Transcripts For CSPAN Hearing Focuses On Athlete Safety 20170521

Topics include head injuries, concussions, opioid addiction, and doping at the olympic level. This is two hours and 20 minutes. Sexual abuse and dealt with at the olympic level. This is two hours and 15 minutes. Good morning and welcome to todays hearing. It is no exaggeration to say that americans love sports. We love watching them, playing them, collecting Sports Memorabilia and even arguing about our favorite teams and athletes. Whether it is watching the super bowl with friends, joining an office bracket pool for march madness or stretching out for the turkey trot 5k races on things giving morning. And a pickup Football Game later that afternoon. We love our sports personally, i made doctors and a packers fan. Some of my best moments have been spent competing in sports or cheering on my two daughters at their meats and games. This committee is committed to promoting american success and international competition. Ensuring exciting play in that the professional leagues providing opportunity for student athletes and maintaining a vibrant sports culture. At the same time protecting the health and safety of american athletes of all levels. Professional, amateur, student and youth. A longstanding priority of the Commerce Committee. The issue of sexual abuse within the United States Olympic Movement has received considerable Media Attention in recent months. Troubling nature of these reports trigger the committees inquiry into the ability of the Us Olympic Committee and the National Governing bodies for individual sports to conduct effective timely and impartial investigations into allegations of abuse. Im glad that the United States senator josc sports is here to discuss the centers work to discuss these athletes. While they believe that nothing prevents them from taking immediate steps to reason move a suspected predator from being in contact with athletes, it is also clear that certain stakeholders have at times some confusion about the legal requirements of the test he was olympic and amateur sports act and manufactured ambiguities behind which to hide. I am pleased that senator feinstein and colleagues on the Judiciary Committee havent advanced legislation on the issue and i look forward to working with her to strengthen her bill at his advances to the full senate. Specifically legislation to address the issue must include unambiguous language, clarifying that it is the responsibility of our olympic leaders to provide an environment that is free from abuse. In the same way congress codified the United States Antidoping Agency to combat use of performanceenhancing drugs in 2001. I believe we should authorize the us center for safe sport as an independent organization with expertise to investigate and adjudicate abuse allegations as they arise. Speaking of antidoping, i am pleased that we are doing here today by olympic medalist and sport investor Lauryn Williams. Who will testify on behalf of the committee since that time has been active on a number of sport issues. For instance in 2016 following the revelation of an elaborate doping Program Sponsored by the russian government they conducted oversight of the world Antidoping Agency response prompting the agency to appoint a new independent investigator and to expand the scope of investigation. Following every analysis of samples collected during the 2008 olympics. And to award the bronze medal to an american just last month. The issue of prescription opioids to treat sports injuries is another growing concern. In particular because of the addiction and overdose risk that they carry. The Substance Abuse and misuse. While the media has focused recent attention on the use of prescription of drugs and professional sport leagues, the issue impacts all athletes including at the high school and collegiate levels. While i wish she were here under different circumstances, and whether we are joined by Maureen Deutsche and her husband who will testify about the family tragedy involving the loss of their son nick to opioid painkillers. Maureen and jeff i am deeply sorry for your loss and thank you for your bravery in sharing your story with us today. Finally the issue of concussions in the sports is a longstanding issue. This committee has sought to address. Concussions are common injuries among athletes participating in Contact Sports and are among the most complex injuries to managing Sports Medicine. The committee has conducted oversight of efforts to prevent and mitigate the occurrence of concussions in sports including game rule changes, coaching and player education guidelines as well as the development of brain injury and equipment research. Doctor jay Clarence Butler m. D. Of the department of health and social services mr. Scott sailor, president of the National Athletic Trainers Association and doctor robert stern of Boston University schoolof medicine will be able to speak with us to this issue. I would like to thank you all for being here today and i look forward to hearing your testimony and the opportunity for you to interact with members of the committee and give us a chance to ask questions. With that i will yield to the distinguished senator from florida Ranking Member senator nelson. Thank you, mr. Chairman. I think this is an opportunity as the chairman has said to start a conversation about what more can be done to protect americas athletes. Obviously, we must protect the Young Athletes. Some of whom are children. They are starting early. They are training for the olympics. Obviously, we were all shocked by the revelations of widespread sexual abuse in usa gymnastics. Usa tae kwon do and other olympic sports. Even more appalling was evidence that responsible adults were indifferent and look the other way when so many young victims can be horribly abused by adults for so long without repercussions. It is a stand on americas proud olympic heritage. So, we in Congress Need to respond. To this travesty. I, along with many others are the builder has been introduced and this bill would require immediate reporting of sexual abuse allegations require National Governing bodies to adopt strict protocol and measures to protect children. And make it easier for victims to come forward and report to the authorities. We also need, as the chairman has already outlined very well, to examine athletic doping at the interNational Level. You know, there was a time when we thought of the olympics and we thought it this was above reproach and what now we think of olympics . You think of the scandals that have been revealed in the doping. Well, over 100 russian athletes were banned from the Olympic Games in rio. We should address attacks unclean drugfree sports and protect athletes who do things the right way. And then, the issue of head injuries. It is something that is becoming alarming. Each one of us more than likely has had a fellow athlete friend along the way that has had concussions. And now at our ages later, we are seeing the manifestations of those concussions. Concussions and cte are not limited to pro sports. It is about kids and the devastating effects on their developing young brains. And i want to recognize and command senator udall who is with us and has been a champion and leader on this issue. His dedication preventing concussions and youth athletics safety is well known to everyone here. I want to thank him on behalf of the committee. For raising awareness about this very troubling issue. Thank you, mr. Chairman. You senator nelson. I want to recognize for an introduction one of our panels today. Senator sullivan. He introduced doctor butler followed by senator markey and then doctor stern. Senator sullivan. Thank you and Ranking Members for holiness important hearing. I do want to recognize doctor j butler that came from the great state of alaska to testify today. Doctor butler does great work in the state of alaska. He is essentially the states Surgeon General. Although it is not enough, doctor butler has committed his time and efforts across the state. Billy across the country to help stymie the Opioid Epidemic that is raging through alaska like it is and so many of the other states in the United States. His efforts have included education and awareness on the dangers of opioid use. Especially for our young alaskans. Aiding in the distribution of naloxone and nonmedical personnel and facilities and currently serving as the president of the association of state and Territorial Health officials representing the state of alaska and his position of direct Republic Health and the chief medical officer for the state and i will not go through his extensive resume but we will just mention briefly mr. Chairman my experience with doctor butler. We worked together last year when we put on a summit. A wellness summit in the states. It was focused on conquering the opioid crisis. And doctor butler was instrumental in the success of the summit. Over 500 alaskans, several hundred more online showed up at the summit. He participated in planning on the steering committee, he interviewed the United States Surgeon General for a fireside chat and moderated the discussion at the summit. I just want to thank you for again traveling from alaska. All of the work is doing in our state and participating on the National Level on this important issue that crosses partisan lines. This is an issue that is impacting every single state in our great nation and doctor butler is a leader in this. Not only in alaska but in our country. Thank you. Thank you senator sullivan. Nice to have you. Senator markey. Thank you, mr. Chairman. Doctor robert stern is a professor at the University School of medicine and director of Clinical Research for the chronic traumatic encephalopathy center. This is a neurodegenerative disease. While it focuses on repeating brain coming up with the known best for his work on alzheimers disease as well as as he is the director of the clinical transfer at the alzheimers disease sector. So throughout his career, he has won multiple national and federally funded grants for his work. He has published more than 250 journal articles, chapters and abstracts in his field and he is a fellow of both the American Neuropsychiatric Association and the American Academy of neuropsychology. I want to thank you doctor for all of the work which you have done on the brain and helping to explain not only alzheimers and the pathways that are possible for funding if for finding a cure. But also you have become the National Leader and i want to thank you for that. Thank you senator markey. Welcome doctor stern. I want to introduce again for the panel, in terms of the board of presentation. We will start on my left. Doctor butler who is the chief medical officer as pointed out from alaska. The Alaska Department of health and social services. Ms. Maureen deutsche who is a family representative of prescription Opioid Abuse Advisory Committee on behalf of south Dakota Department of health. Ms. Shelly pfohl chief executive offer for us center for safe sport. Mr. Scott sailor president of National Athletic Trainers Association. Doctor robert stern professor of neurology bus University School of medicine. And ms. Lauryn williams, a true sport ambassador and United States Antidoping Agency. If you would proceed in that order. Doctor butler and if you could, confine your oral remarks to his closely divided minutes as possible so all will have an opportunity to ask questions. Thank you all for being here. Doctor butler. Good morning chairman thune, Ranking Member nelson, members of the committee. It is an honor to be able to speak with you today. In my role as chief medical officer in alaska, i oversee state related prevention, preparedness and response activities. During the past three months in addition to the roles that senator sullivan has described ive also served as the Incident Commander governor bill walkers opioid response. In alaska, we responded to the Opioid Epidemic as much as we would to any other disaster. Whether an earthquake or tsunami. Using the incident command structure to coordinate communication across state government. This response is addressing a 3 to 4 fold increase in opioid Overdose Deaths have occurred in alaska in the past two decades. Which mirrors an increase that has occurred across the nation. The epidemic started somewhat silently. With gradually increases and deaths caused by prescription painkillers. As more and more of these drugs were prescribed. The problems had been compounded by availability of heroin and fentanyls. The majority of people to use heroin and fentanyl report that they first became addicted through use of prescription opioid pain relievers. I want to be clear. The Health Benefits of participation in sports and physical activity are extensive and well