Patient and Physician Safety and Protection Act of 2003

Mr. President, I am pleased to cosponsor legislation being introduced today that will dramatically improve the child tax credit. I thank my friend and colleague, Senator Lincoln, for her hard work on behalf of our Nation's working families.

In the 6 years since the child tax credit was first enacted, it has provided important tax relief to families across the country. Income taxes can be particularly burdensome to moderate income families who are facing increased costs for food, housing, medicine, education, and other basic needs for their children. Indeed, almost half of the benefits of this credit are enjoyed by families with taxable income under $50,000 per year. This is important in States like mine; in West Virginia, almost 80 percent of the taxpayers have annual incomes below $50,000.

While the current child tax credit is excellent--it could be even better. The $600 credit, which is available only for children under the age of 17, does not truly recognize the costs that face many families raising children. Moreover, many working families do not have enough income to qualify for the credit. Make no mistake, I am talking about hard-working parents who go to

their jobs every day and take their responsibilities to their children very seriously. These parents are paying payroll taxes, but cannot provide for some of the basic needs of their children. The legislation introduced today would improve the law so that a greater portion of the child tax credit could be refunded to these admirable parents.

Specifically, this legislation includes two important improvements to the current child tax credit that will benefit all families who claim the credit. First, the legislation would increase the amount of the tax credit from $600 to $1,000 immediately. Second, the bill increases the age of children who are eligible for the credit from 16 to 18. We know that 17- and 18-year-old children are facing enormous educational expenses in order to attend college or technical school. We ought to help parents pay for this education by allowing them to continue to receive the child tax credit until their child is a legal adult. The bill also includes two important improvements to the eligibility criteria for the refundable credit. By lowering the income threshold for the refundable credit and increasing the percentage of income eligible for the refundable credit, we can ensure that more of the families most in need of assistance can benefit from this credit.

The child tax credit is one of the most important ways that Congress can demonstrate its support for America's families. And I hope that my colleagues will support this legislation which would dramatically improve the child tax credit.

Mr. President, the continuing economic crisis facing the U.S. airline industry also imperils the future of hundreds of small and rural communities across our country as air carriers drastically reduce service to small and rural communities. While small and rural communities have long had to cope with limited and unreliable service, these problems have been exacerbated by the weakened financial condition of most major U.S. airlines.

Faced with declining revenues brought on by the Nation's economic downturn, the events of September 11, 2001 and the war in Iraq most carriers have substantially reduced or eliminated service to many communities. In the last month, United Air Lines, US Airways and Continental Airlines announced significant service cuts to West Virginia.

Last month, this Congress provided $3.5 billion in direct and indirect benefits to the Nation's airlines. I strongly supported this package because our economy requires a strong and vibrant airline industry. In my own aviation relief package, I had provided resources to the airlines to continue to provide air service to small and rural communities. Even in the best of times, these communities face a difficult time maintaining and developing new air service options. Today, their challenge is preventing the complete loss of air service. In these difficult economic and uncertain times, I strongly believe that the Federal Government must continue to assist our most vulnerable communities stay connected to the Nation's aviation network--a network paid for by all Americans.

The reduction or elimination of air service had a devastating effect on the economy of a community. Having adequate air service is not just a matter of convenience, but a matter of economic survival. Without access to reliable air service, no business is willing to locate their operations in these areas of the country no matter how attractive the quality of life. Airports are economic engines that attract critical new development opportunities and jobs.

West Virginia has been able to attract firms from around the world because corporate executives know they can visit their operations with ease. Rural and small town America must continue to be adequately linked to the Nation's air transportation network if its people and businesses are to compete economically with larger urban areas in this country and around the world.

In the Aviation Investment and Reform Act for the 21st Century, we began to address the need to improve air service in small and rural communities. I, along with many of my colleagues, supported the creation of the Small Community Air Service Development Pilot Program, a competitive grant program to provide communities with the resources they needed to attract new air service to their communities. The program is an enormous success. Over 180 communities applied for 40 grants in the first year funds were available. The Department of Transportation has announced the next round of funding.

In West Virginia, Charleston received money under the program and has used it to successfully attract a new service connection to Houston, an important gateway to the markets of Latin America. This program gave local communities the ability and flexibility to meet local air transportation needs.

