Daniel Inouye

Mr. INOUYE

Mr. INOUYE. Mr. President, today, I am reintroducing a bill which is of great importance to a group of patriotic Americans. This legislation is designed to extend space-available travel privileges on military aircraft to those who have been totally disabled in the service of our country. Currently, retired members of the Armed Forces are permitted to travel on space-available basis on non-scheduled military flights within the continental United States and on scheduled overseas flights operated by the Military Airlift Command. My bill would provide the same benefits for 100 percent, service-connected disabled veterans. Surely, we owe these heroic men and women, who have given so much to our country, a debt of gratitude. Of course, we can never repay them for the sacrifice they have made on behalf of all of us but we can surely try to make their lives more pleasant and fulfilling. One way in which we can help is to extend military travel privileges to these distinguished American veterans. I have received numerous letters from all over the country attesting to the importance attached to this issue by veterans. Therefore, I ask that my colleagues show their concern and join me in saying ``thank you'' by supporting this legislation. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. INOUYE. Mr. President, on behalf of our Nation's clinical social workers, I am introducing legislation to amend the Public Health Service Act. This legislation will first, establish a new social work training program; second, ensure that social work students are eligible for support under the Health Careers Opportunity Program and that social work schools are eligible for support under the Minority Centers for Excellence programs; third, permit schools offering degrees in social work to obtain grants for training projects in geriatrics; and fourth, ensure that social work is recognized as a profession under the Public Health Maintenance Organization [HMO] Act. Despite the impressive range of services social workers provide to the people of this Nation, particularly our elderly, disadvantaged, and minority populations, few Federal programs exist to provide opportunities for social work training in health and mental health care. This legislation builds on the health professions education legislation enacted by the 102d Congress enabling schools of social work to apply for AIDS training funding and resources to establish collaborative relationships with rural health care providers and schools of medicine or osteopathic medicine. My bill provides funding for traineeships and fellowships for individuals who plan to specialize in, practice, or teach social work, or for operating approved social work training programs; it assists disadvantaged students to earn graduate degrees in social work with concentrations in health or mental health; it provides new resources and opportunities in social work training for minorities; and it encourages schools of social work to expand programs in geriatrics. Finally, the recognition of social work as a profession merely codifies current social work practice and reflects the modifications made by the Medicare HMO legislation. I believe it is important to ensure that the special expertise and skills social workers possess continue to be available to the citizens of this nation. This legislation, by providing financial assistance to schools of social work and social work students, recognizes the long history and critical importance of the services provided by social work professionals. In addition, since social workers have provided quality mental health services to our citizens for a long time and continue to be at the forefront of establishing innovative programs to serve our disadvantaged populations, I believe that it is time to provide them with the proper recognition of their profession that they have clearly earned and deserve. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, I am introducing legislation today to amend Title VII of the Public Health Service Act to establish a psychology post- doctoral program. Psychologists have made a unique contribution in serving the nation's medically underserved populations. Expertise in behavioral science is useful in addressing many of our most distressing concerns such as violence, addiction, mental illness, children's behavior disorders, and family disruption. Establishment of a psychology post-doctoral program could be most effective in finding solutions to these pressing societal issues. Similar programs supporting additional, specialized training in traditionally underserved settings or with specific underserved populations have been demonstrated to be successful in providing services to those same underserved populations during the years following the training experience. That is, mental health professionals who have participated in these specialized federally funded programs have tended not only to meet their payback obligations, but have continued to work in the public sector or with the underserved populations with whom they have been trained to work. While the doctorate in psychology provides broad-based knowledge and mastery in a wide variety of clinical skills, the specialized post- doctoral fellowship programs provide particular diagnostic and treatment skills required to effectively respond to these underserved populations. For example, what be a withdrawal related to hearing loss, or what looks like poor academic motivation in a child recently relocated from Southeast Asia might be reflective of a cultural value of reserve rather than a disinterest in academic learning. Each of these situations requires very different interventions, of course, and specialized assessment skills. Domestic violence is not just a problem for the criminal justice system, it is a significant public health problem. A single aspect of the issue, domestic violence against women results in almost 100,000 days of hospitalization, 30,000 emergency room visits, and 40,000 visits to physicians each year. Rates of child and spouse abuse in rural areas are particularly high as are the rates of alcohol abuse and depression in adolescents. A post-doctoral fellowship program in the psychology of rural populations could be of special benefit in addressing these problems. Given the changing demographics of the nation--the increasing life span and numbers of the elderly, the rising percentage of minority populations within the country, as well as an increased recognition of the long-term sequelae of violence and abuse--and given the demonstrated success and effectiveness of these kinds of specialized training programs, it is incumbent upon us to encourage participation in post-doctoral fellowship programs that respond to the needs of the nation's underserved. Mr. President, I ask unanimous consent that the text of the bill be printed in the Congressional Record.

