasing the dollars Maternal Mortality review committees that comes to my attention 53 of Maternal Deaths were occurring one week to one year after delivery. Ive been focusing on that time in the hospital. By broadening the lens of a little bit more lives can be saved. As a consequence estate plan amendment available to medicare im sorry to medicaid and chip program, host a low inclusion up to a full year after delivery picked texas, i am happy to say enacted that march 1 of this year. An out new moms in texas are going to have the benefit of an additional year of postpartum coverage. I encourage you to look at that as a senate. With our approach the mortality and causes of Maternal Deaths. Continuing bipartisan work in abaco workforce. We can start by paying our doctors who retire early. Or never enter the practice of medicine and the first place for for that as a bed in a particular concern of mine since coming to congress. Repeal of the Sustainable Growth rate formula. The approach to value based care that followed in its place. Although it is imperfect and weve got a ways to go. These are important parameters that will benefit all americans. Ive had the good fortune of working with your future colleague lisa blunt at rochester soon to be a senator from delaware is my understanding. I also work with robin kellyanne danny davis. To improve the care of the sicklecell patient improved therapies in over 40 years until we began to work on that right after the cares act passed. I know my time is done. I just want to stress there are important things we can work on together. It is our obligation to the future americans that we do so. This is a generation of doctors is coming out for the hub tools to alleviate human suffering note generation of doctors has ever known. It is our job to deliver that in a timely fashion but thank you for your attention this morning and i yield back in. Thank you very much congressman burgess. Thank you very much senator beutler we appreciate your testimony and your excellent work. Will now hear from our second speaker. Thank you. [background noises] [background noises] [background noises] let me thank all of our knowledgeable panelists for being with us this morning. We have five panelists. Doctor yolanda lawton, doctor sam mccook, doctor michael valdes, doctor james andre rios, doctor brian stoner but we think all of them for being here. Our first witness will be doctor yolanda lawton. President of the National Medical association for the Largest Organization representing black physicians. Doctor lawton ob gyn who is committed to addressing Health Inequities improving diversity among physicians. She is committed to eliminate maternal Health Disparities. Doctor lawton thanks for sharing with us. Thank you. Is your mike on . Press the button. Good morning chairman sanders and a Ranking Member doctor cassidy and members of the committee. Thank you for the opportunity to appear before the committee to discuss this critical issue addressing the shortage of racially prioritized Healthcare Professionals Maternal Health disparity i doctor yolanda lawton on testifying ob gyn practicing in dallas, texas founder and a birthing center. I am currently the executive medical director Maternal Health Healthcare Services corporation. Today i speak to you primarily in my capacity as a president of the National Medical association. We have the largest and Oldest National organization representing more than 50000 africanamerican physicians and the patients they serve of all racial and ethnic backgrounds. As a physician my first duty is to the health of my patients as president my first duty is able to fulfill our mission to eliminate Health Disparities in this country. The act is africanamerican as well as other people of color are not as healthy as their white counterparts. African americans expand the lowest Life Expectancy across a myriad of helpful outcomes compared to white americans. Irrespective of their socioeconomic status. Research demonstrating and Health Outcomes have existed since federal recordkeeping began. They cannot be explained solely by socioeconomic differences. They were largely preventable through structural interventions implementation of equitable held policy and measures before a Prospective Patient even entered a traditional medical sense. 20205 people died just this extraordinary moment spotlighted a chronic problem of the ongoing Health Disparities that exist for blacks in this country. People are disproportionately affected by virtually every major chronic diseases including diabetes, high Blood Pressure and obesity. Even more disturbing art disparities in Maternal Health. You all know the numbers. Black women are three four times more likely to die from pregnancy related complications the white women. Maternal Health Disparities persist as a pressing Public Health challenge in the United States. Despite advances in medical technology in healthcare delivery. These disparities are not solely attributable to socioeconomic factors. But are deeply rooted in systemic racism and unequal treatment, bias and inadequate access to quality healthcare. This is not just a matter of equity or fairness. There more sick people and our nation such an imbalance dynamic creates a bigger burden on our Healthcare System but reduces workforce productivity, increases disability racist medical costs that ultimately we all pay for. Whether through medicare, medicaid or other high Health Insurance premiums. Avoidable Health Disparities are deeply rooted in the operating in the operationalized. [laughter] about systemic racism and discrimination. And in the persistence of unequal access to quality healthcare. Each of these elements erodes a patients healthcare experience. In support of their help today and across their lifetime for today is like to emphasize a critical piece of the American Healthcare proposal the shortage of black physicians. Research consistently demonstrates patients from racial and ethnic minority backgrounds experience and Better Outcomes when treated by Healthcare Providers surely racial or ethnic background. In short, patients can have better Health Outcomes when their doctors look like them. Yet, lack of doctors are vastly underrepresented representation is critical in black physicians and Healthcare Providers more likely to understand the unique challenges that black patients make that affect black Patient Health theyre more likely to trust and comply with the recommendations of a black position. This country as a legacy of distrust among albert American Healthcare institutions rather real or perceived this is rooted in historical abuses of power 70 of all black physicians in the u. S. Today attend hbcus in the early 20th century we know that number was reduced after the flexner report was released instead of addressing those concerns about the quality of education at hvc medical schools the ama allow them