Mike DeWine

Mr. DeWINE

Mr. DeWINE. Mr. President, I suggest the absence of a quorum.

Mr. DeWINE. Mr. President, I ask unanimous consent that the Senate be in a period for morning business until 2 p.m.

Mr. DeWINE

Mr. DeWINE. Mr. President, I ask unanimous consent that the Subcommittee on Clean Air, Climate Change, and Nuclear Safety be authorized to meet on Wednesday, September 24, at 9 a.m. to examine the findings of the General Accounting Office concerning the Federal Emergency Management Agency's financial allocations and activities after the terrorist attacks on September 11, and to conduct oversight on the Federal Emergency Management Agency's effectiveness since becoming part of the Department of Homeland Security. The hearing will take place in SD 406, hearing room.

Mr. DeWINE. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, September 24, 2003 at 2:30 p.m. to hold a hearing on Iraq: Next Steps.

Mr. DeWINE. Mr. President, I ask unanimous consent that the Committee on Governmental Affairs be authorized to meet on Wednesday, September 24, 2003, at 9:30 a.m. for a hearing titled ``Penalty for Public Service: Do the Social Security Government Pension Offset and Windfall Elimination Provision Unfairly Discriminate Against Employees and Retirees?''

Mr. DeWINE. Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, September 24, 2003, at 10 a.m. in room 485 of the Russell Senate Office Building to conduct a hearing on S. 1601, the Indian Child Protection and Family Violence Prevention Act of 2003.

Mr. DeWINE. Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be authorized to meet for a hearing on Intellectual Diversity during the session of the Senate on Wednesday, September 24, 2003 at 10 a.m. in SD-430.

Mr. DeWINE. Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, September 24, 2003 at 9:30 a.m. to hold a hearing on Iraq: Next Steps.

Mr. DeWINE

Mr. DeWINE. Mr. President, I ask unanimous consent that further reading of the amendment be dispensed with.

Mr. DeWINE. Mr. President, I have a substitute amendment at the desk.