Mr. INOUYE. Mr. President, I am introducing legislation today to modify title VII of the U.S. Public Health Service Act in order to provide students enrolled in graduate psychology programs with the opportunity to participate in various health professions loan programs. Providing students enrolled in graduate psychology programs with eligibility for financial assistance in the form of loans, loan guarantees, and scholarships will facilitate a much needed infusion of behavioral science expertise into our public health efforts. There is a growing recognition of the valuable contribution that is being made by our nation's psychologists toward solving some of our nation's most distressing problems such as domestic violence, addictions, occupational stress, child abuse, and depression. The participation of students of all kinds is vital to the success of health care training. The title VII programs play a significant role in providing financial support for the recruitment of minorities, women, and individuals from economically disadvantaged backgrounds. Minority therapists, for example, have an advantage in the provision of critical services to minority populations because they are more likely to understand or, perhaps, share the cultural background of their clients and are often able to communicate to them in their own language. Also significant is the fact that, when compared with non-minority graduates, ethnic minority graduates are less likely to work in private practice and more likely to work in community or non-profit settings, where ethnic minority and economically disadvantaged individuals are more likely to seek care. It is important that a continued emphasis be placed on the needy populations of our nation and that continued support be provided for the training of individuals who are most likely to provide services in underserved areas. Mr. President, I ask unanimous consent that the text of this bill be printed in the Congressional Record.

Mr. INOUYE. Mr. President, today I am introducing legislation to amend Title XVIII of the Social Security Act to correct discrepancies in the reimbursement of clinical social workers covered through Medicare, Part B. The three proposed changes that are contained in this legislation are necessary to clarify the current payment process for clinical social workers and to establish a reimbursement methodology for the profession that is similar to other health care professionals reimbursed through the Medicare program. First, this legislation would set payment for clinical social worker services according to a fee schedule established by the Secretary. Currently, the methodology for reimbursing clinical social another non-physician provider group, creating a greater differential in charges than that which exists in the marketplace. I am aware of no other provision in the Medicare statute where one non-physician's reimbursement rate is tied to that of another non-physician provider. This is a precedent that clinical social workers understandably wish to change. I also wish to see that clinical social workers' services are valued on their own merit. Second, this legislation makes it clear that services and supplies furnished incident to a clinical social worker's services are a covered Medicare expense, just as these services are currently covered for other mental health professionals in Medicare. Third, the bill would allow a clinical social worker to be reimbursed for services provided to a client who is hospitalized. Clinical social workers are valued members of our health care provider team. They are legally regulated in every State of our Nation and are recognized as independent providers of mental health care throughout the health care system. Clinical social worker services were made available to Medicare beneficiaries through the Omnibus Budget Reconciliation Act of 1989. I believe that it is time now to correct the reimbursement problems that this profession has experienced through Medicare. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, today I am introducing legislation to authorize the autonomous functioning of clinical psychologists and clinical social workers within the Medicare comprehensive outpatient rehabilitation facility program. In my judgment, it is truly unfortunate that programs such as this currently require clinical supervision of the services provided by certain health professionals and do not allow each of the various health professions to truly function to the extent of their State practice acts. In my judgment, it is especially appropriate that those who need the services of outpatient rehabilitation facilities have access to a wide range of social and behavioral science expertise. Clinical psychologists and clinical social workers are recognized as independent providers of mental health care services through the Federal Employees Health Benefits Program, the Civilian Health and Medical Program of the Uniformed Services, the Medicare (Part B) Program, and numerous private insurance plans. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, I introduce the Rural Preventive Health Care Training Act of 1995, a bill that responds to the dire situation our rural communities face in obtaining quality health care and disease prevention programs. Recently, the Institute of Medicine [IOM] released a report from their 2-year study entitled, ``Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research.'' This study, mandated by the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, of which I am a member and the distinguished Senator from Pennsylvania is Chair, highlights the benefits of preventive care for all health problems. Almost one fourth of Americans live in rural areas and thus frequently lack access to adequate physical and mental health care. For example, approximately 1,700 rural communities in virtually every State of the union suffer critical shortages of health care providers. As many as 21 million of the 34 million people living in underserved rural areas are without access to a primary care provider. In areas where providers exist, there are numerous limits to access, such as geography and distance, lack of transportation, and lack of knowledge about available resources. Additionally, due to the diversity of rural populations, ranging from native Americans to migrant farm workers, language and cultural obstacles are often a factor. Compound these problems with slim financial resources and many of America's rural communities go without vital health care, especially preventive care. Children fail to receive immunizations and routine checkups. Preventable illnesses and injuries occur needlessly and lead to expensive hospitalizations. Early symptoms of emotional problems and substance abuse go undetected and often develop into full blown disorders. Rural health care providers face a lack of training opportunities. Training in prevention is crucial in order to meet the demand for care in underserved areas. The Institute of Medicine Committee recommended that Congress and Federal agencies should immediately take steps to develop and support the training of additional researchers who can develop new preventive intervention research trials as well as evaluate the effectiveness of current service projects. Beyond the scope of simple prevention training, interdisciplinary preventive training in rural health is important because of a growing array of evidence that links mental disorders to physical