to close. We know that likely they never black physicians in this country today will be more proportionate to the black population if those institutions had remained open. Believes we must create pathway programs to address inequities in the education system. We must address financial constraints for many black students, medical school as a financial impossibility. We support programs such as a National Health Service Corps and ask for resources for the medical schools to address education and infrastructure. Medical schools must adopt more holistic admission processes. And the attrition rate. We advocate in regards to Maternal Health a companion bill from the senate to the black mortality and finally, we must take steps to reduce the bias in our Healthcare System by establishing Regional Centers of excellence to address implicit bias and cultural competencies and profession setting 600 durban and representative robin kelseys care for moms ask for i believe there out a turning point. In my lifetime two major events have significantly virtually white counterpart the covid19 pandemic and hurricane katrina. Both catastrophic events re build the glaring Health Inequities that are present in our country for there is much work to do. But we also have a historic opportunity to change the story. Thank you, senator. Thank you very much. The next would be doctor samuel cook at he received his medical degree from trachsel universityy and advocate for improving diversity. Doctor cook, thanks for much for being here. Thank you sir. Senator and chairman sanders, et ceteras of the health committee, my fellow esteemed panelists and gas, thank you so much for having me here today. Im doctor statement david cook internal medicine resident at Morehouse School of Medicine Press born and raised ronald cook ambassador Susan Johnson cook. Instilled in me a deep love of god and the impetus to serve those among us were most in need. For all of us in this room today, our redblooded american scout my journey to this platform has been anything but traditional. The doctors i saw as a child never look like me. Made my lifes mission to be the change i saw it in medicine. During my undergraduate studies at Johns Hopkins university i was told by my medical School Admissions counselor that my above average gpa one of our nations top 10 universities was not Strong Enough to make medicine a reality. Nevertheless i persisted and entered a postbaccalaureate Pipeline Program for underrepresented minorities at Drexel University college of medicine. This pathway to medical School Program i thrived. The specialist supportive environment and quickly excelled. Having graduated to become a medical student at drexel, right writer top Academic Awards above my peers a ball and published by medical research, even authoring a paper with decoration from harvard medical school. As a sanko you cannot judge a book by its cover and it takes a village to raise a child. It is a fact, not an opinion that colleges and universities have been instrumental and create their own pipeline to medical school. Between 2009 and 2090 hbcus have the most black graduates to them. Faster hvc medical School Produce 10 of our nations black doctors only accounting for 2 of all medical colleges. Beat in educational system that stacked against us. Many black students are faced with hundreds of thousands of dollars in student loan debt. For me, the cert medicals cool loan debt plus accrued interest stands just shy of 400,000. Though they costs are the same amount of the students arrays, the Financial Impact it will have on their families is not. Systemic is an undeniable truth in our nation. Its far too many students of color from becoming the doctors they were qualified to be. But call and huge increase funding to reduce the cost of producing high quality positions of color. This is with the understanding these institutions have a proven track record of incubating some of our nations brightest minds. Those nearly snuffed out by the waves of racial bias and injustice. How does having a black doctor better serve black patients arer save them from undue harm . I wrote in my testimony about black woman who was nearly committed in chemically and physically restrained all because her medical team did not know that hitting your head and scratch and itchy scalp does not make you crazy. It simply means you dont want to miss of your hair. I was the presence of a black psychiatrist that save them and that hospital from what wouldnt have been a viable malpractice lawsuit. Its not just an issue for black american senators. This is an issue for all americans. What is more, 2016 study found half of white medical trainees surveyed 50 believe that such myths as black people have thicker skin or less sensitive nerve endings than white people. They continued made less accurate treatment recommendations for this population of white medical students we see evidence of negative racial bias currently and have long been harming americas a black patients. Senators, i humbly come before you today as nothing more than a mouthpiece for our collective struggles. Recruiting. Therefore, i am challenging you, senators, calling upon you to each assure the American Public and your constituents. Thank you very much, dr. Cook. Our next witness look dr. Michael galvez who specializes in pediatric reconstructive hand surgery, de. 6 to bring attention to the need, dr. Galvez, thanks so much for being with us. Thank you for having me. My name is dr. Michael galvez and i stand before you as husband, father, son of peruvian immigrants and surgeon and advocate for my latino community. Im honored to serve as a pediatric hand surgeon to help children with complex hand conditions in the central valley, california. [speaking in spanish] i speak spanish every day with my patients and in my practice of medicine i come to recognize that my language and culture are as valuable as my training at prestigious universities. Theres nothing like seeing a face of a lot know child mother when i come to a clinic door and begin speaking spanish alleviating fear as First Encounter with a physician that speaks the language. Understanding the culture as clarity and connection. After working at medical institutions across the United States, i ask myself why i dont see faculty like myself. I cofound National Physician latino day. And nearly every medical organization in this country and multiple hospitals across the country. We rally behind the motto 6 is not enough in recognition of the public Health Crisis affecting our Community Despite being the largest Minority Group in the United States, latinos represent only 6. 