S. 2037 – Critical Access Hospital Relief Act of 2014

Sen. Tom HarkinD-IA · Feb 24, 2014

Mr. President, I come to the floor today to introduce a bill to support teachers, paraprofessionals and especially students, students with challenging behaviors. Last week I released a report titled…

Mr. President, I come to the floor today to introduce a bill to support teachers, paraprofessionals and especially students, students with challenging behaviors.

Last week I released a report titled ``Dangerous Use of Seclusion and Restraints in Schools Remains Widespread and Difficult To Remedy: Ten Case Studies.'' This report is the product of a 6-month investigation by my HELP Committee staff

The report highlights the continued use of seclusion and restraints in schools, the lack of information families have about these practices, and the inability, in many cases, of families to stop the use of them on their children.

We found that in many cases, families may not know their children are being secluded and restrained. In some cases children are being secluded and restrained for months at a time, multiple times a day, sometimes for many hours, all without the knowledge of their families.

We also found that families do not have the tools to stop these practices. Provisions of some of our education laws, such as the Individuals with Disabilities Education Act, prohibit families from seeking redress and relief from the use of seclusion and restraints with their children unless they exhaust their due process options, which can take months or even years. This often leaves families with no choice but to remove their children from school in order to protect them.

Finally, the report found it is almost impossible for families to gather the information they need to prove harm and to stop the use of seclusion and restraints. The lack of access to information causes families to give up on their schools and there are many cases where families move to a new city or even out of state.

These events are not isolated incidents, as some claim. In March 2011, the U.S. Department of Education published the ``Civil Rights Data Collection Report'' that showed there were over 66,000 occurrences of seclusion and restraints during the 2009-2010 school year. In other words, there were 66,000 times when children were put at risk of injury, psychological trauma and death.

These incidents occur everywhere, even in my own state of Iowa. Last year, in a public residential school, at least three young women were secluded for up to 23 hours a day--in one case, for as long as nine months. If it were not for the good work of my state's Protection and Advocacy agency, Disability Rights Iowa, that practice might have continued indefinitely.

These practices aren't just ineffective, they can cause harm. Take for example 8-year-old Isabel Loeffler, who

was subjected to restraint and seclusion when she was living in Iowa. Isabel was locked in a seclusion room for up to three hours at a time on over 100 different occasions. She was held from behind and forced to draw with crayons, sometimes with four staff members holding her. When Isabel failed a task, she was secluded or restrained. The use of these practices made her behaviors worse, not better, so her parents withdrew her from school.

Injuries, both physical and psychological, are horrible enough, but at times the use of seclusion and restraints results in death. Jonathan King was secluded in an 8-by-8-foot concrete room in his Georgia school from the time he was a kindergartener. During one school year Jonathan was placed in a seclusion room, unobserved, 19 times over the course of 29 days for over an hour and a half.

His parents did not know this was happening to him.

On the day he died, his teacher had given him a rope to hold up his pants before she secluded him. Jonathan, who hated wearing a belt, had threatened to kill himself before. While he was in seclusion that day he hung himself with that rope. Jonathan was just 13-years-old.

It is time to put a stop to these abuses. We need make sure schools have access to the practices to serve our children well. The data show that too many teachers do not have the tools they need to help children with challenging behaviors. Too many parents do not know how their children are being treated at school. And too many children are being mentally and physically scarred because of the use of these harmful practices and the lack of knowledge about positive alternatives.

So I have come to the floor, today, to urge my colleagues to join with me in stopping these unconscionable practices. I come to ask that we work to provide teachers and administrators with the knowledge and skills they need to teach children in safe, supportive environments and to stop these violations of basic human rights. It is time to stop the systematic use of restraint and seclusion in our schools.

In the United States, we have regulations to protect people in hospitals, in nursing homes, and in psychological facilities from restraint and seclusion. But not in our schools. The last frontier for prohibiting seclusion and allowing restraint only in emergency situations is our classrooms.

This is why, today, I am introducing the Keeping All Students Safe Act. This bill prohibits the use of seclusion as well as mechanical and chemical restraints in schools. Period. Complete prohibition of these practices that have no educational or therapeutic benefits for children.

My bill also places strict limits on when, how, and by whom physical restraints may be used. Physical restraints could only be used in emergency situations. Not for so-called treatment. Not as discipline. Not as negative reinforcement. For emergencies only.

My bill would also create greater transparency so parents will know when an emergency situation happens and when a restraint has been used. It requires that schools meet with parents to explain the emergency and to plan for how to avoid emergencies in the future.

In addition, the bill allows families to file a civil action even if they have not exhausted their due process rights under IDEA. This will give families more power to stop the use of seclusion and restraints with their children.