ailments. For example, it has been estimated that from 50 to 70 percent of visits to physicians for medical symptoms are due in part or whole to psychosocial problems. By encouraging interdisciplinary training, rural communities can integrate the behavioral, biological, and psychological sciences to form the most effective preventive care possible. The problems with quality, access, and understanding of health care in rural areas all suggest that promoting interdisciplinary training of psychologists, nurses, and social workers is essential. The need becomes clearer when considering that many of the behavior-related problems afflicting rural communities are amenable to proven risk reduction strategies that are best provided by trained mental health care professionals. Interdisciplinary team prevention training will facilitate both health and mental health clinics sharing single service sites and routine consultation between groups. Social workers, psychologists, clinical psychiatric nurse specialists, and paraprofessionals play an important role in extending rural mental health services to those in need. Linkage of these services can provide better utilization of existing mental health care personnel, increase awareness and understanding of mental health services, and contribute to the overall health of rural communities. The Rural Preventive Health Care Training Act of 1995, targeted specifically toward rural communities, would implement the risk- reduction model described in the IOM study. This model is based on the identification of risk factors for a certain disorder and the implementation of specific preventive strategies to target groups with those risk factors. The IOM Committee aptly demonstrates that methods of risk reduction have proven highly successful in many health-related areas, such as cardiovascular disease, smoking reduction, and the numerous childhood diseases and conditions that are preventable by early prenatal care for pregnant women. The cost of human suffering caused by poor health is immeasurable, but the huge financial burden placed on communities, families, and individuals is evident. By implementing preventive measures, the potential for savings in psychological and financial realms is enormous. This savings is the goal of the Rural Preventive Health Care Training Act of 1995. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, today, I rise to introduce legislation which amends Public Law 97-359, the Amerasian Immigration Act, to include Amerasian children from the Philippines and Japan as eligible applicants. This legislation also expands the eligibility period for the Philippines until the completion of the last United States military base closure and until the date of enactment of the proposed legislation for Japan. Under the current Amerasian immigration law, only children born in Korea, Laos, Kampuchea, Thailand, and Vietnam after December 31, 1950, and before October 22, 1982, who were fathered by United States citizens, are allowed to immigrate to the United States. When this legislation was first introduced in the 97th Congress, it included Amerasian children born in the Philippines and Japan with no time limits concerning their births. The final version of this bill, however, included only areas where the United States had engaged in active military combat from the Korean War onward, and hence, excluded both the Philippines and Japan. Although the Philippines and Japan were not considered a war zone from 1950 to 1982, the extent and nature of United States military involvement in both countries were quite similar to the involvement of the United States military in other Asian countries during the Korean and Vietnam wars. As a result, interracial marriages in both countries were common, thereby leading to a significant number of Amerasian children fathered by U.S. citizens. There are now over 50,000 Amerasian children in the Philippines and 6,000 Amerasian children in Japan born between 1987 and 1992. These children face similar problems to the Amerasian children provided for under Public Law 97-359. Due to the illegitimate or mixed ethnic make-up, they are often ostracized within their home countries. This stigmatization, in turn, leaves many without viable opportunities of employment, education, or family life. As a result, Amerasian children are subjected to conditions of severe poverty and prejudice, with very little hope of escaping their plight. Public Law 97-359 was passed in hopes of redressing the situation of Amerasian children in Korea, Laos, Kampuchea, Thailand, and Vietnam. Now is the time for the Senate to recognize our responsibilities to Amerasian children in the Philippines and Japan, and pass legislation that would lessen the severity of their impoverished lives. Mr. President, I ask unanimous consent that the text of my bill be placed in the Record.

Mr. INOUYE. Mr. President, today, I rise to introduce legislation which amends title 38, United States Code, to restore full veterans' benefits, by reason of service, to certain organized military forces of the Philippine Commonwealth Army and the Philippine Scouts. On July 26, 1941, President Roosevelt issued a military order that called members of the Philippine Commonwealth Army into the service of the United States Forces of the Far East. Under the Command of General Douglas MacArthur, our Filipino allies joined alongside American soldiers in fighting some of the most fierce battles of World War II. From the onset of the war through February 18, 1946, Filipinos who were called into service under President Roosevelt's order were entitled to full veterans' benefits by reason of their active service in our armed forces. Unfortunately, on February 18, 1946, the Congress enacted the Rescission Act of 1946 (now codified as Section 107, Title 38, United States Code), which states that service performed by these Filipino veterans is not deemed as active service for purposes of any law of the United States conferring rights, privileges, or benefits. On May 27, 1946, the Congress extended the limitation on benefits to the new Filipino Scout units. Interestingly enough, Section 107 denied Filipino veterans access to health care, particularly for nonservice connected disability, and denied them other benefits such as pensions and home loan guarantees. Additionally, Section 107 limited the benefits received for service- connected disabilities and death compensation to 50 percent of what was received by their American counterparts. As a result, Filipino veterans sued to obtain relief from this discriminatory treatment. The U.S. District Court for the District of Columbia, on May 12, 1989, in Quiban v. U.S. Veterans Administration, declared Section 107 unconstitutional. However, the U.S. Court of Appeals for the District of Columbia reversed that ruling and the veterans did not file a petition for certiorari to the U.S. Supreme Court. Thus, the Congress is responsible for rectifying this injustice. For many years, Filipino veterans of World War II have sought to correct this injustice by seeking equal treatment for their valiant military service in our Armed Forces. We must not ignore the recognition they duly deserve as U.S. veterans. Accordingly, I urge my colleagues to support this measure which would restore full veterans' benefits, by reason of service, to our Filipino allies of World War II. Mr. President, I ask unanimous consent that the text of my bill be placed in the Record.