9 to have latino Physician Workforce which is contrast of 20 in the nations population and nearly 40 in the state of california and texas. There are not enough physicians to provide highquality care to communities. Latinos in the u. S. Have the fifth largest Gross Domestic Product in the world, gdp, however, limited access to health care, face language and cultural barriers, experience poor, cancer and maternal Health Outcomes and increased covid mortality during the pandemic. This burdens the social net. More missed days for children and lower productived which stun it is potential of our country. Our hospitals, our institutions, medical stools and, indeed, congress have the ethical responsibility to address the underrepresentation of latino physicians to meet the needs of a growing latino population which is estimated comprise onethird by 2050. But it can really just be the its really the only educational option for some students to expand the percentage of latino physicians and minority physicians in general it is critical to meet them where they are and that is in our Nations Community colleges. The commercialization of medical School Admissions and reliance on standardized test overlooks potential of a compassionate and capable physician. Im in disbelief when they are not recruited despite shortage. National latino physician days highlights persistent shortage of latino physicians which underscores the need for change and opportunities that action that congress can take. First, expand funding for pathway programs and new medical School Programs. We can increase the minority workforce by recognizing the value of lived experience of latino identified individuals through pathway programs that begin at Community Colleges, early exposure to medicine and advocate for Holistic School admission. We need bilingual and bicultural medical school, partnered with local hospitals, we can start with regional satellites of medical schools and n predominantly latino areas of california. We also should not be ignoring language. Language proficiency by physicians is a proven strategy for improving Patient Outcome demonstrated by ucla latino policy and Politics Institute which is shown that language enhances compliance with medication adherence. By tieing medical School Funding nih grants to admission practice that is prioritize these elements this will drive medical schools to align more closely to their local underserved areas. For example, the university of california could be mandated to recruit, accept and retain these qualified students to take care of underserved programs. In california im grateful to be recipient of cal healthcare loan repayment to serve patients on med cal but federally the service cops essential to attract physicians in underserved areas ensuring affordable healthcare access. We can no longer allow the status quo from our medical schools as lat foe population increases we must confront this public Health Crisis head on. We need more, thank you so much. Thank you very much, dr. Galvez. Yes, my pleasure to introduce im sorry. Completed Nurse Practitioner at elms college 2020 and bachelor of science and nursing in 2014. Shes a native of Springfield Massachusetts dedicated professional career dedicated to vulnerable populations. She credits experience to pursuing career in health care. By Clinical Experience as registered nurse began as a correctional nurse for the Hampton County Sheriffs Department where she conducted Mental Health evaluations and incorporated multidisciplinary approach to care. Later joined the mason square neighborhood clinic providing drug and alcohol abuse nursing care. She enhanced clinical skill and joined Medical Center team as trauma surgery Nurse Practitioner in september 2020. Her commitment to be a voice for the disenfranchise has allowed her to be a change agent and a role model for others. Dr. Andrade, thank you for being here. I thank you for the opportunity and your attention for addressing the shortage of Minority Healthcare professionals. I want to tell you a bit of my experience and offer you some insight into ways i believe congress can help increase the number of Minority Healthcare workers in the future. I went to high school in Springfield Massachusettss at putnam high school, urban Vocational School and enrolleded in the Cosmetology Program and had dreams of becoming a lawyer. At that time i struggled to figure out how to make this dream come true. Coming from a singleparent home where my mother didnt have the means to save for college or law school, i was fortunate, though, she did have the drive to instill a strong work ethic and foresight to encourage me to contemplate my talent and choose a career which would offer economic stability. One day at medical appointment with my mom a nurse started talking to me about the opportunities nursing could offer and i was intrigued and to get a better sense on the path of becoming nurse i started taking courses and took prerequisites for the Nursing Program and eventually enrolled to elms college to earn my bachelor to nursing. While i was going to school i wanted to support myself. So i began working in Environmental Services as a custodian at bay state Medical Center. I work to keep surgery and procedure rooms clean. This allowed me to see firsthand what nurses did what i would need to know moving ahead in the healthcare environment and to get advice on how to proceed in my career. My colleagues offered incredible insight into ways i could fund my education. They pointed me towards resources like to western Community Foundation where i had access to scholarships and interest free loans. Without my colleagues i would not have been able to find these resources which i believe were instrumental to my education. These resources need to be made more visible and accessible to students. I proceeded through my Nursing School and stayed at Medical Center in Environmental Services. Eventually i was hired as a nurse once i graduated in a community Health Center, mason square, there again with the support of my colleagues i was encouraged to earn my doctor doctorate of nursing practice. I did this at the height of the covid19 pandemic which was not easy and eventually i was able to come full circle and take a job as a Nurse Practitioner and n trauma surgery, again, at the bay state Medical Center. Looking back at my experience if i could make suggestions to lawmakers on how to improve the shortage of Minority Health care providers i would offer a few thoughts. First, i would save robust college and Career Planning is very critical. Many students at all schools, most especially those in lowerincome areas aware of healthcare as obtainable career, opportunity would go so far. Letting the students know it is within their reach and that there are Resources Available to them to embark on their journey to Higher Education is key. At the bay state Medical Center we have a program called the bay state springfield Educational Partnership or bsep. This is a program for the youth and springfield which helps connect to hospitalbased learning and opportunities to learn about different professions within the Healthcare System. It