The subcommittee on Border Security facilitation and operations will come to order. The subcommittee is meeting today to receive testimony on assessing the adequacy of dhs efforts to prevent child deaths in custody. Without objection the chair is authorized to declare the subcommittee in recess at any point. The chair asks unanimous consent that representative underwood be permitted to sit and question the witnesses. The chair asks unanimous consent that represent garcia would be permitted to sit and question the witnesses. Without objection, so ordered. Jacqueline call mckean, 7 years old. Phillipe gomez alonso, 8 years old. Darlene krista bell cordova, 10 years old. Wanda leone gutierrez, 16 years old. Wilmer ramirez vasquez, 2 years old. Carlos hernandez vasquez, 16 years old. These six children died in the custody of the United States government just in the past 18 months. These children were migrants from Central America who died of preventible conditions that went untreated. And three of these children spent the last hours of their lives in detention facilities on our southern border. We must never forget their names, their suffering, or the terrible losses their families had to endure. So we are here this morning to examine the conditions that led to these avoidable tragedies. Weve seen an increase in the families arriving on the southern border, most of them fleeing Gang Violence and cartels and extreme poverty. These families should have been met with safe refuge. Instead they encountered this administrations myriad inhumane border policies like family separation, zero tolerance, detention, and the remain in mexico policy. These policies and management decisions by the administration have contributed to mass overcrowding and widespread inhumane conditions at customs and Border Protection facilities across our southern border. Numerous reports by the office of Inspector General and courtordered attorneys confirm these intolerable conditions. Ive seen these conditions with my own eyes along with several of my colleagues on both sides of the aisle. When pressed, dhs has consistently failed to maintain transparency by stymieing congressional inquiries. This raises concerns theyre hiding serious issues with management in addition to the leadership vacancies at the top of the department. One example of this is the departments decision to conceal information on the death of Carlos Hernandez vasquez. Carlos was a teenage boy from guatemala who died tragically in u. S. Custody on the morning of may 20th, 2019. Cbp issued a press release later that day calling the death a tragedy and declaring that they considered the health, safety, and humane treatment of migrants to be of the highest priority. However, despite information requests by this committee, it was not until a pro publica report was received seven months later that congress and the public learned more about what happened to carlos, that his death may have been caused by the failure to provide urgently needed medical care and the failure to follow the most basic procedures to simply check on a sick child. While i understand this specific case is still under investigation, this lack of transparency by the department is completely unacceptable. The office of the Inspector General must be doing everything in its power to examine the factors that led to these tragedies. Thats why im extremely disappointed that the current dhs Inspector General declined our invitation to testify this morning especially given the recent news that his Office Closed the investigations into the first two child deaths in Border Control custody. Publicly available summaries of these investigations are extraordinarily narrow in scope. They focus only on whether dhs personnel committed mail felfea and not whether the departments policies and resources could probably take care of the children in its care. We still do not know why phillipe and his father were in cpb custody for six days before phillipe passed away. I and other members of this committee remain concerned that dhs still isnt doing enough to protect children in its company. Reporting indicates cpb continues to detain families with Young Children in need of medical attention well beyond the 72 hours allowed by the agencys own protocols. This is a disturbing pattern that needs to be remedies immediately or we risk losing more children to preventible deaths in the future. We must act urgently to ensure that the policies and decisions that contributed to these tragic deaths are addressed. I hope the witnesses here today are prepared to explain whether the departments current approach incorporates the Lessons Learned after these tragedies and how they intend to safeguard children in dhs custody going forward. As members of congress we may disagree about immigration policy. But there should be no disagreement that the federal government must take responsibility for the human beings in its custody, particularly Young Children. We must never forget jacqueline, felipe, darlene, juan, wilmer, and carlos, and we must never let this happen to another child again. I want to thank the witnesses for joining us and i now recognize the Ranking Member for his Opening Statement. Thank you, madam chair. I thank our professionals who are appearing before us today, the panelists, hastings and eastman, for your service at the board and for being here today. I look forward to hearing about the actions dhs has taken to enhance customs and Border Protections ability to handle migrants arriving at the border in deteriorating health and to prevent deaths in its custody. The crisis that unfolded along our border last year was real. It was not the fault of the men and women of customs and Border Protection. It wasnt the fault of the executive branch nor the president of the United States. The truth is, this past year, we saw record numbers of family units, unaccompanied minors, large groups of 100 migrants or more, 213 groups to be exact, arriving at our border during the height of flu season and during months of extreme heat. At the time the Border Patrol was referring 50 cases per day to medical professionals. The border crisis was a result of legal loopholes, activist judges, propaganda from criminal cartels, killers who smuggle and try to exploit migrants for profit. In 2014, under the obama administration, the number of unaccompanied minors encountered at the border was viewed as crisis level leading to former dhs secretary johnson writing an open american to Central American parents telling them to not send their children. Its clear that sufficient corrective actions were not taken at that time. If that was a crisis, then there are no words to describe what we experienced at the border during fiscal year 2019. Not only were more than 321,000 minors encountered by customs and Border Protection, family unit apprehensions were more than 590 in fiscal year 19 as compared to fiscal year 14. Throughout the crisis, most cbp facilities were at or over capacity. Customs and Border Protection personnel were working overtime more than a month without pay to process the large groups. Resources were depleted in record time as key personnel at the department were furloughed. Customs and Border Protection Law Enforcement officers still scraped together enough money out of their own pockets to buy toys and bring extra supplies for the migrants in their custody. Many of them parents themselves, caring for and loving to the best of their ability the children in their custody. After a 35day shutdown that began in the end of 2018, the federal government reopened in january 2019 and the crisis continued. In light of the growing issues related to the mass influx of migrants, President Trump made an official request to congress for supplemental funding for the border. Two months went by before we sent that money to the field. My colleagues across the aisle blocked a vote on supplemental assistance more than 15 times. While leaders of the Majority Party were repeating a message of tweets like fake emergency, the chief of the Border Patrol was testifying in front of congress that without the funding we may, quote unquote, lose the border. The bipartisan Homeland Security Advisory Council released a report saying the delay in passion the supplement resulted in unaccompanied minors being held in customs and Border Protection facilities for dangerous lengths of time. There are members on this committee who voted against the emergency supplemental. A no vote meant a vote to keep unaccompanied minors in customs and Border Protection custody instead of out of the department of Health Facilities suitable for children. It meant releasing thousands of migrants on the streets of border communities. A sheriff testified before this committee that during the crisis, social Service Resources that should address local issues of hunger and homelessness are now completely unable to do so while the men of women of cpb were struggling to keep the lights on at the border they were the subject of partisan attacks. One member even claimed deaths of children in custody were intentional. An ugly statement, an absurdity that was completely debunked as the dhs Inspector General found no misconduct or malfeasance by dhs personnel upon completion of their investigations into the heartbreaking deaths of jacqueline and phillipe in december of 2018. Every life is precious and even one death in custody is too many, which is why i encourage i am encouraged to learn about the immediate steps cbp took to enhance their ability to diagnose the health of migrants in custody and work with the dhs chief medical officer to make longneeded, long term improvements. In december 2018, then commissioner Kevin Mccaleenan initiated the cbp care policy. Since then cbp established a phased approach to conducting Health Interviews of all migrants during initial processing and a subsequent full medical assessment of all unaccompanied minors and atrisk adults. On top of that, customs and Border Protection now has over 700 medical personnel and contractors stationed across the southwest border to provide medical support to migrants in custody. Today i look forward to hearing from our witnesses about how cbps incustody medical capabilities have improved since the fall of 2018. The collaboration process between cbp to office of dhs chief medical officer and other relevant stakeholders to bolster customs and Border Protections ability to stop preventible deaths in custody and their Expert Opinions on how to prevent another crisis in the future. Madam chair, thank you for your indulg indulgence and i yield back. Thank you, mr. Higgins. The chair recognizes the chairman of the overall Homeland Security committee, the gentleman from mississippi, mr. Thompson, for an Opening Statement. Thank you very much, madam chair. Good morning to those of you who are here on the committee. Todays hearing topic is sobering as it centers on the death of innocent children. In our current hectic and rapidly changing political environment, it can be easy to move on quickly from past disasters and tragedies. The Trump Administration contributes to this situation by piling scandal on scandal, exhausting the public, the media, and oversight organizations. It is our oversight responsibility as members of congress to refuse to allow the most disturbing and upsetting events fade into the past and help ensure that they are not repeated. We are here today to examine the treatment of Migrant Children in the custody of the department of Homeland Security in 2018 and 2019, and look at what changes may still be necessary. Certainly the detention of migrants did not begin with the current administration. But in earlier administrations, both democratic and republican, officials took steps to avoid risking the health and safety of the most Vulnerable People in custody. Under the Trump Administration, we now find that the elderly, the infirm, and children in detention facilities such as Border Patrol stations not designed or equipped to hold people for extended periods of time. When arrivals at our southern border increased in 2018 and 2019, attorneys and members of congress including me observed and reported on the conditions inside these facilities for months. Cpb argued throughout this crisis that they faced severe resource constraints despite congress providing billions in humanitarian funding in early 2019. Standing room only cells, inadequate Hygiene Products and families kept outside in extreme temperatures were commonplace at cpb facilities during the height of migrant arrivals last year. In such an environment the spread of illnesses such as the flu are inevitable. Whether individual deaths can be directly attributed to specific conditions in a given facility or not, we need to understand whether the policies and Resource Management decisions made by the administration put lives in jeopardy. Congress cannot allow dhs and cbp leaders to make poor decisions or ignore existing policies and law. Secure borders are a priority for our country and for all of us on this panel, and have been for decades. Part of our responsibility as members of congress is to check actions by the executive