Mr. DeWINE. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DeWINE. Mr. President, as chairman of the District of Columbia Subcommittee, it is my pleasure to present to the Members of the Senate this morning a bill that has been approved by the Appropriations Committee. Let me first thank the Senator from Louisiana, Ms. Mary Landrieu, my colleague, for her excellent work on this bill. She has worked very hard with me. I thank her for her efforts in drafting this appropriations bill that is before us this morning. This bill provides $545 million in Federal funds for the District of Columbia, and it also includes the city's own local budget of $5.7 billion. The funds in this bill focus on a number of key priorities for the District of Columbia. I wish to highlight four of those priorities. First is improving the lives and opportunities for children in foster care. Second is enhancing educational opportunities for inner-city students. Third is reducing and preventing crime in the District of Columbia. Fourth is increasing the security in our Nation's Capital. Mr. President, I wish to discuss the first priority at some length-- improving foster care in the District of Columbia. No one who is familiar with our Nation's Capital needs to be reminded about the sorry state of the foster care system in the District of Columbia. No one who reads the Washington Post, no one who lives in the District of Columbia, no one who listens to the radio needs to be reminded of this. The foster care system in the District of Columbia is a scandal; it is a crime; it is a tragedy. The fact that it exists in our Nation's Capital makes it even worse. We have an obligation as Members of the Senate and this Congress to do something about it. Senator Landrieu and I started well over a year ago to focus on the foster care system. We decided to have a series of hearings, where we would bring in experts from the District and from across the country to look at the foster care system in the District of Columbia. Our goal was to try to find out as much as we could about the foster care system in the District of Columbia, try to find out what was wrong with it, and try to find out what we could do as Members of the Senate, what the Federal Government could do to try to be of assistance. This bill represents the first attempt by the Federal Government to directly impact this foster care system in a very meaningful way. What we did was listen to the testimony, listen to the foster parents, listen to the experts, and take their suggestions. What you will find in this bill are the ideas that came from these parents, from the experts, from the people who see this system day after day. We have provided some money, which we believe will help with these ideas and begin to change this system. It is the right thing to do. As Members know, over the years, the District of Columbia has had an abysmal record in protecting the lives and well-being of the children in the District's care. Children in foster care have died, been abused, or they have languished for years in foster care, often bouncing from foster home to foster home without ever finding permanent placement with a loving family. The statistics are shocking. Children in foster care in the District spend an average of 5 years in foster care before they achieve a permanent placement. I will repeat that. The children in the District of Columbia spend an average of 5 years before they ever find a permanent home. Obviously, that means some children languish in foster care much longer than 5 years. That is wrong, and we must do something about it. During our subcommittee hearings, we found that the District of Columbia is unable to track its children in foster care. They cannot even keep track of them. We have this very sophisticated--supposedly-- computer system, yet inputs are not being made, the tracking is not taking place, and complete data is not even available in the child and family services computer system for over 70 percent of children in foster care today. How can we keep track of these poor kids and determine their well-being when much of their personal information is not ever entered into this automated computer system? This simply must change. While putting together this bill, Senator Landrieu and I learned a lot. We learned that only about one-third of the children in foster care who need mental health services are actually receiving the services. Moreover, many children who come into care wait for weeks and weeks, or months and months, before they even receive that first mental health assessment. Let's understand that these are not just your average children. These are children who, many times, have been neglected, abandoned, physically or sexually abused, or they have witnessed, many times, terrifying domestic violence. These are obviously children who need some initial, at least, assessment in regard to their mental health problems. For them to wait months before an assessment is just wrong. It makes no sense. It is just asking for trouble. Clearly, we all understand that these kids, after experiencing trauma and abuse and neglect, are in desperate need of mental health services. We need to provide those services quickly to these children. Furthermore, during our committee hearings on foster care, Senator Landrieu and I learned that there is a severe shortage of social workers in the District. That should not have been a revelation to anybody. We know that from articles we have read in the newspapers. But it was brought home even more starkly in the hearings we held--the shortage of well-trained social workers in the District of Columbia. Many of these workers are carrying extremely high caseloads, making it very difficult for them to do their job. Also, many of these caseworkers simply are not being provided the tools they need to get their jobs done. We found there are several critical needs that, if addressed, could certainly go a long way in improving the lives of thousands of children in the District's foster care system, and it would expedite their placement in stable, loving homes. Therefore, this bill does contain $14 million in new money to address these needs. Let me explain what these new programs and ideas are. No. 1, we provide for intensive early intervention. This means when a child comes into care, the case will be treated as an emergency situation. Just as hospitals triage medical trauma, the District's child and family service agency triage the emotional trauma facing children who are brought into their care. The earlier a child is stabilized, the better his or her chances of avoiding long-term damage. If a child can remain with an appropriate or qualified family member, he or she will face much less emotional trauma. Some of the funds provided in this bill will allow the agency to staff such an early intervention program and will establish a flexible fund for the purchase of beds, clothing, and other items to ensure that a relative can bring a child into his or her home immediately without forcing the child to stay in a group home or foster home. Second, early mental health evaluations and timely mental health services for all children in foster care. What does this mean? The bill provides $3 million for the District's Department of Mental Health to ensure all children receive mental health assessments within 15 days of coming into foster care; further, that all mental health assessment reports are provided to the court within 5 days of assessment and that all children receive mental health services immediately after the court orders those services. This will help alleviate the current intolerable situation. According to the District of Columbia Family Court, in most child abuse and neglect cases where mental health services have been ordered, there are long delays in providing these services to the child or to the family. It can often take up to 6 to 8 weeks, or longer, to complete an evaluation and up to 60 days after the evaluation before the mental health services are actually provided, even in very serious and dangerous situations. Under this bill, that would change. The third provision of this bill will provide for the recruitment and retention of qualified social workers and will begin to deal with this problem. How do we do this? The bill will provide $3 million in new money for the repayment of student loans to encourage social workers to enter or to stay in the field. It will allow this money to be provided as an incentive to pay back student loans if the young social workers agree to continue to stay and work. It will take that burden away from that social worker. One of the problems, of course, is a person wants to be a social worker, they want to do good, they want to stay in the field, but because of this low rate of pay and they have this big burden, this big debt, they cannot stay in the field very long. They have to do something elsewhere where they can make more money to pay back the debt. This bill will help them ease that burden. It is no surprise that the higher the caseload per social worker, the lower the quality of service to each of the children. The District, like many cities, suffers from a high turnover of social workers. That is not good for the kids. In fact, the national current turnover rate has doubled since 1991. Clearly, the relatively low pay and difficult working conditions of social workers have resulted in a child welfare workforce crisis in the District. Without doubt, steps must be taken to encourage more social workers to enter the child welfare workforce and we must improve the salaries, we must improve the working conditions and the training of workers, and we want to retain