allows students to engage with professionals and learn from them like i did while being a custodian, but in this program they are still in high school and this option helps them evaluate what Healthcare Careers they could select. I did not go through this program myself but i would recommend supporting similar opportunities from minority youth, for early professional mentorship. There are a number of physicians, physician assistants and Nurse Practitioners like myself who entered bsap as High School Students and now work for bay state. Many of the bsep students also fulfill other roles in bay state while advancing their education. I believe federal support for programs like this could lead to many more minority students embarking on prosperous careers in health care. Another way to make this journey more accessible is tuitionfree Community College. This would allow students to begin their education without taking on a financial burden. This opportunity to begin to pursue the education needed to become a professional Healthcare Providers should not be underestimated. State and federal grants to reduce loan costs would make career paths a more appealing option. Helping fund the education of minority students interested in becoming professional Healthcare Providers is a wise investment. It connects people with practical careers which would allow them economic stability to support themselves and their families. Thank you again for the opportunity to testify and share my experience with you. I appreciate your consideration of my recommendation. I will let my senator from alabama introduce thank you, senator cassidy, welcome to all of you. Its my honor to introduce today dr. Brian stone of jasper, alabama, dr. Stone grew up in birmingham and received undergrad degree from rutgers. He was identified as a top urologist in new york and new jersey and years of tenure at colombia University College of physicians and surgeons. He has receive sod many awards for success its hard to count them all. Theyve been honored by the ncaap, more house school of medicine, the American Cancer Society and the american urology, he has served in my capacities as a consultant and scientific adviser, he has served in advisory positions on the local, national and International Level over the years. He also worked with pastors in different nominations in Jefferson County to educate and reclout black patients to participate in Clinical Trials process and he serves on the committee in conjunction with school of medicines National Alumni association. He created a medical Scholarship Program for deserving male students of color from alabama who have been accepted into the uab school of medicine. Goal to increase the minority physicians who are from alabama and are willing to Practice Medicine in the state. Thank you, dr. Stone. There we go. Good morning, i would like to thank chairman sanders, senator tuberville. My background is a urologist. I think im the old guy on the committee. I graduated in 1985. Ive had a breathe of experience working in tinner city, having trained in the bronx, having worked at harlem hospital which was connected to Colombia University and im now in a rural setting and i see the similarities between the Health Problems that we see in the inner city as well as in rural america. When i think of america i think of the saying that you cant choose your family but you have to love them anyway. Our Diverse People make the country the greatest country in world but the greatness cannot be maintained if we cant keep our people healthy. Currently, we have about 71,000 physicians retiring per year over the past few years and we only graduating 21,000 medical students per year. And if you follow the mathematics, you see where we are going to end up. We are going to need Creative Ideas to get us out of the situation. The impact of under the numbers of physicians has down stream impact on the initial of specialists and we feel that at our hospital now with our inability to recruit physicians in various specialties and unhealthy nation is a less productive nation. Certain segments of American Population are less healthy than others as other speakers have spoken about, black americans have the highest death rate from all causes in our country. These high rates of disease and death have economic consequences and that is why this is important for us to address. I grew up in a segregated birmingham where every black regardless of his socioeconomic status lived in the same neighborhood. This had benefits because i had the opportunity to grow up with role models like dr. James montgomery, clarence hickson, hamilton, my uncle dr. Meadows, first surgeon in atlanta. The role models made me know that i could what i wanted to be but thats not the case for a lot of kid in America Today. Unfortunately, technology has almost become an impediment to educating our children and america appears to be at the Inflection Point on how we educate our children because this is the pool from which physicians are recruited. America and the black community have a serious challenge in addressing the stem gap that exist between white and black students. Noted that progress was being made and recruitment of africanamericans to medical school peaked in 1994. By 2018 Pew Research Study showed that the Poor Foundation of Stem Education in k through 12 was the root cause of the recruitment problem for medical schools of medical students. Theres a wealth of data showing better Health Outcomes when black patients have black physicians and this applies across different cultures and this is because when you have cultural connectivity, you have better communication, you have shared experiences and you can overcome the mistrust that has developed over the decades. Alabama has a population of 4. 8 Million People, 25. 8 of whom are black and yet we only have 7 to have Physician Workforce as black. We are dealing with some serious healthcare issues in our state particularly with limited access to healthcare and we had closure of rural hospitals and clinics particularly in the black belt of the state and we have to come up with some real solutions. Most of our physicians tend to be concentrated in the major metropolitan areas of the state leaving our rural areas at risk. Its no wonder that Alabama Always ranks at the lowest as far as health amongst states in the area and its its not only as the Overall Health of alabamans poor compared to residents of other states but the Health Disparities between africanamericans and whites are very considerable. What are some of the potential solutions enhancing k through 12 Stem Education, incorporating mentors early, creating a health focus fast track students into medicine and reducing the financial burden of medical education, increasing the size of medical school classes, increasing the size of Residency Training programs. The problem cannot be corrected overnight but