branch that are misguided. Hearings such as this are a critical part of that effort. I have strong objections to the policies the Trump Administration has put in place along our border that continue to endanger the safety of Migrant Children such as remain in mexico. I hope to hear from our dhs witnesses this morning that the department will take its responsibility toward people in its custody more seriously going forward. One child death was one too many. Im eager to know what the Department Plans to do differently in order to safeguard childrens safety while in dhs custody. I thank the chairwoman and Ranking Member for holding todays important hearing and i yield back. Thank you, mr. Chairman. Other members of the subcommittee are reminded that under the committee rules, Opening Statements may be submitted for the record. I welcome the panel of witnesses. Our first witness, mr. Brian s. Hastings, is chief, Law Enforcement operations, u. S. Border patrol, department of Homeland Security. Brian s. Hastings is chief of the Law Enforcement Operations Directorate in washington, d. C. He is responsible for oversight of the day to day Law Enforcement operations at Border Patrol sectors throughout the United States and is a principal adviser to the chief of Border Patrol on border operations. He began his service in 1995 and has been stationed in various sectors across all u. S. Borders and was promoted to the Senior Executive service in 2018. Our second witness, dr. Alexander l. Eastman, is the senior medical officer for operations within the United States department of Homeland Securitys countering weapons of mass destruction office. In this role he is responsible for operational medicine across dhs, in addition to countering threats to the u. S. Worldwide. Previously dr. Eastman served as the chief of the reese jones Trauma Center at parkland Memorial Hospital and as an assistant professor and trauma at the university of texas sorti Southwestern Medical Center and is a decorated Police Officer in the Dallas Police department. Without objection, full statements will be inserted in the record. I ask each witness to summarize his statement for five minutes beginning with mr. Hastings. Good morning, chairman rice, Ranking Member higgins, and members of the subcommittee. Its part of cpbs mission to safeguard americas borders. We complete initial approving of individuals in our custody before transferring them to our partners. Our Holding Facilities were designed for only short term custody. We take seriously our responsibility to protect and care for individuals until they can be transferred. During fiscal year 2019, cbp apprehended or found inadmissible more than 1. 1 million people. In december 2018, we began alerting congress, the media, and the public that an unprecedented spike in Central American families and children was creating a crisis on our southern border. For months our requests for emergency funding went unanswered and we began diverting our funds to the Border Security mission to address the crisis. I reflect on the numerous actions that cbp has taken and continues to take in response to this crisis. I could not be more proud of the extraordinary efforts undertaken by the men and women of cbp. I would like to share with you many examples today of the challenges we faced and our Rapid Actions to address them. First is the apprehension skyrocketed we had more people in our custody than we could quickly process. We continued to prioritize processing of the uacs first, followed by families, and then single adults. Cbp surged more than 1,050 agents to the busiest sectors, to securing the border and caring for those in custody. Over 700 dhs personnel provided support at our facilities. We expanded our transportation contract and purchased more than 200 buses and vans to expedite transportation of large groups of migrants. We chartered planes and drove bus loads of more than 43,000 people from overwhelmed locations to facilities with more processing capacity. Second, even when processing was complete, i. C. E. And hhs had a limited capacity to accept aliens which further contributed to facilities. And in march of 2019, Border Patrol began releasing noncriminal family units directly into the United States rather than transferring them to i. C. E. During fiscal year 19 a total of 145,000 family members were released. Cbp rapidly constructed six soft sided facilities and provided capacity for an additional 6500 fram list and adults. By june, secretary azar stated hhs shelters were full and they could not accept uacs from Border Control custody. When hhs received supplemental funding in july, the number of uacs in our custody quickly dropped from a peak of 2700 down to 300. Third, we addressed the need for amenities at the shortterm Holding Facilities were not designed to provide. We outfitted the new softsided facilities and our highest volume stations with portable showers, toilets, sinks, laundry, a control system and kitchen equipment. We expanded our Food Service Contract to provide millions of meals and stock countless snack, water bottles, clothing and hygiene items. Finally, we accelerated the expansion of our medical support program, cbp issued interim medical directive in january 2019 which was superseded by an enhanced medical directive in december this. Directive sets forth the foundational levels of medical support for cbp. It utilized the phased approach through initial observations, medical interviews with the standardized health questionnaire, and medical assessments to identify potential medical issues and low acuity treatment. In the last year cbp has dramatically increased the number of contract medical professionals to more than 700. While we built this capacity, the u. S. Coast guard and Public Health Services Medical personnel were dispatched to many of our facilities. Now, on any given day approximately 300 contract medical personnel are engaged at more than 40 facilities along our southwest border providing 24 7 onsite medical support. Our medical support follows a family practitioner model which has been observed and validated by medical experts this. Model ensures our medical providers are trained, licensed and credentials to care for all populations in our custody. Including children and pregnant women. Physicians to include pediatricians provide oversight and Training Consultation for medical direction, and medical quality management. Onsite medical personnel may provide care, write prescriptions, or recommend advanced care in local Health Care Systems. In the last year, nearly 250,000 juveniles in more than 296,000 adults have received medical interviews. Nearly 60,000 juveniles and more than 95,000 adults have referred medical assessments. During fiscal year 2019, Border Patrol took a total of 26,000 people to a hospital or a medical facility when advanced care was needed, or requested. Agents spent more than 319,000 hours providing transportation to and from medical facilities and on hospital watch. Today, with the help of our interagency partners and our governmental partners in the hemisphere, we have effectively ended catch and release at the border. The flow of aliens has dropped by 72 . However, these initiatives like the supplemental funding are only temporary fixes. As we have said many times before, Congress Must close the loopholes in our Immigration Service system, that serve as pull factors. Or we risk returning to peak levels and overwhelm the immigration system yet again. Thank you and i look forward to your questions. Thank you for your testimony. I now recognize dr. Easten to summarize his statement for five minutes. Good morning, chair woman rice, Ranking Member higgen, chairman johnson, distinguished members of the subcommittee and guests. It is an honor to be here today to discuss the department of Homeland Securitys efforts to prevent child deaths in custody, through our provision and expansion of medical care during the recent migration crisis. Im dr. Allen, the senior medical officer at dhs, a practicing physician for 20 years and in addition during my role here continue to be a trauma surgeon and intense vist. I was a chief at the reese johns Trauma Center in dallas, texas. At parkland, we cared for human beings from all back grounds in their most desperate time. You care for everyone without regards to race, color, creed, means, religion. Quickly, it becomes apparent that when life and death are on the line, none of these things matter. Providing care for patients no matter the challenges was my goal then, and it is our goal now. From all your visits to the border and it is nice to see you all again this morning, i know youre aware that we continue to improve the care for all people in our custody, especially children. From the medical perspective, the crux of this humanitarian crisis was a massive increase in the potential demand for care. At times, nearly 400 . A number that would gridlock any conventional Health Care System. Additionally, while correctional facilities have imbedded Detainee Health care systems, Law Enforcement agencies do not. Cbp is primary a Law Enforcement organization. Never designed to have a Health Care System within its walls. Doing so would be akin to building a Minute Clinic in every Police Station in america. Yet our challenge in the midst of this crushing demand, was an unconventional problem that required an unconventional solution. To help cbp and other other dhs components rise to the risk of providing care to an overwhelming number of people including children in our custody. The expansion to where we are today, the system currently in place, and the direction we are headed, represents a herk leann effort in response to an unprecedented challenge. In december 2018, the dhs secretary directed the provision of immediate assistance with the rising humanitarian demands of the migration crisis. We immediately deployed and for the last 13 months, have been working on the border alongside colleagues from cbp, i. C. E. , federal agencies like history hs and cdc, as well as state and local Public Health, medical experts and professional, to improve the care of migrants in custody. With particular attention to the children and the most vulnerable adults the law directs us to hold. Our First Priority was to rapidly and urgently expand our medical capabilities along the southwest border, particularly at cbp which had the biggest need. In support of this mission, the United States coast guard deployed more than 30 teams to the southwest border, providing more than 3,450 medical officer days, and more than 8275 care in response to this crisis. The coast guard served as our lifeline, the response from a medical standpoint. America should be grateful for the truly lifesaving and timely work of the coast guard during this crisis as well as so many others. Dhs also received critical assistance from the United States Public Health service. Our nations assistant secretary for health, admiral brett juwa himself a pediatrician and intense vist, was a critical partner as we facilitated the targeted deployment of Public Health Service Officers to critical areas along the southwest border. There were more than 475 Public Health Service Officers deployed to the border, totaling more than 6,750 days of care provided to migrants. No mission was too difficult, including even loading into helicopters and going to our most remote Border Regions to immediately begin assessing migrants and providing any care necessary as early as possible. When large groups overwhelmed us, in areas without Public Health service or coast guard assistance, we moved them there. These two organizations gave so freely of their time and expertise, the officers and physicians and nurses who came down, saved lives directly and continued to do so with the legacy they have left along the southwest border. As the interagency was countering the crushing surge, cbp was diligently working to build the system that would assume care from the emergency responders. As mentioned, that system now includes, among other aspects, more than 700 contracted providers, enhanced Counter Measures for influence za and other disease, and lay the path forward to continue the it riv process to allow the system to evolve as require. Our approach to improved care has been collaborative. Not just by coordinating with federal interagency partners but also by building and continuing critical partnerships, collaborating with the Mexican Government and calling upon nongovernment experts to assist when needed. At several systemic reviews of this system have been taken in the last year and auld agree that the approach is sound. We have a legal, moral, and ethical duty to care for those in our custody. The challenge was unprecedented. Required an unconventional solution. And we responded. At dhs, and across the government, we remain committed to ensuring that individuals, especially in our children, receive, especially our children, receive appropriate medical care. Thank you very much. And i look forward to answering your questions. Thank all the witnesses for their testimony. I will remind each member that he or she will have five minutes to