more of the qualified and experienced social workers. The reality is, the longer a social worker is there, the more experience they get, and we want to retain the experienced social workers. The fourth provision of this new program is recruitment and retention of foster parents. The bill provides $1.1 million to recruit and retain foster parents. CFSA has experienced difficulties with recruiting and retaining an adequate number of appropriate foster care parents. One reason for this is lack of availability of respite care for foster parents. This is one of the items Senator Landrieu and I heard foster parents tell us--good people who were very much overburdened. One mom who came in was taking care of many children. She said: If we just had the opportunity for a few hours to have a break, this would be of great help. Foster parents do not have the same opportunities for respite as biological parents many times do. The funds in this bill would provide emergency respite, planned respite, and ongoing regularly scheduled respite care. This is critical to provide foster parents the rest they need to continue to stay on as foster parents. The fifth provision is to improve computer tracking of all children in foster care. I talked earlier about the situation of the computer system and how bad it is. The bill provides $3 million to move the agency's current client-server system to a Web-based architecture and to provide laptop computers to all CFSA social workers. The subcommittee heard testimony from the General Accounting Office that CFSA's database lacks many active foster care cases and the system is often down. In addition, social workers do not have access to the database via laptop computers when they are with children, foster families, or while waiting in court. This would be a great opportunity to better utilize the precious time of social workers so they can use that time sitting in court or, when they are out in the field, to put the data directly, immediately into that computer. This is to better utilize the precious time social workers have. Social workers now must return to the office late at night and enter the data of children in care. With laptop computers and Web-based access to information, social workers would then be able to enter key data from off-site locations. We want social workers to use that precious time hands on, dealing with kids, dealing with families. That is most important. Using technology better will enable them to spend more time with these families. We want them to spend time on case plans and working with the families. This will enable them to do that. I spoke at length about the foster care initiative in this bill because it is so very important. It breaks new ground. It does something about which Senator Landrieu and I feel very passionately. We feel passionately about it because we learned so much about it in the hearings we held. This subject deserves this Congress's time. It deserves our attention. It deserves our money. As chairman of this subcommittee, I and the ranking member, Senator Landrieu, have listened to far too many horror stories about children dying or being abused in the District's foster care system. As a Federal partner with this city, I believe it is imperative we provide funds and seek ways to protect the lives of these very precious children. It is our duty and it is our moral responsibility to do so. The second priority which this bill funds is enhancing educational opportunities for inner-city kids. This bill provides a total of $40 million new money--I emphasize ``new money''--for three interrelated components: $13 million to promote excellence in traditional public schools in the District of Columbia; $13 million to expand choice through high-quality charter schools; and $13 million for opportunity scholarships for low-income students in failing schools to attend private schools; and $1 million for administrative fees. That is $40 million in new money for the District of Columbia's children to help educate them. This is a balanced approach. It is balanced because, as I said, it is $13 million, $13 million, and $13 million. It is evenly divided. The charter schools, $13 million; public schools, $13 million; and $13 million for the new scholarships. Let us make no mistake about it. This is new money. It is not taking it from the public schools. It is not taking it anywhere else from public education. This is money that Senator Gregg has worked long and hard to come up with, other Members have worked long and hard to come up with, to put together in a package that is balanced, that is reasonable, and that we will be talking about more on the Senate floor later. It is for the kids in the District of Columbia and it makes sense. This is a plus-up in funding. This is new money. It is for the kids in the District of Columbia. Turning to the bill itself, I will read directly from the language of the bill. We will be discussing this later. I think the bill says it very well on page 21, when we talk about these scholarships. It provides students and their families with the widest range of educational options, because that is really what we are talking about: public schools, charter schools, and, with this additional $13 million to scholarships, options for the parents, options for the students. I am pleased to report that this three-sector approach to improving DC schools is wholeheartedly supported by Mayor Anthony Williams. He has been out front in leading the charge for this plan. He was on Capitol Hill yesterday very eloquently describing why this is needed for the District of Columbia. The plan for the District has wide support, but the most important supporters for this program are the thousands of low-income parents of schoolchildren in this city whose children are languishing in failing schools. Under this bill, the priority for children to be able to get these scholarships is children who are in what are described as the failing schools. These parents want an opportunity to try a new approach. I believe they deserve that opportunity. Their hope is for a brighter future for their children. The third priority funded by this bill is reducing and preventing crime in the District of Columbia. The Federal Government entirely funds the DC courts and the Court Services and Supervision Agency. This bill provides a total of $377 million for these agencies, which is $18 million more than the President's budget request. Most of these additional resources are to integrate the 18 different computer systems that track offender and litigation information. In addition, the bill provides additional resources to allow the Court Services and Supervision Agency to enhance its supervision of high-risk sex offenders, as well as offenders with mental health problems and offenders with a history of domestic violence. I submit that these are the most dangerous offenders. These are offenders who are the most likely to cause harm and damage to the citizens of the District of Columbia, and to the tourists and visitors who come here every single day. Senator Landrieu and I held a hearing. We heard from the people in the Government of the District of Columbia and the Federal officials who are charged by law with supervising these individuals who are out on parole and probation. What they told us was these are the most high- risk offenders. They are out on the streets. Right or wrong, they are out on the streets. They told us these are the most dangerous individuals. I must say from my experience years ago as a county prosecutor that there is no doubt these are the most dangerous offenders. What we learned is that the ratio of the supervisors to these offenders today is only 42 to 1, many times. In other words, 42 offenders to 1 supervisor. What our bill would do is to take that ratio down to 25 to 1. It is the right thing to do, and we are going to do it with this bill. We are targeting those dangerous offenders. This is a boost to safety in the District of Columbia. Additional resources also will expand the Agency's use of GPS-based electronic monitoring equipment to ensure that offenders are not near locations such as schools or specific residences. The fourth priority in this bill is increasing security in the Nation's Capital. Since September 11, we all understand the importance of security in the District of Columbia. Therefore, the bill includes security funding, including resources to complete a Unified Communications Center which will be the center for coordinated multiagency responses in the event of regional and national emergencies. Funds also are included to continue to prepare the District's largest hospital, Washington Hospital Center, and its only dedicated children's hospital, Children's National Medical Center, for bioterrorist and chemical attacks. We began this process last year and further funding is in this year's budget. The bill also continues to provide funds to reimburse the District for increased police, fire, and emergency personnel costs associated with the presence of the Federal Government. Let me again thank Senator Landrieu, who is the ranking member of the subcommittee. It is always a pleasure to work with her. She has done a great job on this bill. She and I share the same concerns for the children and the residents who live in our Nation's Capital. We have worked very closely together on this bill. I believe we have put together a bill that is within budget. It is a bill that focuses on improving the well-being of the District's children and protecting the safety of all those who live and work here. So I thank Senator Landrieu, I thank the Chair, and I will at this point yield to Senator Landrieu.