The Aviation Investment and Revitalization Vision Act, cosponsored by myself and Senator Lott, reauthorizes the expands the successful Small Community Air Service Development Program. The bill authorizes the participation of 120 communities over 3 years.

Many of our most isolated and vulnerable communities whose only service is through the Essential Air Service Program have indicated that they would like to develop innovative and flexible programs that communities who received Small Community Air Service Development grants to improve the quality of their air service.

It is for this reason that I, along with Senator Lott, have introduced the Small Community and Rural Air Service Revitalization Act of 2003. The legislation reauthorizes the Department of Transportation's Essential Air Service, EAS, program and creates a series of pilot programs for EAS communities to participate to stimulate passenger demand for air service in their communities.

Under the bill, communities are given the option on continuing their EAS as is or they may apply to participate in new incentive programs to help them develop new and innovative solutions to increasing local demand for air

service. The EAS Marketing and Community Flexibility Programs would provide communities new resources and tools to implement locally developed plans to improve their air service. By providing communities the ability to design their own air service proposals, a community has the ability to develop a plan that meets it locally determined needs, improves air service choices, and gives the community a greater stake in the EAS program.

Specifically, these new EAS pilot programs include authorization for the use of smaller planes to decrease cost or increase frequency, communities to cost-share for service above base EAS subsidy level, alternative service at up to 3 EAS points if a community applies, an opt out of the EAS program with a one-time infusion of funding to assist in transition out of the program, and DOT to mandate multiple code-sharing arrangements for EAS providers.

A pilot program added at the request of Senator Lott would allow DOT to require a cost-share for up to 10 communities within 100 miles of a hub. I have significant reservations about forcing communities to pay for a service the Federal Government promised them.

In addition, the communities that participate in EAS are small and isolated and have lower than average per captia incomes than urban or suburban communities. Cash-strapped communities will have to provide anywhere between $50,000 and $120,000 in local funds to continue their EAS service. I worked with Senator Lott to make sure DOT considers a variety of relevant factors when selecting communities, to provide communities appeal rights, and to make sure they have access to all other pro-active pilot programs. I will monitor DOT's implementation of this pilot program closely.

Small and rural communities are the first to bear the brunt of bad economic times and the last to see the benefits of good times. The general economic downturn and the dire straits of the aviation industry have placed exceptional burdens on air service to our most isolated communities. The Federal Government must provide additional resources and tools for small communities to help themselves attract adequate air service. The Federal Government must make sure that our most vulnerable towns and cities are linked to the rest of the Nation. My legislation builds on existing programs and strengthens them. If these bills are enacted, our constituents will have the tools and resources necessary to attract air service, related economic development, and most importantly expand their connections to the national and global economy.

Mr. President, as millions of public school students and teachers around the country prepare to complete their first school year under the No Child Left Behind Act, NCLB, I am introducing a bill that would help to return a measure of local control that was taken from school districts and States by its enactment last year.

I am pleased to be joined in this effort by Senators Jeffords, Dayton, and Leahy.

I have heard a lot of concern from my constituents about various aspects of the President's education bill. Following the enactment of the bill last year, the drumbeat of concern has continued to reverberate throughout my

State, and has gotten even louder, as students, teachers, parents, administrators, school counselors and social workers, and others are learning first-hand about the effect of the NCLB.

I strongly support maintaining local control over decisions affecting our children's day-to-day classroom experiences. I also believe that the Federal Government has an important role to play in supporting our State educational agencies and local school districts as they carry out their most important responsibility--the education of our children.

I voted against the President's education bill in large part because of the new annual testing mandate for students in grades 3-8. While I agree that there should be a strong accountability system in place to ensure that public school students are making progress, I strongly oppose over-testing students in our public schools. I agree that some tests are needed to ensure that our children are keeping pace, but taking time to test students has to take a back seat to taking the time to teach students in the first place.

I have heard a lot about these new annual tests from the people of Wisconsin, and their response has been almost universally negative. My constituents are concerned about this additional layer of testing for many reasons, including the cost of developing and implementing these tests, the loss of teaching time every year to prepare for and take the tests, and the extra pressure that the tests will place on students, teachers, schools, and school districts.

I share my constituents' concerns about this new Federal mandate. I find it interesting that proponents of the NCLB say that it will return more control to the States and local school districts. In my view, however, this massive new Federal testing mandate runs counter to the idea of local control.