question the panel. I will now recognize myself for questions. Chief hastings, early last month, pro publica released video footage of Carlos Hernandez vasquez, who was being held in Border Patrol custody in may of 2019. And the video shows in heart breaking detail the last hours of his life. He was 16 years old at the time. He died in his cell, just hours after a Nurse Practitioner apparently recommended immediate medical care. In fact, his body was first discovered by his cell mate who was another child who was being held in detention. Understanding that this specific case is still under investigation, what can you tell usion about the lessons cbp has learned from this particular case . So maam, i would start by saying dignity and care of those are of the utmost importance. Im a father, im a, i have a granddaughter as well. I watched the video, i saw the same video from the media report, and the video itself was troubling. As you know, the case is still under oig investigation. I cant speak to what their findings. Are one thing i can add is that i know that all of the video hasnt been turned over, all of the items that we had, the video of all of the cells has been turned over to oig, and they have all of the video. Not just a piece, as i understand it, was pulled from the sheriffs department. So you are insinuating that there is more, im not sure what youre insinuating. So as i said, all of the video that we had throughout this station, that day, has been turned over to oig. And what did it show . I havent seen it maam. I just know we have turned it over and provided it to oig who is the independent investigators. I was just curious about what you were insinuating by saying we just saw a little snippet. Im just insinuating weve turned all over the evidence and all the video. So broadly speaking, what do you think could have been done differently, without talking about what was done, your review of the case, what do you think could have been done differently . Its been indicated that welfare checks were conducted on this young boy, young teen, but the video shows an increasingly sick carlos, in pain, vomiting up blood, wrighting around in pain until he falls unconscious to the floor in his cell and this happened over a course of hours. So im wondering, is there a finding by your, just your internal review, that maybe it wasnt understood, the level of medical attention that he needed, when he was in the cell at that time . So again, its ongoing, and certainly, any Lessons Learned from any of the investigations, this investigation or any others we will look at and make changes. I can tell you that we did put out guidance to the field that any of those, and i believe this was july, a memorandum from then commissioner saunders went out, any subject in our custody will receive welfare checks every 15 minutes and being documented in our system of record. You mean person, not subject because thats what they are, people, not subjects. Can you tell us what policies were in place to ensure that recommendations that you received from medical professionals are actually followed, and what measures exist to protect Health Care Professionals who refuse to clear patients for detention . Im assuming that a cbp officer has to stay with any child or human in detention that they go to a health facility, is that correct . That is correct. And are you aware of the pressure that cbp officers are putting on medical professionals to release patients so that they can get back to their job at the border or whatever facility to which they are assigned. No, maam, im not. In fact, in reviewing some of the investigation material, i saw the contrary, where one of our agents actually asked for additional care, and stood up for one of the children that was sick, until the fever was down. So weve seen thats a good story to hear. But there have also been indications that Health Professionals feel intimidated and pressured by cbp personnel to release patients to detention even when its not medically indicated. And to me, it seems like doctors should be the ones making these decisions, not cbp officers. What policies are in place to ensure that recommendations of medical professionals are followed . I mean are there policies . So, yes, we have multiple policies, and we work closely with both cw and d, as well as our office of support. We have medical staff at our, that we have hired to oversee the contract, and to make sure that were providing the best care we, can and the family practitioner model. Dr. Eastman, its good to see again. As the senior medical officer in the department of Homeland Security, when you make recommendations for the medical care of individuals, in the cbps custody, are they followed by cbp . Nice to see you as well, maam, and yes, we work collaboratively with cbp, to advise and help implement the recommendations that we offer. In fact, we have, our employee, the senior medical adviser at cbp, and this team works collaboratively, to implement the recommendations that are made, with a hearty respect to the fact that there are operation considerations as well. If you look at some of the cases involved with the children that i mentioned, every single one of them was very, very sick, and should have been hospitalized and never released back into cbp custody. So there has to be, i would hope, some effort to review where these americas were made, that these children, who were very, very sick, one of whom had a temperature of 105. 7, when they were initially examined, i mean i just dont understand how that could even be possible. I mean are cbp officers trained to, i know theyre not medical professionals, but it doesnt take, you dont have to be a doctor to see that a child has a 105. 7 temperature. We do the absolute best we can to provide the best care possible to the children in our custody. But there is not a mechanism for us, as the department of Homeland Security, to review the care thats provided outside our system in Community Hospitals all along the border, and i think im not talking it was a Nurse Practitioner i believe who diagnosed carlos and gave him tamiflu, because that was recommended, have you recommended flu vaccine to migrants . Our approach to the flu vaccine is a comprehensive one that encompasses all of the studies, that delivered along the southwest boarder. Is everyone, is every detained migrant given a flu shot. The department of Homeland Securitys vaccination strategy has resulted in more than 60,000 vaccinations being given, primarily in the i. C. E. Service core, our goal is to give the right vaccine to the right person at the right time. Have you spoken with the acting secretary about ensuring that cbp follows your medical recommendations. Maam, like i said, the direction from leadership, from the secretary, to all of the acting secretaries ive worked with is the same, to do the right thing for the people in our custody and for all of us to Work Together to do just that. I understand. Im asking and you can say yes or no, have you specifically spoke within the acting secretary about ways to ensure that cbp follows your medical recommendations . Yes, maam, prior to his current role as the acting secretary, we spoke along the boarder. Did you continue those conversations . Yes, maam, absolutely. I now recognize the Ranking Member mr. Higgens. Thank you, madam chair. Chief hastings, the president requested emergency supplemental assistance to address the crisis at the border on may 1, 2019, it took two months for that money to be approved by congress. And to get that money to the field, to provide relief. Meanwhile, the department of health and Human Services ran out of money. For unaccompanied minor bed space. Please explain to the committee and the americans watching this hearing the Immediate Impact that supplemental funding had on customs and Border Protection operations at the border and cbps ability to move unaccompanied minors out of cbp facilities and into ones more suitable for children, including professional medical care. Thank you for the question, sir. So as everyone is fully aware, we dealt with 321 children last fiscal year, uacs and in families, we have never seen those kind of numbers before, that quickly overwhelmed the entire system. Specifically in may and june time frame, 144,000 apprehensions in may, arrests, inadmissibles as well, and the system got backed up. We were still processing, on average, 25 hours, average, for uac, but the uac couldnt move. Hhs was out of funding. They were out of money. And they were telling us they couldnt move those in our custody. By law, theres nothing more we can do with the uac either, other than turn them over to hhs. Thank you for that clarification. And in the interest of perspective, for the american citizens, you in this hearing, and for my colleagues on committee, let me just say that theres been an undercurrent of insinuation that customs and Border Protection has in some way been neglectful to caring for children, and i believe we all accept that the medical facilities of the United States of america, hospitals of america, will provide some of the finest care in the world, arguably the finest care in the world, and were investigating any death of any child thats in the custody of crossing the Border Protection, and those deaths should be investigated. And every loss of a child is tragic. And we should take a deep breath and look at that. For the sense of perspective, let me say that in 2017 alone, 28,380 juveniles died in professional medical facilities in the United States of america. Many of these children arrived at the border, very sick, struggling, no telling what theyd been through, cbp does their best to take care of them, tragically, sometimes children die, including 28,308 children in american hospitals in 2017 alone. Those are government numbers from the cdc. In our juvenile detention facilities, it is not uncommon Historical Data from the government to show an average of about ten deaths in a sixyear period. These are juveniles in juvenile detention facilities, in america. Much better designed, and equipped, to care for the children in their custody. Men and women that wear badges, care about the children, that come under our care. I lost my firstborn daughter in a hospital. I lost many more on the street, children in my arm, young teen hit in the head, by an ax handle over an unpaid drug debt, i sat in the dark street and held that young mans head, whispering prayer into his ear as life flight led his life. Infant child, unresponsive, hysterical parents, i did my best to perform infant cpr to resuscitate that child. She didnt make it. Dr. Eastman, in my remaining 25 seconds, sir, please respond to the spirit with which customs and Border Protection addresses any sick child that comes into our custody. My experience, sir, cbp officers, Border Patrol agent, theyre Law Enforcement officers, most of them are parents as well, and they act exactly as you described, to do the best they can under the circumstances they are dealt. Thank you, gentlemen, for appearing today. This is a painful and necessary hearing, and i thank madam chair and the chairman over the whole committee, for allowing us to discuss how we can improve the care for our children that come to our border, and let us know forget that we must operate based upon the cornerstones that have defined america as we attempt to care for all of our children. So i thank you again, madam chair for holding this hearing and i yield. I propose what my friend mr. Higgens was asking, would you agree to taking 3. 5 billion from a military Counterdrug Program would be problematic, because theres reporting today, indicating that the president is planning to divert 7. 2 billion in pentagon funding to build his wall. Would you find that to be problematic in terms of addressing the issues that you testified about . Maam, i would also add, though, on the other hand, we had this, we had a very large influx of families and children, we also had an influx of single adults, we saw those numbers go up, and i would also add that we had 147,000 donaways that we know of last year, so we have not only Asylum Seekers turning themselves in but people trying to elude as well, and we need, this is a whole of government approach, to many things that we need to protect, and safeguard our borders. And do you think taking 3. 5 billion from a military Counterdrug Program is a problem, would be a problem to address the issues, yes or no. We need border wall, i can tell you that. I didnt ask you that. Can you answer the question i asked you . Can you ask the question again. Do you think it is problematic the president wants to take 3. 