documented. They reduce risk of cardiovascular disease, obesity, diabetes, certain types of cancer. Also better musculoskeletal strength, and improved sense of wellbeing and connectedness to community. The youth that participate in sports historically have been shown to be less likely to use illicit drugs. Unfortunately athletes have not been immune to the devastating effects of the Opioid Epidemic. Too often, sports related injuries managed with opioid pain relievers have been the beginning of a path to addiction. One coach expressed her frustration to me by describing that she had seen too many times and injury leading to a prescription for pills, leading to additional prescriptions for pills, leading to use of a friends pills, leading to use of any pills that can be obtained by any means. And unfortunately sometimes leading to use of heroin, and Overdose Deaths. Highprofile stories of professional athletes who began using prescription opioids for injury and then struggled with addiction or died of overdose may grab headlines. But we need to recognize that the problem is occurring in all levels of competition. One adult Recreational Softball League in alaska with roughly 750 participants has had five players die of opioid overdose. An epidemiological set study of High School Students in michigan found the boy that participate in organized sports are more likely to be prescribed opioid painkillers than those who did not. As a result, participation in organized work actually increase the risk of subsequent leg misuse. With over 4 million youth sports and recreation associated injuries occurring each year in the us, there is a reason for concern. So what can be done . There are no easy answers and no magic bullets. We need to be clear about that. But i would like to highlight three areas of opportunity. First we can promote evidencebased Pain Management strategies and more rational use of opioid pain relievers. Opioids can be useful in the management of acute pain and many people who receive these medications use them without problem. However, opioids should not be the first line of treatment following in any sports injury. These medications are used best in their prescribed at the lowest effective dose and for the shortest period possible. Generally for less than 3 to 7 days. Larger first time prescriptions have specifically been associated with higher risk of longterm use and thus, greater risk of dependency and addiction. A school nurse recently told me about a student who came back to school after arthroscopic surgery for an athletic injury. In line with school policy, he checked in with her and turned his prescription medicines in. She was shocked to find his bottle of 120 oxycodone containing pills. Special care needs to be taken when prescribing these medications to teenagers. Adolescents is a particularly high risk. Even as prescribed by Healthcare Provider is led to increased likelihood of subsequent misuse. Second, we can provide more information on the risks of opioid pain relievers for both Healthcare Providers and the public. Including coaches and trainers. In talking with teens i frequently had a sentiment that if relievers are really dangerous then why do doctors prescribe them . In talking to people in recovery i frequently hear, no one told me. If i had any idea how dangerous these drugs work. I never would have taken them. We can do a better job not only describing the risk of opioids but also providing information on what can be done in our communities to address the problem. Including promotion of leftover drug return and disposal. And talking openly about recognition and management of dependency and addiction as a health issue rather than as solely a criminal justice issue or some type of moral failing. There is a role for professional athletes as well as olympians and other highprofile athletes to be able to serve as spokespersons in promoting conversations to reduce the stigma of addiction. There is a need for better continuing medical education for all Healthcare Providers to improve their knowledge and confidence and off were finally at the risk of send clinically Effective Response to the epidemic will be a team sport. It will involve coaches, parents, trainers and the act itself as well as the professional sports leagues. Public health agencies, Healthcare Providers, thirdparty payers, the criminal justice system, educators, businesses and lawmakers as well. Working together, Sports Participation cannot only be made safer but i believe can also be part of how we reduce the number of people who become newly dependent on opioids and increase the number of americans living in recovery. Finally, i want to conclude by pointing out that the issue of opioid use is not just an isolated event and not just an isolated topic as we talk about sports safety. It is no accident that we have a broad range of topics that we are discussing today. These topics are complementary and not in competition. Sexual assault is a trauma that ultimately can lead to unhealthy coping mechanisms and increase the risk of selfmedication. Traumatic brain injury is a brain process that can lead to cognition as well as altered Risk Assessment and can also possibly create increased risk of abuse. The question is not to ask one another what are you doing to address these issues but what we can all do together to solve all of them. Thank you for your time. Lets thank you doctor butler. Chairman thune, Ranking Member nelson, members of the committee. Thank you for the opportunity to provide testimony and insight regarding opioid use as it relates to our Young Athletes and our state of south dakota and around the country. In our 30s of marriage my husband jeff and i have been blessed with three wonderful children. Jeremy, nick and danny. Today we are here to tell you about our son nick. Kind, funny, happy, uplifting. These are some of the words used in memory of nick my friends and family following his death on july 18, 2015. We would add smart, intuitive, adventurous, frustrating and amazing. Another recurring theme, nick always had your back. He was a true and loyal friend. We are just a regular midwest Family Gathering for meals and enjoying Family Vacations and celebrating special occasions together. Jeff and i have supported our children and their education and activities as religious leaders, room parents, coaches and club leaders. Nick had positive role models and extended family, teachers and coaches. Our parenting style as i would describe it is consequence and praise and always love. Will take care to be there with one another. So what happened . What did we miss in protecting our son . This has been our daily reflection for the past 21 months and 29 days. We would like to share with you some of next journey through the last four years of his life. Nick excelled in accident mix and athletics. Nick and many various friends. Nick was a bit of a risk taker. Always up for the challenge. Nick experienced with opioids began shortly after his 18th birthday in the fall of 2011. With his acl injury. Second play of the second game senior year. With his sizable state champion football team. Then they prescribed hydrocodone and percocet or oxycodone. Through the tear, rehab, back in play for the last game of the season and subsequent surgery for the full acl tear. As though it were yesterday, we recall driving to Walgreens Pharmacy directly from the game field for the first of a series of prescriptions. I personally maintain possession and control of his prescriptions for his welfare. But my understanding of the risks associated with the medication did not even scratch the surface. We shared an alarm went off in november when nick indicated the hydrocodone was no longer sufficiently addressing his pain. We shared this information with his orthopedic staff and were told they were not concerned with the progression and percocet was prescribed over the phone. And without further evaluation. Following recovery and rehab from surgery through december of that year, the prescriptions abruptly ceased. Beginning in january became very clear that nick was struggling. He underwent counseling and to our physicians alternative medications were prescribed to help with the withdrawals. Culminating in 30 days of residential treatment and still neck graduated with his class as a region scholar. No stranger to hard work, nick made it through that very frightening and challenging time. All while under the care of excellent physicians and all with the continued love and support of his family. And the support of his sizable principles coaches and staff. For the next three years, he attended College Classes and work. But the disease had taken hold and did not retreat. As he continued to struggle, protecting us his family, as best he could from the fear of what could happen to him and the frustration of not being able to diminish the symptoms of addiction. Still good kind and fun nick continued to share with us his hope and recovery. The symptoms of addiction can move a person in directions they do not want to go and often do not comprehend. That happened to nick as he found himself faced with charges stemming from Substance Use in 2014. Nick knew what to do, ask for help. We were blessed to have been able to support him through his work with recovery in 230 days days between october 2014 and march 2015. Coming home in march with a young man renewed in his recovery, attending meetings, getting together with his sponsor going to church, working and spending time at sawgrass. On may 20 of 2015 we attended next sentencing hearing for the 2014 offenses and on june 3, nick strengthens the Work Release Program for just under four months. July 18 brought a visit by the Sheriffs Department at our home at approximately 8 30 p. M. Nick had died in his sleep, having returned to the workrelease facility after work at approximately 330 that afternoon. Spending time with others in the program and laying down for a nap. Nick died in accidental death. Reports indicated Prescription Medications in his system all but two prescribed. One of which was oxycodone. At an elevated level. Nick was 21. We can no longer experience excuse me traffic from what we can discern from speaking to his friends he likely relapse due to the stress of his situation. We believe medications were intended by nick for use of a coping tool and to aid in sleep at the corrections facility. That is to many peoples family members and friends of across the nation are learning every day, for some people, opioids have their own intentions. We can no longer experience the joy of next laughter, awesome hugs and genuine goodness. Hope to reinforce the need for careful consideration of the effects of opioid therapy and the management of injury as our Young Athletes press forward to perform. To highlight responsibility of medical professionals and prescribing practices related to Opioid Pain Medication and to reinforce the need for education of the public on the addiction risks associated with the use of opioid therapy and sports injury management. In our experience with neck, the addiction hit swiftly and without retreat. Reinforcing that addiction is a chronic disease. Over the past 21 months, weve had meetings and conversations with county and state appointed and elected officials. Numbers of the medical and legal communities and judicial system. And Agency Directors and the very misunderstood field of addiction and recovery. Jeff and i provided testimony at our state legislative study on Substance Abuse prevention. As we are currently serving on the south dakota governors Opioid Abuse Advisory Committee. Theyre all of the conversations and meetings the key issues come to the top for jeff and me. Number one, the risk of addiction to a good medications and the rest of that leading to further addictions are seriously misunderstood and understated. Secondly, the prescription opioid issues begin with just that. A prescription. Calling for a responsible practice and monitoring. As parents, jeff and i feel almost Important Role in life was to protect our children. If only we had known then, what we know now. In closing, we are grateful for the current work being done to address the issue at hand. Now we ask for your thoughtful consideration of the information we have provided. Experience came to our journey with our son nick. Thank you. Thank you. Thank you chairman therapy and Ranking Member nelson and members of the committee. Mr. Chairman i am shelly pfohl see him that us center for safe sport. The Ongoing National discourse around sports has focused largely on two issues. Concussions and doping. Which remain important topics today. I thank you, mr. Chairman, Ranking Member nelson and your staff for adding our voice to the conversation. By bringing attention to emotional physical and sexual abuse prevention in sports. You are advancing say sports call to action which is to champion respect and and abuse. 