Many States and local school districts around the country, including Wisconsin, already have comprehensive testing programs in place. The Federal Government should leave decisions about the frequency of using high quality assessments to measure and increase student academic achievement up to the States and local school districts that bear the responsibility for educating our children. Every State and every school district is different. A uniform testing policy may not be the best approach.

I have heard from many education professionals in my State that this new testing requirement is a waste of money and a waste of time. These people are dedicated professionals who are committed to educating Wisconsin's children, and they don't oppose testing. I think we can all agree that testing has its place. What they oppose is the magnitude of testing that is required by this law.

Beginning in the 2005-2006 school year, the NCLB will pile more tests on our Nation's public school students. And of course, when those tests are piled on students, they burden our teachers as well, because teachers must spend more and more time preparing students to take these exams.

This kind of teaching, sometimes called ``teaching to the test,'' is becoming more and more prevalent in our schools as testing has become increasingly common. The dedicated teachers in our classrooms will now be constrained by teaching to yet more tests, instead of being able to use their own judgment about what subject areas the class needs to spend extra time studying. This additional testing time could also reduce the opportunity for teachers to create and implement innovative learning experiences for their students.

Teachers in my State are concerned about the amount of time that they will have to spend preparing their students to take the tests and administering the tests. They are concerned that these additional tests will disrupt the flow of education in their classrooms. One teacher said the preparation for the tests Wisconsin already requires in grades 3, 4, 8, and 10 can take up to a month, and the administration of the test takes another week. That is five weeks out of the school year. And now the Federal Government is requiring teachers to take a huge chunk out of instruction time each year in grades 3-8. In my view, and in the view of the people of my state, this time can be better spent on regular classroom instruction.

The legislation that I am introducing today, the Student Testing Flexibility Act of 2003, would give States and local school districts that have demonstrated academic success the flexibility to apply to waive the new annual testing requirements in the NCLB. States and school districts with waivers would still be required to administer high quality tests to students in, at a minimum, reading or language arts and mathematics at least once in grades 3-5, 6-9, and 10-12 as required under the law.

This bill would allow States and school districts that meet the same specific accountability criteria outlined for school-level excellence under the State Academic Achievement Award Program to apply to the Secretary of Education for a waiver from the new annual reading or language arts and mathematics tests for students in grades 3-8. The waiver would be for a period of three years and would be renewable, so long as the state or school district meets the criteria.

To qualify for the waiver, the State or school district must have significantly closed the achievement gap among a number of subgroups of students as required under Title I, or must have exceeded their adequate yearly progress, AYP, goals for two or more consecutive years. The bill would require the Secretary to grant waivers to states or school districts that meet these criteria and apply for the waiver. Individual districts in states that have waivers would not be required to apply for a separate waiver.

The Federal Government should not impose an additional layer of testing on states that are succeeding in meeting or exceeding their AYP goals or on closing the achievement gap. Instead, we should allow those States that have demonstrated academic success to use their share of Federal testing money to help those schools that need it the most.

The bill I am introducing today would do just that by allowing states with waivers to retain their share of the Federal funding appropriated to develop and implement the new annual tests. These important dollars would be used for activities that these States deem appropriate for improving student achievement at individual public elementary and secondary schools that have failed to make AYP.

I am pleased that this legislation is supported by the American Association of School Administrators, the National PTA, the National Association of Elementary School Principals, the National Association of Secondary School Principals, the School Social Work Association of America, the Wisconsin Department of Public Instruction, the Wisconsin Education Association Council, the Wisconsin Association of School Boards, the Milwaukee Teachers' Education Association, and the Wisconsin School Administrators Alliance, which includes the Association of Wisconsin School Administrators, the Wisconsin Association of School District Administrators, the Wisconsin Association of School Business Officials, and the Wisconsin Council for Administrators of Special Services.

While this bill focuses on the over-testing of students in our public schools, I would like to note that my constituents have raised a number of other concerns about the NCLB that I hope will be addressed by Congress. My constituents are concerned about, among other things, the new AYP requirements, the effect that the Act will have on rural school districts, and about finding the funding necessary to implement all of these provisions of this new law. I share these concerns.