the crisis is real and i think we need to start thinking out of the box. Thank you very much. Well, let me thank all of the panelists, every one of you made extremely important issues and hope this committee will act on some of your thoughts. Let me start off until fairly recently i did not appreciate this issue and a couple of years ago we had young people from Howard University coming into the office and they were chatting and one young woman was talking about the experience her mom had going to a Physicians Office and not being taken seriously and so forth and i know all of you in various ways have raised the issue. So let me ask, i think Many Americans say hey, its a physician, what difference does it make, what difference does it make for having going to a physician who understands your life maybe comes from your community, what difference does it make, dr. Lawson you want to start . Absolutely it makes a huge difference. Me myself in practice many times the trust. When i build trust my patients really do respect and comply with therapy. It is not uncommon many patients play go to a physician of a different race or ethnicity and question, right, the treatment that they are prescribed or have given me or provided personal experiences where they werent respected. It was in the system or they were provided treatment that is were inadequate or sub standard or not given options especially being an obgyn, so many women, latino women underwent hysterectomies. It is really an issue of cultural competence. You dont understand the perspectives and the concerns of people from other races as well as they do for themselves. We grow up in similar situations. We know very similar circumstances that happened to all of our families and as dr. Lawson alluded to theres inherent mistrust, we saw that even with covid vaccinations and inability to get black americans to even take those vaccinations so its a widespread problem and it will only improve with more representation. Thank you very much. Dr. Galvez. Yeah, for thank you. For the latino population, the patient physician cord cordance is so important to have that cultural competency to becreation miscommunication and the language component for latinos in particular is very important because things can get lost in translation, a story i can think of is a patient comes in, their child needs a surgery and everything gets discussed in the visit but the family is more worried about general anesthesia and they leave the visit, maybe book the surgery, we are ready to do the surgery, fix the problem and they book the surgery and the patient cancels because they are so concerned and they didnt get their questions answered. I am puerto rican decent and being able to speak to someone who went through a terrible car accident or some trauma i think gives them a breath of fresh air and, again, as the other panelists have alluded to its the trust that you have someone that speaks your language and looks like you at the forefront of your medical care and i think that makes a difference in Patient Satisfaction and patients trusting the Healthcare System. Thank you. I deal with it daily when it comes to say Prostate Cancer. The different between a black male and how he communicates and white male, the concerns they may have, the trust factor, all of that plays into the relationship and patient compliance. My last question, briefly, im running out of time here. Dr. Cook mentioned that he graduated medical school 400,000 and i talked to doctors nurses graduating with more debt. What does the financial constrictions mean to young people in minority communities that want to pursue career in medicine . Absolutely. The financial implications can almost seem like impossible to pursue the tree would be discouraging to individuals and myself im working on scholarships for students but i was told because i didnt have the resources. Would that make a difference in your communities, dr. Cook . Of course. The price tag in itself is a barrier. Think for one second if you took off 400,000 of debt and you got sick in your first year of residency. You will have no pay to repay that and will be forever in debt. Dr. Galvez. The socioeconomic differences make a big difference and the difference for latinos in particular is the need to work. And the other difference that happens frequently is you have a student that has to work and do classes at the same time and pay for tuition versus a student who is in a more affluent community and has office space to study in dedicated time thats where these disparities begin. Dr. Andrade. It gives a chance to even start to feel that Health Care Career is in the realm of possibilities. I mentor a lot of kids that are bright and can be physicians but offset by the cost. I thank you all. Dr. Stone, my wife is a 1983 graduate of uab. Okay. I kind of hide that fact from louisiana but thats okay. And i will note dr. Galvez you dont respect our spanish if youre interpreting im telling you why you should do it. Thank you all. Dr. Stone, africanamericans have a as we both know as you particularly know higher chance of Prostate Cancer and theres a cultural same sort of thing. I see that you have partnered with communities of faith to express concern. Can you comment on that . Yeah, one of my concerns is lack of inclusion in Clinical Trials and all therapeutics developed in the u. S. Are developed based on data from white patients and the way drugs metabolizes, it may not be appropriate for different culture groups. Im trying to increase participation in Clinical Trials by engaging the faithbase community through which we can recruit and try to get more patients to participate because the trust bridge is already established in the church. Im totally with you. My population was 60 africanamerican. I ended up the lead recruiter for africanamericans because i was work forking two decades in the hospital and there was a trust there. Yes. First time they were invited in not to participate in trial the first time they are invited in to see me and then i saw them for ten years before speaking about a trial. Absolutely. I congratulate you on that because it can bring benefit to the patient. Dr. Andrade, for some reason my rs are not rolling today. Im impressed with how youre kind of, whats the word, inspired to pursue health care and move from cosmetology into doing that Environmental Services work, et cetera. How do we light the same flame in others . I think as i said in my testimony i think again its making the financial burden of students in minority less. Yeah, but im not speaking about it has to have the spark of interest and the next is how do you remove barrier, how do you spark the interest . I think sitting here today is one way to spark the interest so that other minority students can see that this is a reasonable idea for them and they can see someone that looks like them in a space where typically you