5 billion from a military Counterdrug Program. I think we, again, i would say is there a reason why you cant say yes or no. No. You dont think, thats not problematic . For our needs, there are needs that we have on the border as well, to secure our border, and wall and construction is one of those. I now recognize chairman thompson for five minutes. Thank you very much, madam chair. The title of our subCommittee Hearing today is assessing the adequacy of dhss efforts to prevent child deaths in custody. My comments talked about one death in custody is too much. I understand that since the deaths have occurred, there is an interim medical director that talked about, that we will no longer do medical assessments for children under 18. Are you familiar with that, mr. Hastings . Sir, our new policy that just went into effect, were doing Health Interviews for all of those less than 18, and were doing Health Assessments which is basically like a physical for all of those 12 and younger. Or anyone who says that they have a health condition, or a medical issue. So doctor eastman, are you familiar with that . That policy . Yes, sir, i am. Explain it a little bit for the committee. Yes, sir. Cbp uses a phased approach. The first, to meet the medical needs of the population in our custody. The first phase involves recognition of illness, and the encouragement of migrants to report to us that they have an issue. The second phase is a Health Interview thats been standardized across customs and Border Protection, using a questionnaire, able to be administered by Law Enforcement officer, but developed in concert with experts at the cdc and across the government. With a twofold purpose, to identify an emerge meant medical condition but also to identify the potential of an Infectious Disease that might harm the migrant or threaten the United States. And the third phase of that approach is a medical assessment from qualified provider, that medical assessment in the final medical directive is given to anyone with a positive finding, on the Health Interview, or to any child under 12, or to anyone who requests it. I would also add, sir, the last phase of that care plan is for any true world emergencies, you know, someone that would need cardiac care, were obviously utilizing the local Health Care System where the migrants are. So why would you determine 12 as the cutoff for an assessment . Yes, sir, the way the direct ive was derived was a collaborative approach from all of us involved from dhs and cbp and the other experts, and the way the directive was approached, was felt that a teenager would be able to seek and request medical care when necessary. So what outside groups did you talk to when you did this assessment . Yes, sir, we have incorporated advice from the assistant secretary for health, as i mentioned, several members of his staff, who are seasoned pediatricians. In addition, we work with a number of Public Health Service Officers along the border who help give us, who are pediatricians themselves, with vast experience in everything from Disaster Response to responding to ebola. In addition we hired a senior medical supervisor for pediatricians, an outside pediatrician with vast experience to come assist us and we also, and we continue to listen to the groups that are involved in the care, including the American Academy of pediatrics, family practitioners, and other organizations, who have given us advice on this topic. We continue to utilize that advice to form our policies and procedures. Well, im happy that you mentioned it, American Academy of pediatrics, madam chair, i have a letter from the American Academy of pediatrics, that says there is no medical justification to only assess children younger than 12. And so i want you to seriously consider the group you talked about, theyre the ones dealing with children, and theyre saying 12 is not a magic number, and some of us are concerned that between 18 and 12, theres a vast shortage of opportunity for us to help children that were talking about here today. So i just want to put that in the record, madam chair. So received. So mr. Hastings, why did it take the department as long as it did to revise this directive . Are you familiar with that . So we did put out an interim directive immediately in december, and then we worked, with these various components that were mentioned earlier internally and externally, our stakeholders, to make sure that we got this right. But the interim policy was in effect since december of 2018. And additionally, we didnt wait to take action. We were taking many other actions, including increasing our contract personnel, even before that. So are you familiar with the clause that is subject to availability of resources, and Operational Requirements . In that directive . Resources and obligations . Resources and Operational Requirements. In my, im not sure what youve referring to. Which part. Im saying directive, you talked about that has been developed. One thing, so we need funding, and it does mention funding in there to continue our assistance with resources, as funding, basically, that can continue the assistance with our contract medical providers. So who makes decisions as to whether resources are available . Its based on budgetary needs. The other thing who makes that decision . We continue to receive funding, to provide the current services, we are contract services, well continue to do that. Do you make the decision or who . Sir, we have to be funded to continue for im not talking about, im saying who makes the decision, what individual . In the implementation of this directive . As i said, we have implemented the directive. When we would have had difficulty, what youre referring to, in staying with the directive, would have been very difficult, when we were backed up and had 7500 children so when you said we, is that you . Thats the Border Patrol. So who at the Border Patrol makes that decision . We would make it operationally. And provide, provide the heads up to congressional. So theres no individual by name that you can give this committee . Sir, we constantly brief what we have going on, on the board herb, as far as the amount of numbers were seeing and the resources that were using down there. We consistently brief what were seeing on the border and the situation, and throughout the crisis, we continue to brief those numbers. We were overwhelmed, is my point. But im talking about the directive. Im not talking about the conditions. You put a directive in place, and you said subject to availability of resources and Operational Requirements, and im asking you, who makes that determination . What individual . We will continue to do that. I would imagine that would go to the highest level. So it would probably go to the chief or the commissioner to stop something thats important to this, and we would certainly notify other entities if we were forced into a situation, overwhelmed, where were not budgeted for this. I am having real difficulty with you not giving us a name. I mean im not, its not a got you question, you got a requirement that you pushed out, someone has to be responsible for making decisions on that requirement. And im just asking, for my sake and i hope for other members of the committee, who that individual is. It would be the chief in consultation with the commissioner. And we would advise, like i said is that you . Im not the chief of Border Patrol. Im eight chief of operations. I oversee all of the operations in the field. So the chief of Border Patrol would interpret the policy were talking about now . In terms of resources and other things . When we did not have the resources to fulfill that obligation, thats what youre referring to, i believe. No, im talking about the new policy that was put in place in response to the death of the children, and it said that it is subject to the availability of resources and Operational Requirements. And im just trying to get a sense of who is in charge of making those determinations. We, again, it would be, we have to be properly resourced to be able to carry this out with our contract employees. We have to be properly, we have to have the proper funding to do that. Operationally, it would be the chief and the commissioner that would pass this down, in close work with the field commanders and the chiefs in the field. Madam chair, i think my problem is, weve had a problem, and weve had some proposed solutions, but were not, im not comfortable with who is responsible for carrying it out to the point that we might end up with another situation, because the directive is unclear, and subject to anyones interpretation. Im just trying to make sure that these problems dont happen again. The gentleman yield, ten seconds. Id be happy to. Thank you, mr. Chairman. Madam ircha chair, i believe the witness is trying to attempt to answer the question to the best of his ability and you asked for one name and there are many name, the chain of command is a multitude of men and women that make these decisions on an operational basis, based upon what theyre dealing with in the field at that time, and they report up chain and down chain, so the answer is, it is not one name ultimately, the gentleman referred to at the highest level, is responsible, but the implementation of a new policy will be, will be based upon the work done throughout the chain of command. So its many people it seems to me. Well, you didnt help either, with the response. So i am still, for clarity sake, if we come up with a new policy, madam chair, we might just have to follow up with some subsequent language requests, but i think its not unreasonable, if a policy is put out, on an issue this critical, for us not to have those individuals who are tasked with the responsibility to make sure theyre carried out. So i yield back. Thank you. The gentleman from pennsylvania, is now recognized. Thank you mr. Chairman, madam chair. Mr. Ranking member. Dr. Eastman, in the fiscal year 2019, more than 200 large groups of 100 people or more, often of various ages, arrived along our southwest border. Many of these large groups arrived during the height of the flu season, enduring months of intense high heat. Can you give an estimate of how many of these migrants likely arrived at the border with a preexisting illness or Infectious Disease, in fiscal year 2019 . On an individual basis, most of the migrants we saw overwhelmingly were well. But there were notable cases that were not. Ill take that back for the record, to try to get you a more exact number. Because i think weve got the data, i dont have a specific number, but mostly overwhelming, they were well, but your point is exactly accurate, that folks were coming to us after a long journey, many of them with the flu or another Infectious Disease that needed to be addressed. For those who were traveling hundreds of miles to our border, what was the likelihood that they had access to medical treatment along their journey . Sir, im not the expert on the care that occurs from prior to them reaching, you know, our southern border, we have worked collaboratively with the government of mexico to try to, you know, help them do everything they can to improve conditions on the mexican side of the border. And i know the department has a number of efforts in central and south america to facilitate other parts of this, but im certainly not the expert of on what happens prior to the migrants reaching our shore, our border. Thank you. You mentioned that potential Infectious Diseases have been with these migrants as they presented to our border. Can you tell us more about that, please. Yes, sir, predominantly what weve seen is seasonal influenza. Weve also seen sporadic cases of tuberculosis, chicken pox, varicella oster virus, weve seen some mumps. We knock on wood, superstitious and hesitant to say this we have not seen a case of the measles but those are predominantly the diseases weve seen. In contrast to children who presented with grave illnesses can you tell us how many children you estimate have been saved by the medical attention provided under the United States government custody . Sir, that number is a difficult one to pin down directly, but from the beginnings of my work along the border, we know that about 10 of the migrants that come across will end up going into the medical assessment process, and again, those are rough, very early numbers in the crisis. How many were saved directly, i cant pin down, its hard to predict, but there are certainly lives that have been saved by the response of this crisis. Dr. Eastman, continuing, during this crisis, cbp received medical surge assistance from inneragency partners like the United States coast guard medical teams, and personnel from the United States Public Health service. How important is having additional medical staff onsite at cbp facilities . Sir, its important to remember that cbp is a Law Enforcement organization. We think that health care is best provided in Health Care Settings. However, by virtue of the unprecedented crisis we faced, we had to mount an unprecedented solution. And that care that was initially, you know, assessment of care that was initially provided by our first responder, the coast guard, by our intermediate respond ers, the hbl Health Service and subsequently thats placed on to the back of the cbp contracted medical providers, that care is vital. Its vital because we got an unprecedented problem in the system. And thats a very unconventional solution. I know of no other Law Enforcement agency that ive ever interacted with or heard of that has such a developed Health Care Structure inside. So in face of this unprecedented crisis, we, you, have been able to