45 million in the us play sports as well as scores of adults at the collegiate professional and recreational level. Athletics offers unparalleled opportunities for personal growth and developing character. All while advancing health and fitness. A study of 400 female executives found that more than 90 percent participated in sports at sometime in their life. I can honestly say i would not be who i am today without sports. We never want to see those benefits that i just mentioned undermined by abuse. Sadly, it exists in society as it does in sports. Whether it is an athlete bullying another athlete or a coach exploiting his or her power to sexually assault a player. While we do not have stats specific to sports, we know that in the us one in five youth are bullied and one in 10 will be sexually abused before the age of 18. Fancy slogans are not enough to prevent abuse. We know that best practices and prevention include policies, tools, training that are embedded in an organizations culture. While we are working to get data on how well sports organizations are doing at preventing abuse, we know anecdotally that much more needs to be done. Ask any parent of a child playing sports these three simple questions. Did you or your child receive training on how to prevent abuse . Do know that what the sports organizations policy on adult to youth interaction is . Would you know who to turn to if you are concerned about an abusive situation involving your child . My guess is they would answer no to at least one of those questions. Which is simply unacceptable. Our goal is to create a standard that people and organizations can use as a measuring stick. Practices, resources, training tools will that help organizations to get to where they need to be. Safe sport has counseled Many Organizations in establishing a safe sport coat. I referred to in my testimony. From the interaction with other professionals including those from youth serving organizations, we understand that simply conducting criminal background checks is not enough. Awareness and training at the heart of a good prevention effort and are essential to our work. To date, more than 300,000 coaches affiliated with the us olympics and paralympic movements receive safesport training. We must now work to expand the education the oncologist to include parents and athletes and at all levels of competition beyond the olympics. In addition to the education and outreach effort, safesport is the independent response and Resolution Office for the us olympics and paralympic movement. Including the 47 National Governing bodies that represent each of the sports. Reports can be made multiple ways including anonymously. And are handled by the team of highly qualified investigators. Reports of Sexual Misconduct falls within the exclusive authority of safesport. If a report is substantiated, safesport will determine appropriate resolution which could include a lifetime ban that would apply across any us olympic organization. Sports are in my dna. Every person here is a sports experience. Either your own or through a family member. Underscoring the magnitude of this challenge. We have an lot of work to do. Your efforts to prioritize the health and safety of us athletes goes a long way towards making our safe sport call to action to champion respect and end abuse a reality. Thank you and i look forward to your questions. Thank you miss shelly pfohl. Chairman theory, Ranking Member nelson and members of the Senate Committee on commerce science and transportation. Thank you for the opportunity to participate in todays hearing. My name is scott sailor chair of the department of kinesiology and Athletic Training Program at State University of fresno. Im proud to be the president of the National Athletic Trainers Association. A professional Organization Serving more than 46,000 certified athletic trainers, students of athletic training and other Healthcare Professionals. Protect the health and safety of athletes is exactly what members of National Athletic Trainers Association has been doing since him been founded. The mission is to engage and project continued growth and developing of the training profession and athletic trainers as unique Healthcare Providers. Athletic trainers are Healthcare Professionals who collaborate with physicians to provide Preventative Services diagnosis, therapeutic intervention and rehabilitation of injuries. They are required to graduate from an accredited program in academic athletic trainers are licensed and otherwise regulated in 49 states and district of columbia. They have long been a leader in bringing invoice to the many health and safety issues facing athletes and reactively provide expertise and specific recommendations as policymakers at the local, state and federal levels. Nat believes congress should fully invest in efforts to track youth sports injuries and fatalities. It is only with a comprehensive system for collecting and analyzing this data that we will be able to understand the scope of the problem and the best methods for addressing it. Based upon current published studies and available data when america faces challenges balancing an active and healthy sports culture while protecting the safety of the youth athlete. I would like to give you a few of the current statistics on athletic involvement and injuries in the United States. There are 420,000 collegelevel athletes who experienced 209,000 injuries per year. At the secondary school level there are 7. 6 million athletes who have 1. 4 million injuries per year. The 46. 5 million children playing team sports in our country have 1. 35 million injuries per year. In 2013 there were hundred 24 million emergency room visits by children 19 years of age and younger for injuries related to sport. The injuries statistics are compelling for the athletic trainers, the most compelling fact is that the secondary School Athletic population leaves the nation and athletic related deaths. Between 2008 2015 there were more than 300 sports related fatalities among Young Athletes. Let me underscore that fact. In a seven year period, we lost over 300 children who were merely playing sports. As a nation, we must do a better job at protecting our youth athletes. However an estimated 42 percent of high schools only have an estimated 42 percent of high schools employed fulltime athletic trainer. We need to improve access to athletic trainers at secondary schools and youth sports organizations. Have a responsibility to our office to provide an appropriate medical care. The investment and proper Safety Measures and adequate medical supervision such as a fulltime athletic trainer is not costly when compared to death or catastrophic injury of young athlete. In 2010 they founded the youth safety alliance. The members of that has advocate groups research institutions, professional associations, Healthcare Organizations and youth sports leagues. An ata and why ssa are working to promote and preserve sports but we also must assure the sports are played safely. When injuries occur we must adequately be adequately prepared to respond. In 2013 nata also sponsored the safe school award. Taking all of the necessary steps to ensure athletes safety to date, there have been more than 1100 schools that have received this award. They partner with the American Medical Society and the cory Stringer Institute in organizing collaborative institutions for safety and sport. This is an annual event. Among you sports leaders from every state who come together to discuss appropriate Sports Medicine policies. Finally over the past several years they have partnered with the nfl foundation gatorade and others to fund multimillion dollar efforts to place athletic trainers in underserved high schools. With the knowledge and understanding of the physical and mental effects of being physically active, nata has taken a leadership role within a number of National Coalitions involved in promoting physical activity issues. This week nata members were on capitol hill urging members of congress to support the personal Health Investment today act or the fit act. Legislation provides an incentive for adults in their children to get fit. Which will help prevent healthcare costs related preventable chronic disease. I would like to thank chairman thune for being the lead sponsor of the bill in the senate. And senator zwicker, and baldwin for being cosponsored. Athletic trainers are uniquely positioned to help with opiate abuse and successful rehabilitation from injury among student athletes. Nata supports proposals to access and training and administering naloxone. They also support the student and student athlete opioid misuse prevention act introduced by the New Hampshire senator. This bill authorizes new federal Grant Funding and support for programs our students and studentathletes as well as training for teachers and administrators and athletic trainers. As a leading organization representing athletic training, we fully support chairman thune and senator Sports Medicine license or clarity act. I would like to thank the senators for being cosponsors of the bill. The Sports Medicine licensing act clarifies to ensure that they are probably covered by Liability Insurance while traveling with athletic teams in a another state. The legislation also has the support of sports leagues and professional medical associations. This week most offices were visited by the trainers requesting support for the legislation. I want to join my fellow athletic trainers in the more than 46,000 members of nata and urging members of the senate including this committee to cosponsor this Sports Medicine licensure clarity act. Thank you for this opportunity to prevent abuse of the National Athletic Trainers Association and i welcome your questions. Thank you. Good morning mr. Chairman, Ranking Member nelson and distinguished members of the committee. It is a great honor to appear before you today. My name is doctor robert stern. Im a professor of neurology neurosurgery and anatomy and neurobiology at Boston University school of medicine. I also a director of clinical core of the alzheimers disease and ct center. For the past 30 years i have been conducting Clinical Neuroscience research. Primarily focused on issues pertaining to neurodegenerative diseases. Such as alzheimers. Since 2008, my research has focused on the longterm consequences of repetitive brain trauma and athletes. Including chronic traumatic encephalopathy or cte. Cte is a neurodegenerative disease. It can lead to dramatic changes in mood, behavior, movement and cognition. Eventually leading to dementia. It is similar to alzheimers disease. But it is a unique disease. Easily distinguish from alzheimers and other diseases to postmortem pathological examination. Weve actually known about cte for almost 100 years. It was originally called punchdrunk or dementia transport in the early 1900s when it was believed to occur only in boxers. However, cte has now been found in people who never boxed. From ages 16 to 98 including former Youth College and professional contact sport athletes. Such as football, hockey, soccer and rugby players. At this time, cte can only be diagnosed after death to postmortem neuro pathological examination. It is very important to understand that concussion and cte are very distant. A concussion is an acute brain injury which treated appropriately has transient symptoms without longterm consequences. Cte on the other hand is a neurodegenerative disease that appears to begin earlier in life when repetitive brain trauma starts to trigger a cascade of events leading to progressive destruction of the brain tissue. The symptoms often begin years or decades after the brain trauma. After the cessation of the athletic activity. And continued to worsen as the individual ages. There been numerous cases of advanced stage cte diagnosed postmortem and former athletes who had no symptoms of concussion. No history of concussion. But who had extensive exposure to what is referred to as self concussive trauma. Several important questions about cte remain unanswered. Such as how common is cte. What is one person get it when another person does not . How can be differentiated during live from other diseases and conditions with other similar symptoms . To answer these and other questions the ability to diagnose cte while someone is living his the critical next step. Our group at Boston University and other scientists from around the country and abroad are actively conducting research to develop methods to accurately diagnose cte during life. I am honored to be the lead investigator of a seven year longitudinal multicenter investigation funded by the National Institute