I regret that, for the second year in a row, the President's budget request did not fully fund NCLB requirements and failed to provide any funding to crucial programs such as rural education and school counseling. If we are to truly leave no child behind, we must provide adequate funding for programs such as Title I, special education and professional development in order to ensure that all students have the means to succeed. To do less sets up some of our most vulnerable students for failure.

I hope that my bill, the Student Testing Flexibility Act, will help to focus attention on the perhaps unintended consequences of the ongoing implementation of the President's education bill for states, school districts, and individual schools, teachers, and students.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, today I offer a bill that will make a very small change in our Cuba policy. It deals only with travel provisions to Cuba.

I have been watching Cuba since the 1960s. I went to George Washington University, and I was there at the time of the Cuban missile crisis. I have had the opportunity to watch what has happened with Cuba throughout the years. I am reminded of something my dad used to say, which was that if you keep on doing what you always have been doing, you are going to wind up getting what you already got. That is kind of the situation with Cuba. We have been trying the same thing for over 40 years, and it hasn't worked.

I am suggesting just a small change to maybe get a few more people in there to increase conversation with people who understand the way the United States works and the way Cuba works and how they ought to drift more rapidly toward where we are.

In recent weeks, as we shared the joy of the Iraqi people as they were liberated from the ruthless regime of Saddam Hussein, we also felt the pain of those in Cuba who had dared to speak out in a vain but valiant effort to demand those same freedoms for themselves. As they did, 75 Cuban citizens were arrested and received harsh sentences--some for more than 20 years--all for the crime of yearning to be free. Once again, Castro has shown himself to be his own worst enemy when it comes to Cuba's image overseas, and so, when faced with an outcry from around the world about his actions, he quickly tried to blame the United States for his own actions. It was a hard sell at best, and, given the reactions we've seen from all sides of this issue, I don't think anyone is buying it.

Still, Castro's cruelty might tempt us to tighten the already strong restrictions on the relations between our two countries, but I hope we will not do that. If we increase the diplomatic pressure on the Cuban government that is now emanating from every corner of the world, we might be successful in bringing about a better way of life for the Cuban people.

If, however, we stop Cuban-Americans from bringing financial assistance to their families in Cuba, and end the people to people exchanges that have been so successful, and stop the sale of agricultural and medicinal products to Cuba, we will not be hurting the Cuban government nearly as badly as we will be hurting the Cuban people by diminishing their faith and trust in the United States and reducing the strength of the ties that bind the people of our two countries.

If we allow more and freer travel to Cuba, if we increase trade and dialogue, we take away Castro's ability to blame the hardships of the Cuban people on the United States. In a very real sense, the better we try to make things for the Cuban people, the more we will reduce the level and the tone of the rhetoric used against us by Fidel Castro.

I have often heard it said that it is foolish to do the same thing over and over again and expect different results. In a way, that is what we are doing in Cuba. We are continuing to try to exert pressure from our side and, as we do, we are giving Castro a scapegoat to blame for the poor living conditions in his country in the process. It's time for a different policy, one that goes further than embargoes and replaces a restrictive and confusing travel policy with a new one that will more effectively help us to achieve our goals in that country.

Today, Senators Dorgan, Baucus, and Bingaman and I are introducing the Freedom to Travel to Cuba Act.

Our bill is very straightfoward. It states that the President shall not prohibit, either directly or indirectly, travel to or from Cuba by United States citizens or transactions incident to such travel.

In 1958 the Supreme Court affirmed or Constitutional right to travel, but the U.S. government then prohibited Americans from spending money in Cuba. We simply said, okay, you have a right to travel, but try traveling without spending a dime.

Most of us know that certain people can and do continue to travel to Cuba. Cuban Americans can apply for a license to travel for humanitarian reasons to visit ailing family members and such, but not always conveniently.

The way I got involved in this whole process was a Cuban American from Jackson, WY, who had been in Cuba visiting his family, doing his one visit a year. As he left and was on the plane coming back to Wyoming, one of his

parents died. He could not go back there for a year. That is not a good situation for any family.

Educational groups can apply for licenses to travel for scholarly reasons, for educational opportunities and conferences. Members of the U.S. Government can travel for fact-finding reasons, but for the average American, that process is too complicated.

Even with the proper licenses, the regulations on where you can go and whom you can talk to are confusing, misleading, and frustrating. Each year the Office of Foreign Assets Control levies fines on travelers who followed the law to the best of their ability. Fines and punishments were imposed without guidelines and seemingly at the whim of a nameless bureaucrat.