Mr. DeWINE

Mr. DeWINE. I suggest the absence of a quorum.

Mr. DeWINE. Madam President, I ask unanimous consent that the Senate remain in morning business until 3 o'clock.

Mr. DeWINE

Mr. DeWINE. Mr. President, as we proceed with the District of Columbia appropriations bill, I again thank Senator Landrieu for her great work on this bill. We will be proceeding later on today on the issue of the District of Columbia vouchers. I thank Senator Landrieu for her contribution to this discussion. We are working on some possible amendments, but I wish to take this moment, if I can, to also thank Senator Feinstein for her contribution to that section of the bill. As I have stated publicly in the past--I said it yesterday in a press conference--that section of the bill which has to do with vouchers, the scholarship section was significantly improved because of what my colleague from California, Senator Feinstein, contributed to the bill. She came to me and Senator Gregg and said: I have some suggestions; I have some changes; I have some ideas that I think need to be in this bill to improve the bill, to bring more accountability; to ensure the bill's constitutionality; and also to make sure that the Mayor of the city of Washington is much more directly involved in running this scholarship program. We took those suggestions from Senator Feinstein. She drafted sections of the bill, and we incorporated them in the bill. Those changes are now in the bill that is now before the Senate. I appreciate very much her work. I yield, without losing my right to the floor, for a question from Senator Landrieu.