for neurological disorders. That brings together a network of approximately 50 scientists from 10 Major Research institutions across the country. The study referred to as the diagnose cte Research Project is aimed at developing methods of diagnosing cte during life. In total, hundreds of former professional football players, former College Football players and healthy controls will undergo extensive testing over a three day period at one of four sites around the country. And then returned three years later for a followup evaluation. We are well underway. And yet, it is just one study. So much more research is needed. In closing, it is imperative that we do everything we can as a nation to continue to reap the profound benefits of American Sports and athletic participation. While also assuring that we protect the health and safety of former, current and future american athletes. That is a difficult balance. And it requires a combination of unbiased scientific information and common sense. I want to thank the committee for your interest in addressing this important issue. And for your continued commitment to protecting the health and safety of all athletes. I also want to express my gratitude toward the senate for approving the fiscal year 2017 appropriations bill that was recently signed into law with an increase for 2 million for the National Institutes of health. Including a 400 million of funding for alzheimers disease research. I urge you to continue and to expand upon that type of support. Thank you. Thank you doctor stern. Ms. Williams. Mr. Chairman, Ranking Member nelson, members of the committee. Good morning. My name is Lauryn Williams im a fourtime olympian and threetime olympic medalist and a proud United States Antidoping Agency true sport ambassador. I want to thank the committee for the interest in sports and the opportunity to appear before you today to discuss how we can better protect the rights of athletes around the world. When i started running at nine years old i never imagined i would one day be competing in the Olympic Games. Much less, to compete four times yet, i obtained the unobtainable. I became the First American woman to win medals in both summer and winter olympics. I was naturally fast but talent was not always enough. The cost of prolific achievements is high. Opportunities costly the pursuit of olympic dream cost money, time, experiences, your social life, among other things. But these expenditures are not always a sacrifice but our choice. The thing is, while we choose to chase extraordinary moment we do so believing basic ideas that every athlete deserves to compete on a level Playing Field. Sadly, that notion is under attack. And with that, the very credibility of the Olympic Games. Why . Because of the use of performanceenhancing drugs, shortcuts are being taken for personal gain. Podium mamas are being stolen. And perhaps, most frightening the kind of abuse continuing and nausea because sports leaders around the world cannot find the will or courage to properly protect athletes. Chairman thune, members of the committee, i encourage you to imagine dedicating your entire life to the mission of representing your country and achieving your best performance. To give your blood, literally give your blood, sweat and tears only to have your dreams stolen by someone willing to cheat. Someone willing to corrupt themselves and the sport that you love for a hollow victory. It is devastating. And when this happens, clean athletes up to sport leaders were supposed to be our advocates but we seldom get worthwhile responses. When doping goes unpunished clean athletes are left wondering, what would my life have been like if i actually compete on a level Playing Field. Michigan owed a moment on the podium . Did i miss sponsorships and endorsements only come with an olympic medal . The Unanswered Questions in this experience of course there are individuals that lose their experience to cheers. But this experience is also for others. Everyone is left asking my play of the game is rigged . If the destination has become more important than the journey. I am not the first athlete to say this on capitol hill. The house energy and Commerce Committee heard out of nelson, the american shot putter nine years after the 2004 Olympic Games would receive his gold medal in an airport food court. Really, a food court and they heard from Michael Phelps, the most decorated olympian in the history who despite his own unprecedented success wonders if he truly ever competed on a level Playing Field while on the international stage. The reason why People Like Us speak on issues like this is because we know that here in the United States we are being held to the highest standard there is. However while american athletes are asked to report their whereabouts 24 hours a day, seven days a week so drug testers can knock on our door unannounced request that we pay in a couple give blood, and he athletes her mother parts of the world are not. The simple truth is, not all elite athletes worldwide are being held to the same standard we are and it is a really frustrating reality. I was tested 66 times during my athletic career. That is 66c doping Patrol Officer tapped me on the shoulder after competition or showed up at my home at 6 00 a. M. Waking me and my family to take my blood, watch me. [bleep] in a cup and a matter what time of the month it was. That 66 times i bore the burden of having to prove i was competing clean. That i was doing it the right way. Yet, somehow and this is important 11,470 athletes that competed in Rio De Janeiro last summer, a staggering 4125 of those athletes had no record of being tested in the 12 months prior to the Olympic Games. That is unacceptable so i am here today to ask you this, how many more . How many more Olympic Games are we going to allow to be corrected by performanceenhancing drugs . How many more podium mamas need to be stolen . How many more dreams crushed . What kind of message are we sending to the next generation of competitors . As athletes we have a responsibility to require that all voices are heard and that we have an opportunity to be engaged in the conversation that directly affects us. Mr. Chairman, encourage our government and governments from around the world to exercise your influence for this important cause. We are just 266 days away from the winter games. The clock is ticking and the time is now. Thank you for your time. Thank you miss williams. I will start with questions we will do fiveminute rounds. I would like to begin again by thinking you miss Maureen Deutsche for being here. And looking back in your tragic experience, do your recommendations for other parents whose children face sports injuries and they may be as a followup are there warning signs and you can share with other parents who are in similar situations . Education to me is key for the parent. If that you know when that happened with megan he said the hydrocodone is not cutting it. We should have just said stop. And that would be the advice that i would give to other parents. If it does not seem right, its not. Probably not right. And the thing is that we had excellent physicians. We had a great athletic trainer who was working with nick. So just seems like education and awareness of the issue is just so key. The warning signs for nick the warning signs when he said he needed additional because he wasnt, i told jeff he has his hand up for this hydrocodone. So that is a big red flag. When he was still going to school, he was training, he was rehabbing to get back for the last play for the last game of the season. So i just think education and awareness and follow your instincts. But you know it it was 2011 and there wasnt the highlight on it that there is now. And then following you know i do have to say though that addiction hit so quickly. It just happened before our eyes. You know we all wanted nick to play football. Everyone from the coaches to the other parents and us. So education, awareness. Do not be afraid to raise your hand and say stop. And that was the addiction desk again, it is just a sad thing. Thank you. Miss williams, derek miles who is the associate coach at the university of south dakota recently received a bronze bell for his performance in 2008 Olympic Games in beijing. He received this metal more than eight years after the actual games. Because the athlete that actually stood on the podium in beijing tested positive for a banned substance. Mention this in your testimony but referred to end, how many other american athletes like derek do you think are still waiting to receive the olympic medal that they rightfully earned and what can be done to ensure that that longawaited and deserved metal gets there sooner rather than later . I believe there are many other athletes that are entitled to a metal that they did not receive. Any moment that has been stolen from them and did thing, the most important thing we need to do right now is to store samples a lot longer. Right now they are storing samples for 10 years which is how adams nine years after his medal was able to find out that the person used performanceenhancing drugs. But the language of the samples the better the technology is getting and we can look back to say you know now we have new technology and we can know what you were using at this time and we can restore the opportunities. But what we need to be doing is to stop that from happening and get the technology now so we are getting positive tests and not giving metals to people who do not rightfully earned them. Getting your olympic medal at a food court is anticlimatic. Very anticlimatic. You state that underlying causes of sudden death in athletics might include asthma, catastrophic brain injury, cervical spine injuries, diabetes, heatstroke and sudden cardiac arrest. That is a quote from your statement. Given a diverse range of underlying causes that Young Athletes may experience, is it reasonable to single out contact football is most problematic sport that is a fundamental change . Welcome at athletic trainers would recognize the number one cause of death in athletes is cardiac. It is important that we have individuals there and a plan in place to care for those athletes when the situations exist. These are not strictly limited to the support of football. We see concussion, heat, and cardiac in many of our sports. Its important for us to be prepared for those. To think assess ability and influence is a more appropriate solution than fundamentally offering the sports like football for example . I believe in a comprehensive aspect of addressing these issues. I advocate for athletic trainers because i believe it is important for an individual, and adults to be present that is taking into consideration the safety as well as preparation for catastrophic injury at that site. Often we have other adults but their primary charges things like coaching, strategy and things like that. We need a trained professional that looks at things like an Emergency Action plan, access to appropriate medical care, how do we access facilities in the case of a catastrophic injury, thats what an applicator does by nature. Thank you. I yield. Ill be quick so that we can get on to our members. First of all, i want to say that i want to say, amen. Thank you, you did it the right way and others cheated and you still got the metals. So, amen. And i want to say i dont understand how you survived and what i dont understand is when your son was asking for some more oxycontin, what was it that you said that you ought to stop right there . As i said, everybody wanted nick to play football. He loved being part of the team and loved everything about that sport. But we should of said stop, reevaluate, is this worth it. He was getting ball letters and he was looking forward to playing college ball. So, had we know then what we know now i wouldve said stop, we need to decide if this is worthwhile or right. Unfortunately we didnt. To all of the panel the chairman and i were discussing, we could have a separate heari hearing. Doctor stern, i got the impression that you said that a person could not have any concussions and still get to cte. So, what is it about that and if you have many concussions, does that also is that a cause of ultimately becoming cte . Yes, to both of those. Concussion is a form of a mild traumatic brain injury. There is no real hard, fast line between what is a concussion and what is not a concussion. Right now, i think there is 140 or more published definitions of concussion that was published, that was one of my favorites. But, it is all based on having symptoms, having an individual report symptoms or signs of the injury. That does not mean that there are no problems to the brain, the brain cells in the brain tissue if the injury does not either result