Im going to go ahead and get this straight. Thank you, everybody. Appreciate it. We are here today to examine the department of health and Human ServicesPublic Health preparedness for and response to the 2017 Hurricane Season. In the last two months, texas, florida, puerto rico, and the u. S. Virgin islands have been devastated by hurricanes. I first want to express our heartfelt sorrow for the millions of americans impacted by these devastating storms and say that all members of this committee on both sides of the aisle stand with those affected by the hurricanes. I would also like to thank dr. Burgess and dr. Ruiz, both members of this subcommittee, who each recently visited puerto rico to assess the impact these hurricanes have had, and continue to have, on our fellowe americans. This committee has been conducting oversight of the federal response to the recent hurricanes since shortly after harvey made landfall in texas. Unfortunately, i expect that our work here will continue for years to come. The committees jurisdiction involves not just the Public Health issues we will be discussing today, but also rebuilding the electrical grid, addressing environmental cleanup, and restoring telecommunications, to name only a few. The people of puerto rico and the u. S. Virgin islands continue to face a long road to recovery and many are living without power and Running Water. We are joined today bynd representative Jenniffer Gonzalezcolon from puerto rico, someone who knows all too well about the difficult challengess her home is facing. Thank you for being here for this important hearing. From coordinating the overall federal health care response, to ensuring that individuals have the medical treatment they need, to protecting the blood and pharmaceutical supply, to granting emergency waivers, andr everything in between, hhs has been working tirelessly to provide medical care and services to individuals affected by the storms. The overwhelming majority of Health Care Facilities in the impacted areas went above and treat to protect and those in harms way. Yet, media reports indicate that some Health Care Providers failed in their duty to protect their patients. There was a tragic situation at a nursing home in florida where fourteen residents died after the facility lost its air conditioning and this despite a hospital across the street that never lost power or cooling. The response in puerto rico and the u. S. Virgin islands has involved numerous federal agencies, working together with each other and state and local officials. For example, before Hurricane Maria made landfall in puerto i rico and every day since, hhs, the department of defense, the department of veterans affairs, and the federal Emergency Management agency, or fema, have been coordinating with local Emergency Response officials to provide medical care and help reestablish the islands health care infrastructure. Hhs has worked with puerto ricos department of health to prioritize resources needed for dialysis facilities and has coordinated with fema to help ensure critical supplies are delivered where they are needed. Similar efforts are ongoing in the u. S. Virgin islands, too. But many questions remain. Has the interagency response been effective, from the perspective of hhs . Are federal policies causing delays in response efforts . Are we utilizing our resources in the most efficient and effective ways to help our fellow americans in puerto rico and the u. S. Virgin islands in particular . Finally, it is critical that we understand the Public Health challenges ahead. Mold formation is likely in nearly all the affected regions. As we have seen after Hurricane Harvey, there is an increased risk for the spread of Infectious Disease due to contaminated water. Media reports indicate that one month after Hurricane Maria, over one million americans are still without clean, safens Drinking Water. Rebuilding puerto rico and the u. S. Virgin islands will take years. The Health Care Systems are inhe dire condition and most of the operational facilities need some degree of assistance. To make matters worse, the electrical grid has been devastated which has significantly hampered Recovery Efforts. We still dont even know the full extent of the damage, let alone when our fellow citizens will have electricity and Running Water restored. We are trying to make sure wene are doing Everything Possible to address the short and longterm needs of those living in the areas impacted by hurricanes harvey, irma, and maria, especially in the face of the Public Health threats that have resulted and will continue to result from these storms. I would like to thank the witnesses for testifying heresl today and i look forward to hearing your testimony. F andd without i will know you fie minutes for an Opening Statement to the Ranking Member from colorado. Thank you so much, mr. Chairman. This 2017 Hurricane Season has been one of the most damaging on record. Hurricane harvey wrote thehe record for the greatest amount of rain recorded from a single Tropical Storm or hurricane in the United States and inundated houston and south texas with more than 51 inches of rain. Hurricane irma became the strongest atlanta