Mr. INOUYE. Mr. President, today I am introducing the ``Physical and Occupational Therapy Education Assistance Act of 1995''. This legislation will assist in educating greater numbers of physical and occupational therapy practitioners to meet the current and future demand for the valuable services they provide our communities. In its most recent report, the Department of Labor's Bureau of Labor Statistics projected that the demand for services provided by physical and occupational therapy practitioners will increase dramatically over the next decade. According to the Bureau, between 1992 and 2005 the increase in demand will create a need for 79,400 additional physical therapists, an 88% increase over 1992 figures. Demand for physical therapist assistants is expected to grow at an even faster rate, experiencing a 93% increase over the same period. High demand is also expected for occupational therapists and occupational therapist assistants at 60% and 78%, respectively, by the year 2005. Current shortages exacerbate the problem and call for quick response. In a survey released in May 1994 regarding hospital employment (1992 Survey of Human Resources), the American Hospital Association confirmed that physical therapy and occupational therapy maintain the highest average vacancy rates at 16.3% and 14%, respectively, of 26 health occupations. The legislation I introduce today would provide necessary assistance to physical therapy and occupational therapy programs throughout the country to address this current problem and assist in providing an adequate work force for the future. In awarding grants, preference would be given to those applicants that train practitioners in either rural or urban medically underserved communities. In addition, a shortage of physical and occupational therapy faculty threatens the ability of education programs to train an adequate supply of practitioners. The critical shortage of doctorally prepared physical and occupational therapists has resulted in an almost nonexistent pool of potential faculty. For the 1993 academic year, 65 faculty shortages were reported from the 131 accredited, professional-level physical therapy programs in the United States. Similarly, 50 faculty shortages were reported from the 85 accredited, professional-level occupational therapy programs. The legislation I introduce today would assist in the development of a pool of qualified faculty by giving preference to those grant applicants seeking to develop and expand post-professional programs for the advanced training of physical and occupational therapists. Passage of the ``Physical and Occupational Therapy Education Assistance Act of 1995'', as part of this year's reauthorization of Title VII of the Public Health Service Act, is essential to ensure adequate numbers of providers to meet the health needs of our nation. I look forward to working with my colleagues in the Congress and the Administration to enact this legislation. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, I rise today to introduce the Nursing School Clinics Act of 1995, a bill that has two main purposes. First, it builds on our concerted efforts to provide access to quality health care for all Americans by furnishing grants and incentives for nursing schools to establish primary care clinics in areas where additional medical services are most needed. Second, it provides the opportunity for nursing schools to enhance the scope of their students' training and education by giving them firsthand clinical experience in primary care facilities. hand and resources are tight, the most important act is the one that makes full use of all available resources. The American health care system is particularly deficient in this regard. We all know only too well that many individuals in the Nation have no or inadequate access to health care services, especially if they live in many of our rural towns and villages or inhabit our Indian communities. Many good people are trying to deliver services that are so vitally needed, but we need to do more. We must make full use of all health care practitioners, especially those who have been long waiting to give the nation the full measure of their professional abilities. Nursing is one of the noblest professions, with an enduring history of offering effective and sensitive care to those in need. Yet it is only in the last few years that we have begun to recognize the role that nurses can play as independent providers of care. Only recently, in 1990, Medicare was changed to authorize direct reimbursements to nurse practitioners. Medicaid is gradually being reformed to incorporate their services more effectively. The Nursing School Clinics Act continues the progress toward fully incorporating nurses in the delivery of health care services. Under the act, nursing schools will be able to establish clinics, supervised and staffed by nurse practitioners and nurse practitioner students, that provide primary care targeted to medically underserved rural and Native American populations. In the process of giving direct ambulatory care to their patients, these clinics will also furnish the forums in which both public and private schools of nursing can design and implement clinical training programs for their students. Simultaneous school-based education and clinical training have been a traditional part of physician development, but nurses have enjoyed fewer opportunities to combine classroom instruction with the practical experience of treating patients. This bill reinforces the principle for nurses of joining schooling with the actual practice of health care. To accomplish these objectives, title XIX of the Social Security Act is amended to designate that the services provided in these nursing school clinics are reimbursable under Medicaid. The combination of grants and the provision of Medicaid reimbursement furnishes the incentives and operational resources to start the clinics and to keep them going. To meet the increasing challenges of bringing cost-effective and quality health care to all Americans, we are going to have to think about and debate a variety of proposals, both large and small. Most important, however, we must approach the issue of health care with creativity and determination, ensuring that all reasonable avenues are pursued. Nurses have always been an integral part of health care delivery. The Nursing School Clinics Act of 1995 recognizes the central role they can perform as care givers to the medically underserved. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, I rise to introduce a bill to provide much needed centers of job training assistance for Native Hawaiians and Native American Samoans. These populations, facing unemployment rates far above the state and national averages, are in desperate need of accessible, effective, and culturally sensitive programs to gain the skills necessary to compete in today's workplace. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. INOUYE. Mr. President, I rise to introduce a bill that begins to address the need for culturally sensitive math and science education targeted toward Native American, Native Hawaiian and Pacific Islander students. Native American, Native Hawaiian and Pacific Island students perform significantly below the national average in these subjects at the elementary and secondary levels and are extremely underrepresented in math and science majors at the college level. My legislation would provide for the development and implementation of culturally sensitive math and science curricula emphasizing the scientific achievements of these native cultures. I ask unanimous consent that the bill be printed in the Record.