I must ask my colleagues, why are we continuing to support a policy that was basically implemented 40 years ago? Why are we supporting a policy that has had little effect on the Government we oppose? Why do we not improve our policy so that it will improve conditions for the Cuban people and their image of the United States?

The bill we are introducing today makes real change in our policy toward Cuba that will lead to a real change for the people of Cuba. What better way to let the Cuban people know of our concern for their plight than for them to hear it from their friends and their extended family in the United States, or let them hear it from the American people who will go there?

The people of this country are our best ambassadors, and we should let them show the people of Cuba what we as a nation are all about. One thing we should not do is to play into Castro's hand by enacting stricter and more stringent regulations and create a situation where the United States is easy to blame for the problems in Cuba. Unilateral sanctions will not improve human rights for Cuban citizens. The rest of the world is not doing what we are doing. Cuba is being supplied by the rest of the world with everything they need.

Open dialog and exchange of ideas and commerce can move a country toward democracy. What better way to share the rewards of democracy than through people-to-people exchanges? We cannot stop that program. If the United States Government continues on its current course to put an economic stranglehold on the Cuban Government, the people of Cuba will suffer. Unilateral sanctions stop not just the flow of goods but the flow of ideas. Ideas of freedom and democracy are the keys to change in any nation.

Some may ask why we want to increase dialog right now, why open the door to Cuba when Castro is behaving so poorly? No one is denying that the actions of Castro and his government are deplorable, as is his refusal to provide basic human rights to his people. But if we truly believe Castro is a dictator with no good intentions, how can we say we should wait for him to behave before we engage? He controls the entire media in Cuba. The entire message that is coming out, unless we have people interacting, is his message. Keeping the door closed and hollering at Castro on the other side does not do anything.

Mr. President, I rise today to introduce this morning a bill on which my distinguished colleagues from Minnesota and Maine and I have collaborated. That is the Older Americans Prescription Drug Tax Relief Act. I will speak a minute or two on it, then should the Senator from Minnesota desire to speak to this, I will yield to the Senator and then resume the balance of my statement.

By way of introduction, all Members of this body have heard the tragic stories about older Americans who must choose between paying for their groceries and paying for their medicines. Many older Americans are forced into this choice because, unbelievably, the Medicare program still lacks an outpatient prescription drug benefit. America's seniors deserve much better.

Our President, the House of Representatives, and every single Member of this Senate, all 100 Members, share the common goal of enacting a comprehensive Medicare prescription drug benefit. Over the years, we worked diligently to achieve those goals but have yet not reached what I would consider, and I think others would consider, success. We have all worked in support of this vitally important goal, but, again, success has alluded us. Unfortunately, we have not been able to reach a consensus.

I hope this bill might be a new initiative that would merit the attention of my colleagues, and that it might provide a basis for that consensus. As we here in the Nation's Capital debate how best to add a Medicare prescription drug benefit and continue to debate the specifics of such benefits such as premiums, co-pays, deductibles, formularies, and whether to run the program through the existing Medicare system or through a public-private partnership, our seniors continue to suffer. Medicare beneficiaries have waited far too long for Congress to provide some sort of relief for their prescription drug costs.

I remain committed, as are my distinguished colleagues from Minnesota and Maine, to working with our colleagues on creating a comprehensive prescription drug benefit in the Medicare program. I believe we must act now, however, to provide some relief at this point in time. We cannot defer this decision any longer. The Warner-Dayton-Collins proposal will provide real relief to Medicare beneficiaries. The legislation is simple and can be described in three points.

I thank my distinguished colleague for responding. I wish to emphasize a very important point the Senator from Minnesota made.

This may not be the final resolution of this complex set of issues. But given the desperate circumstances of so many who have to make the choice between food and drugs, I think it is a very carefully crafted interim step that could be enacted into law and later quickly superseded should that hoped-for event occur in the future of a more comprehensive piece of legislation.

I think the emphasis on that is very important.

I would say, all of us here in the Senate benefit greatly by professional staff. On my staff, Chris Yianilos really worked diligently to bring this legislation into being and he collaborated with a distinguished member of your staff, Mr. Bob Hall. I also thank Priscilla Hanley, who worked with Senator Collins on the legislation.