Mr. DeWINE. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DeWINE. Mr. President, I take back my time. I look forward to working with Senator Landrieu to try to accommodate the concerns she has. I know she is well intentioned, certainly dedicated to the children of the District of Columbia, as I talked about earlier today. I believe the bill before us is a good bill. I believe the scholarship program before us is a good scholarship program. I believe it is clearly constitutional. I believe it is a good program in the sense, as I discussed earlier this morning, that it is value-added. It is a balanced program. It is a program that provides a third of the money for scholarships for the children, $13 million. This is all new money, $13 million new money for the District of Columbia schools, and $13 million additional money for charter schools. It is a three-pronged approach, a very balanced program. I think the language is good language. The bill before us is a good bill. In deference to my colleague, with whom I have worked so very closely on this bill over the last few years, certainly we can take some more time to see if it is possible to reach any kind of compromise or accommodation with regard to any additional language that would satisfy her. I am more than happy to take some time to try to do that. I do believe we have a good bill right now. It is a bill that I think is good for the children of the District of Columbia.

Mr. DeWINE

Mr. DeWINE. Madam President, I ask unanimous consent that the Senate stand in recess until 1 p.m.

Mr. DeWINE

Mr. DeWINE. Mr. President, I would like to take a few moments to talk about a bill I will be introducing today, along with Senator Chris Dodd, a bill that has to do with children. It is an issue that is difficult to think about or talk about but one that is critical to many children and their families in our Nation. What I am taking about is what we do, or what we can do, when a child develops a life-threatening or terminal illness. What I am talking about is we need to make sure we do everything in our power to make sick children as comfortable as possible and as happy as possible-- everything in our power to ease their suffering. What I am talking about is the pressing need for comprehensive, compassionate, continuous care for children who are facing death as a result of serious illness; the need to make palliative care available to any child who is seriously ill and who might possibly be facing death. No parent or family member ever expects a child to die. With today's modern medicine and research advances, it is easy to think that only older people die, but, tragically, we all know that is not the case. That is why today, along with Senator Dodd and Congresswoman Pryce and Congressman Murtha, we are introducing a bill, the Compassionate Care for Children Act, 2003, in an effort to help ensure that very sick children receive a continuum of care and that young lives do not end in preventable pain or fear or sadness. Every year, over 55,000 children die in the United States. Some children will die suddenly and unexpectedly, in a car accident, by drowning, or fire, or by choking. Some may even be murdered. Others, though, thousands of children, will be diagnosed with life- threatening illnesses or disease that might eventually, over a period of time, take away their lives. Children with these kinds of illnesses are in and out of hospitals and clinics. They receive chemotherapy and radiation treatments. They might undergo multiple surgeries. They might have nurses and doctors poking and prodding at them nearly all the time. Some of these children are old enough to realize that they might die if the treatments for their diseases might not work. Others are too young to understand that reality. One poor girl--Liza--knew she was going to die. Shortly after her fourth birthday, she was diagnosed with a form of leukemia. For the next year, Liza's parents explored every possible medical option for her, and every possible treatment. They took her to doctor after doctor after doctor, and they had access to the most cutting-edge therapies available to treat Liza's disease. But nothing seemed to work. At the age of 5, Liza began to ask her mother about what would come next, and whether she would soon die after her bone marrow transplant--her last chance for a cure--had failed. Once the medical treatments had failed, hospitals has little else to offer Liza. There was no discussion, tragically, about end-of-life care at the hospital for this little child. No one wanted to admit that they were out of treatment options, that there was no cure, that she wasn't going to get better, have her life restored and her health restored, and that she wasn't going to grow up and become an adult and have her own children someday. There was no discussion of that. No one in that hospital wanted to talk with Liza about death, even though this little girl pleaded with them to do so. Liza's mother told the Washington Post that Liza asked her oncologist to tell her when death was near. This little 5-year-old girl asked her doctor to tell her when she was going to die. Yet on the final night of her life, as this little child lay dying in her mother's arms, near her father and her older sister, Liza asked, ``Why didn't the doctor call to tell me.'' Liza's parents were able to get some hospice care for their daughter during the last 3 months of her life. Tragically, fewer than 10 percent of children who die in the United States ever receive any sort of hospice care. When children like Liza are terminally ill, parents are forced to make decisions for their children under extremely emotional and stressful conditions. The decisions that confront these parents are ones that they never, of course, expected to have to make. Parents want what is best for their children. They want their children to get better and be healthy. They want their children to be pain free. They want their children to receive comfort and care when they are sick. God forbid that parents find out their children are very sick--so sick they are never going to get better, so sick there are no more treatments and no more cures, and so sick they know their children are going to die. Those parents will try to do everything imaginable and everything possible in their power to help their children and make them comfortable, pain-free, and happy in their remaining days. We have an obligation to help those parents achieve those goals. Children with life-threatening diseases and illnesses require special medical attention to make their shortened lives more comfortable. We know that. Yet despite that knowledge, the fact is, current Federal law and regulations do not take into consideration the special care needs of a gravely ill or dying child. In fact, these Federal laws and regulations get in the way of taking care of these children. The legislation we are introducing today would help correct the deficiencies in current law and help sick children facing possible death live more comfortably and live with dignity and would help them receive the comprehensive care they deserve and the comprehensive care we would expect for our own children. Let me take a few moments to explain what our bill actually does. First, it offers grants so doctors and nurses can receive training and education to enable them to better understand these issues and to help them provide end-of-life care for these kids. The goal of these grants is to improve the quality of care terminally ill children receive. One of the ways we do this is to make sure doctors and nurses truly understand these issues so they can provide the care and be better informed. Our bill also provides money for the National Institutes of Health to conduct research in pain and symptom management in children. This research is critically important to improve the type of care dying children receive. A recent article in the New England Journal of Medicine stated that 89 percent of children dying of cancer die experiencing ``a lot or a great deal'' of pain and suffering. This does not have to happen. We can change that, and we must. This is simply not acceptable. Research has to be done so that children will not suffer needlessly. In addition to grants, the second piece of our bill changes the way care is delivered to children with life-threatening illnesses. Right now, doctors, hospitals, and parents have to overcome significant insurance and eligibility barriers to enroll a dying child in hospice. First, to qualify for hospice, a doctor must certify that a child has 6 months or less to live. The problem with this ``6-month rule'' is that it is harder for a doctor to determine the life expectancy of a sick child than it is to determine the life expectancy of a sick adult or elderly person. A child dying of cancer, for example, may die in 6 months or 6 years, making that child ineligible for hospice care that would ensure a comfortable life while that child is alive. It is very difficult many times to estimate how long that child is going to live. This very rigid 6-month predictability rule which denies care is very inhumane for these kids. It is wrong, and we have to change that rule. According to Dr. Joanne Hilden and Dr. Dan Tobin, ``Sick children are still growing, which is a biological process very much like healing. So when a child is diagnosed with illness such as cancer or heart disease, he is much more likely to be cured than an adult.'' Simply put, diseases progress differently in children than adults, and children with terminal diseases get lost in the health care system designed for adults--a health care system that does not take into consideration the special needs of children. Furthermore, the current system does not allow a patient to receive curative and palliative care simultaneously. In other words, current law does not allow doctors to continue trying life-prolonging treatments--treatments that could cure an illness or extend their life, and also at the same time provide palliative care to that patient. In other words, current law does not allow the assistance, the doctors to go in to try to provide typical hospice care where you make that child comfortable and do all the things to alleviate the pain and at the same time you are still trying to save the child's life. That is wrong. That is simply wrong. That presents a parent with a horrible choice, a choice that no parent should have. That is tragic. Palliative care offers a continuum of care, care that involves counseling to families and patients about how to confront death, care that involves making the patient comfortable in his or her sickest hours, care that acknowledges that death is a real possibility. Federal law requires a person who wishes to receive end-of-life care to discontinue receiving curative or life-prolonging treatment. When a child is involved, this means a parent must agree to no longer provide curative treatment, treatment that could cure the child--that is wrong--in order for their child to receive care and support for the possible end of life. This should not be an either/or decision for parents. I don't know of any parent who would give up trying to cure a sick child when there was any chance that child might be saved. They should not be put in this position. Current law places parents in impossible positions. We simply must fix this. End-of-life care should be integrated with curative care so that parents, children, and doctors have access to a range of benefits and services. As I said earlier, palliative care should not be confined to the dying. It should be available to any child who is seriously ill. That is why our bill creates Medicare and private market demonstration programs to remove these barriers, making it simpler and easier for doctors and parents to make end-of-life decisions for children. the demonstration program will allow children to receive curative and palliative care concurrently. This means children can continue to receive treatment and life-prolonging care while receiving palliative care at the same time. The demonstration program also removes the 6-month rule so children can receive palliative care benefit at the time of diagnosis. I take a moment to tell my colleagues about another girl, Rachel Ann. Rachel Ann was a little girl who did receive palliative care from the time she was diagnosed with a grave heart problem. Rachel Ann had a heart that doctors describe as ``incompatible with life.'' Most babies with heart malformations like Rachel Ann die within a matter of days after birth. Rachel Ann's parents were devastated and distraught to see their tiny baby connected to a sea of wire and tubes, clinging to life. Rachel Ann's parents were referred to a pediatric hospice and decided to bring their daughter home from the hospital so she could experience life with her family, surrounded by parents, brothers, relatives and church community at home. Rachel Ann's parents say she seemed truly happy at home. She smiled and wiggled in response to voices and being held. Her brothers doted on their baby sister. Rachel Ann was able to spend her life at home in comfort with her family. She lived for 42 days and her family was able to make every single moment count. On Christmas day, after spending the morning with her family, Rachel Ann passed away. This is truly a tragic story. Fortunately, Rachel Ann and her family were able to spend as much time together as possible with Rachel Ann as comfortable as possible. Her brothers were able to know their sister and to talk with hospice professionals about what was happening to her. Rachel Ann's parents and grandparents also were able to talk about her condition with hospice professionals and maintained an active role in her care. There was a support system in place for this family. The terminal illness of a child must be an incredibly difficult thing to confront for a parent and a family. No one wants to think about children dying. No one wants to believe that children suffer, especially in this age of great medical advances. It is a horrible situation. But it is one that we must face. We can always do more to improve the care that our children receive. We should continue to support research and finding cures for the diseases and illnesses from which children suffer. But until those cures are found, and as long as children die from these diseases, we must provide care and support for a dying child. We have an obligation to provide that care and that support. The bill we will introduce later today will be an important step in this direction. It will provide tools and support networks to help grieving families in their time of need. It is the right thing to do. I encourage my colleagues to join us in cosponsoring this important piece of legislation. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DeWINE