provide Vital Health Care is, that the message that im hearing from you, sir . I wouldnt say i. I would say we. This has been a collaborative interagency approach, and at the heat of the crisis, i spoke to admiral juwa and the chief medical officers of the coast guard, who had changed hats recently, but i spoke to them daily, and we, the department, received help from them, and many other ent ties to provide what is clearly an unconventional solution to this unprecedented problem. And we thank you for doing that. Thank you both for coming here today. For testifying. In front of us. And i yield the remainder of my time. Thank you. The gentle woman from mexico, ms. Torres small is recognized for five minutes. Thank you, madam chair and Ranking Member and thank you dr. Hastings and dr. Eastman for being here today in december of 2018, yakima and philipe died while in cbp custody after being detained in the district that i represent. And subsequently, the dhs office of Inspector General opened an investigation into their deaths. Three months later, in this Committee Hearing room, former secretary nielsen testified that she directed the cbps office of professional responsibility and the Inspector General to work as quickly as possible, to complete these investigations. Then, in may of 2019, my colleagues and i again urged the department and the Inspector General to complete the investigations in a timely manner. The oiig responded to our question, saying it was working to complete the investigations as expeditiously as possible. But it was only last month, merely a year later after these tragic deaths that the investigations were completed and provided to congress. Even more concerning, the oig limited its investigation scope to only determine whether there was malfeasance by personnel, and did not consider whether cbps policies and procedures are adequate to prevent mirt migrant child deaths. As i said from the beginning, the reason for these investigations is not to punish people, its to keep this from happening together. Its to make sure that we have the protocols in place. In case were faced with this challenge again. Its the committees understanding that the investigations did not even interview medical professionals outside of the offices of the medical examiner and the department. This is unacceptable. Especially given the significant number of family units and unaccompanied children that travelled to the southwest border last year. Now, chief hastings, i deeply appreciate the work that the men and women of the Border Patrol did. Every single day. And in the past year, to mitigate the situation we saw at the southern border. And i want to find out whether the policies and procedures of the agency are setting our agents up for success, to keep Migrant Children safe. So chief hastings, has cbp received the full reports of these investigations . I have not seen a full report. Ive seen an abbreviated report from our office of professional responsibility. Thank you, chief hastings. Thats deeply concerning. The committee was told by the oig that cbp has referred the reports. So that is something we will follow up on. I have not personally. I have not. From the information that you received, have you identified specific Lessons Learned that cbp took from the reports and have recommended protocol changes to enforce them . So i think one of the Lessons Learned is we needed a standardized health form across the board, for all of cbp. One of the things that we saw, there were multiple forms being used in the field, throughout this entire year, and that is now standardized. And you have the updated form. Yes, maam. Any other lessons . That is one of the bigger ones. You visited the location where we lost jakeland, you are well aware of the remoteness and the amount of time it would take to get even our own agent out of that area. So i think youre very well versed with the issues of remoteness and rugged terrain that we had out there as well as transportation. We have also added a large transportation contract buses and many other things to help get folks from the boarder. Thank you, a great Lesson Learned and certainly something i sawed so im pleased that Border Patrol is addressing that. Do you have multiple buses now under contract . We do, and under contract, and our own personal, that we have purchased, vans and buses, as i mentioned earlier. What about pediatric equipment, what are the Lessons Learned from the yakimas passing is not having the appropriate cuff to take her Blood Pressure. Is there pediatric equipment across the board along the border if necessary . We dedicated a large portion of the supplemental funding to our emts. We have over 1500 emt ncaa the field and we have, emts in the field and we have since updated them with the equipment and make sure they have everything that they need to meet their daily needs. And that is part of protocol and if required, if there is an deficiency, the agency has an alert to alert to fill that deficiency . Thats correct. Thank you. I want to shift now to preventing the spread of Infectious Diseases in cbp stations. Chief hastings, what are the protocols that cbp has in place to protect both migrants and cbp personnel from the spread of Infectious Diseases such as the flu inside Border Patrol stations, Processing Centers and places of entries. With the Border Patrols in about 40 location, put those personnel, based upon the highest vulnerable population, highest flow that were seeing as well as the least amount of medical assistance in the general area, thats how we decided where to put them. They are fully trained. And are able to care and provide any type of antiviral flu and flu testing, and theyre able to do that, theyre able to do acute care and other things that arent referred to as secondary care. And you have written protocols that support that . Just yes or no, im out of town. Yes, maam, absolutely. And you can supply those to supplement the record, i would appreciate it. We will work to get that to you. My time has expired. Thank you. Thank you. We now recognize the gentleman from mr. Mississippi, mr. Guest. Thank you, ms. Chair. Chief hastings, i want to speak to you on the overall Immigration Crisis that we have, and are currently experiencing along our southwest border. I note on page seven of your written testimony, you refer to fundamental flaws in the immigration system. You go on to say, cbp has pleaded with congress to address the layers of existing law, and judicial systems that adversely impact our ability to effectively manage our immigration system. There are three key gaps in our Legal Framework that congress has yet to address and you list there the settlement, the cbpra and the psalm assertion. Could you take a few moments to expand on each of these factors that youve listed there, in your report, and how it impacts your departments ability to secure our border . We need the ability, under flores, we need the ability to be able to uphold in a setting that is very, that provides apparent expeditious immigration proceedings. Flores is a major issue for us. Completing that under the current 20day process thats required. When we released over 149,000 families, when we were interviewing these individuals, they literally told us that we were told, bring a child and we will be released. That is what is encouraging this large flow that we continue to see. We believe that they should be housed in an frc 2 gather with all of the adequate things that have been provided, medical, dental, pharmacy, education, all of the many other things, and the double standard for noncontiguous uacs being able to return a uac to guatemala, honduras, other countries like we are currently with mexico and canada, that would assist with the large number of the uacs that were seeing cross our borders today. And again, a vulnerable population. Lastly, tightening the asylum bar, to the low asylum bar for credible fear, would see the massive backlog of over a million cases right now. And would you agree, chief, that if congress were to address these three issues that you have set forth in your report, that it would help stem the flow of illegal immigration that weve recently seen across our southwest border . Yes, we believe it obviously absolutely it would. And chief you were asked about the shifting or moving of money, from the department of defense, to our southwest border for the purpose of border wall construction. Do you feel like that the construction of the border wall system has improved your agencys ability to protect our homeland . Absolutely. So again, a border wall system is more than just a wall. With the technology, it comes with road, gives us situational awareness, it gives us impedence and denial and time to respond. Ive seen it work personally, in the many areas ive been in the field. Ive seen what it does for us. And i strongly support it. Thank you. And just lastly, chief is, there any other recommendations that you would make to this committee as to how we can better help your department again to secure our homeland, and then those individuals that are within our custody, that we can do our best to make sure that they are protected, and receive the care that they need . Just would request if were, if were not coming to an agreement on some of the recommendations we gave, that we continue to find hhs, and so we can move those uacs through the cycle and get them into the proper environment for care, would also request assistance with i. C. E. Funding as well for single adult bed space because thats another, another demographic that we see backing up in our facilities at times, and i. C. E. Needs proper funding for single adult bed space. Chief hasting, thank you for your service to our nation, and madam chair, i yield back. I now recognize the gentle woman from new york, ms. Clark. Thank you, madam chair and i thank our witnesses for testifying before us here today. Chief hastings, last year, you testified before the Judiciary Committee, and my colleague congressman liu asked you whether a 3yearold girl could pose a criminal or National Security threat, and you responded i dont know. I think attitude goes a long way in addressing the multitude of issues that you have before you. But specifically, preening child deaths in custody. And i believe that we shouldnt be surprised when children dont receive medical attention they need, particularly when we dont know whether a 3yearold can pose a criminal or National Security threat. Having said that, last fall, i introduced hr37, 77, the National Commission to investigation the treatment of migrant families and children act. Which would create an independent commission to study issues like family separation, as well as the death of children in cbp custody. But short of passing my legislation, we have to rely on the Inspector General to get to the bottom of these matters. In the report recently released by dhs, oig, it states that a Border Patrol supervisor had to pay out of their own pocket for overthecounter medication for an 8yearold fe lee may, because Border Patrols insurance did not cover it. In addition, the christmas cbp emt was unable to take a Blood Pressure of jakelin age seven, because they lacked a pediatric cuff. What steps has cbp taken to ensure access to basic medical necessities and equipment across the sought west boarder. Maam, thank you for the question. So we did indeed see an issue, or a problem with us being Border Patrol, or cbp, of being able to fund nonprescriptions, overthecounter prescriptions. We have since fixed that. We have a contract through i. C. E. To be able to purchase for any needed overthecounter remedy that is prescribed. So we have that. And additionally, as i mentioned earlier, thank you for the supplemental funding, that we were able to provide muchneeded equipment for our emts out in the field. So those have been fixed. Wonderful. I appreciate that. But you know, in the decade prior to 2018, there is not one single child death in custody. So im a bit concerned that it just seems to be a callousness taking place. So im glad that were focused on this. However, if were able to shift funding for our border wall, we should be able to shift funding to save human lives, particularly the lives of children. We need to understand what went wrong in 2018 and 2019. If a cbp official failed to take reasonable steps to prevent the death of a child, what kind of disciplinary measure does you think would be appropriate . Maam, i havent seen anything just asking, hypothetically. I would have to see all of the, everything that went into the report, i would have to see the specifics, but if it was negligible, we would certainly take immediate action. Thats good to know. Has any cbp official faced accountability for the death of children in custody . No, maam, there has been no negative findings of malfeasance. No problem. How did cbp determine what expenses qualify as consumables or medical care . How do we determine, im sorry . How does cbp determine what expenses qualify as consumables for medical care . Lets me help chief hastings with that. We use the medpar system which is actually administered through i. C. E. , it