Mr. INOUYE. Mr. President, I am introducing legislation today to amend Chapter 74 of Title 38, United States Code, to revise certain provisions relating to the appointment of clinical and counseling psychologists in the Veterans Health Administration [VHA]. The VHA has a long history of maintaining a staff of the very best health care professionals to provide care to those men and women who have served their country in the Armed Forces. It is certainly fitting that this should be done. Recently a quite distressing situation regarding the care of our veterans has come to my attention. In particular, the recruitment and retention of psychologists in the VHA of the Department of Veterans Affairs has become a significant problem. The Congress has recognized the important contribution of the behavioral sciences in the treatment of several conditions from which a significant portion of our veterans suffer. For example, programs related to homelessness, substance abuse, and post traumatic stress disorder [PTSD] have received funding from the Congress in recent years. Certainly, psychologists, as behavioral science experts, are essential to the successful implementation of these programs. However, the high vacancy and turnover rates for psychologists in the VHA (over 11% and 18% respectively as reported in one recent survey) might seriously jeopardize these programs and will negatively impact overall patient care in the VHA. Recruitment of psychologists by the VHA is hindered by a number of factors including a pay scale not commensurate with private sector rates of pay as well as by the low number of clinical and counseling psychologists appearing on the register of the Office of Personnel Management [OPM]. Most new hires have no post-doctoral experience and are hired immediately after a VA internship. Recruitment, when successful, takes up to six months or more. Retention of psychologists in the VA system poses an even more significant problem. I have been informed that almost 40% of VHA psychologists had five years or less of post-doctoral experience. Without doubt, our veterans would benefit from a higher percentage of senior staff who are more experienced in working with veterans and their particular concerns. May bill provides incentives for psychologists to continue their work with the VHA and seek additional education and training. Several factors are associated with the difficulties in retention of VHA psychologists including low salaries and lack of career advancement opportunities. It seems that psychologists are apt to leave the VA system after 5 years because they have almost reached peak levels for salary and professional development in the VHA. Furthermore, under the present system psychologists cannot be recognized nor appropriately compensated for excellence or for taking on additional responsibilities such as running treatment programs. In effect, the current system for hiring psychologists in the VHA supports mediocrity, not excellence and mastery. Our veterans with behavioral disorders and mental health problems are deserving of better psychological care from more experienced professionals than they are currently receiving. A hybrid Title 38 appointment authority for psychologists would help ameliorate the recruitment and retention problems in several ways. The length of time it takes to recruit psychologists could be abbreviated by eliminating the requirement for applicants to be rated by the Office of Personnel Management. This would also facilitate the recruitment of applicants who are not recent VA interns by reducing the amount of time between that applicant a position. It is expected that problems in retention of behavioral science experts will be greatly alleviated with the implementation of a hybrid Title 38 system for VA psychologists, primarily through offering financial incentives for psychologists to pursue professional development with the VHA. Achievements that would merit salary increases under Title 38 should include such activities as assuming supervisory responsibilities for clinical programs, implementing innovative clinical treatments that improve the effectiveness and/or efficiency of patient care, making significant contributions to the science of psychology, earning the ABPP diplomat status, and becoming a Fellow of the American Psychological Association. Currently, psychologists are the only doctoral level health care providers in the VHA who are not included in Title 38. This is, without question, a significant factor in the recruitment and retention difficulties that I have addressed. Ultimately, an across-the-board salary increase might be necessary. However, the conversion of psychologists to a hybrid Title 38, as proposed by this amendment, would provide relief for these difficulties and enhance the quality of care for our Nation's veterans and their families. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, this private relief bill that I am introducing would authorize a certificate of documentation and coastwise trade endorsement for the vessel Bagger, a small boat to be used for charter fishing. I ask unanimous consent that the bill be printed in the Record.

Mr. INOUYE. Mr. President, all to often we find that our Nation's Civilians who have been captured by a hostile government do not receive the recognition they deserve. My bill would correct this inequity and provide a prisoner-of-war medal for civilian employees of the Federal Government. Mr. President, I ask unanimous consent that the bill be printed in the Record.

Mr. INOUYE. Mr. President, today I am introducing a bill to allow for the deferral of duty on merchandise admitted into a U.S. foreign trade zone, or subzone, for use within such a zone as production equipment, or parts thereof, until such merchandise is completely assembled, installed, tested, and used in the production for which it was admitted. This bill does not relieve any manufacturer operating in a U.S. foreign trade zone or subzone of its obligation to pay all applicable duty on such equipment, but rather it would allow these firms to defer the payment of duty until the equipment begins commercial operations in the zone or subzone, or enters the customs territory of the United States. The duty chargeable shall be at the same rate as would have been imposed on such production machinery and related equipment, and parts thereof--taking into account the privileged foreign or nonprivileged foreign zone status of merchandise--had duty been imposed at the time of entry into the customs territory of the United States. This legislation provides several practical advantages for U.S. manufacturers. Production equipment entering customs territory subject to duty often must be stored, assembled, tested, and/or reconfigured prior to beginning commercial operation for its intended purpose. Many times this equipment is found to be broken, flawed, lacking in components or materials and/or otherwise scrapped as useless. If duties have been filed, recovery of these funds through drawbacks can be burdensome and often full recovery of these financial resources is never realized. This can provide a tremendous financial strain on U.S. manufacturing firms by imposing an unnecessary economic burden. Under current law, production and capital equipment can be produced or assembled in one foreign trade zone, entered into the customs territory with payment of duties, and then transferred to another zone where it will be used. However, for many firms this is not always a realistic solution. Often production and capital equipment used in a foreign trade zone, once assembled, cannot be moved. Prior to 1988, the U.S. Customs Service allowed for the deferral of duty on foreign production equipment in U.S. foreign trade zones where it was to be used until such time as the equipment was placed in commercial operation. In 1988, however, Customs overturned its own ruling without any direction from the Congress. My legislation is consistent with the intent of the Foreign Trade Zones Act of 1934--19 U.S.C. 81(c)--which provides for the deferral of duty on merchandise in a foreign trade zone. Mr. President, I realize this bill will not eliminate the U.S. trade imbalance but it will remove an unnecessary economic burden on U.S. manufacturers and will further enhance our ability to compete in the global marketplace. Further, it will help preserve the American manufacturing base and preserve American jobs. For these reasons, I urge my colleagues to support the prompt passage of this important legislation. Mr. President, I ask unanimous consent that the text of my bill be placed in the Record.