in the type of problem that leads to the symptoms, or very commonly the person does not report the symptoms for a range of reasons. What our research and that of many others is now showing, is that the sub hits, the ones that happen in every play very game and practice, they do have consequences, shortterm, longterm. There is growing evidence that one season of football, the football in high school, there are changes to the brain, and physiological changes to the brain, changes to blood base biomarkers and changes to thinking and memory, without symptomatic concussions. Those changes are directly associated with a number of hits a person gets to the head as measured by excel rahman is in the helmet. So that would apply to soccer soccer hitters as well. That is the very scary part of the journey. There is a growing evidence that heading in soccer does seem to lead to changes over one season but also after a lifetime. There is now just recently several cases of postmortem confirmed cte and individuals who are demented at the end of their lifetime who never had histories of concussion, maybe just one concussion through professional and semi professional football. But, they had a huge amount of heading through their career. Suggesting the exposure to the competitive hits whether they lead to concussions seem to be raising the risk to the later life complications. Are you following our former military members and the traumatic brain injury there . Seeing if that produces cte . Theyre supposed to blast other brain trauma. Its a very complex issue. Its a very important 11 that the department of affairs and defense is taken seriously. The symptoms of ptsd, the longterm problems of traumatic brain injury, the difficulties we see in suicide, all of those overlap of the symptoms of cte. We are seeing that ct may be playing an Important Role in the cognitive and behavioral mood changes in our military service members. Thank you. Doctor stern, thank you for the comments. I can what you describe in your family situation, who you are the way you conduct your lives is the way that i recognize, the way that so many live their lives. We dont expect bad things to happen. Im very sorry. I chair the subcommittee that has responsibility here over amateur and professional sports. The senator and i wrote wrote the ceo of the United States and pics committee about two months ago raising questions about sexual abuse and harassment within the Olympic Games. I take way from the response we received a set your organization was coming into play, the solution to this challenge lies with you. I would ask if thats what you see, the relationship between the Olympic Committee and safe sport. What is that relationship and who has responsibility for the issues . Thank you. To quote doctor butler, i think it will take all of us, first and foremost. We like the u. S. Anti doping association. We were informed first with the u. S. Olympic committee we are an independent 5o1c3 Nonprofit Organization charged with this issue. All of the 47 in gigabytes of the olympic sport have safe sport responsibility. They are a Safe Sport Program by which they are tasked with implementing training, with making sure their coaches and covered individuals are certified, related to safe sport. So implementing and creating a culture that prevents abuse is really important we are absolutely working in partnership of the usc and the National Governing bodies. Were independent in terms of investigation. U. S. Oc has retained us to investigate all areas of sexual abuse. Any report of Sexual Misconduct or abuse, we investigate those reports. It let me ask if you are the investigative arm, who is enforcing a . The sanctions, if we have a finding from a report, a case if you will, if we have a finding, that finding goes to the National Governing trying governing body and not only must they enforce anything up to and including a lifetime ban. Not only must that an gigabyte aforesaid sanction, and must be enforced across the olympic and paralympic movements. Why is that is it ignored or why is it taken as a recommendation and who determines what the consequences. The usoc has created and mandated if you will, that the in gigabytes adhere and part of the safe code in that case we hand down a sanction and the usoc and the ntbs make sure its enforced. Is it any different than the way the anti doping work . You sought has the ability to have a sanction down and then. It seems to me that your organization was slow to come into existence and my impression is its related to fundraising, the ability to have the necessary resources to do the work your set out to do. Can you sure is the dollars an hour available. Thank you that is the reason why it is taking us to get up and running. We open the doors in early march. We have funding from the usoc, from and g bees and other charitable organizations. Ive asked the Committee Support in the senate race support as the chairman stated at the beginning of his remark, authorization and authorizing the center and legislation would go a long way to establishing our credibility, our place if you will in terms of addressing these safe sport issues. Make no mistake, we have a ways to go, we need more funding. Part of my job is to raise private sector donors in addition. No one you know of would object to legislation that the chairman was describing . Not that i know of. Thank you mr. Chairman. That was a Good Exchange of discussion there because we need to figure out how to formalize that role and ensure there are enforceability there associated with that. Thank you. Thank you mr. Chairman. The cover story this week in Sports Illustrated is an the great football player, hall of fame football player. Essentially what it says is that his brain has atrophied to a point where he cannot tie his tie or his shoes. Unfortunately that is the story that is all too common to former athletes. Doctor stern, if you could could you talk a little bit about the warnings that you are giving to the country, especially to those who have Young Athletes and their families about injuries that can occur, not just in football but in hockey, soccer in any sport where concussions are possible. What is the core message youre sending to athletes and especially to the parents . Thank you. It is a complex message. It is one that is hard to always get across because theres many different forces out there that move the message in different ways. One important part of the message is that concussion is just the tip of the iceberg. Weve heard so much about concussion, theres bank concussion this and that, and thank goodness because there have been so many important changes in the way concussion is being dealt with, being detected, and managed and thinks nta and others the problems associated with concussion are indeed moving in the right direction. But, for me what people need to understand is when they read stories about nick and others, those were not necessarily caused by concussions, they were caused by the cumulative amount of the hits they received it to the head from youth to high school, to college to the pros. One part of the messages, just because your kid plays football does not mean theyre going to develop this bad disease and have suicidal , we cannot havea kneejerk response. We have to have appropriate scientific understanding. We need advances in our scientific knowledge that can be given to informed parents, to informed leaders, informed policymakers. But as for gathering that scientific information people also have to make decisions based on common sense. In other words, our brains are pretty darn important. They control who we are, what we are, how we move, they control athleticism and passion to participate, they do everything and they are precious. One thing were focusing on this what happens in the time in childhood when their brain is going through unbelievable growth and maturation. Theres all kinds of changes and developmental milestones are occurring. If we say its okay to put our kids in fields and say go ahead move that brain around over and over again during the time a potential vulnerability then we may need to question that decision. So what percentage of research is funded by the federal government . Around 90 of my Current Research is funded by the federal government. So if it was cut by 18 which is the proposal here how that impact . It would be devastating not just me personally into the research and our future research it would be devastating to science as we know it. It would get rid of an entire generation future scientists across all areas. I can speak to the Brain Research in particular, we cannot move forward, even with the current budgets at the rate that is required to make important discovery to alleviate the pain and suffering. The senators doing great work on this, my question is, is there a relationship between the relationship you are now doing on brain injury and your Alzheimers Research . Can one inform the other in terms of perhaps trying to find the clues that can give hope to families . Thats why i got involved and interested in the work in the first place. As a researcher i realized this is a very similar disease and as we learn more the more we understand that what we are gaining in our understanding of cte is directly informing what we know about alzheimers and other disorders. While we learned about alzheimers is now helping us move forward rather quickly in our understanding of cte. Very intertwined. How much more transparency would you like to see in terms of the information about brain injury being put out into the public so there can be a full understanding of this problem . There so Many Organizations out there and statements made that are filled with conflict of interest. Organizations that are funded directly or indirectly from professional sports leagues around the world. Those conflicts lead to a misunderstanding or misrepresentation about what science tells us. Scientist need to be transparent themselves. We need to share data, we need to break down silos and explain our findings in ways that are meaningful, appropriate and not beyond what the sign says. I think the brain health of this generation of Young Athletes will depend upon the transparency of this generation of leaders who control the information and to help inform parents in making the correct decision. Thank you. Senator udall. Chairman, thank you so much. You and i have been talking for a long time about doing the hearing like this. We appreciate you doing it. I also want to thank senator nelson for his kind comments and senator marquis. The issue and i think i want to emphasize i dont think you have had a chance to say this specifically, and i will read it from your testimony and ask you to talk more about it. You see its only in the past 55 or 60 years that large numbers of human beings have been exposed to repetitive head impacts. So, were talking about constant impacts to the head. While the epidemiologist ct as i know, it is possible that millions were talking about living older adults are currently at high risk for cte or other longterm neurological conditions due to their history of exposer to repetitive head impact. This is something we need to realize in terms of Human History. Talk about Human History and repetitive head impacts and where we are. I think thats where we get from to millions of people. People would be surprised and shocked to know were talking about millions of people cte, especially if they have seen the sports figures and the deterioration in things that happen. Please put that in context. As a prophesy, im not an anthropologist or epidemiologist. But im someone who speaks with those experts and look at what history tells us. Boxing has been around for a thousand years. Boxers only started putting these heavy padded gloves on the part of last century to protect him from being broken. It also led to increase its to the face and head and change the numbers of those hits that boxers kit. More portly for this country, our National Pastime of american football. It wasnt until the mid 1950s that hard plastic encasements, big helmets started to be used. In american football, plus the big facemask. Even though we have been playing football since the 1800s it wasnt until then and leather helmets were used to prevent skull fractures and that they have done an amazing job at protecting. But in the mid 1950s to late 50s early 60s, there was the beginning of a sense of invincibility. It didnt hurt to hit your head. And the way the game was changed included loss of hits. Not the big hits and spearing and use of the helmet as a weapon, im talking about routine hits. Wasnt until the 1960s and 70s that pop warner football began to be a National Pastime and our kids six years old and older were going into fields wearing helmets