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POISON CONTROL CENTERS: IS THERE AN ANTIDOTE FOR BUDGET CUTS? Y 4. G 74/7: P 75/5 Poison Control Centers: Is There at. . . HEARING BEFORE THE HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS SUBCOMMITTEE OF THE COMMITTEE ON GOVERNMENT OPERATIONS HOUSE OP REPRESENTATIVES ONE HUNDRED THIRD CONGRESS SECOND SESSION MARCH 15, 1994 Printed for the use of the Committee on Government Operations °CT 26 fig* J U.S. GOVERNMENT PRINTING OFFICE 82-892CC WASHINGTON : 1994 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-045845-5 POISON CONTROL CENTERS: IS THERE AN ^ ANTIDOTE FOR BUDGET CUTS? Y 4. G 74/7: P 75/5 Poison Control Centers: Is There an... HEARING BEFORE THE HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS SUBCOMMITTEE OF THE COMMITTEE ON GOVERNMENT OPERATIONS HOUSE OP REPRESENTATIVES ONE HUNDRED THIRD CONGRESS SECOND SESSION MARCH 15, 1994 Printed for the use of the Committee on Government Operations OCT 26 1994 ^kommpw U.S. GOVERNMENT PRINTING OFFICE 82-892CC WASHINGTON : 1994 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-045845-5 COMMITTEE ON GOVERNMENT OPERATIONS JOHN CONYERS, JR., Michigan, Chairman CARDISS COLLINS, Illinois WILLIAM F. CLINGER, Jr., Pennsylvania HENRY A. WAXMAN, California AL McCANDLESS, California MIKE SYNAR, Oklahoma J. DENNIS HASTERT, Illinois STEPHEN L. NEAL, North Carolina JON L. KYL, Arizona TOM LANTOS, California CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York STEVEN SCHIFF, New Mexico EDOLPHUS TOWNS, New York C. CHRISTOPHER COX, California JOHNM. SPRATT, JR., South Carolina CRAIG THOMAS, Wyoming GARY A. CONDIT, California ILEANA ROS-LEHTINEN, Florida COLLIN C. PETERSON, Minnesota DICK ZIMMER, New Jersey KAREN L. THURMAN, Florida WILLIAM H. ZELIFF, Jr., New Hampshire BOBBY L. RUSH, Illinois JOHN M. MCHUGH, New York CAROLYN B. MALONEY, New York STEPHEN HORN, California THOMAS M. BARRETT, Wisconsin DEBORAH PRYCE, Ohio DONALD M. PAYNE, New Jersey JOHN L. MICA, Florida FLOYD H. FLAKE, New York ROB PORTMAN, Ohio JAMES A. HAYES, Louisiana CRAIG A. WASHINGTON, Texas BARBARA-ROSE COLLINS, Michigan BERNARD SANDERS, Vermont CORRINE BROWN, Florida (Independent) MARJORIE MARGOLIES-MEZV1NSKY, Pennsylvania LYNN C. WOOLSEY, California GENE GREEN, Texas BART STUPAK, Michigan JUUAN EPSTEIN, StaffDirector Matthew R. Fletcher, Minority StaffDirector Human Resources and Intergovernmental Relations Subcommittee EDOLPHUS TOWNS, New York, Chairman HENRY A. WAXMAN, California STEVEN SCHIFF, New Mexico THOMAS M. BARRETT, Wisconsin JOHN L. MICA, Florida DONALD M. PAYNE, New Jersey ROB PORTMAN, Ohio CRAIG A. WASHINGTON, Texas BERNARD SANDERS, Vermont (Ind.) Ex Officio JOHN CONYERS, Jk., Michigan WILLIAM F. CLINGER, JR., Pennsylvania RONALD A. Stroman, StaffDirector William M. Layden, ProfessionalStaffMember Martine M. DiCroce, Clerk MARTHA B. MORGAN, Minority Professional Staff (II) CONTENTS Page Hearingheldon March 15, 1994 1 Statementof: Brown, Ann,chairman, U.S. ConsumerProductSafety Commission „ 114 Dosh, Cheryl, motherofpoisonedchild 14 Fise, Mary Ellen R., product safety director, Consumer Federation of America 196 Grover,Jennifer, motherofpoisonedchild 4 Kauffman, Ralph E., M.D., medical director, regional poison control center, Childrens HospitalofMichigan 44 Kearney, Thomas E., Pharm.D., American Association ofPoison Control Centers 70 Krenzelok, EdwardP., Pharm.D., director, Pittsburgh poison center, Chil- dren's HospitalofPittsburgh 62 Litovitz, Toby L., M.D., director, National Capital Poison Center, Wash- ington, DC 52 Marcus, Steven M., M.D., New Jersey Poison Information and Education System 155 McDonald, Margaret, motherofpoisonedchild 8 McGinnis, J. Michael, M.D., Deputy Assistant Secretary for Health, and Director, Office of Disease Prevention and Health Promotion, Health and Human Services, accompanied by Rick Waxweiler, National Center forInjuryPrevention and Control 119 Miller, Ted, Ph.D., National Public Services Research Institute 183 Rodgers, George C, M.D., Ph.D., AmericanAcademyofPediatrics 144 Simon, Jeffrey L., NewYork State DepartmentofHealth 206 Towns, Hon. Edolphus, a Representative in Congress from the State ofNew York, and chairman, Human Resources and Intergovernmental RelationsSubcommittee: Opening statement 1 Trestrail, John H. Ill, R.Ph., codirector, Blodgett Regional Poison Center, GrandRapids, MI 30 Letters, statements, etc., submitted forthe recordby: Brown, Ann, chairman, U.S. ConsumerProductSafety