dont see minorities. I accept that. That makes sense to me that you would do that. And then what inspired you to continue to up skill if you, will, to become Nurse Practitioner because its a way, i went to med school with a med tech and she had taken premed courses and she advanced her skills and became an md, so just to point that out, that works, right . So your thoughts on that . I was inspired to continue my education to become a Nurse Practitioner by actually africanamerican nurse Gloria Wilson who worked with me at mason square, she was in her 60s at the time and she was going to school for her masters degree and kept saying, you can do it, you can do it and i just said, okay, i will apply if i get in and i will continue my education so my inspiration to continue was this africanamerican nurse who was in her 60s and still searching and looking for opportunities. Role model and mentor. Again, a role model. Dr. Galvez, you had mentioned increasingly Latino Workforce by having some sort of, you know, federal funding tie, so square the circle for me. Seems we are creating another barrier to require a second language. Its a great question, and thank you so much for it. It really is as i mentioned as well in my testimony, language has frequently been ignored and, yes, its challenging. I didnt want like my parents forced me to speak spanish at home. Thats how i learned it. And, yes, im privileged that i was able to learn it at home and very grateful because its my superpower like i mentioned but it is something that i believe should be encouraged especially if you have the medical school that, for example, in california by 2050 its going to be almost 50 latino and so those considerations of language will improve efficiency in your clinic, right. If you have i accept that. We are almost out of time. Sorry. Maybe question for the record, as a physician i thank you all for still seeing patients, so thank you. I yield. Senator casey. Let me start by thanking you, mr. Chairman, and Ranking Member, whether diversity or Maternal Health or Maternal Mortality. I believe that in order to nurture a future generation of black and brown healthcare workers or in order to close gaps between outcomes for white and black mothers, we have to start in childhood and that means that the congress of the United States has to get into the game in a way that we havent ever really. I believe it comes down to at least five basic freedoms that every child should have a right to enjoy. And we should invest in those freedoms, not just talk about them like they are platitudes. The freedom to be healthy, the freedom to learn, the freedom to have Economic Security which means giving children the opportunity, their families the opportunity to save at a very young age for their future, the fourth freedom would be the freedom from hunger and the fifth freedom would be the freedom to be safe from harm. If every child has those five, health, the opportunity to learn, Economic Security, freedom from hunger and to be safe, we will have a much different outcome on all these issues we are here to talk about but the federal government hasnt done that and so i think it requires a maximum commitment to our children. I will start with dr. Lawson. In the context of mat earnty care, what is your experience been with mid wives and dulas and what role can they play in reducing Health Disparities . Absolutely, thank you, senator. Ive had a 22year history we are experiencing obg yn. Very impactful. I think women should have a choice in what type of provider they want and thats what mid wives can do. Mood disorders, sometimes share things with the dula they may not want to share with me. Very important aspect and addon support for women during pregnancy and childbirth. Thank you, we are all trying to do more to invest in programs that would support more dulas and mid wives. Im amazed at the sophistication of the curriculum and how we prepared young people are coming out of those Community Colleges. How can we better use the opportunity that Community Colleges offer to help grow and diversify the Healthcare Workforce . It really was i didnt know how to study, it wasnt until Community College i learned how to study and i learned those skill i used those skills at stanford for medical school. The same study skills. I think its an untapped resource. I think recruiting early and encouraging students to consider and other healthcare fields is a very diverse pool, and better use them and include them is to create pathway programs where we have in california we have medical School Scholars program but it really is providing mentorship and guiding them but its not its not guarantied acceptance and thats where, i think, taking it a step further and guarantying these students and creating even a quota for medical school so they can better reflect their community is a strategy for for this for diversifying the workforce. Doctor, thanks very much, before i conclude i want to commend dr. Cook for your telling your story here today, the fact that you would send [laughter] its a Great American story and i know you worked hard to achieve it so thanks for being here today and providing that testimony. Thanks, mr. Chairman. Thank you. Senator marshal. Yes, we need more minority doctors, nurses, the whole gamut. I totally acknowledge that. Mr. Chairman, i would suggest that the work we have done with community Health Centers will do more to impact this than all the other ideas we are hearing about that our vision of the community Health Centers would have prenatal clinics in them and help take care baby is delivered. Something i didnt do a good job until about six weeks and the other thing that would impact us is stopping illegal crossings on our border and fentanyl poisoning that is accumulating problems for my moms as well. You have to hear my story and im sorry but im firstgeneration College Student too. I went to a Community College. My wife went to a Community College. 90 of nurses in our hospital are communitycollege nurses. Went to Residency Program in tampa. 