There has been a lot of debate on whether it is right to implement a complete ban on seclusion in schools. I answer with an unequivocal yes. Putting a child in a locked room without supervision is absolutely wrong. Because when children are locked up, they frequently hurt themselves in frustration. Sometimes they hit their bodies against the wall until they are bruised and bloodied. Sometimes they vomit. Sometimes, as in the case of Jonathan King, they die.

Something is seriously wrong when a child suffers post-traumatic stress disorder after attending school. To lock a child up with no supervision is dangerous and, in many instances, can amount to acute psychological torture.

Proponents of the use of seclusion and restraints call them ``effective practices'' or ``useful techniques.'' But they are not. A child does not learn how to hold herself still, to listen more attentively, or to do her work by having her teacher lock her up, strap her down, or sit on her. Using euphemisms and politically correct terms to describe these practices does not disguise their barbarity and harmfulness. By no stretch of the imagination can sitting on a child be about educating.

There are alternatives. We know that school-wide, preventive practices can reduce and eliminate the use of seclusion and restraints. Ten years ago, at the Centennial School in Lehigh, PA, a school that serves children with the most challenging behaviors, the use of restraints was pervasive; over 1,000 occurrences per school year. Now, through the leadership of Dr. Michael George and the systematic use of preventive strategies, restraints are used less than 5 times a year and only in the most severe of emergency situations, only by trained personnel, and never as punishment or behavior management.

The Keeping All Students Safe Act will make positive behavioral interventions more widely available for educators. It will provide supports to schools to improve the school climate and culture through evidence-based practices and data-driven decision-making. The bill calls for better data collection on the use of seclusion and restraints in order to document their occurrence and efforts to eliminate them. The bill calls for mandatory reporting so that parents will know why, when, and how physical restraints are used on their children.

We know that teachers want to teach and to keep all their students safe. Let us give them the skills and knowledge to prevent challenging behaviors, and when they occur, to respond to them in the most effective ways possible.

If Isabel's teachers had the support, knowledge and training that the Keeping All Students Safe Act will make available, they could have identified the interventions she needed to be successful. They could have known what reinforcements worked for her. And they could have known what triggers would make her behavior worse. Instead of locking her in a closet, where she wet herself and hit herself in the head, Isabel's teachers could have fundamentally improved her educational experience, helping her to reach her potential.

All children have the right to be safe. Parents entrust schools to protect their children and help them to flourish. Let us make good on that trust by prohibiting seclusion and making the use of restraint so uncommon that it is only used in emergency situations. I urge my colleagues to join with me to protect all students, and to ensure that all educators have the tools they need to keep all of students safe.

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

Sen. Angus S. King Jr.I-ME · Feb 24, 2014

Mr. President, it was a great privilege for me a few moments ago to read George Washington's Farewell Address for a number of reasons; one, we learned in doing a little research on this…

Mr. President, it was a great privilege for me a few moments ago to read George Washington's Farewell Address for a number of reasons; one, we learned in doing a little research on this practice--which as the majority leader indicated goes back more than 100 years--that the last Senator from Maine to read President Washington's Farewell Address was Senator Ed Muskie, who read it on this floor exactly 50 years ago. The last Senator to read before him from Maine was a freshman Senator in 1949, one Margaret Chase Smith. So if you believe that I am honored and humbled to be following in those footsteps, you would be correct. This is one of the seminal documents in American history. It really ranks with the Federalist Papers, the Declaration of Independence, and the Constitution itself. As the majority leader indicated, it didn't simply spring from Washington's mind. It actually has an interesting history. It was originally drafted in 1792, at the end of Washington's first term, when he intended to retire. He kept wanting to retire all the way from the end of the Revolutionary War, and the public kept calling him back into service.

The first speech in 1792 was drafted by James Madison, who was the father of our Constitution. Madison, Hamilton, and Jefferson convinced Washington that he couldn't leave at the end of his first term because there was too much going on in the country. The country was still in its very formative years, and patriotism required him to stay for a second term, which he reluctantly did.

This speech was delivered in September of 1796--at the end of Washington's second term--and was based upon the original Madison draft, edited and updated by Alexander Hamilton. I don't know about others, but I wouldn't mind having Madison and Hamilton be my ghostwriters--two of the greatest minds in American history and minds which didn't always agree about all the principles of what the country should work toward, but they agreed to work with Washington on this remarkable address.

I would like to take a moment to talk about Washington's importance. I used to teach about leadership, and one of the fundamental principles I used to pound into my students was that execution is as important as vision--that

having a good idea and a concept is not enough; it has to be executed well in order to take root and actually achieve the benefits that are intended.