is the dhs system that pays for care for migrants in our custody. In addition to that could you just provide us examples of the types of projects or activities for which consumables and medical care funds have been obligated or expended since supplemental was enacted. Absolutely, maam. And again, thank you for the supplemental funding. In response to that, at our more than 40 locations that now have contracted medical support, this very a standardized formulary of medications and equipment that is used to care for the migrants in custody, so that is a clear example of how money has been appropriated from the supplemental to help further the care of children in our custody. And how is that replenished . How do the subcontractors, are they theres, the contractor, im not an expert in their supply chain management, maam, but they have a system that replenishes those and again the supplemental pays for that. Very well. Madam chair, i yield back the balance of my time. I now recognize the gentleman from california, mr. Correa. Thank you, madam chair. Gentlemen, thank you for being here today. As a member of this committee, as well as the house Judiciary Committee, where weve had numerous oversight hearings concerning the dangerous detention facilities an adequate standards of care for migrants including Young Children, and like my colleagues here, im troubled by the multiple reports of overcrowded facilities, of action towards some of those facilities, and there is a general agreement that cbp, your facilities are not meant to handle the influx of children and families that have been seen over the last two years. My question is, what contingency plans does the department have in place to ensure the safety of those within your custody . So, sir, there are a couple of things i would add, as i mentioned in my opening, we have sick softsided facilities with complete wraparound, medical food services, shower, pretty much all amenities. And additionally, we plan long term to put central Processing Centers up in our busiest area, primarily the rio grande valley, the el paso sector, and the yuma sector. Those are actually, those are modular buildings that are being completed now, or will be completed, and started in the spring for yuma, but theyre co now for el paso, so making in other words, having those facilities and those Wraparound Services is something that were planning for now, and we have a longterm solution. Mr. Hastings, i know youre chief of operations, but if you can pull back a little bit. When general kelly was secretary of Homeland Security here in this committee he testified, is and im going to paraphrase him, that Border Security goes beyond our border, and im thinking to myself you dont wake up one morning and say, oh, my gosh, look at all those folks at our doorstep. I have to imagine you coordinate with other agencies and the federal government, with other governments and begin to see that flow of refugees, that flow of migrants moving, and so my thought is how do you prepare, or are you preparing for those ensuing waves of refugees that are coming, not only from south of the border, not only from Central America, but other part of the world . I dont see this as a one instant phenomena but rather as a world as areas of conflict continue to escalate as you have folks in harms way. This is going to continue to continue to be a challenge, migration, refugees from around the world. Are you doing anything to anticipate these kinds of situations near future and long term . Yeah. So were embedded with multiple different governments working closely with the new york triangle and have agents on the ground down there working with them now, and also work very strongly with our mexican Law Enforcement partners as well on a daytoday basis and the chiefs in the field. Let me ask you something. Sir, may i just add something. Yes, go ahead, dr. Eastman. In addition to what the Border Patrol does the National Information center which is an entity with the chief medical officers works directly with our partners in mexico, south of the border and worldwide to identify and begin to recognize healthbased threats to the United States. Thats part of the package. A little while ago my colleagues talked about the flu vaccinations and essentially your response, i believe, and you can confirm this or not, operational challenges have prevented you from really vaccinating a lot of those individuals that need a it, it yes, no . Yes, sir, thats definitely not my response. What is your response . Our approach is comprehensive. There are migrants who have come into the United States custody that have gotten vaccinations, including and up to this entire cdc catchup protocol at hhs. Weve administered more than 60,000 independent vaccines predominantly in the are you moving in that direction, this discussion weve had of independent doctors volunteering to to get you up to speed to get there, thats not a factor . You couldnt use them or youre doing fine on your own . Medical volunteerism is a challenge to medical organizations, not just ours, but because of the difficulties with licensure and administration, weve actually encouraged them to volunteer in the local government shelters, and cvp that has some and both cvp and our offices have done work to investigator those volunteers that can use them more easily. Im running out of time, madam chair, but i would like to follow up on this issue of challenges of having licensed doctors integrated into your system of being able to actually vaccinate some of these children and deliver medical services that maybe cvp is not able to deliver, you know, because of limited capacity, and finally, madam chair, if i can get 30 seconds, dr. East man, you talked about you made a statement that mexico is trying to improve on their side of the Mexican Border some health care. Are we coordinating at all with the mexican authorities in terms of making sure that health care disease does not respect the border and that it addresses both sides. Are we addressing both sides of the border. We made a visit, the chief medical officer made a visit to counterparents in mexico city. We continue the dialogue and continue to make the sure workable. Madam chair, id like to have written testimony on that for review. Well take the questions. Thank you very much, and thank the gentlemen for being here today. Thank you. I now recognize the gentleman from texas, mr. Green. Thank you, madam chair. I greatly appreciate the opportunity and i thank the witnesses for appearing as well. To boast th of you. Do you take the president seriously when he makes comments . Sir, i dont what comments are you referring to . Hes our president. You hear his comments. When we receive i dont know what youre referring to. About the wall. Yeah, i think the wall works from my experience, from what ive seen it doing in the field firsthand. So you take him seriously then . On the wall on the wall. The wall works. So you think mexico should pay for the wall . Sir, all i can tell you is the wall works. You take the president seriously, dont you . I can just tell you i know the wall the president said mexico should pay for the wall. Im not involved in funding the wall. Im just telling you that the wall you take the president seriously. So lets go on. How many lives would the wall have saved . I dont know the answer to that question, sir. Thats speculative. Well, let me ask you this. Are asylees criminals . Im sorry, are the what . The people who seek asylum criminals. People who cross the border illegally i didnt ask you cross the border illegally. You know what an asylee is, do you not . Do you know the definition of an asylee. Then my question is are asylees, asylees, people who are seeking asylum, asylees, are they criminals . Were asking them to go to a port of entry to that has little to do with my question, sir. My question is are they criminals . Why are you evading . Why will you not state what you know to be the truth. Why are you if they cross the border illegally, they have committed a crime. Are asylees, people seeking asylum illegally its a crime. Where do you find this in the law to support your position that people who are seeking asylum are criminals . Are the babies criminals . This is why you treat them the way you treat them . You perceive them as criminals . Babies arent criminals. They have no malice aforethought. What would you recommend we do to prevent future deaths . As ive discussed, sir, were taking a lot of those actions and have been taking those actions for quite some time. I think were taking the right steps now to prevent further deaths. It will be difficult, as weve explained to say were going to prevent every death. The people that we encounter on the border, many of whom have traveled over 2,000 miles or more, some have never seen health care, some may not have had treatments or eaten or drank anything but were running into this obviously many times in their worst condition and worst Case Scenario and were doing everything we can to get them immediate treatment when thats the case. Again, what can we do meaning congress . As i mentioned earlier, i think taking some of the actions for the double standards for noncontiguous uacs, thats up. Withdrawing uacs up to our border because were unable to return them unless its mexico or canada, and then i think, as i mentioned earlier, the flores fix, being able to hold everyone together, the entire family in the proper setting while they go through their expeditious hearing. For edification purposes, uac i find to be a pejorative. Its in the law. I understand. But i still find it to be a pejorative. These are children. Uacs. Madam chair, im going to yield back the balance of my time. Thank you. Thank you. I now recognize the gentlewoman from illinois, miss underwood. Thank you, madam chair for holding this hearing to continue this committees oversight work on the humanitarian situation at our southern border. During thigh three oversight trips to the border last year i saw and heard firsthand about the need for resources to improve medical Record Keeping. As a nurse i know how important clear Record Keeping is when it comes to both Patient Outcomes and ensuring Health Care Providers can most effectively do their jobs. In response to what i saw at the border im so proud that we passed Bipartisan Legislation last year to provide cvp with an Electronic Health record and just a few days ago President Trump signed an appropriations package that includes 30 million in dedicated funding for that Electronic Health record. Dr. Eastman, as a physician, can you tell us more about why ehrs are so important to your work at the border. Yes, maam, thank you very much, and, again, thank you for passing the funding we need. Ehrs serve a very specific function. They not only allow us to effectively document the care thats provided, but they also allow us easy access to the data to do things like quality assurance. It ensures that were able to measure the care that were providing. It ensures that were able to assess the quality of that care, and it ensures were able to learn lessons from that. In addition an ehr system that we intend to develop will improve our ability to conduct disease and Health Disease surveillance using Artificial Intelligence techniques that will trigger the presence of potentially an Infectious Disease before a human being could pick it up. Again, from your perspective as a medical provider how do ehrs better communicate about patient care . Is Electronic Health records, they are a complicated topic, but they allow us to describe the care that weve provided from the point of apprehension to the point of release from our custody, not only internally. They dont only help us communicate internally across multiple settings, but they also allow us to communicate to expersonal partners and one of the things that i think is important in this hearing to mention is that the system thats provided not only protects migrants. The system that has been put together. It also protects the integrity of the Health Care Systems and local communities that were we not absorbing some of the blow, some of the local community Health Care Systems would be overrun by the amount of care thats required. I. C. E. And orr already have Electronic Health records and we know that dhs has already begun the process of building one for cvp along with the dedicated funding that congress directed dhs to come up with an Implementation Plan for this ehr during 0 days. Dr. Eastman, can you give us an update of where dhs is in this process and what specific actions have been taken so far. Yes, maam, i can. Right four were in the process sort of the first phase of this which is to identify some Immediate Solutions that can integrate the existing technology thats out there. That work is ongoing immediately. Were also working to plan for the long term, and weve hired a chief medical informatics officer who we think has the talent and the expertise to help build a system that will will not only create an effective customized solution for us but will harness our ability to help our operators do their job more effectively. Everything that we do has to