hurricane on record for hits the Virgin Islands of Florida Atlantic while the storms have been devastating, Hurricane Marias impact on puerto rico and the u. S. Virgin islands has been nothing less than catastrophic. Mr. Chairman, as you said the scope of potential health risk thats caused by this ongoing crisis is the come into focus but its clearly considerable. Over a month after maria hit, the infrastructure of puerto rico in the Virgin Islands remained decimated. Nearly 80 of puerto rico still doesnt have power and hhs reported that a substantial number of puerto rico hospitals are either nonoperational or required diesel to runic generators in order just to keep functioning. Over a third the puerto rican residents lack reliable access to Potable Water. Contaminated water is also spreading contagious diseases, andr. While i certainly apprecie the effort by volunteers including physicians and nurses volunteering their time with the hhs teams, i and concern for management of hurricane response at a federal level may be hindering response efforts. The federal government i delete probably doesnt have a complete picture of what healthcare challenges exist because, frankly, most of the island of puerto rico lacks adequate communication. N. I think these communities to hold further hearings to address the status of all these Vital Services that you, mr. Chairman, talked about. And even think as time goes on we should have field hearings on puerto rico in particular but also the Virgin Islands, as much of the recovery effort as you so accurately describe involve the jurisdiction of this committee. I cant stress enough how important it is for us to send our staff downca there to investigate this, and how important it is for members to go and investigate this. Part of a a group of members that went after Hurricane Katrina to new orleans to observe the Recovery Efforts. What we found through years of oversight on this subcommittee was that washingtons understanding regarding the situation on thehe ground was vy different and we were able to observe first hand. When we went into the basement of Cherry Hospital we saw what happened to those records. When we had our field hearing, congressman blackburn was and a bunch of the rest of us, and we saw what it happened to Small Business people down there in new orleans. You just cannot substitute for that. As we begin to think about our publicr response as members of congress, we need to see what we are doing on the ground. Mr. Chairman, last week President Trump said the administration deserves a test for its response to the devastation of Hurricane Maria. Given the fact that most residents lack power, nearly 1,000,000 americans lack access to safe and reliable Drinking Water, and english reports of new substances living for many, i find that statement to be breathtaking. I hope that our Witnesses Today are better prepared than that to talk about whats really happening on the ground and what we can do to address this unfolding crisis. I hope it will be the beginning of an ongoing concerted effort to understand whats going on, and i would now like to yield the balance of my time to representative caster who wants to talk appropriate about the Health Challenges facing her state of florida. Well, i think Ranking Member degette forgetting the tie. This into what a cattle with the catastrophic routine season, and with so many challenges ahead. I want to thank our witnesses who are here today. I want to thank all of my colleagues for holy history. Hopefully this is the first of many because this is going to be a very long recovery. After 75 lives lost in texas, 75 lives lost in florida, including 14 related to a nursing home that were completely avoidable, we need to discuss that. We know that we have about 50 deaths in puerto rico so far with the threat of bacterial infections growing. Im very concerned about puerto rico and the whole interplay between the folks that live there and the u. S. Virgin islands and their migration and what that means for the health needs of everyone. On the island, the Drinking Water issueyo is hypocritical. So i look forward to your expert testimony today and theer committees were in the days ahead. D. Thank you your yield back. Gentle video back. Recognize a few chairman of the full committee, mr. Walden of oregon. I think the vicechairman for holy this hearing. I want to express my deepest sympathy for those of an impacted by these horrible storms, particularly our fellow citizens in puerto rico and the u. S. Virgin islands. This committee stands ready to assist in whatever way we can get will continuepp to be diligt in our oversight of the work that the agencies are doing and the needs of the people there. Im very pleased dr. Burgess pictures are Health Subcommittee has only been toin puerto rico, visit some hospitals to look at Health Care Issues between a with much more work to do and we hope to hear from all of you today about whats out there head, where weve made progress, where theres still problems we need to uncover and think of better solutions. Today we examine hhs continue efforts to protect the Public Health in texas, florida, puerto rico and the the u. S. Virgin