Washington was the execution of the vision of the Constitution. When he took office, there was no United States. There was an idea, there was a vision, there was a concept, but how it was actually put into practice was so much in the consequences of Washington's decisions on a day-to-day basis, starting with only running for two terms, starting with when they asked him what the President should be called--and, of course, in Europe it was ``Your Excellency'' and all these fancy titles--and he said: ``Mr. President'' is the proper appellation for an executive in a republican form of government. But Washington was essential to the success of this country because of his role as the person who did the executing of the vision embodied in the Declaration of Independence and the Constitution.

The speech itself is amazing. In many parts, it could have been written last week. Several things come through to me very quickly.

One is his wonderful, inspiring, powerful, passionate commitment to public service. He talked about his humbleness, his patriotism, his feeling of duty in order to serve his country. Next, he is passionate about national unity, and indeed his comments foreshadow the Civil War. He talked about regional differences and the importance of unity not only to the country as a whole but as benefits to the regions themselves. He talks about the North and South and the East and the Atlantic. He is presaging the arguments of the 1830s, 1840s, and 1850s that led to the attempted dissolutions of the country and passionately argued for the importance and significance not only as an abstract principle but in a very material, concrete interest, how important union was.

Of course, as one of the two Independents in this body, it would be unbecoming for me to dwell at too great length on his imprecations about the dangers of party to our society. I will let those speak for themselves. But he was very worried about what he called factions and later on in the address actually refers to them as ``parties.''

He also talks about the dangers of concentration of power and the usurpation of power by one branch or another of the government--again, a fundamental principle and a realization of the important role the Constitution played in dividing powers between what he calls the segments of the government.

I think one of the aspects that comes through in this document, as it comes through in the Federalist Papers--which is the other sort of seminal explanation of how our government came to be and what the thinking is--is a brilliant in-depth understanding of human nature. He is talking to the ages in this speech. He is not talking to the politics of 1796 or the politics of 1800s or the politics of the Revolutionary War; he is talking about human nature and the tendency toward despotism, the tendency toward usurpation, the tendency toward power being accumulated in one place, and that comes through. Often he talks about human nature. I think that was one of the most important and most salient characteristics of all of the founding individuals of this country.

There is a very interesting provision on religion expressly stating that religion is part of our heritage and that morality is part of our heritage. He has an interesting image: How can an oath mean anything if religion doesn't mean anything?

Finally, there is a short but powerful passage about the importance of education. He calls it the ``general diffusion of knowledge.'' That is public education. The general diffusion of knowledge means everyone, not just the elite. That is one of the secrets of America, the general diffusion of knowledge.

Of course, one that speaks to us today is his admonition to cherish the public credit and not get into debt, and if you get into debt because of a war, endeavor during peacetime to pay off the debt. I think that is something we really need to take to heart and think about, lest our debt swamp us in the future. He uses a phrase I couldn't help but emphasize when I read the speech: that we should not ungenerously throw upon posterity the burden which we ourselves ought to bear. In other words, we ought to pay our own bill, and right now in this country we are not doing that.

He also has a sort of amusing passage about taxes, saying: Nobody likes taxes. They are never fun. They are always inconvenient. But they are necessary. And he talks about how the members of the government have to prepare the public for the idea that they have to pay for those expenditures that are going to be entailed in the pursuit of any governmental enterprise.

Finally, he talks about foreign entanglements, probably the most famous portion of the speech, where he talks about being neutral, the luxury we have being protected by huge oceans, and that we really should avoid foreign entanglements.

Interestingly, on that provision I went back and read the comments. Each time a Senator reads the speech, there is a leather-bound book in which they put their notes, which I am going to be doing in a few minutes. I went back and read the notes of Ed Muskie and Margaret Chase Smith. In 1949 Margaret Chase Smith wrote in her note: I wonder if we should be entering into NATO. This was indeed the first major foreign commitment of American enterprise after Washington's speech. Margaret Chase Smith obviously had second thoughts after she had read the speech here on the Senate floor in 1949.

Finally, this speech is so powerful because it is so fresh and it speaks to us today. My favorite quote from Mark Twain--and there are many, but one which I suspect I will repeat on this floor at least half a dozen times during my tenure here: History doesn't always repeat itself, but it usually rhymes. In this case, what Washington was telling us in the fall of 1796 rhymes. It helps us to think through so many of the issues which are confronting us here today and the wisdom of Washington expressing it. Remember, two of the most brilliant minds of that period--Hamilton and Madison--participated in the drafting of the speech--words well worth remembering, a wonderful contribution to the life of our country.

I thank the majority leader and the leadership for giving me the privilege and the honor to read the speech today on behalf of my colleagues.