take into account the effects that it has on the individual operator who is doing the job at the border and at Processing Centers and in ports of entry along the border. What are are the next phases in the implementation of this ehr . The next phase is we work our fingers to the bone to try to get this plan together to come back to brief you in 90 days as to where were headed. Excellent. So you mentioned you hired this informatics officer. Yes, maam. What date were they hired . Ill have to take the specifics of the question. Its been around five or six months. In your medical opinion why is it so important to ensure cvps ehr is interoperable with those used by orr and other individual components . Thank you, mam. Again, we want to make sure to provide a seamless picture of all the care thats provided from the point of apprehension and the point discharge. Its important for a provider at i. C. E. To know what happened upstream of that when the person when for the care thats provided on the Border Patrol. That being said, were working hand in hand with the Border Patrol to make sure that the solutions that we craft together not only accomplish the goals of the ehr but also are user friendly and dont add to the load the processing load and time that the operators have to put forth to take care of the migrants in our custody. Well, i appreciate those operational benefits, but other benefit of an Electronic Health record is saving lives, were not losing patients, missing opportunities to identify Infectious Diseases or changes in current status. Were heading into another flu season thats projected to be severe. Dr. Eastman, you noted in your testimony that youre working with cdc, asper and other Health Agencies to improve the response and what specific steps have they have taken to stop the flu outbreaks at the border during this flu season which we know has been particularly harmful and deadly for children throughout the United States . No question. This flu season, according to the cdc and other experts appears it may be rough. We have worked hand in hand with cvp to help craft enhanced flucontrol measures that were crafted with input from experts from the cdc when they performed a threephase assessment along the border very early on in the crisis. In addition, weve helped provide cvp with the ability to rapidly diagnose and treat the flu in our facilities at cvp. Again, these are that capability is present now in over 40 facilities along the southwest border, and i would challenge folks to find another Law Enforcement agency that diagnose and treat the flu on the Law Enforcement side, not the custodial chair. Madam chair, if i may one lost followup. What date, was it new for this flu season that the rapid capability has been deployed . Its not our understanding that that was available last year. Thats been developing all along the course of 2019. As the contract support has been developing, that flu capability has been put into play, you know, continuously over the year. Okay. Thank you so much, madam chair, and to our witnesses for appearing today. I yield back. Thank you. I ask nonmouse question that representative jackson lee be able to sit and question witnesses without objection. I now recognize the gentle lady from texas, miss jackson lee, for five minutes. Madam chair and Ranking Member, thank you very much for this important hearing, and let me thank the witnesses for for being present today, and i think its very important. Mr. Hastings, let me just be clear that you handle Law Enforcement operations covering poet u. S. Border patrol and customs and border protect. Is that no, maam, just border a parole. All right. So this is a slight typo. It has you in both positions, and youre not. I just wanted to clarify that for the record. Just Border Patrol, maam. All right. Let me just for the record take note of the fact that a number of children that died in 2018, that in fact no child had died in cvp custody for the entire decade before 2018, and we lost in particular jake lin, felipe and a number of children that proceeded to get medical care and who were detained in cvp and ultimately four Migrant Children passed away while in or shortly after being released from federal custody. Would both of you, whether you have children or not or are around children or around relatives, acknowledge that the death of any child is a crisis and tragic. Mr. Hastings . Maam, as i said earlier, im a father and a grandfather, and it it is as tragedy. Dr. Eastman . Maam, im a parent and the death of any child is devastating, but i think its important to not only note that its not just devastating to the parents but i was in our facility in lordsberg and i went and sought our personnel who tried valiantly to save one child and despite their best efforts they werent successful. Thats brutal on the caregivers as well. You go right to me point, that dying in the custody of individuals who are basically Law Enforcement but seeing when they are basically committed to defend and protect alongside of the immigration responsibilities, their chief responsibilities, that that is both a cries and tragic for them toll have died in federal custody or having just been released, is that your opinion . Maam, the death of any child, any person in Law Enforcement custody is tragic, and as you know, you know, Law Enforcement officers across this country take very seriously their responsibility that when we place our handcuffs on someone we know we have an ethical, moral and legal duty to care for them as well. And a child is particularly vulnerable. I assume, mr. Hastings, you agree with that as well, that any death in federal custody of a child is tragic and on the brink of a crisis . It is tragic, and, yes. And the idea of those line officers i call, and i have been and seen the efforts that they have made during some very difficult times, buying diapers, getting formula, i think that should be put on the record, but i think the key point, and i appreciate some of the many great steps that congresswoman underwood has made. We traveled together to the border and several times thereafter, but my question would be is it time now, and have we as you present reports pursuant to the legislation passed, to stand up a very effective parallel medical system based on the present policies of this administration meaning that asylum is being denied. They are not being able to access asylum in the way that it should. There are migrant camps, just on the border in mexico where disease is rampant or to be rampant so that means when they come over they may be sick. Do we have an effective medical system that is parallel to your Law Enforcement system that can do additional things we sides the records being done in some of the other aspects of reporting, an effective almost semiquasi Health Center for these individuals that are coming in. You wanted me to start . Go ahead. Maam, i think we have to be very cautious that we confab late a Health Care Facility with a Law Enforcement facility. We officially believe at dhs and its my personal belief as a physician that health care is best provided in a Health Care Setting so what we ought to continue to do is facilitate the movement of people through our system to the best place to care for them. For children, thats at hhs. For single adults thats in i. C. E. Custody but we have to continue to harden systems for the times we face Unprecedented Demand for carrick and i believe thats exactly what were doing right now. Mr. Hastings and madam chair, could i have a quick followup to dr. Hastings. Mr. Hastings, your point on this parallel health system. I would agree completely. We want the Border Patrol and cvp wants to see uacs vulnerable population out of our custody as quickly as possible. Thats what we want to see through the proper places where they can receive the needed care. So let me ask this quick question because it might have been interpreted that i wanted a hospital established and thats cat the case. First of all, the children were not out of the population as soon as possible and well put that aside. The other question is there is some process that can do care than putting him in the police car and suching him to the hospital. The doe is do with have an effective Emergency Response on site that can deal with some of the crises such as one of the young men, 16yearolds was found not responsive and this was not much to deal with his unresponsiveness. So quickly to mr. Hastings and dr. Eastman. To answer your question, were certainly going in the right direction. We went from three sectors covered by medical personnel, contract medical support western el. They are in our busiest hole locations where we need them. Were stone stantly monitor them when where need to and we have 1,500 emmts that do and will provide support and the i believe were taking all the right steps that we into. Mr. Ied man . Our strategy is to deploy the right care to right person and, you know, we sever certainlyism reserve the right to assess this condition as conditions change but its my believe at dhs and personally that were looking in the right decks. I thank the chair for her indulgence and i yield back. Thank you. Texas recognizes the gentlelady from texas, miss garcia. Thank you and thank you for waving your involving and ive been vulg this issue since i was the probably ive visited ten facilities either under the jurisdiction or. Oo after i seen a lot of differences in the medical protocols and all the care thats provided in all those different facilities. I must say ive never found them to be adequate. Ive never started to the believe of them as a clinic or a hospital, and the to just bother the reports to my nox. Dr. Eastman, i made the winches, substation or police department. Facility. I dont think were asking for that either, but i think what we do want is what many of us have been talking about the right protocols, the right screening to make sure we get on it as quickly be a possible. I was completely stunned at the look of any kind of. Think thins i visited with jacqueline died they localry off a table to let berle lay fer, and and they she hadded up going to the pop the. Ry. Under todays protocols that that would change. I know that we do absbecause they did in my Opening Statement i said when we were faced with Unprecedented Demand for care in a large cass hats that changed in a maam, the system thats in. To get on. If i could take that one. A lot of areas that weve mutt in place and many of those areas includingeling was. That will give some increased that we need but, still, many of our stations in many of our different locations, they havent changed. They were built for a completely different demographic. They have not changed. Weve added as much as we did in those locations in the way of food, health care products, those types of things. I mean, they were not built to has for long periods of time at all. I appreciate your entry but i would like dr. Eastman to just to be clear. The system involved today an vp bears little reslum to with a it looks many people are using that. Very arent each getting close enough to make entry. The question is has that one now been nchlg, you know, typical system. What person first of all, the expansion ever Border Patrol can use the proofers to coy i so thats a yes gle correction there is there is blow contracts control and well seat you the details where the bat and there are some screening protocols to ensure that this would never happen again. Yes, maam. We have the tiered approach as i described earlier this hearing is all in place along the southwest border. What about the medical. Anyil in. Are they screened at all, and i understand theres been a number of people turned away under this number that are very, very dij. Im not shower whatsing done on moment can saw. Developin returning us so legal individually theres a map as to where we are different as for as the 30 different locatio locations are. Ma than so youre telling me that although they are being turned away to go back to mexico that you do screen them . Can can i just take that one, sir. Go ahead. Yeah, the approach to the medical to the Health Interview and medical assessment applies to everyone thats in our custody with the parameters we discussed earlier. These folks are not in custody. Youre turning them away. If they are in our custody they get the assessment and care described. As i said, its outside my scope to know what happens south of the border. Madam chair, obviously apparent l apparently the witness is not understanding the question. Im asking about the folks turned around in the return to mexico program. Mr. Ranking member, do you have any additional questions . Yes, madam chair. Madam chair, before i ask my second round of questions, i ask unanimous consent to submit to it the Homeland Security Advisory Council final report by the cvp families and Children Care panel which was established in november of 2019. I ask unanimous consent to submit it for the record. So received. Mr. Hastings, would you like to clarify the medical screening that that all human beings that cross the border and come in our custody regardless of what program they