and facemasks. And again hitting their heads repeatedly. That is where the concept of, we dont know where we are yet with a little bit of fear or perhaps a lot of fear. See only type of experience that humans have been involved with that really include repetitive hits to the head with a brain moving back and forth and millions of people just in our country alone. The people to start a plane high school and College Football the 50s and 60s in youth football in the late 60s and 70s there their late 50s to 70s right now that ch we see clinical manifestation of many diseases of aging. We also see a lot of the incidence of cte. With the millions of people who had that exposure to those hits for the first time in history, i do fear that based on the knowledge of what we understand for the risk of cte and other problems, we are going to see a very shocking number of people over the next few decades. I really appreciate the testimony. I want to be clear that i think sports are good for young people and i think exercise is good. What you are emphasizing is talking about repetitive hits to the head. When you have protective equipment that can make it feel like it doesnt hurt and its okay but what you are telling us is we need to be recognizing this could have a big impact. We may be on the tip of the iceberg as to what we start seen in the future. Thank you for your work of her being here and being so frank about this. Thank you senator. Senator blumenthal. Thank you mr. Chairman and thank you for having the siri which could extend for several days, the topics are so varied and important, as a father for children who all play sports, i know we cannot protect our children from all sports injuries, but at least we can protect them from some if we are attentive and respectful. I want to talk about two areas right think we have been less than respectful. One is the nhl into nine concussion science and i intend to reintroduce legislation that would in effect create very strong incentives for improvements in the siri. The other relates to Sexual Assault particularly in gymnastics. There is a hearing and i will last some questions a fivetime let me begin with you doctor stern if i may. Last year and nhl executive made headlines about having a hearing like this one, this should have been shattering news but it was, for the first time the nhl admitted there is in fact a link between head trauma and cte. You know how debilitating and destructive that diseases. But, report surfaced last year revealing emails from league officials, recognizing the danger of concussion but also demonstrating a dismissive attitude in addressing them. I wrote the nhl commissioner in response he dismissed and a connection between head trauma concussion and cte. My letter i cited Research Done at Boston University and beyond the resistance there are now troubling reports that the nhl is trying to intimidate scientists using tactics employed in other industries without making on fair comparisons, the Tobacco Industry is one of them. That is a big deal. I understand that but i think that Everyone Needs to put athletes first. What the nhl did and the commissioners statements have done is indeed sad. I dont agree with them. I find them kind of antiquated and perhaps they should take the lead of what the nfl has recently done and accepted knee i think you are accusing confusing the nhl with the nfl. The nhl continues to say oh no theres no association, contradicting the science. I can go on too much about it because in fact you raise the issue of their attempt to get in the way of science and in fact my colleague and i were subpoenaed by the nhl for a great deal of information that went way beyond any reasonable request within how science is good. In fact they denied their request. So i cant really get into it because its an ongoing case. Thank you. Let me ask you ms. Pfohl recently the committee had hearings on technical abuse and gymnastics typically the youngest participants in this sport. Statistics from sports indicate one in 10 youth to participate in organized sports will be victims of sexual abuse and i think you would agree with me that number is clearly unacceptable. The United States Olympic Committee by law requires National Governing bodies to comply with policies in order to remain in good standing. How can those policies be better enforced . Thank you senator blumenthal. Just a quick note. The one in 10 that will be abused thats actually in the general population. One of the problems is we dont know the true prevalence within the Sports Community and thats one of the reasons we exist is to gather that data to have that data to follow the trends and to help our prevention efforts. Thats what needs to happen. So your support certainly of the u. S. Center for safe sport and hopefully being authorized perhaps at 534 protecting young victims from sexual abuse act of 2017 would go a long way in helping us to develop policies. We are to have code taken up by the usoc and the ngvs but our work goes far beyond the olympic olympic. Would you support Young Athletes having their cases in courts as opposed to being arbitrated . In terms of what is currently in the s534 we are certainly favorable to the bill overall in providing that Technical Assistance so we support the rights of athletes period. Thank you. C thank you senator blumenthal. Senator cortes. Like my colleagues think you for bringing this topic forward. There are many topics and i agree they could all have a separate hearing and every single one of the hearings we will continue to work to address a let you say first of all thank you so much. I was an attorney general for eight years and this was an issue. I chaired a working group on opioid abuse followed by heroin abuse. Its a problem not just in nevada but across the country and you coming forward and telling your story you will make a difference to save the life so thank you to both of you for being here. Dr. Stern i have a quick question for you. From your knowledge are the medical resources and research into ct and other longterm brain concerns equally distributed between males and females and what would you say is the allocation by gender . Its one of the most important issues. Cte as it did degenerate disease diagnosed only after death at this point has been found almost exclusively in males today. Thereve been a small number of women, not athletes. It includes a woman who is domestically abused. This goes along with my testimony earlier about whats going to happen in the future. I think women have been involved now with sports at the level where their heads are being hit to such a degree and over greater period of time again over the last 60 years or so for example soccer and divisional football. Women in this country, women started back in the 1970s playing at an early age and playing club sports and playing around the year and doing a lot of heading in having a lot of concussions. So i think now as that generation gets older sadly we will probably be seeing more of this disease however just because we havent seen the disease in women that doesnt mean the rest of the resources being focused on brain diseases, brain conditions associated with involvement should be focused on that. We need to put a large effort. In fact im hoping to be starting a few different studies coming up where we are actively going to be following women to be able to look at the effects of area sports, various aspects of the sport such as head trauma in terms of life problems. Its a very big deal. It is and i thank you for saying that because in my own family i have a niece who played soccer through high school, college and there are concerns because they have head injuries and soccer just like they do football and other sports. As you well know in nevada and he said it in your testimony that Cleveland Clinic for brain health in las vegas is a leader in this research particularly when it comes to the brain health of officers in mma fighters and we know a lot of women now are partaking in those sports. I am glad to see that you are actually going to be looking at Womens Brain Health as well. With respect to boxers and mma fighters do you feel there is enough being done at the state level to ensure that standardize safety protections are protected sex nevada just recently adopted a requirement by the f. Out of commission ensuring that the brains health of our fighters is tested and we are making sure they are being checked. You think enough is being done across the country . Im not aware enough to be able to answer about all states. I know in nevada thanks to the partnership between the state and the city of las vegas and the commission that the center there has been a tremendous gain including Great Research being done to look at what is really important. When it comes to boxing and mma to me i always have to stop and say what could be done at the state level . What kind of rules and changes could be done when you have sports that are geared towards inducing brain damage . If in boxing a knockout as a way to win a knockout is brain damage and i may be saying things to him delicately but one has to question how can we really make those that served these safe in terms of brain health . Thank you very much for all of you being here today. Appreciate your testimony. Thank you senator cortes masto. Thank you very much mr. Chair and thank you to all the witnesses for being here today. Especially i would like to extend my thanks to mr. Deutsche and four sharing and honoring your sons life and story by being here. I want to focus a little bit on the issue of athletes and addiction to help address the increased level of risk of opioid addiction. Earlier this year i cosponsored the student and student athlete opioid misuse prevention act. This bill by my friend and colleague senator shaheen and it was authorized substanceabuse Health Administration or samhsa in the department of education to grant money to help educate students about opiate use of these and samhsa grants have been an integral part of funding interstate Substance Abuse and prevention efforts so this is really a question to the whole panel. Do you agree that to resources and dedicated funding would help what you and others are doing to meet the tough challenges associated with opioid addiction . Thank you senator for that question and do you mind if i go first . I just want to agree with doc or sterns comments about importance of support to the nih and that applies in terms of our understanding of pain and also the understanding of addiction. Nih or Francis Collins has observed when we have a millennia of writing about pain its a cardinal sign of information that we know so little about. I also want to point out the critical importance of education and using that knowledge that we already have much of which is representative through agencies such as the centers for Disease Control and prevention and also samhsa. It is i think that an either or as we look at new knowledge verses acting on the information that we are to have. It really is going to require both to address these issues. Another component of the bill is to provide funding to state and local officials and coaches and trainers among others to recognize and address Substance Abuse among students. Would this be helpful in your view and especially mr. Sailor you would like to comment on that. Yes the association is in full support of this bill and we appreciate that. Thank you. And also to ms. Williams and mr. Sailor although we are starting to have a greater understanding of Substance Abuse disorders there is as we all know still a lot of stigma attached and one of the reasons im so grateful to mrs. Deutsche and her family is because when people stand up and talk about their experiences and help us understand that this is the disease it really makes a difference and has really helped us to begin to change the conversation. But i expect it may be essentially true for athletes who may suffer consequences of being sidelined if they admit to an addiction to an opioid or acknowledge the injury that underlines the use of their use of pain does this prevent acknowledging a dependency on opioids . I definitely think the stigma is a problem and something that we need to address. Think the way that we address it is by our reach indicating from the grassroots revel all to the way this professional level starting the conversation before comes a problem for people who are not using opioids getting that conversation going and having it frequently instead of oh i think my friend is struggling but im not sure exactly what i should do about it before it becomes a problem. We need to implement that as a thing we are doing on a regular basis and that conversation being had. As a trainer we believe in a conference of Health Care System for