Recognition of the Minority Leader

Sen. Pat RobertsR-KS · Feb 24, 2014

Mr. President, I started my public service career fighting for rural health. In a State that has many rural hospitals, the rural health care delivery system is especially important to Kansas. One of…

Mr. President, I started my public service career fighting for rural health. In a State that has many rural hospitals, the rural health care delivery system is especially important to Kansas. One of my first speeches was to rural hospitals. Since that time, I have been beating the drum, so to speak, for our rural areas about how important it is to focus on rural health.

I have always said that people in rural towns deserve the same access to care and level of treatment as their urban counterparts. I have made it my mission to protect our rural health system and patient access to the best possible care. I am honored to serve as the cochair of the Senate Rural Health Caucus where I work with my colleagues to fight for our rural health care system every day.

Unfortunately, these days it feels as though rural health care, and all of those involved in it, face an uphill battle. Over the past few years, the rural health system has continued to face even more challenges.

Funding for rural health care programs has been targeted again and again. This year the Senate Finance Committee held a markup with regular order where we considered some of the rural extenders that are absolutely vital to our rural communities. Regrettably, we have more work to do. We have to convince and educate our colleagues, this administration, and everyone else about the importance of rural health care. We have been successful in protecting some of the ideas I have championed, especially on the rural extenders side, but we have more work to do. As this process moves forward, we need to ensure we follow regular order on the floor of the Senate and for any pay-fors for the doc fix package. While I was pleased with some of the additions that addressed rural health care in the package passed out of committee, I have concerns that these issues were not included or addressed in the most recent package introduced in the House and in the Senate.

In addition to ensuring rural health is part of any moving legislation, I wish to ensure it is a package that is offset and paid for, and this has to be done before I can support it. But the bottom line is that we, the Senate, need to return to regular order and ensure that practice does continue.

As will many of my colleagues in the Senate, I will continue to vigorously fight to rein in Federal spending and to

reduce the deficit. In order to address this fiscal crisis, I think Congress must enact basic structural changes to entitlement programs that will strengthen and preserve these programs for future generations while protecting current participants. Without real tangible reform and cuts in Federal spending, we will bankrupt the country. At the same time, we need to ensure that any of those policies we put in place do not result in a disproportionate impact on our rural health care system or restrict patients' access to the care they need. As I started saying today, this is going to be an uphill battle. But I, for one, am ready to lead the charge.

As a member of both the Finance and HELP Committees, as well as the cochair of the Rural Health Caucus, I have tried to be a leader in the discussion about the need to address the entire health system.

I have made it a point that within our health care system discussions, we need to talk about the differences between our rural areas and the care and treatment provided in those rural settings and their urban counterparts. We need to address common misconceptions about funding challenges in rural communities before taking a Lizzie Borden ax to the funding streams.

Throughout my career in public office, I have made it a point to always fight for Kansas and rural health care providers. This has been one of my top priorities in Congress. I understand the important role of rural health in America and continue to advocate for policies that protect and preserve these benefits.

Most recently, the Centers for Medicare and Medicaid Services--CMS-- have made some changes that will be particularly harmful to rural health. More specifically, their changes will force doctors into a guessing game about their patients. The condition of payment changes CMS is making would require the physician, and no other level provider, to not only predict at the time of admission to the critical access hospital that the patient will require hospital care for more than two midnights, but also that the patient can be cared for and discharged in less than 96 hours. This is an extremely narrow CMS window for the physician to make a determination about that patient's future needs-- extremely difficult, if not impossible. A physician may certify that they expect the patient to be treated and discharged within 96 hours, but, unfortunately, the patient's situation may change and they may need to be kept longer. The physician's concern will be that they have failed to meet the terms of their certification according to CMS. This is likely to lead to premature discharges and readmissions, both of which CMS has taken actions to minimize.

A CEO for one of our critical access hospitals in Council Grove, KS, writes:

This new ``condition of payment'' rule causes potential

conflicts with what is best for the patient, causes issues

for the physician in having to predict outcomes at admission

in complex cases, and may cause increased expense for

medically unnecessary transfers to more costly care centers.

Today I am introducing the Critical Access Hospital Relief Act of 2014. My bipartisan legislation would remove the condition of payment for critical access hospitals that requires a physician to certify that each patient will be discharged or transferred in less than 96 hours. This is another example of having to tell CMS, ``If it isn't broken, then there is no need to fix it.'' We need to focus on ensuring rural patients have access to their health system, not coming up with bureaucratic ways to make it harder for patients in rural areas to get quality care from their doctors.

I urge my colleagues to cosponsor the Critical Access Hospital Relief Act of 2014.