Mr. DeWINE. Mr. President, first, I would like to thank my colleague from Pennsylvania, Senator Santorum, as well as Senator Brownback, Senator Graham of South Carolina, and Majority Leader Frist for their unending and unwavering efforts to put a permanent end to this horrible partial-birth abortion procedure. During the time we have served together in this body, they have never given up hope that this Congress and this country would put an end to this barbaric procedure. Let me also thank my colleague from the State of Ohio, Congressman Chabot, for his tremendous work in this area as well. He has remained dedicated and continues to be focused on this effort. It is time that this Senate, this Congress, this country banned a procedure that is inhumane and that has absolutely no medical purpose and that is, quite simply, morally reprehensible. There is no debate about these facts. There is no debate about what takes place during a partial-birth abortion. I submit to my colleagues that the more we know about this procedure, the worse it is. The more we know about it, the clearer it is that we must oppose it. The more we know about it, the easier it is to ban it once and for all. This is a procedure in which the abortionist pulls a living baby feet first out of the womb and into the birth canal, except for the head, which the abortionist purposely keeps lodged just inside the cervix. As many of us have explained in detail on this Senate floor before, the abortionist then punctures the base of the baby's skull with a long scissors-like surgical instrument and then inserts a tube into the womb removing the baby's brain with a powerful suction machine. This causes the skull to collapse, after which the abortionist completes the delivery of the now-dead baby. These are the essential facts. No one has ever come to the Senate floor to dispute these facts. This is what a partial-birth abortion is. No one can deny the facts. I can think of nothing more inhumane and indifferent to the human condition. Every year the tragic effect of this extreme indifference to human life becomes more and more apparent as the procedure is performed all over this country. It is also, of course, performed in my home State of Ohio and actually performed within 20 miles of my home in Ohio. I have spoken on the Senate floor many times before about two particular partial-birth abortions that occurred in Ohio, and I will take a few minutes to recount these tragedies again. They were two typical partial-birth abortions, typical except for the way they turned out. On April 6, 1999, in Dayton, OH, a woman entered the Dayton Medical Center to undergo a partial-birth abortion. This facility was and tragically continues to be operated by Dr. Martin Haskell, one of the main providers of partial-birth abortions in this entire country. Usually, the partial-birth abortion procedure takes place behind closed doors where it can be ignored, where people do not really know much about it, but in this particular case the procedure was different. There was light shed upon it. This is what happened, and this is how light was shed upon it: This Dayton abortionist inserted a surgical instrument into the woman to dilate her cervix so the child could eventually be removed and then killed. We have to understand that this procedure usually takes 3 or 4 days. This is not a quick procedure. It takes 3 days to do it. The woman went home to Cincinnati, expecting to return for the completion of the procedure in 2 or 3 days. In this case, though, her cervix dilated too quickly and, as a result, shortly after midnight of that day she was admitted to the Bethesda North Hospital of Cincinnati, in her hometown, and the child was born. The medical technician pointed out the child was alive but, sadly, apparently the chance of the baby's survival was slim and after 3 hours and 8 minutes the baby died. The baby was named Hope. On the death certificate, of course, there is a space for cause of death or method of death. In the case of baby Hope, the method of death is listed as ``natural.'' We, of course, know that is not true. We know all the facts. There was nothing natural about the events that led to the death of this tiny little child because baby Hope did not die of natural causes. Baby Hope died the victim of a barbaric procedure that is opposed by the vast majority of the American people. In fact, a Gallup poll conducted in January of this year shows well over 70 percent of the American people want to see this procedure permanently banned because the American people know it is wrong. They feel strongly about it. We as a Senate, Members of the Congress, should listen to the American people. But more importantly, besides listening to the American people, we need to listen to our own conscience. We know this is wrong. To almost underscore the inhumanity of this procedure, 4 months later it happened again; again in Ohio, again with the same abortionist. This time, though, something quite different occurred. Once again, in Dayton, this time on August 18, 1999, a woman who was 25 weeks pregnant went to Dr. Haskell's office for a partial-birth abortion. As usual, the abortionist performed the preparatory steps for this barbaric procedure by dilating the mother's cervix. The next day, the woman went into labor and was rushed to Good Samaritan Hospital--again, not what was expected. Remember, the procedure normally takes 3 full days, but she was rushed there in labor. This time, however, despite the massive trauma to this baby's environment, a miracle occurred and, by the grace of God, this little baby survived and, quite appropriately, she is today called baby Grace. These types of tragedies have been recounted by medical professionals who have been shocked by the events. There are other stories I would like to tell the Members of the Senate. Brenda Pratt Shafer, a registered nurse, was assigned to an Ohio abortion clinic in the early 1990s. She was assigned to the same Dr. Haskell abortion clinic. Nurse Shafer observed Dr. Haskell use the procedure, this procedure, to abort babies. In fact, she testified about it before our Senate Judiciary Committee in 1995. I would like to share with my colleagues what she said because she gave--this nurse did--very gripping, very telling testimony. Nurse Shafer described a partial-birth abortion she witnessed on a child of 26\1/2\ weeks. This is what she observed: The young woman was 18, unmarried, and a little over 6 months pregnant. She cried the entire 3 days she was at the abortion clinic. The doctor told us I am afraid she is going to want to see the baby. Try to discourage her from it. We don't like them to see their babies. Nurse Shafer continues: Dr. Haskell went in with forceps and grabbed the baby's legs and pulled them down into the birth canal. Then he delivered the baby's body and arms, everything but the head. The doctor kept the head right inside the uterus. The baby's little fingers were clasping and unclasping, his little feet were kicking. The baby was hanging there and the doctor was holding his neck to keep his head from slipping out. The doctor took a pair of scissors and inserted them into the back of the baby's head and the baby's arm jerked out with a flinch, a startle reaction like a baby does when he thinks he might fall. The doctor opened up the scissors, stuck a high- powered suction tube into the opening, and sucked the baby's brains out. Now the baby went completely limp. He cut the umbilical cord and delivered the placenta. He threw the baby into a pan along with the placenta and the instruments he had just used. I saw the baby move in the pan. I asked the other nurse and she said it was just reflexes. The baby boy had the most perfect angelic face I think I have ever seen in my life. When the mother started coming around, she was crying. ``I want to see my baby,'' she said. So we cleaned him up and put him into a blanket. We put her in a private room and handed her the baby. She held that baby in her arms, and when she looked into his face, she started screaming: ``Oh, my God, what have I done? This is my baby. This is my baby.'' It is my prayer that there will come a day when I don't have to retell Nurse Shafer's story, that there will come a day when my colleagues, like Senator Santorum and Senator Brownback, the Presiding Officer, Majority Leader Frist, and the rest of us who have fought this battle will not have to come to the Senate floor and talk about partial-birth abortion. Nobody wants to talk about this. But until that day comes when this procedure has been outlawed in our country once and for all, we will have to continue to fight against this ghastly procedure. Now is the time to ban this awful procedure. It simply is the right thing to do. This Senate must do that. (The remarks of Mr. DeWine pertaining to the introduction of S. 1629 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. DeWINE