5,000 deliveries a year. In 20,000 moms that we delivered, you know how many Maternal Deaths we had . Zero and how the answer is how come . Two things, one we had incredible committed doctors and nurses and ultrasound techs but number 2 as i said prenatal clinic. When i got there, maybe half of our moms are not getting any prenatal care. That was one simple solution and half of my moms, i delivered over 5,000 babies personally and half of my moms drove 60 miles to see me. The worst thing than no prenatal care is bad prenatal care. Thats a scary situation as well. Zero deaths why and half of the babies we delivered were minority, half delivered in my private practice were minorities, half of which were on medicaid or had no money. So it wasnt like it was Perfect Group of people that had everything in life. Half of my patients spoke spanish that i delivered so, you know, those were challenges, but no deaths because we gave prenatal care and i was obsessed with prenatal care and my nurses were obsessed with giving prenatal care. Asked the panel, how many women died in 2023, Maternal Deaths in 2023 . Does anybody know the answer to that . It was 684. In 2021 it was 1,205. So we dropped from 1200 to 684,so first of all, i want to thanks doctors that are making a difference. Next, whats the most common cause of Maternal Death now . Does the panel know now . In black woman cardiovascular disease and yeah, i wish that was the case but the most common cause of Maternal Death now is is suicide and drug overdosing and fentanyl poisoning. Thats the number one cause. What percentage of the deaths occur more than a week of delivery . Over half, 52 . Half of the deaths are occurring thats why the community Health Centers are so important to follow up on the Mental Health aspect let alone addiction issues as well, okay. Number one, hemorrhages, hypertension. Those are the ones that we can impact with prenatal care and interpartum care and why is Heart Disease spiking right now . Well, several reasons. Our moms are older, number two, is they are heavier and number 3 is diabetes. The type 2 diabetics that i saw in my clinic doubled or tripled over 25year career. Again, we go back to our community Health Centers with nutrition as a component with Mental Health as a component that we hopefully have helped your moms before they get pregnant. Thats whats going to impact all these. We dont need to form committees and pray about it. We know the solutions. I think our community Health Center is the best thing i see out there thats going to touch all people and look forward senator marshal and senator among others, senator played an Important Role on that and i hope that we can get that legislation moving again. Senator kane. Thank you, chair sanders and thanks to the panel. You all in your professional lives have some pinnacle dais and i want to reflect as i think about the work that we do here, we may not have as many s but we have some and three times in the 11 years that i have been here we have passed meaningful legislation by one vote and on those days it makes me think, wow, what if i hadnt run n. August of 2017 we saved the Affordable Care act in the United States senate by one vote and 30 Million People did not lose Health Insurance and tens of millions of people did not lose the ability to be protected against discrimination because they had a preexisting condition. In 2020 we passed Inflation Reduction Act by one vote capping Prescription Drug prices, outofpocket costs, negotiating for Prescription Drugs under medicare passed by one vote. The third one voter is not generally thought of as a health bill. Its the American Rescue plan in march of 2021. But it had within it something really important, prior to the American Rescue plan medicaid would cover a mom after birth for 60 days. In the American Rescue plan and then subsequently in Appropriations Bills we extended at option states could choose that a mom would be covered post delivery for a year by medicaid. Its interesting, it was a state option. 46 states have embraced this option, 3 in the process of embracing and only one has not pursued it. What is this likely to mean playing out over time that medicaid will now cover moms not just the kids but will cover moms for a year after delivering . So this has a huge impacts and i extend to you that it is even maternal care. You look top causes of infant mortality in the country, two of those five are either to maternal complications or lowbirth weight babies due to bring term birth. So you are talk about lifelong and impact because we know that infant health is also an important marker of the Overall Health of society, so when you talk about how impactful this is, major impactful, again, im in texas, we are excited. I remember and my colleagues that have done ob gyn, she had medicate coverable and we thank you for the work that you have done with this. The ability not to have to cram it in six weeks but have it for a year, i think we will start to see statistics. But started to eat away at disparities that we are seeing in mortalities and im interested in following this, its still relatively recent implemented. I think virginia might have been the first state that embraced it. We happened to have a doctor as governor when this got passed in the American Rescue plan. The fact that now every state has done it or in the process of doing it say one, we seldom do things that are so popular here where states say i want to be part of this. My colleague asked questions about Community Colleges and i dont need to go into it as much. I think both dr. Galvez and andrade and Community College, Community College students, who is a Community College student . The average Community College student is older than 25, receives a pell grant, attends parttime and is a woman. And is more likely than the population to be a person of color. Thats our Community College population. So many fantastic Healthcare Professionals start there and we need to do more to recognize the Community Colleges as great beginning places, accelerators, onramps, onramps to success including healthcare professions so i think its just interesting in the randomness that are our five witnesses, you know, we have two who begin in Community College and i appreciate that. Theres been some recent turn about whether the statistics that we have been using are accurate and im kind of a data geek and i really hope that we can Work Together with the cdc to arrest any confusion about the statistics. I think measured accurately we are still going to find we are outlier with other nations and we are still going find the significant disparities but to the extent theres been con con controversy i hope that we can improve the data and how we report it. Thank you, mr. Chairman. In my home state of indiana we have the third highest Maternal Mortality rate, thats sad. Regarding the sad state of affairs, local news articles said that nothing has changed in ten years. That needs to change. That lack of improvement is disappointing state by state thats why ive been vocal on health care in general and we did pas out of this committee the premie to promote healthy pregnancies. The improving access to Maternal Health for military and dependent moms act, that is being reviewed hopefully we get that through this committee and the standing with moms act which would increase the availability of pregnancyrelated resources to expected mothers, another bill. So we are drawing attention to it. My question is for dr. Lawson, in your home state of texas, what have you seen there . Have they been improving . Theres a lot more agility at the state level to address things. Tell me whats been happening there. Thank you for the question. So over the up until 2021 we have not improved