athletes and that includes having access to resources that we can help obtain for them when they are in need of things like Addiction Treatment and things like that. Thank you all very much for being here. I will echo with the other senators have said. We should have a hearing on each of the issues that you all have spoken about and i know with or to continuing to work with you to help make athletics safer. Thank you senator hassan. Sentry young. Thank you chairman and i want to thank you for holding this hearing in protecting the health and safety of american athletes and i thank all of our panelists for being here today. Its a timely hearing given the scrutiny of the usoc has received. Thanks in large part to the indianapolis stars but i want to commend them on their investigative reporting. Im proud to work with many of my colleagues in the senate to address this issue and i look forward to working with you mr. Chairman as we continue to find ways to address this very real problem. Ms. Three i would like to ask you a question about the independence of safe sport from usoc. Usoc initially created safe sport and provided the initial seed funding and i think this was certainly a recognition by usoc that they finally need to act in an aggressive manner to address the serious problem that has been lurking within its ranks for years and they ought to be applauded for implementing those initiatives. I have concerns about it because i started independent personnel staffing issues. What is your policy on hiring individuals directly from usoc and National Governing bodies into safe sport and do you have any reservations about safe sports independence if you are a burger station hires individuals from usoc and mgd . Thank you senator. I have no issues or concerns related to our independence. Our board, we have a nine person board of independent directors. We have independent investigators about site counsel and arbitrators said meade high bar of independence so we really look for those. I will tell you that we have brought to people from the usoc as employees. These are at least one of them her subject Matter Experts in this space. Not only in terms of safe sports and in terms of the abuse issue but in terms of how the olympic and paralympic movements are structured which is hugely helpful to us. Again following in the footsteps of view saga they too were born within the usoc. They had Staff Members that came over. I dont think anyone can question their independence so we have followed that trademark. These independent investigators presumably produce reports and various funding to inform your future work. Are these reports made available to members of the public or would they be made available to congress . I presume they touch on staffing issues. If we have the actual report from victims if you will, cases that come in. Is that what you were speaking to sir . Yeah and also former employees of the National Governing bodies and usoc. If they are consistently subpar suboptimal or conflicted which you have emphasized they are not there would be a finding that would be of interest to this committee i know. Our jurisdiction lies in addressing Sexual Misconduct and abuse within the olympic and paralympic movement. We would take in reports. If we have a finding against an employee of an ng br usoc or a coach or anyone that isnt covered individual that sanction is then handed down a few well and it must be enforced across the olympic and paralympic movement. With your permission i may have a followup question and im will send it in writing and the courtesy of your response i would be grateful. Absolutely. I want to turn to another matter. A no reporting incidents of abuse is critical in starting the investigation process and unfortunately our staff discovered a problem here. There is a link. Unfortunately that link is broken. Takes visitors a page not found web site. If someone were to find morons confidentiality those concerns as referenced in your materials to the usoc athlete ombudsman and www. That web site doesnt work either. I know this is like a surprise. What im thinking from you is some insurance that you will resolve this matter expeditiously and give the courtesy of informing a stab this week of its status. You can defer from mr. Lack of seriousness taken towards a situation which i havent heard from your testimony so far by the way. Can i get your commitment to refer back on this or im missing something . Apsley senator. We will check in it and get back to you. Thank you chairman. Thank you senator young. Senator moore capito. Thank thank you chairman and thank all of you for being here today. I come from a state of west virginia. We have unfortunately some of the greatest statistics of overdose and death caused by drug addiction and drug overdose. We have lots of things going on in terms of the sports area. W. Bu Sports Medicine center is a think and edge of some of the research being done. I would like personally ms. Deutsche thank you for coming in telling your story. I think it is so important that we hear from you because its a hesitating thing for parents ingram parents to talk about. So i read your testimony and im sorry wasnt here to hear you give it. We are trying to work with families in certain things. One of them was an athlete. She described herself in the hospital as an addict. She had been in and out of recovery and unbeknownst to the discharging physician who didnt read all the charge that discharged her with oxycodone into her pic line and didnt wake up the next day. We are trying to fix those kinds of things so that situation can happen again but one of the things, im curious to know tracing back and looking at what happened with your son we are trying to get this acute pain issue. If you have an acute athletic injury that you dont need two weeks of Pain Medicine or maybe 48 hours or 72 hours. Was that ever offer to your son, shortterm treatment for shortterm prescription option for him of the initial prescription . I believe a shorter term. I dont have the record i do get the record for the prescription that it was a friday night and we got them into the evaluated. The other in a series of prescription started later in the season when he was rehabbing to get back into the game. Those prescriptions if memory serves me correct he were 40 or 50 tablets. Were there any diversionary pain methods to deal with the pain offered to him . Tylenol but no not in the discussion. It went to hydrocodone right away. That is Something Else we been working on with senator warren from massachusetts to look into partial fill and also an acute pain issue that im working with gillibrand on to try to eliminate that link the prescription that becomes quite a temptation in a lot of cases. So i want to ask ms. Williams actually on the appropriator for the general government which also covers the office of National Health and the u. S. Antidosing agency. Because of that i got to see Michael Phelps and i get to meet you so thats good. Its interesting we do appropriate that as a member of the antidosing association in the United States and also try to help the Worldwide Organization for athletes competing on the stage such as you. Essentially what he said to me, and about how many races he has been and he said i dont think ive ever had a clean race. He wasnt talking about him. Was talking about everybody else in the pool and he still won all the gold medals than you did two im thinking to myself what kind of pressure is that at the elite level because of what the other countries are doing . I think there is a good amount of pressure for athletes and thats why its so important educating athletes at the Grassroots Level. The world antidosing does a great job. Being able to create example so for example i can use any supplements my whole career. Not only did i not used performanceenhancing drugs i didnt use vitamin store powders. I tell people i made it to Olympic Games without any of those things. Whatever the case may be so being able to explain to athletes all the way up to the professional level that its not worth it. That one moment on the podium is not going to be reporting enough and you are not going to deal satisfied because she did this thing that was wrong in order to get to that point. For people to articulate that in a way thats going to hit home because they are encouraged to try to reach the next level or win at all cost is the least important thing. Thank you for being that advocate. I got a chance to meet some and she is working in outreach with young people to inspire them on Different Levels and clean living and staying away from substances so is so important work you are doing and i appreciate you all working with the next group of stellar athletes. Mr. Chairman could i know that my colleague is dropping a lot of names gratuitously. [laughter] you wonder why they all come to meet me. And they are out there dropping her name. Thank you senator capito. I think senator sullivan is on his way back and would like to ask a question or two so we may keep it going for just a minute. Ms. Pfohl is the former executive director of the president s counsel and fitness and nutrition you have talked a lot about the challenges we face and the problems and things that we need to address to the world of competitive sports. This is a question. You think we have to be discouraging participation in certain sports . Other positive benefits to playing sports including Contact Sports that we had to be talking about as well . Thank you chairman vin. You know obviously i believe in sports and all that comes from it. Not only the health and fitness benefits but certainly the emotional benefits that come from it come the teamwork that you learn, the perseverance, the dedication. All of those kinds of character building things that are learned through sports. Not just competitive sports that were regional and getting out there and having fun i believe are so important that i think all the issues that have been talked about on this panel are also critical. So that we can save the sport not only for our generation but for every generation to come so its absolutely critical. And go packers by the way. There you go. I like you more already. Is your focus just olympic athletes or does your work go along you lead level sports purchase offense and is your focus solely on kids or does your work go beyond youth in terms of the things you entertain . Thank you for that question chairman. Absolute goes beyond kids. We address our faith at every age and at every level so from the rec leagues if you will for folks that are just going out and having fun whether thats kids or adults all the way up to the the olympic and professional ranks so all of the above. In terms of our education and outreach and the training and awareness that we want to get out for sports organizations parents athletes all across the nation. We appreciate everything that save sports is doing to prevent abuse within the Olympic Movement and as we imagine legislative proposals for this area i heard some of my colleagues speak to that earlier today we have to consider how best to craft policy governing more and more contact between athletes and coaches. Want to avoid situations that would run yet hath its and situations of abuse and avoid overbroad policies that constrain the athlete coach relationship. The question is does a riskbased standard like the standard at the centers for Disease Control make more sense . Thank you again chairman thune. The really follow the center for Disease Control standards as guidelines in this state. We record nice and agree with the centers for Disease Control that limiting those oneonone interactions between adults and kids and making sure their two adults present as often as possible is the absolute right thing to do. We also agree with their risk based guidelines as you indicated which basically says hey maybe one size doesnt fit all. There are so many sports organizations are so diverse. There may be multiple options for achieving safety so they are standards are there guidelines certainly are those that we have made part of our best practices. Just out of curiosity other members of the panel share that view . And the others want to comment on back . Do you agree with that is articulated by ms. Pfohl . [laughter] senator sullivan is coming in the door. There he is. [laughter] senator udall had asked that we include in the record three items that he wanted included so we will do that without objection. I would say to all of you, thank you for being here and thanks so much for your thoughtful input and suggestions in response to our questions. These are all important issues. In many cases lifeanddeath issues and certainly when it comes to safety really critical that we get this right. We welcome your continued input and i