Mr. INOUYE. Mr. President, today I am introducing legislation to provide for a Federal income tax credit for those families who purchase a child restraint system for their automobiles. Accidents and injuries continue to cause almost half of the deaths of children between the ages of one and four, more than half of the deaths of children between five and fifteen, and continue to be the leading cause of death among children and young adults. It is my understanding that although the Department of Transportation has made injury prevention among children a top priority, a significant number of parents either do not have adequate child restraint systems or do not have them properly installed. It is imperative that we create this opportunity to provide America's parents with a financially accessible alternative to the insufficient level of child safety measures currently available for use in automobiles. Mr. President, I ask unanimous consent that the text of this bill be printed in the Congressional Record.

Mr. INOUYE. Mr. President, I rise today to introduce a bill that will add a measure of fairness to the Perishable Agriculture Commodities Act of 1930 [PACA], which currently ignores an important segment of perishable agricultural items, namely, fresh cut flowers and fresh cut foliage. The PACA currently protects the interests of consumers and producers of fresh fruits and vegetables by requiring that the Secretary of Agriculture provide a licensing mechanism for brokers and dealers of these products. In addition, the PACA defines unfair and unlawful practices by such brokers and dealers, requires that such brokers and dealers hold commodities and proceeds of sales in trust for the benefit of unpaid growers, and outlines administrative and judicial causes of action for anyone injured by any violations of the PACA. The purpose of the PACA is to ensure that the public is assured of quality in the marketing of fresh products and that the producers' interests are protected when they entrust a shortlived commodity to a broker or dealer for transfer and sale. Consumers and producers of fresh cut flowers and fresh cut foliage experience many of the same risks as consumers PACA seeks to alleviate. For this reason, consumers and producers of fresh cut flowers and fresh cut foliage should be afforded the same quality control and protections provided by the PACA with respect to fruits and vegetables. I urge my colleagues to join me in supporting my bill which will amend the PACA to include fresh cut flowers and fresh cut foliage in its coverage. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. INOUYE. Mr. President, I rise today to introduce a bill that will address an important need of the people of American Samoa. The American Samoa Nutrition Assistance Program [ASNAP], which serves the low-income elderly, blind and disabled in American Samoa, operates as a modified Food Stamp program coordinated by the Food and Nutrition Service [FNS] of the U.S. Department of Agriculture [USDA]. The ASNAP is currently supported through annual appropriations out of discretionary funds in the FNS account. Because of the small population of American Samoa--approximately 53,000 people--and the limited scope of the beneficiaries of this program, the cost of ASNAP only amounts to approximately $5.5 million annually. Yet, this is an important program to those individuals who look to it for sustenance. Unfortunately, the discretionary funding mechanism for the ASNAP makes annual funding unsure and makes it difficult for administrators to plan ahead. Similar programs for Puerto Rico and the Commonwealth of the Northern Mariana Islands are supported with mandatory funds through the Food Stamp Act of 1977. There is no reason that the ASNAP should be treated any differently. It should be funded through the identical mechanism. My bill will require the Secretary of Agriculture to extend the ASNAP to the low-income elderly, blind and disabled people of American Samoa under the Food Stamp Act. I urge my colleagues to join me in making this small, but worthwhile gesture for the benefit of those in need in American Samoa. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. INOUYE. Mr. President, today I am introducing legislation that is directed to relieving the suffering of a small but significant number of our citizens--patients who are terminally ill with cancer and whose pain has not been effectively mitigated with currently available medications. For many years, the thought of cancer and its accompanying pain have sent chills of fear through all of us; likewise, the thought of heroin and its addictive qualities produces similar fears. In my judgment, we are in a position now where we can make a logical and thoughtful decision to legalize the therapeutic use of heroin for the terminally ill cancer patient suffering intractable pain while at the same time safeguarding against the diversion of the drug into illicit channels. The legislation I am introducing today is supported by thousands of Americans. Furthermore, it reflects the evolution and attitude of our Nation's health care system as evidenced by an editorial in the January 14, 1982, issue of the prestigious New England Journal of Medicine, that urged more flexibility in the use of addictive drugs in the treatment of pain. This attitude is also present in an official statement made by the American Psychiatric Association that endorses the ``principle that the effectiveness of relief of pain in terminal cancer patients should take priority over a concern about `addiction' of the terminal cancer patient and should take priority over a concern about medication diversion to addicts''. A later article in the August 23, 1984 issue of the New England Journal of Medicine by Dr. Allen Mondzac reviewed the unique characteristics of heroin and its valuable clinical role where it is available. The need for this legislation is dramatic. Although over the past two decades, a great deal of progress has been made in treating cancer, each year an estimated 800,000 Americans are diagnosed as having cancer, and over 400,000 die from the disease. Most of these individuals will have received competent and compassionate medical care, and many will receive adequate relief of pain. Unfortunately, the reality is also that a certain number of cancer patients do not obtain relief of pain from the current available analgesic medication--even the strongest narcotics. A panel from the National Institutes of Health [NIH] convened in May 1986 and heard testimony that 50 to 60 percent of patients with cancer pain