some new data. I know that our mmrc is working on the biannual report will hopefully have that this summer to see where we are in 2022 but overall in texas, you know texas has one of the worst rates of maternal morbidity and mortality, we are excited post partum extension was made. From work perspective is having enough physicians for the population and enough physicians to actually take medicaid coverage for those populations. We have some strong county Hospital Networks there but, of course, weve not seen the reduction in numbers that we would like to see ideally. Have any states from your observation found best practices that are doing a good job, do you keep track of that because you think among 50 that someone would actually be doing a decent job with it . Are you noticed anything to that effect . There are some states that i think i can point to california, the california collaborative and done really great work and especially when you think about that population, also in new york is doing some really great work i think in collaboration with the mmrcs, the data piece is very important that drives a lot of policy from a Public Health perspective and for hospital Quality Improvement projects. This is such an important area along with getting more doctors and professionals paying attention to it especially among minorities as well. We should be throwing everything in the kitchen sink at this both federally and by state. I want to segue to one other issue that i bring up always is the broken nature of our Healthcare System thats increasingly being run by large corporate entities that i dont know that have any interest in prevention in wellness and until we get that fixed we will keep avoiding what we all know makes more sense prevention in wellness and thats going to take a cultural change within health care itself. Probably the biggest thing would how do you lower costs among Insurance Companies in hospitals. I can tell you whats been happening has been the opposite. Its alienated even a lot of physicians and nurses from getting into the business because their dream wasnt to be working for huge corporations that dont have practitioners in mind and the patient. Thats got to change in terms of what we can do state by state in here as well. Senator sanders and i introduced a bill and its already got a lot of bipartisan support, senator smith, hickenlooper, coons, baldwin and this would be transformational. Its a bill thats going to force corporate healthcare to accept transparency and competition, not to have barriers in the entry for people to get into the Healthcare Industry or corner the market with high costs along the way, so i would urge all of you to make sure in a grassroots way you get behind it and until we break that grip to where that is in control we are never going to address this or many other issues related to health care. Thank you for being here today. Well, let me just thank senator braden for his work and to mention him, this whole issue of corporative, private equity control over Healthcare System is exploding. Young doctors dont want to be corporate employees. Its an issue that we will deal with. Senator hickenlooper. Thank you, mr. Chair, thank all of you for being here and your service, you could be making more money doing other thicks and i appreciate your commitment. You know, im from colorado and weve been working a lot on apprenticeships and on a broader scale they can help address the shortage of Minority Healthcare professionals. Colorado Public Health works is one of the first of its kind that connects amercorps volunteers and their goal is to recruit a more Diverse Workforce and allows to get valuable on the job apprenticeship experience while we make progress in our Public Health needs. So i will start with dr. Galvez and dr. Andrades. How are apprenticeship models and other on the job training models particularly helpful in terms of recruitment and retention of diverse healthcare forces and then follow that up with additional federal support for apprenticeship programs which weve worked on on this committee, would this be helpful also in terms of recruiting students of color . Thank you for that question, senator. Apprenticeship model is fantastic and i think of it from the medical side we frequently shadow and shadowing a physician is where you learn what you potentially could be, what youre getting into, right, and so theres some shadowing experiences that arent great like at an er where you are passing out juice and blankets. Thats not really learning about what the er if you thinks but when youre in the er taking care of patients or helping translate and seeing where what a physician is doing, that that buyin that spark is what really gets people hook that they want to proceed and go into that model. And so i think thats a good format and it likely would reduce attrition because an example is you have one that goes to ivy league school, right, they want to be a doctors and, yes, they will get research experience. Yes, they will shadow in a clinical setting but its you see high attrition rate in people entering medicine who didnt really get a great initial experience so apprenticeships are fantastic models. I can be the surgeond Nurse Practitioner and again it offers them an opportunity they wouldnt have in other ways. Weve worked on this and have a lot of support on the committee. As you noted in your testimony cdc reports black women are tragically two, three, four times likely. Weve heard a lot of that is due to Mental Health issues. There is a report that found basically a third of all deaths were attributed to suicide or accidental overdose which is staggering. How do you think we both address this Mental Health Substance Use disorder epidemic that we have . That brings up one of our focus areas there are certain specialties we are worried about the workforce and the availability. Ive not been to one state during my presidency and this past term where they do not have a shortage of behavioral Healthcare Providers about 55 of women even if they had, there is a coverage gap and or psychology colleagues do not accept commercial insurance because of low reimbursement so the root cause of this is reimbursement for behavioral Healthcare Services issuing value in that. Thank you. I will yield back. I want to thank the witnesses for coming and your dedication to the health of women and pregnancies and deliveries and other aspects. I just want to echo senator marshall this is without exception excellent testimony and we look forward to continuing to work to implement these important suggestions so thank you all and with that let me just say the hearing is over and if anyone wishes to ask additional questions they will be due in ten Business Days and i would ask unanimous consent from the stakeholder groups the committee stands adjourned. Thank you again. 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