Commission: Informationconcerningpoison control centers 134 Prepared statement 116 Dosh, Cheryl, motherofpoisonedchild: Preparedstatement 16 Fise, Mary Ellen R., product safety director, Consumer Federation of America: Preparedstatement 198 Grover,Jennifer, motherofpoisonedchild: Prepared statement 6 Kauffman, Ralph E., M.D., medical director, regional poison control center, Childrens Hospital ofMichigan: Prepared statement 46 Kearney, Thomas E., Pharm.D., American Association of Poison Control Centers: Prepared statement 72 Krenzelok, EdwardP., Pharm.D., director, Pittsburgh poison center, Chil- dren's Hospital ofPittsburgh: Preparedstatement 64 Litovitz, Toby L., M.D., director, National Capital Poison Center, Wash- ington, DC: Informationconcerningcertified regional poisoncenters 109 Preparedstatement 54 Marcus, Steven M., M.D., New Jersey Poison Information and Education System: Prepared statement 157 McDonald, Margaret, motherofpoisonedchild: Prepared statement 11 McGinnis, J. Michael, M.D., Deputy Assistant Secretary for Health, and Director, Office of Disease Prevention and Health Promotion, Health andHuman Services: Informationconcerningthe injurycontrol board 141 (III) IV — Page Letters, statements, etc., submitted forthe recordby Continued McGinnis, J. Michael, M.D., Deputy Assistant Secretary for Health, and Director, Office of D—isease Prevention and Health Promotion, Health andHuman Services Continued Prepared statement 122 Miller, Ted, Ph.D., National Public Services Research Institute: Prepared statement 185 RockyMountain Poison Center: Prepared statement 19 Rodgers, George C, M.D., Ph.D., American Academy of Pediatrics: Pre- paredstatement 147 Simon, Jeffrey L., New York State Department ofHealth: Prepared statement 208 Trestrail, John H. ID, R.Ph., codirector, Blodgett Regional Poison Center, GrandRapids, MI: A condensed transcript of a recording of an actual call to a poison control center 31 Prepared statement 34 APPENDDC Additional material forthe record 221 POISON CONTROL CENTERS: IS THERE AN ANTIDOTE FOR BUDGET CUTS? TUESDAY, MARCH 15, 1994 House of Representatives, Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, Washington, DC. The subcommittee met, pursuant to notice, at 10:10 a.m., in room 2247, Rayburn House Office Building, Hon. Edolphus Towns (chairman oftne subcommittee) presiding. Present: Representatives Edolphus Towns, Donald M. Payne, and John L. Mica. Also present: Representative Barbara-Rose Collins. Staff present: Ronald A. Stroman, staff director; William M. Layden, professional staffmember; Martine M. DiCroce, clerk; and Martha B. Morgan, minority professional staff, Committee on Gov- ernment Operations. OPENING STATEMENT OF CHAIRMANTOWNS Mr. Towns. The Human Resources and Intergovernmental Rela- tions Subcommittee of the Government Operations Committee will now come to order. When your child is poisoned, you have a life threatening emergency. You need immediate help. Who do you call? You call your poison center. That phone call may be the difference between life or death. But who do you call when your poison center closes? The subcommittee's 6-month investigation into the funding plight ofpoison control centers has found that the Nation's poison centers are in critical condition. Only about half of all Americans have access to poison centers that meet national quality standards, and the number is declining rapidly. As hospitals cut nonrevenue gen- erating community services, poison centers across the country are closing down. The subcommittee has found that poison centers have been forced to put emergency calls on hold or tell frightened parents that they cannot help a poisoned child because ofbudget cuts. Poi- son experts have stopped visiting schools to teach children about the dangers of poison. Poison experts have stopped spreading the word about "Mr. Yuk." Poison centers save lives, and they save money. In 1992 poison centers provided free first aid advice over the phone to 2.4 million poisoning cases, about 60 percent ofwhich involved children younger than 6 years of age. Because over 70 percent of cases reported (1) to poison centers are handled over the phone in the patient's own home, poison centers avoid unnecessary emergency room visits, am- bulance runs, and hospital admissions. Several studies have shown that every $1 spent on poison control centers saves between $4 and $9 in unnecessary health care expenses. Today the subcommittee will explore whether there is an