lived the last part of their lives with unrelieved pain. A recent, 1992, survey by the Eastern Cooperative Oncology Group has found that as a general rule, patients underreport pain and physicians undertreat it. As a minimal figure, it has elsewhere been estimated that about 20 percent of terminal cancer patients suffer significant pain. Of this 20 percent, it has been estimated that 10 percent do not obtain relief with presently prescribed medications. In human terms, these percentages mean that as many as 8,000 Americans will die in agony this year because of the intractable pain associated with terminal cancer. I have been assured by experts in the field that in many cases this pain can be alleviated with the therapeutic use of heroin, making the last months, weeks, or days of these patients more bearable. These dying patients are not now given the option of dying with dignity because of our Nation's continued and overriding fear of heroin. In my judgement, this fear alone has continued to prevent us, the lawmakers of our Nation, from making clear and rational decisions regarding the limited use of this long-proven and already available substance. Heroin has been proven effective with a number of patients in relieving pain. Research completed at Georgetown University's Vincent T. Lombardi Cancer Research Center has found heroin to be an effective analgesic for the control of cancer-related pain. In particular, it has been reported to be more potent than morphine in relieving cancer pain. Less than half a dose of heroin the terminal phase of cancer, many patients cannot take medication by mouth, and might require injections. As the disease progresses, individuals might require higher doses at more frequent intervals to provide relief. This is when it would be desirable to have the option of using heroin in treating pain, since heroin is more potent and more soluble than morphine salts, and an effective dose can be administered in considerably smaller volumes. Thus, physicians have informed me that it is less painful to have such an injection--an important consideration in the emaciated, cachectic patient with little tissue mass remaining. In addition, its euphoric effects might be beneficial for people who know they are dying. Further, the onset of action of heroin is more rapid than morphine because of its solubility, giving relief of pain and a sense of well- being sooner. It is most unfortunate that the use of heroin for these patients has not been allowed up to this date. This legislation will enable physicians to treat the dying cancer patient who suffers from intractable pain with a proven, effective medication. The time has now come to address the issue of why heroin should not be readily available as a therapeutic medication for our Nation's physicians in very specific situations when we have dying cancer patients who are suffering extreme pain. William F. Buckley, Jr., Editor-at-Large of National Review, has described our irrational maintenance of the prohibition against such uses of heroin in very real terms. As he pointed out: The irony is that anybody in a major city can acquire the knowledge necessary to buy heroin from a dirty little drug pimp, but licensed doctors may not administer the identical drug to men and women--and children--literally dying from excruciating pain. Our colleagues on the House Subcommittee on Health and the Environment held hearings on a similar bill as early as September 4, 1980. At the time, a number of practicing physicians and others asked that the Federal controls on heroin be eased to permit the prescription of heroin for patients for whom more conventional pain killers were inadequate. It was further pointed out that in Great Britain, heroin has been used for years for these patients and that it has been shown to be particularly effective for those 10 percent of terminal cancer patients who require injected medication. British physicians consider heroin to be an indispensable potent narcotic analgesic in the treatment of advanced cancer. Use of heroin in specific situations is also permitted in Belgium, New Zealand, China, and many other civilized nations. Since this information was made public in the House hearings, the editorial writers of our country have taken up the issue, as reflected in supportive statements by, among a number of others, the New York Times, the Washington Post, the Washington Times, the Los Angles Times, the San Francisco Chronicle, the San Francisco Examiner, the Honolulu Star-Bulletin, the Honolulu Advertiser, the Chicago Sun-Times, the Cleveland Plain Dealer, the Rocky Mountain News, and the Richmond Times-Dispatch. Both the National Review and the New Republic have backed the proposal. The American Nurses' Association has strongly endorsed this merciful action. As a result of widespread support among physicians and the general public, heroin has become available in Canada for terminal cancer patients. The bill I am introducing today will give a very high priority to relief from intractable pain for terminal cancer patients. It authorizes the Secretary of the Department of Health and Human Services to establish demonstration programs that will permit the use of heroin by terminally ill cancer patients only, when suffering from pain that is not effectively treated with currently available analgesic medications. My bill has more than adequate safeguards to prevent the drug from being introduced to the general public. For example, a diagnosis must be made by the attending physician that his or her patient is ill with cancer and is suffering from pain that is not being effectively treated with other available analgesic medications. This diagnosis must be reviewed and approved by a medical review board of the hospital that will dispense the heroin. The heroin used in the program will be from that supply now confiscated under current laws. The Secretary of Health and Human Services is further authorized to establish additional regulations for the safe use and storage of heroin, to prevent its diversion into illicit channels. This program will be in force for a 5- year period and periodic reporting is required of the Secretary on the activities under the bill. I strongly believe that the proposal will provide substantial benefits to those who are in intractable pain from terminal cancer and I am hopeful that my colleagues on the Senate Labor and Human Resources Committee will give this measure their prompt and most serious consideration. Mr. President, I request unanimous consent that the text of this bill be printed in the Congressional Record.