Mr. DeWINE. Mr. President, I would like to take a few moments to talk about a bill I will be introducing today, along with Senator Chris Dodd, a bill that has to do with children. It is an issue that is difficult to think about or talk about but one that is critical to many children and their families in our Nation. What I am taking about is what we do, or what we can do, when a child develops a life-threatening or terminal illness. What I am talking about is we need to make sure we do everything in our power to make sick children as comfortable as possible and as happy as possible-- everything in our power to ease their suffering. What I am talking about is the pressing need for comprehensive, compassionate, continuous care for children who are facing death as a result of serious illness; the need to make palliative care available to any child who is seriously ill and who might possibly be facing death. No parent or family member ever expects a child to die. With today's modern medicine and research advances, it is easy to think that only older people die, but, tragically, we all know that is not the case. That is why today, along with Senator Dodd and Congresswoman Pryce and Congressman Murtha, we are introducing a bill, the Compassionate Care for Children Act, 2003, in an effort to help ensure that very sick children receive a continuum of care and that young lives do not end in preventable pain or fear or sadness. Every year, over 55,000 children die in the United States. Some children will die suddenly and unexpectedly, in a car accident, by drowning, or fire, or by choking. Some may even be murdered. Others, though, thousands of children, will be diagnosed with life- threatening illnesses or disease that might eventually, over a period of time, take away their lives. Children with these kinds of illnesses are in and out of hospitals and clinics. They receive chemotherapy and radiation treatments. They might undergo multiple surgeries. They might have nurses and doctors poking and prodding at them nearly all the time. Some of these children are old enough to realize that they might die if the treatments for their diseases might not work. Others are too young to understand that reality. One poor girl--Liza--knew she was going to die. Shortly after her fourth birthday, she was diagnosed with a form of leukemia. For the next year, Liza's parents explored every possible medical option for her, and every possible treatment. They took her to doctor after doctor after doctor, and they had access to the most cutting-edge therapies available to treat Liza's disease. But nothing seemed to work. At the age of 5, Liza began to ask her mother about what would come next, and whether she would soon die after her bone marrow transplant--her last chance for a cure--had failed. Once the medical treatments had failed, hospitals has little else to offer Liza. There was no discussion, tragically, about end-of-life care at the hospital for this little child. No one wanted to admit that they were out of treatment options, that there was no cure, that she wasn't going to get better, have her life restored and her health restored, and that she wasn't going to grow up and become an adult and have her own children someday. There was no discussion of that. No one in that hospital wanted to talk with Liza about death, even though this little girl pleaded with them to do so. Liza's mother told the Washington Post that Liza asked her oncologist to tell her when death was near. This little 5-year-old girl asked her doctor to tell her when she was going to die. Yet on the final night of her life, as this little child lay dying in her mother's arms, near her father and her older sister, Liza asked, ``Why didn't the doctor call to tell me.'' Liza's parents were able to get some hospice care for their daughter during the last 3 months of her life. Tragically, fewer than 10 percent of children who die in the United States ever receive any sort of hospice care. When children like Liza are terminally ill, parents are forced to make decisions for their children under extremely emotional and stressful conditions. The decisions that confront these parents are ones that they never, of course, expected to have to make. Parents want what is best for their children. They want their children to get better and be healthy. They want their children to be pain free. They want their children to receive comfort and care when they are sick. God forbid that parents find out their children are very sick--so sick they are never going to get better, so sick there are no more treatments and no more cures, and so sick they know their children are going to die. Those parents will try to do everything imaginable and everything possible in their power to help their children and make them comfortable, pain-free, and happy in their remaining days. We have an obligation to help those parents achieve those goals. Children with life-threatening diseases and illnesses require special medical attention to make their shortened lives more comfortable. We know that. Yet despite that knowledge, the fact is, current Federal law and regulations do not take into consideration the special care needs of a gravely ill or dying child. In fact, these Federal laws and regulations get in the way of taking care of these children. The legislation we are introducing today would help correct the deficiencies in current law and help sick children facing possible death live more comfortably and live with dignity and would help them receive the comprehensive care they deserve and the comprehensive care we would expect for our own children. Let me take a few moments to explain what our bill actually does. First, it offers grants so doctors and nurses can receive training and education to enable them to better understand these issues and to help them provide end-of-life care for these kids. The goal of these grants is to improve the quality of care terminally ill children receive. One of the ways we do this is to make sure doctors and nurses truly understand these issues so they can provide the care and be better informed. Our bill also provides money for the National Institutes of Health to conduct research in pain and symptom management in children. This research is critically important to improve the type of care dying children receive. A recent article in the New England Journal of Medicine stated that 89 percent of children dying of cancer die experiencing ``a lot or a great deal'' of pain and suffering. This does not have to happen. We can change that, and we must. This is simply not acceptable. Research has to be done so that children will not suffer needlessly. In addition to grants, the second piece of our bill changes the way care is delivered to children with life-threatening illnesses. Right now, doctors, hospitals, and parents have to overcome significant insurance and eligibility barriers to enroll a dying child in hospice. First, to qualify for hospice, a doctor must certify that a child has 6 months or less to live. The problem with this ``6-month rule'' is that it is harder for a doctor to determine the life expectancy of a sick child than it is to determine the life expectancy of a sick adult or elderly person. A child dying of cancer, for example, may die in 6 months or 6 years, making that child ineligible for hospice care that would ensure a comfortable life while that child is alive. It is very difficult many times to estimate how long that child is going to live. This very rigid 6-month predictability rule which denies care is very inhumane for these kids. It is wrong, and we have to change that rule. According to Dr. Joanne Hilden and Dr. Dan Tobin, ``Sick children are still growing, which is a biological process very much like healing. So when a child is diagnosed with illness such as cancer or heart disease, he is much more likely to be cured than an adult.'' Simply put, diseases progress differently in children than adults, and children with terminal diseases get lost in the health care system designed for adults--a health care system that does not take into consideration the special needs of children. Furthermore, the current system does not allow a patient to receive curative and palliative care simultaneously. In other words, current law does not allow doctors to continue trying life-prolonging treatments--treatments that could cure an illness or extend their life, and also at the same time provide palliative care to that patient. In other words, current law does not allow the assistance, the doctors to go in to try to provide typical hospice care where you make that child comfortable and do all the things to alleviate the pain and at the same time you are still trying to save the child's life. That is wrong. That is simply wrong. That presents a parent with a horrible choice, a choice that no parent should have. That is tragic. Palliative care offers a continuum of care, care that involves counseling to families and patients about how to confront death, care that involves making the patient comfortable in his or her sickest hours, care that acknowledges that death is a real possibility. Federal law requires a person who wishes to receive end-of-life care to discontinue receiving curative or life-prolonging treatment. When a child is involved, this means a parent must agree to no longer provide curative treatment, treatment that could cure the child--that is wrong--in order for their child to receive care and support for the possible end of life. This should not be an either/or decision for parents. I don't know of any parent who would give up trying to cure a sick child when there was any chance that child might be saved. They should not be put in this position. Current law places parents in impossible positions. We simply must fix this. End-of-life care should be integrated with curative care so that parents, children, and doctors have access to a range of benefits and services. As I said earlier, palliative care should not be confined to the dying. It should be available to any child who is seriously ill. That is why our bill creates Medicare and private market demonstration programs to remove these barriers, making it simpler and easier for doctors and parents to make end-of-life decisions for children. the demonstration program will allow children to receive curative and palliative care concurrently. This means children can continue to receive treatment and life-prolonging care while receiving palliative care at the same time. The demonstration program also removes the 6-month rule so children can receive palliative care benefit at the time of diagnosis. I take a moment to tell my colleagues about another girl, Rachel Ann. Rachel Ann was a little girl who did receive palliative care from the time she was diagnosed with a grave heart problem. Rachel Ann had a heart that doctors describe as ``incompatible with life.'' Most babies with heart malformations like Rachel Ann die within a matter of days after birth. Rachel Ann's parents were devastated and distraught to see their tiny baby connected to a sea of wire and tubes, clinging to life. Rachel Ann's parents were referred to a pediatric hospice and decided to bring their daughter home from the hospital so she could experience life with her family, surrounded by parents, brothers, relatives and church community at home. Rachel Ann's parents say she seemed truly happy at home. She smiled and wiggled in response to voices and being held. Her brothers doted on their baby sister. Rachel Ann was able to spend her life at home in comfort with her family. She lived for 42 days and her family was able to make every single moment count. On Christmas day, after spending the morning with her family, Rachel Ann passed away. This is truly a tragic story. Fortunately, Rachel Ann and her family were able to spend as much time together as possible with Rachel Ann as comfortable as possible. Her brothers were able to know their sister and to talk with hospice professionals about what was happening to her. Rachel Ann's parents and grandparents also were able to talk about her condition with hospice professionals and maintained an active role in her care. There was a support system in place for this family. The terminal illness of a child must be an incredibly difficult thing to confront for a parent and a family. No one wants to think about children dying. No one wants to believe that children suffer, especially in this age of great medical advances. It is a horrible situation. But it is one that we must face. We can always do more to improve the care that our children receive. We should continue to support research and finding cures for the diseases and illnesses from which children suffer. But until those cures are found, and as long as children die from these diseases, we must provide care and support for a dying child. We have an obligation to provide that care and that support. The bill we will introduce later today will be an important step in this direction. It will provide tools and support networks to help grieving families in their time of need. It is the right thing to do. I encourage my colleagues to join us in cosponsoring this important piece of legislation. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DeWINE