antidote for the budget cuts that are forcing the Nation's poison centers to close. Closing poison centers is health care retreat, not health care reform, and we need to understand that. Next week is National Poison Prevention Week. It is a chance for the Nation to recommit itselfto prevent poisonings and deaths due to poisonings. Let's work together to ensure that we guarantee access to quality poison control services to all Americans. At this time, I would like to yield to Congressman Payne, a mem- ber ofthe subcommittee from New Jersey. Mr. Payne. Thank you very much, Mr. Chairman. I would like to commend you, Mr. Chairman, for your leadership in calling this hearing today. I also would like to thank the witnesses who have agreed to testify today. Also, let me congratulate you for the press conference held on Poison Prevention Week, because we feel that it is very important to focus on this issue, educating children and parents about taking safety precautions that can literally be a mat- ter oflife and death. Furthermore, I would like to welcome Dr. Steven Marcus, execu- tive director of the New Jersey Poison Information and Education System, who will testify later in the hearing. He has worked tire- lessly in eliminating dangers to our children's health. Unintentional childhood poisonings are a very, very serious problem in this country. Almost half of emergency telephone cases involve children under 2. Almost 60 percent of these cases involve children younger than 6. In New Jersey, childhood lead poisoning remains a very, very serious problem in our public health system. According to the 1988 statistics of the Agency for Toxic Sub- stance and Disease Registry, 80,300 children living in Newark were at risk of lead poisoning because they resided in dwellings with lead interior paint. Newark ranked 6th and Jersey City, 21st among cities with the most children living in danger of poisoning because of their hous- ing. The increased number ofhazardous chemical compounds available on the market are also fueling the increase in the number of children exposed to these dangers. Unfortunately, it is statistics like these that dictate the need for places like New Jersey Poison Information and Education System, headed by Dr. Marcus in New- ark, to have more attention. Most cases of unintentional poisonings are handled over the phone in the patient's home. In recent years, funding for these life- saving centers has dwindled, and every time government has sought to reduce expenditures, these centers have been the first lined up for the budgetary axe. Because unnecessary runs to emergency rooms have been eliminated, as has been indicated by the chairman, poison control centers have shown that we can save between $4 and $9 in unnecessary health care expenses by having these activities. Having been active in lead abatement efforts in New Jersey, I have a personal stake in ensuring that everyone has access to these types oflife-saving services. I believe that tne issue shaping the de- bate should be the health and welfare ofour children. I would like once again to thank you, Mr. Chairman, for calling this hearing on this very important subject. I look forward to hearing the testimony ofour witnesses. Mr. Towns. I would like to thank the gentleman from New Jer- sey, first of all, for his kind remarks and also to thank him for all the work that he has done in this area. He believes in doing any- thing that you can do to protect the lives of people, and he has been in the forefront ofnot only this issue, but other issues as well. At this time, I would like to yield to Congresswoman Barbara- Rose Collins, who is another person who has been in the forefront ofsaving lives, as well. Congresswoman Barbara-Rose Collins. Ms. Collins. Thank you very much, Mr. Chairman. I applaud Congressman Towns for recognizing the importance of children's poison centers' saving children, and I want to thank him and the subcommittee for inviting me to participate in today's hearings on the need to support poison control centers across tne Nation. What parent has not been jolted out ofhis or her wits by a young child eating or drinking something potentially dangerous? What parent has not had that gripping fear when a child has accidentally imbibed a substance that may be poisonous? Most of us have. I have as a grandmother. Today's homes are full of dangerous sub- stances, from bleach to floor polish, from hair mousse to bug spray. Parents are tremendously comforted by