Mr. INOUYE. Mr. President, in our effort to accommodate many Americans by making the last Monday in May, Memorial Day, we have lost sight of the significance of this day to our Nation. My bill would restore Memorial Day to May 30 and authorize our flag to fly at half mast on that day. In addition, this legislation would authorize the President to issue a proclamation making both Memorial Day and Veterans Day as days for prayers and ceremonies. This legislation would help restore the recognition our veterans deserve for the sacrifices they have made on behalf of our Nation. Mr. President, I ask unanimous consent that the bill be printed in the Record.

Mr. INOUYE. Mr. President, today I am introducing legislation that would provide a federal charter for the National Academies of Practice. This organization represents outstanding practitioners who have made significant contributions to the practice of applied psychology, medicine, dentistry, nursing, optometry, podiatry, social work, and veterinary medicine. When fully established, each of the nine academies will possess 100 distinguished practitioners selected by their peers. This umbrella organization will be able to provide the Congress of the United States and the executive branch with considerable health policy expertise, especially from the perspective of those individuals who are in the forefront of actually providing health care. As we continue to grapple with the many complex issues surrounding the delivery of health care services, it is clearly in our best interest to ensure that the Congress have systematic access to the recommendations of an interdisciplinary body of health care practitioners. Mr. President, I ask unanimous consent that the text of this bill be printed in the Congressional Record.

Mr. INOUYE. Mr. President, today I am introducing legislation to amend Title 18 of the United States Code to allow our Nation's clinical social workers to provide their mental health expertise to the Federal judiciary. I feel that the time has come to allow our Nation's judicial system to have access to a wide range of behavioral science and mental health expertise. I am confident that the enactment of this legislation would be very much in our Nation's best interest. Mr. President, I ask unanimous consent that the text of this bill be printed in the Congressional Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, the law of the land, specifically section 1 of the Merchant Marine Act of 1936, declares that the United States shall have a merchant marine sufficient, among other things, to: Carry a substantial portion of our international waterborne Commerce; and to serve as a fourth arm of defense in time of war and national emergency. The importance of these requirements has been dramatically illustrated by the vital role of our merchant marine in World War II, Korea, Vietnam, during Operations Desert Shield and Desert Storm, and most recently in Haiti. While the privately owned and operated U.S. flag merchant marine has performed so magnificently and effectively in times of crisis, it has also made extraordinary efforts to ensure that a substantial portion of commercial cargo bound to and from the United States moves on U.S. bottoms. Given the chronic overtonnaging in international shipping, cut-throat competition, and the competitive edge our trading partners give their national flags, this has not been easy. Nevertheless, if our commercial fleet is to continue to be an effective auxiliary in times of war or national emergency, it must first be commercially viable in times of peace. Otherwise, there will be no merchant fleet when the need arises. I think we all would agree that there is a substantial national interest in promoting our merchant fleet. Indeed, several laws of our land recognize that national interest and spell out specifically how the U.S. Government is to go about promoting it. Federal laws require that all U.S. military cargo, cargo purchased with all loan funds and guarantees from the Eximbank, 75 percent of concessionary agricultural, and at least 50 percent of all other international ocean borne cargo generated directly or indirectly by the Federal Government, be carried on U.S. flag vessels. According to the latest statistics of the Maritime Administration [MarAd], in 1993 these cargo reservation programs generated $1.58 billion in revenue to the U.S. fleet and accounted for one-third of all revenue from the U.S. flag foreign trade cargo. The alarming news is that according to MarAd the total volume of cargo moving under these programs is declining and will continue to do so. According to a soon to be published report by Nathan Associates Inc., the 1992 economic impacts of cargo preference for the United States were 40,000 direct, indirect and induced jobs, $2.2 billion in direct, indirect and induced household earnings, $354 million in direct, indirect and induced Federal personal and business income tax revenues--$1.20 for every dollar of government outlay on cargo preference, and $1.2 billion in foreign exchange. It is, therefore, imperative that U.S. flag vessels carry every ton of cargo which these programs and the law intend them to carry. This brings me to the reason for the resolution I am introducing today. There are two substantial problems which threaten the viability of these programs and, therefore, the viability of our merchant fleet. Several agencies administering cargo reservation programs continue to do their almighty best to evade the spirit and letter of the reservation laws, that is, find the law inapplicable to a particular program, or employ other loopholes. Because of this problem of evasion and uneven confidence, the Congress amended the Merchant Marine Act of 1970 to centralize monitoring and compliance authority for all cargo reservation programs in MarAd. Nevertheless, the problem remains. Critics of MarAd maintain the agency is too timid, and does not discharge its obligation aggressively. MarAd, on the other hand, says it has limited enforcement powers over those Government agencies which are not in compliance. As the Secretary of Transportation recently announced the administration's intent to consolidate the Department of Transportation's operating divisions, I believe it is more important than ever for the Congress to reiterate its support for our cargo reservation laws, so that their administration and enforcement will not suffer from any Departmental reorganization. Mr. President, the resolution I am introducing today merely expresses the sense of the Senate that all of these Federal agencies do what they are supposed to be doing now, under existing law.