Mr. DeWINE. Children's hospitals train almost 30 percent of all pediatricians and half of all pediatric specialists. They also provide more than 40 percent of the hospital care in this country for children needing cardiac surgery, children suffering with cancer, and children with cerebral palsy.

Mr. DeWINE. The House included $305 million in its Fiscal Year 2004 Labor-Health and Human Services-Education bill. I have agreed to withdraw my amendment, but I urge the senior Senator from Pennsylvania to continue working to provide in conference the most funding possible for the Graduate Medical Education program.

Mr. DeWINE. Labor, Health and Human Services, and Education.

Mr. DeWINE. Mr. President, I thank my colleague, Senator Specter, for all of the work he has put into drafting and shepherding the Fiscal Year 2004 Labor-Health and Human Services-Education appropriations bill. His leadership and his efforts should be commended. Last week, I offered an amendment in support of our Nation's children's hospitals. My amendment would equalize the funding that children's hospitals receive compared to adult hospitals. Specifically, the amendment would provide an additional $15 million to fund the pediatric Graduate Medical Education program at $305 million. These monies are used by children's hospitals across the country to hire and retain residents who are interested in pediatric research and in becoming pediatricians. I ask my colleague, the Senior Senator from Pennsylvania, if he supports our Nation's children's hospitals and the Graduate Medical Education program?