The first is that the Warner-Dayton-Collins bill provides Medicare beneficiaries with a refundable--I repeat--a refundable tax credit of 50 cents on every dollar of out-of-pocket prescription drug costs. Whether you actually pay income taxes or not, you are eligible to get the benefit of this tax credit.

The benefit is capped at $500 for the expenses of an individual senior. Married seniors would be eligible for a credit up to $1,000. The cap is based on a recent study by the Kaiser Family Foundation that estimates that the average senior's out-of-pocket prescription drug costs is almost $1,000. Thus the proposal will cover 50 percent of the out-of-pocket drug costs for the average senior.

To take advantage of this refundable tax credit, Medicare beneficiaries will not have to worry about whether their drug is covered under some formulary. In addition, there are no premiums, no deductibles. Medicare beneficiaries will simply take their prescriptions, get them filled, and then apply for their refundable tax credit.

Second, in recognition that a generous but necessary refundable tax credit such as this can be costly, we have imposed a responsible income phase-out on older Americans who can benefit from this tax credit. The phase-out level begins for individuals who earn $75,000 per year. Married Medicare beneficiaries begin to phase-out of the benefit at $150,000 a year. This cost containment mechanism will affect less than 10 percent of all Medicare beneficiaries but allows us to responsibly provide a refundable tax credit that will cover about 50 percent of the average Medicare beneficiary's out-of-pocket drug costs.

Again 90 percent of all Medicare beneficiaries will not be affected by the phase-out. In other words, they are beneath the phase-out caps. Only those individuals who are blessed with a larger income among America's seniors, who can afford in large measure to pay for their prescription drugs, will be phased-out.

Third, the legislation will sunset once a comprehensive Medicare prescription drug benefit is signed into law. Again, as my colleague from Minnesota mentioned, and others, this is an interim proposal. Therefore, it can be superseded by a more comprehensive bill.

We wholeheartedly agree this legislation is not a substitute for a comprehensive prescription drug Medicare benefit, and we will continue to work with the President and our colleagues from both sides of the aisle in the Senate who support a more comprehensive piece of legislation. But as I stated earlier, America's seniors cannot wait any longer for relief, and this proposal provides a real benefit to America's seniors.

I am pleased to be joined by Senator Dayton and Senator Collins in introducing the Older Americans Prescription Drug Tax Relief Act. I urge my colleagues to give this matter consideration and, hopefully, it can be enacted into law.

Let us do something. Let us open the door and talk to the Cuban people.

Travel and other policies that deal with Cuba will continue to be a top priority for those of us in the newly formed Senate Cuba Working Group. The working group members have expressed their support for changes in our policies toward Cuba, and we will continue to be a part of the dialogue. I do encourage all of my colleagues to join us in that effort.

I encourage all of my colleagues to take a look at this bill that has been introduced today. I know there are people looking at it. I expect a lot more cosponsors on it. This is the most reasonable provision dealing with Cuba that has been presented during the 6 years I have been here. We have tried some bigger bites at the apple. They have not worked. So we are moving back to the travel restrictions, a bill that is very limited. It allows one to travel and to have those things that are necessary for travel. For instance, the right to take baggage to Cuba cannot be cut off. That is another way the law can be subverted. So it is a very straightforward travel policy that will get Americans into Cuba to talk to Cubans to promote the ideas we believe in. I ask my colleagues to join me in this effort.

Mr. President, I rise today to reintroduce the Patient Abuse Prevention Act, which will go a long way in protecting patients in long-term care from abuse and neglect. This legislation will establish a National Registry of abusive long-term care workers and require criminal background checks for potential employees. It is necessary so we can ensure that people with violent and abusive backgrounds cannot find work in nursing homes and home health and prey on our elderly relatives. After many years of refinement so that the background checks will run smoothly, and with the strong support of both patient advocates and the American Association of Homes and Services for the Aging, I sincerely hope that this is the year when we will finally take action and enact these common-sense protections.

There is absolutely no excuse for abuse or neglect of the elderly and disabled at the hands of those who are supposed to care for them. Our parents and grandparents made our country what it is today, and they deserve to live with dignity and the highest quality care.

Unfortunately, this is not always the case. We know that the majority of caregivers are dedicated, professional, and do their best under difficult circumstances. But it only takes a few abusive staff to cast a dark shadow over what should be a healing environment.