want to indicate to you that there are members of this committee who will have questions that i would like to submit to the record and if he could get those back to us as it is possible. They normally keep the record open for a couple of weeks to allow your responses so if you could get back to us as quickly as possible we would appreciate it. But that i will yield to my colleague from alaska senator sullivan but let me thank you for being here today and tell you how much we appreciate your participation. Thank you mr. Chairman and i want to thank you again for calling this hearing. Its a really important issue that is impacting the entire country so thank you for your leadership on that and i want to thank the panel. Again im sorry i had to step out. I had my freshman duties were have to preside over the senate. If you are a senior esteemed senators like chairman thune you dont have those duties but i have had those for the last hour or so wasnt a lack of interest. I was over with another gavel on the senate floor. They do want to thank the panel again. I know in keeping tabs with my staff i havent read the testimony so let me just start. Her butler i want to start with you. Thanks again for coming and thanks again for all that you are doing. You may have seen you were quoted in the Alaska Dispatch news this morning, front page above the fold headline, anchorage is seeing a dramatic surge in heroin overdoses. So let me ask a little parochial question but still important because i think he can shed light on whats going on in the country. What do you think is behind that surge in our biggest city back home and as i mentioned we have this in the senate last august in the matsu valley and one of the reasons i posted that was as a warning signal to our state which was hey this is happening in a lot of places. We are not in dire straits as some lower 48 communities yet, hopefully never that this could be coming and unfortunately i fear since we held a summit and you are a key participant we have been focused on this a lot in congress but in alaska its getting worse. Throughout the country is getting worse so do you mind addressing the headline today in the paper that dramatic surge in heroin overdoses in anchorage and if you want to address what do you think its getting worse in alaska or not in any of the panelists want to talk about it relating to the nation because it does look like we are not winning this battle right now. Senator sullivan i think alaska really reflects what is happening nationally and what we have seen an alaska is that while we have had some leveling of the number of overdoses due to prescription opioids there has been an additive effect of increasing numbers of overdoses due to heroin and also the synthetic fentanyl related, related compounds and we have seen a decline in opioid prescribing. Its important to point out that we may be beginning to bend that trend but we are nowhere near where we need to be. We have heard a number of stories this morning but where large amounts of opioids have been prescribed and have led to problems or problems with misuse have gone underrecognized and a lot of that is driven by a lack of Awareness Among the Health Care Provider community and even among the public in terms of the risks associated with these drugs. Specifically what is happening in anchorage i think highlights a number of issues. At this point we dont know if a decrease in overdoses is accompanied by an increase in Overdose Deaths. It is possible that we are actually seeing more people survive to interact with the ems system because we have been very aggressive and getting the loss and kits out in the public. Also highlights the importance of the interagency communication between Public Health and Law Enforcement so we are sharing data and able to discuss exact do what we are seeing from our own did. For example its not clear whether or not this may be a batch of some substance that is much more powerful that its been on the street in the past or is that an influx of primarily people who are tolerant . We dont know the degree of detail yet but thats were working together and having our instinct command responses help to be able to facilitate those communications. We learned a bit of this during an outbreak of spice and overdoses of the cannabinoids overdoses were it took a couple of weeks to connect the dots. In this case we were actually aware of the increased. We were able to start having those conversations as soon as we recognized it. The final comment i was going to make while its important to address the challenge of illicit opioids we have to recognize that part of the reason heroin found such a ready market when he came in larger quantities at much lower prices start at around a decade ago is we had a much larger proportion of our population that had physical dependency or addiction to opioids and the way we often abuse use opioids with Good Intention can be a set up for physical contingency and withdrawal can be awful even if its not the more chronic condition of an addiction. People oftentimes turn to whatever they can turn to to avoid the rigors of sickness. Anyone else on the panel want to comment to what they see nationally as a trend and the reasons for it . I do want to comment, ms. Deutsche i was here for your testimony and i really just appreciated. I know that couldnt have been easy for you to testify before this committee and recall some things that are obviously incredibly heartwrenching for you personally and your family. But unfortunately as i have dug into this issue a story that you told about your son is not an uncommon story in terms of an athlete who has a bright future, a High School Star and there is an injury and then this happens. Have we learned more from matt . At the very common story that we are hearing. You know how you talk to that you didnt understand fully the risks. Do you think that there is more that needs to be done . Do you think that people are recognizing that and again i just want to commend you for being here today and im sure its not easy. Thank you. I dont think there is enough being done. I think funding is an issue to get the awareness out to get into the high schools, to get it to the coaches and not to the general public of opioids in general but also as it relates to our athletes. We have great coaches. Jeff and i are very involved and a great athletic trainer and great physicians but as i have told a couple of deliveries we have made in our state it was ignorance. We just didnt know and so i think that is so crucial. Thank you. Any other thoughts on the broader trend on the opioid issue throughout the country in what direction you see it going in . Spin that this is not my area of expertise that i would like to add something senator. I have lost three of my classmates. Im with the graduating class of 88 in my small town in pennsylvania to heroin overdose and i think the thing thats really important said multiple times is outraging communication. What are we not communicating to people where its getting to the point where there is something thats happened because we werent the bad kids. These were bright students. There were people who have transitioned well from high school and college and gone on to professional careers that we have now lost to heroin. What environment is being created out that of the likud opioid use . What are the gateways that people are entering into heroin use and what can we do by having constant communication constant outreach. Growing up there was powell and rap about not using drugs. They saw something and was working and we got away from it. Its about here and there occasionally but is not at the Grassroots Level saying this is really important. You have to stay away from drugs and at some point they are doing something that are really good people from going down a bad path. Iowa cynthia a. I video some of you may have seen it chasing the dragon which is very graphic and scaring the young kids. This can happen to you and trying to get to high schools to wake up all these young men and women but you are certainly correct about the point of how at some of the best and brightest in the country that are getting addicted. Let me finish with one final question again i want to thank everybody for your patience and testimony today. On another issue and dr. But what you mentioned how some of these things are related and i certainly have seen that as well on the issue of the Sexual Assault abuse of our athletes, do we have enough saved guards do you think in place with regards to our young men and women who are some of the finest and most disciplined packs a lot of the reports of alarmed a lot of us and im just wondering the expertise here the panel if you believe we do have enough saved guards. Congress always tries to act and maybe its an appropriate role for what you think the role is that we should be doing in the role that you should be doing . I would be happy to start. Thank you senator sullivan. I think the answer is no. We dont have enough saved guards. That is the reason the u. S. Center for safe sport has been created in the reason we assist in the reason we need to exist. You asked what the senate can do and i will tell you again i think being able, having an authorization following in the footsteps of you saw the being authorizing legislation. Certainly we wouldnt turn down an appropriation but being authorized and legislation goes a long way to establishing the credibility and the need for these safeguards as you have said and its our absolute goal, our mission to not only address the abuse and beat out the bad actors but to get upstream on prevention and to make sure that we are educating all parents and youth sports organizers if you will, the athletes themselves on how to identify behaviors for example. What does that look like and so all of the education and outreach in the training that needs to take place that is not currently taking place. That is why we are here and we are absolutely committed to creating change and again our motto is champion championed respect in and abuse. That is our call to action. Anyone else on that question . I would also say the safeguards we have in place are not enough. What we need in place is uniform baseline education across all the Different Levels of sports from the Grassroots Level moving up into the elite ranks. There needs to be something for when a person of authority is going to be dealing with an athlete on a regular basis what are the baseline requirements to make sure you are going to theres no uniformity across these Different Levels and different organizations that exist and you wake up one morning and say im going to coach people. Hes nice and you are bringing kids homes of baseline education and points of entry and the requirements to make sure we do have conversations those are the things that need to be in order. Quebec thank you. Therefore we conclude i would ask unanimous consent to include in the wreck letters from stakeholders providing additional perspectives on todays hearing including the Sports Coalition and the positive coaching alliance. Without objection, so ordered. A turing wreck will remain open or two weeks. During this time senators are asked to send any questions for the wreck for our witnesses. Upon receipt the witnesses are requested to submit their written answers to the committee as soon as possible. They i want to again thank the witnesses for appearing today. These are very important issues and you can see there is a lot of bipartisan interest and i think motivation to address it on the bipartisan way and we are going to continue to engage with you and others to make sure we address some of these in the best way possible. This hearing is now adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] announcer cspans washington journal, live it every day with news and policy issues that affect you. , authorp this morning graff. Torian garrett discussn hughes will recordings secretly taken in the oval office. Join me discussion. Words,ward n Stuart Taylor is advertised about his new book. What is short general thesis we are looking at . The gist of it is there has been a huge myth that has taken root that there is an epidemic of campus rape. A culture of campus rape encouraged and condoned even by the college administrators. That it is worth worse on campus than it is offcampus and it is worth demolishing all due accused,or those ofecially males who are 99 those accused. It was first ahead by the obama administration. 9 00ncer watch tonight at p. M. Eastern on cspans booktv. Chiefs local police testify on crime, terrorism, Homeland Security, in investigations. They will also discuss the challenges faced in investigations. This is just under two hours. The subcommittee on crime, terrorism, Homeland Security and ve