the security of having knowledgeable, authoritative people we can call for instant answers on how to handle emergency situations like this. We depend on our established institutions to be there for us in an emergency. In my home area of Detroit, we have an outstanding program, the poison control center at the Children's Hospital of Michigan, part ofWayne State University, which serves 18 counties in south- eastern Michigan with a population of 5.9 million. Our center provides 24-hour telephone assistance, thank God. And we get about 60,000 calls every year. We have a physician toxicologist available 24 hours a day. Our center also provides educational services for professionals and the general public on poison prevention and treatment. Until 1991, our center received $250,000 or one-fourth of its budget from the State. The legislature approved funding in 1992 and 1993, but it was vetoed by our Governor. Today our center re- ceives no Federal, State, county, or city funding. Children's Hos- pital and some generous donors have essentially been financing the center's operations. But the hospital board has said that new funding must be found or the center may be closed on October 1, a mere 7 months away. Our center has already cut some education services, services that prevent poisoning and prevent hospitalizations and prevent death. We have already eliminated the toll-free 800 public access number. Our center is struggling to survive. I hope today's testimony will help us formulate a survival plan. I want to welcome to the subcommittee this morning, Mr. Chair- man, Dr. Ralph E. Kauffman, medical director ofthe poison control A center at Children's Hospital of Michigan. professor of pediatrics and pharmacology, Dr. Kauffman will make a strong case for find- ing the funds to Keep our poison centers going nationwide. Again, thank you for the opportunity to participate in this important hearing. I look forward to working with you to find a way to prevent poison incidents and to maintain public services for people who have public accidents. In our civilized society, we expect poison control centers to be there when we need them. Thank you, Mr. Chairman. Mr. Towns. Thank you very much, Congresswoman Collins, for your statement and also, as indicated early on, your involvement not only in this issue but in so many issues that lead to saving lives. Thank you for your participation. I know that you have another hearing and we understand the time demands that you have. We are just delighted that you were able to come by, make a statement, and show your support. Ms. Collins. Thank you. Mr. Towns. At this time, I would like to call on Jennifer Grover. mother ofa poisoned child, ifshe would come forward. And I would like to ask Margaret McDonald, mother of a poisoned child, to please come forward, and Cheryl Dosh, mother of a poisoned child, to also come forward. I would like to request special permission from the members, because, as you can see, Ms. Grover has a little one with her, and I would like to allow her to go first. Then after that, any questions that you might have for Ms. Grover, you can raise them with her, and then we would allow her to be excused. We can see that she is extremely busy. Without objection, we would take her out of order, and of course we would have questions with her and then move forward. Also, let me just say that there is a light in front of you. When you start out, the light will be on green; 5 minutes later, the light will turn red. Now, I know that some ofyou have an opening statement, but I will assure you that your entire statement will be put in the record, every period, every I, every T, every everything will be in the record. So at that point, when trie light goes to red, ifyou wouldjust quickly summarize we would certainly appreciate it, and then we will allow the members of the panel to raise specific questions with you. At this time, Ms. Grover, ifyou would go forward. STATEMENT OFJENNIFER GROVER, MOTHER OF POISONED CHILD Ms. Grover. Mr. Chairman and members of the subcommittee, my name is Jennifer Grover, and this is my son Henry. He is IOV2 months old. Thank you for inviting us here to share our story with you about the poison control center. About 3 weeks ago, Henry was bitten by a lizard. We had been visiting my next-door neighbor in the evening, and she has a pet lizard. It's really very small, only about 3 inches long and only about as wide as two ofmy fingers. Henry reached out to touch the