Current State and national safeguards are inadequate to screen out abusive workers. All States are required to maintain registries of abusive nurse aides. But nurse aides are not the only workers involved in abuse, and other workers are not tracked at all. Even worse, there is no system to coordinate information about abusive nurse aides between States. A known abuser in Iowa would have little trouble moving to Wisconsin and continuing to work with patients there.

In addition, there is no Federal requirement that long-term care facilities conduct criminal background checks on prospective employees. People with violent criminal backgrounds--people who have already been

convicted of murder, rape, and assault--could easily get a job in a nursing home or other health care setting without their past ever being discovered.

Our legislation will go a long way toward solving this problem. First, it will create a National Registry of abusive long-term care employees. States will be required to submit information from their current State registries to the National Registry. Facilities will be required to check the National Registry before hiring a prospective worker. Any worker with a substantiated finding of patient abuse will be prohibited from working in long-term care.

Second, the bill provides a second line of defense to protect patients from violent criminals. If the National Registry does not contain information about a prospective worker, the facility is then required to initiate an FBI background check. Any conviction for patient abuse or a relevant violent crime would bar that applicant from working with patients.

A disturbing number of cases have been reported where workers with criminal backgrounds have been cleared to work in direct patient care, and have subsequently abused patients in their care. Unfortunately, these news reports have tragically become commonplace over the years. In 1997, the Milwaukee Journal-Sentinel ran a series of articles describing this problem, including a Green Bay employee who was convicted of sexually assaulting a disabled woman, an Oshkosh employee who physically and emotionally abused nursing home residents, and a Milwaukee employee who charged more than $2,000 on a home health client's credit card. All had prior criminal convictions. A 1999 Bergen Record study of home health workers found that in nearly every county, criminals were working in the homes of the elderly and infirm. Many aides had committed offenses against patients in their care, but they were still listed as certified and eligible for work in State records. Most recently, the Chicago Sun-Times ran an article on November 1, 2002, in which a home care aide beat his disabled client to death with a hammer. That caregiver had previously been convicted of shooting a man in the face.

In 1998, at my request, the Senate Special Committee on Aging held a hearing that focused on how easy it is for known abusers to find work in long-term care and continue to prey on patients. At that hearing, the HHS Inspector General presented a report which found that, in the two States they studied, between 5 to 10 percent of employees currently working in nursing homes had serious criminal convictions in their past. They also found that among aides who had abused patients, 15 to 20 percent of them had at least one conviction in their past.

In 1998, I offered an amendment which became law that allowed long- term care providers to voluntarily use the FBI system for background checks. So far, 7 percent of those checks have come back with criminal convictions, including rape and kidnapping.

And on July 30, 2001, the House Government Reform Committee's Special Investigations Division of the Minority staff issued a report which found that in the past two years, over 30 percent of nursing homes in the U.S. were cited for a physical, sexual, or verbal abuse violation that had the potential to harm residents. Even more striking, the report found that nearly 10 percent of nursing homes had violations that caused actual harm to residents.

Let me say again that despite this evidence, I know that the vast majority of caregivers in nursing homes and home health care do an excellent job and have their patients' best interests at heart. But clearly, a national background check system is a critical tool that all long-term care providers should have--after all, they don't want abusive caregivers working for them any more than families do. I am pleased that the nursing home industry has worked with me over the years to refine this legislation, and I greatly appreciate their continued support of the bill. This bill reflects their input and will help ensure a smooth transition to an efficient, accurate background check system. This is a common-sense, cost-effective step we can and should take to protect patients by helping long-term care providers thoroughly screen potential caregivers.

I realize that this legislation will not solve all instances of abuse. We still need to do more to stop abuse from occurring in the first place. But this bill will ensure that those who have already abused an elderly or disabled patient, and those who have committed violent crimes against people in the past, are kept away from vulnerable patients.

I want to repeat again that I strongly believe that most long-term care providers and their staff work hard to deliver the highest quality care. However, it is imperative that Congress act immediately to get rid of those that don't.

This bill is the product of collaboration and input from the health care industry, patient and employee advocates--who all have the same goal I do: protecting patients in long-term care. I look forward to continuing to work with my colleagues, the Administration, and the health care industry in this effort. Protecting our nation's seniors and disabled deserves our full attention.

I ask unanimous consent that the text of the bill be printed in the Record.