are then subject to, would you clarify for my colleague miss garcia and for the rest of the committee. Thank you for the opportunity, sir. That is correct. Maam, anyone that comes into our facility regardless of what program or initiative that they are going into will go through that all of that medical assess at any time, medical screening and interviewing. Are you clarifying that minors including karen receive medical screening. Or return. What if they are sick. Well take them to the medical care. What if they are sick . They will did to the hospital or appropriate medical care. If screening gherms that they are sick to the extent that they, were getting them that medical attention before we sent them back to mexico. As evident to the 26,000. Is that across the border or in only one location. Thats across the border. Dr. Eastman, you mentioned the close working relation season between cp bor and the chief hot medical others and base on your begs been has committed has they havin to. The relationship literally is hand in hand. Our office and Border Patrol and cvp communicate constantly. The cvp medical senior advisers, an employee from our office, to help in a sill tate these issues. We communicate literally at multiple levels probably safe to say daily. With regards to your second question, my direction has been clear and our direction has been clear from every leader in the department, whether thats at dhs or cvp that the direction i was given what about the direction youve received or changed . Does it go all the way to the top . Its been unanimous. Do you feel that the executive brand an their leadership to discuss immediate call cape abilities. I have, may directions come from the secretaries and the commissioner of seesh. Do the right thing, break down barriers take of people in our society. That thats been man many thank you for the clarification and thanks for the second round of questions and i yeemd. I now recognize the gentle whoever from illinois. I have a couple of followup questions based on what was submitted today in the written tam. Mr. Hastings commits rein condition. It says enhance medical directivens sure that cvp will sustain enhanced medical support with emphasis on aaron at a cpd can you delay the what that it does, yes,m. And then just discuss when it includes the border pole trace, why the with the migrant of the mpp policy, then you can under. Thats being all of those individuals he had a kelt. Yes, and knows, they will get a medical assessment. Yes, thats correct. Are you confirm that thats happening in all facilities . Yes, maam, and in the cases where doe have medical support and care yet, we use medical resources to get those assessments. If the interview occurs and folks need health care and they dont have it there, they will get it in the local system. Just to reiterate. The individuals that are coming to the United States that under current policy under dhs you all want to send them back, to remain in mexico or go through the mpp, and they present with a health care issue. You saying they are getting an interview and korean willing and they have the medical staffs. This they had a medical blood well certainly use the local health system, yes, sim. My follow question question is on page 4 of the testimony. He says current hi each day theres approximately 300 contracted medical professionals engaged at more than who facilities at the southwest border provide 24 1 onsite medical support and support is all available at all nine southwest border usb sectors and the southwest border of all field office oz. So bases on that, would you would you then consider there to be 100 coverage . No, maam, no, i would not. As we mentioned earlier, we believe we have ten more locations that we need to cover and were working rapidly to get coverage now, but how we determine where this went is where the highest vulnerable population was. I understand. Where we had the least medical support in our nearest areas and the highest flow rate that we were seeing. We have about ten more locations that were looking to expand to now. And do you have the current funding to support that expansion . Yes, sir. So the numbers that are submitted in your testimony are current as of what date so these locations and individuals were staffed as of what diet . As of december 2019. Thank you, madam chair. I field back. Where are are the ten additional locations . Id have to look at the chart, maam. I can get back to you it. I dont have the chart in front of me. Thank you. I now rec nis the gentle woman from texas, miss garcia. Thank you, madam chair, just a quick followup. Mr. Hastings, what is the average stay these days for a child in custody . . That varies, maam, day to day and hour to hour but on average right now the average time in custody is approximately 39 hours the last time i looked. 39 hours. The last time i looked, yes, maam. They are leaving quickly since hhs is funded. Do you remember what month that was . That is obviously not the numbers that im seeing. Its been a while since i looked at the time, the kiem and custody time. Just shy of two kays sgrz thats shy of two days. We are doing well. Let me ask you this. I dont know the age of your grandchildren but would you be comfortable with having your grandchild in custody in one of your own facilities for 39 hours . I wouldnt i dont want any child in my facilities for that long, maam. Im sory is, in the crisis. Right now for 39 hours, i trust that our employees are taking good care of the detainees that they are charged with oversthigt. So you would be comfortable if your grandchild were there . Were doing very well providing Proper Services for all those in our custody right now. During the crisis, no, i wouldnt. I wouldnt want my granddaughter in custody anywhere, but i think were doing the best we can with everything that we have out there on the border right now, with all the improvements that weve made and how quickly were getting these unaccompanied alien children out of our custody. What about you, dr. Eastman . I know i dont know if you have children or grandchildren or or little nieces and nephews like i do, but would i feel comfortable with a member of your family with no offense to chief hastings im a little young for grandchildren. Never make assumptions, ive learned in this business. I understand, maam. I want to be clear with chief hastings that it would be my preference that we dont ever hold children in our custody. Thats certainly my preference if the child has not committed any crimes as my colleague from texas has said, mr. Green. However, let me be clear from my perspective as a physician that we provide care i respective of kirk. It does not matter to us what they have or have not done. Our care is provided to every human being in our custody the same no matter what the circumstances are. Right. To answer your question i would be very comfortable with my children receiving care in this system if it were necessary, and i know that were going to continue to do everything we can to improve it every day. Let me follow up on my colleagues questions. Like him i also serve on the subcommittee of the Judiciary Committee on immigration. He was asking about volunteer doctors. I know that that im from houston. We have a large Medical Center which means we have a lot of doctors around. Many of them do a lot of good volunteer work in a number of of areas and many of them do missions abroad. They have mentioned to me that, you know, they have tried to help and tried to volunteer and tried to even bring especially the flu vaccine to some facilities. I mean, what is the real beef of their texas facilities and texas doctors and they are willing to help . Why wouldnt we allow them to help . So just to be clear, maam. Im a texas doctor as well. I know that. I saw your resume. But the provision of volunteer medical support presents challenges not just to the department of Homeland Security but to medical organizations in this country in every state, and so while we sometimes have difficult with the licensure and administrative requirements, we certainly, and we have done this, weve tried to investigator volunteers who want to provide that help to some of the other locations that arent as fortunate to have medical support like ngo shelters across the southwest border. When weve had texas volunteers weve trying to investigator them in and while thats not my role as a dhs medical officers because in many ways were the intermediary between the medical volunteers. For example, youre from hues top. I talked to dr. Maddox almost daily, and we talk routinely about things like this. And one of the things that i think is really important is during the course of this crisis we have worked with state and local Health Departments and doctors all across the southwest border, and its been a handtohand, direct, facetoface meetings to Work Together. Weve tried to be the best partner possible and some of you saw that when you visited the border and well continue to well continue to try to be boast partner position. What impediments are there, anything can doe in terms of legislation to be vied access to volunteer doctors. My suggestion is we take this offline and Work Together because the provision of volunteer services, volunteer medical services is something we even interested in being i would love to Work Together with you to try to help solve the problem. I think its in the scope thats not only focused on we have the same children of as many children will not al people to visit the children in any way to try to assist in particularly in terms of their Mental Health wellbeing. Well take it offline and dr. Maddox is a good friend so well making a threeway charge. Let me just say that i think i can speak for my goode friend. But i want to thank dr. Hastings and dr. East man for coming today. There are people in positions who dont show up, dont apartments the call and the fact that two showed up and took come difficult years, know, is im grateful, im very grateful because you done what they did. Were well our contusional obligation will a rolled in oversight. I want to think the ranking subcommittee because the weve anyone is a republican, democrat, black, white, all human beings, i think we youll an even one death net dust can i is a. One of the issues weve tried to address is hue quickly we can bring qualified people in like you to help solve this problem. I want to thing you. I think awful about miss underworpd what as a, and its issues like that it represent us dress these these are children being brought here for a better which are which is all they focht. The xhems of the subxhoity of whichy peng. We is it that you record as expeditiously as will you and recorder question the Sub Committee report will be be open for ten days. Hearing no further business, the subcommittee stands adjourned. [background sounds] [background sounds] [background sounds] [background sounds] coming up here on cspan 3, Energy Secretary dan buhlette joins a discussion on National Competitiveness and later a House Foreign Affairs committee on u. S. Policy towards iran. After being injured tim couldnt return to work and fell on hard times. He applied for s. N. A. P. So he could afford to buy forward because the state of maine would not waive abods and three months is the limit, not 36. He repeatedly asked to it the numerous officials who passed him along in the bureaucratic maze what do i eat between now and then . Nobody had an answer for tim. Without s. N. A. P. Tim had no aid and became homeless. He scrounged for food and reflecting on his time tim shared, quote, there were many times when i would go two or three days without food. The food bank has only limited resources. I had to add seven holes on my belt to keep my pants on. For people like tim s. N. A. P. Can literally save lives. We know s. N. A. P. Helps 1. 3 lowincome veterans and nearly twothirds of veterans who struggle with hunger and are eligible for s. N. A. P. Are not currently enrolled and certainly no veteran like tim should ever be forced to ask what can i eat because they cant the help they need from the country they fought to protect . Thats one story that a house veterans subcommittee heard on the state of military veterans. Veterans are looking into the effectiveness of federal programs aimed at helping veterans. Watch the entire hearing tonight at 8 00 eastern here on cspan 3. 2020 democratic president ial candidates joe biden, pete buttigieg, Senators Amy Klobuchar and Elizabeth Warren deliver remarks at this years legislative conference of the Iowa State Education Association union in des moines. Watch Live Saturday beginning at so 25 eastern on cspan, online at cspan. Org or listen live with the free cspan radio app. Campaign 2020, watch our continuing coverage of the president ial candidates on the campaign trail and make up your own mind. As the voting begins next month, watch our live coverage of the Iowa Caucuses on monday, february 3rd, cspans campaign 2020. Your unfiltered view of politics. The u. S. Council on competitiveness held its annual forum featuring government officials, business
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