is in the aftermath of the hurricanes. This is theer first in a seriesf hearings on preparedness for and responses to hurricanes, and in also hold weeks will hearings before the energy and environment subcommittees on these matters. As vicechairman stated this committee will be conducting oversight of the rebuilding of puerto rico and the u. S. Virgin islands for years to come. The Public Health risk typically associate with a Natural Disasters are varied and include heightened incidence of Infectious Diseases, diminished access to medical care and longterm Mental Health trauma, just to name a few of the concerns we all need to be aware of. These risk can be particularly dangerous especially for vulnerable populations such as infants, dialysis patients, individuals who may be immunosuppressed and, of course, the elderly. Tragically we saw this in the aftermath of Hurricane Irma where 14 elderly residents as weve heard before of the Rehabilitation Center of Hollywood Hills in florida loss the lives of result of heat induced death issues after the airconditioning system failed during the storm. Last week this committee sent a bipartisan letter to the Nursing Homes owner requesting information on the facilities Emergency Preparedness plan, inspection history and the steps it took to protect residents after snack conditioning system stopped working. We will do today that while the three major hurricanes to impact the United States in 2017 were distinct and present and continued to present their own unique challenges, many of the protocols that are necessary to conduct an effective Public Health response are immutable. For example, federal agencies responding to disasters must be able to communicate effectively with each other and with local state and territorial officials to identify any areas of need, cheering individuals have adequate access to basic necessities such as food water and medical supplies. As we head into our recovery face its important we also carefully monitor patient as the transition from hospitals or under medical supervision back to their homes. More than 6 of Puerto Ricans are now homeless as a result of the devastating hurricanes. We need toe make sure when patients are discharged from hospitals that they are safe places to go and dont end up on the streets and then back into the hospital. Following Hurricane Maria various media reports have calledup into question whether e federal government hasas adequately meeting its obligation to protectel health d welfare of american citizens in puerto rico and Virgin Islands. On this matter and eager to gain the perspective of our witnesses who have been on the ground, in the areas that have been affected by the most recent hurricanes. Making sure americans in need get the assistance they require cannot and should not be a partisan matter. Certain agencies are not pulling their weight, we want to know. If there are federal laws and policies that are impeding the Recovery Efforts, we want to know as well. In addition also wanted about any best practices that can be clean fun ongoing recovery effort that can be utilized to the response of any future Natural Disaster. Thanks to you and yourur chancef being on the ground trying to do the best you can in these horrible circumstances. We really need to know the facts whats working, whats not, where theyve been shortfalls, what are the Lessons Learned and where do you need additional help to help our citizens. With that, mr. Vice chair, i yield back the balance of my time and look forward to the testimony of eyewitnesses. Before i do that, id also like to welcome our newest member to the committee, mr. Duncan. It was just approved by the house conference this morning, Steering Committee last night replacing dr. Murphy and we are delighted to have you on board to the committee. Thanks for being here today. Thank you, mr. Chairman. Never denies a Ranking Member of the full committee mr. Pallone of new jersey. Thank you, mr. Chairman. Thank you for holding this hearing on this critical issue. I hope this hearing is a first of many hurricane related hearings this Congress Needs to hear further from hhs and other agencies regarding the ongoing response and Recovery Efforts in all of the affected areas. I would like to take a moment to recognize the federal, state and local responders are working hard to address the many Public Health issues whicher exist as response and recovery continues in all the areas that were impacted by these three major hurricanes. I know firsthand of the tragic devastation causedl, by such and its Natural Disasters. In 2012 my district was hit hard by hurricane sandy. Ive never seen worse storm damage in are any in my lifetime. Many of the storm was a worstcase scenario, homes flooded and businesses lost. The fifth and avs coming up this weekend and we still have a lot of people that are not back in their homes or their businesses. Our nation is now experiencing historical levels of destruction andd loss of puerto rico and the Virgin Islands as well as in florida, texas and along the gulf coast in the wake of hurricanes harvey, irma and maria. While no to Natural Disasters are like, the areas affected by these massive