Statements On Introduced Bills And Joint Resolutions

Floor Speech

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Mr. GRASSLEY:

S. 641. A bill to amend the Controlled Substances Act to prevent the abuse of dehydroepiandrosterone, and for other purposes; to the Committee on the Judiciary.

Mr. GRASSLEY. Mr. President, I remain very concerned about the continuing prevalence of performance-enhancing drugs in sports. The ongoing reports of the vast use of performance-enhancing drugs in professional sports, especially Major League Baseball, illustrate the presence of a disturbing culture throughout all sports. It is becoming all too common to read not only about professional athletes using performance-enhancing drugs, but also college and high school athletes turning to these substances to gain a competitive edge. Although Congress passed the Anabolic Steroid Control Act to disrupt this cycle of abuse in 2004, we cannot relent in our efforts to keep performance-enhancing drugs out of our society and away from our children.

The dietary supplement, Dehydroepiandrosterone, DHEA, is readily available online and on the shelves of nutritional stores, but can be used as a performance-enhancing substance. In response to the growing use of performance-enhancing drugs in professional sports, Congress passed the Anabolic Steroid Control Act in 2004. When this bill was being considered, DHEA was among 23 anabolic steroids that are now schedule III controlled substances. Some of my colleagues objected to DHEA being included on this list, because they believed DHEA was harmless and did not have the same anabolic effects as the other steroids on the list. DHEA was subsequently removed from the bill, but the facts do not back up the claims that DHEA is not a performance-enhancing drug or harmless.

According to the U.S. Anti-Doping Agency, DHEA is a pre-cursor hormone to androstenedione and testosterone. These substances became illegal anabolic steroids as a result of the Anabolic Steroid Control Act of 2004. Although the body naturally produces DHEA, the natural production of the hormone ceases around the age of 35. Many people over this age use DHEA, in low doses, as part of an ``anti-aging'' regimen. However, when taken in high doses over time, DHEA, like its other relatives in the steroid family, may cause liver damage and cancer. In fact, one study conducted by scientists at Oxford University revealed DHEA use to be strongly associated with breast cancer development. The truth is there are few studies about the long term effects DHEA has on the body. According to Dr. F. Clark Holmes, Director of Sports Medicine at Georgetown University, many proposed studies involving high doses of DHEA are denied approval out of concern that the product may cause irreversible harm to human subjects. Because DHEA is marketed as a dietary supplement, companies are not required to prove their safety to the Food and Drug Administration. However, nearly all the professional sports leagues, the Olympics and the NCAA have banned their athletes from using it for good reason.

What is even more disturbing is the fact that DHEA is being marketed online to younger athletes. One bodybuilding website, directed towards teenagers, features a teen bodybuilder of the week to promote performance-enhancing supplements. A 19-year-old Junior National Champion bodybuilder is one of the bodybuilders on this website. When asked what supplement gave him the greatest gains for his competition this teenager replied, ``DHEA.'' In another website, DHEA is advertized as follows, ``If you're a bodybuilder, and want to increase lean body mass at the expense of body fat, actual studies show this supplement may significantly alter body composition, favoring lean mass accrual.'' Another example on another website describes DHEA in this way, ``DHEA is HOT, and you will see why. As a pre-cursor hormone, it leads to the production of other hormones. When this compound is supplemented, it has shown to have awesome effects.'' These advertisements are geared to the younger crowd, even though DHEA has no legitimate use for teenagers.

These DHEA advertisements, and others like it, are having some impact on young athletes, especially in my state of Iowa. The Iowa Orthopaedic Journal published a study on nutritional supplement use in 20 Northwest Iowa high schools. In this study, 495 male football players and 407 female volleyball players were asked if they used nutritional supplements. The results of this anonymous survey revealed that 8 percent of football players and 2 percent of Volleyball players used supplements. These students identified DHEA as one of the supplements that they used. The students were then asked to give the reason why they used DHEA and the general response was ``for performance enhancement.''

We have to find a way to keep young people from using a substance that can do them harm. Three states currently prohibit the sale of DHEA to minors. There are also various supplement stores like GNC and Walgreens that have policies in place that prohibit the sale of DHEA to anyone under 18. If we cannot place DHEA behind the counter, then we should at least make it difficult for teens to walk out of a store with a potentially harmful substance in hand. This is why I'm pleased to introduce the DHEA Abuse Reduction Act of 2009. This bill will place a nationwide restriction on the sale of DHEA for those under 18 years of age. It will also allow those who use DHEA, legitimately, to not have to obtain a prescription to do so. The Coalition for Anabolic Steroid Precursor and Ephedra Regulation, which is comprised of the Nation's leading medical, public health and sports organizations support this legislation. The U.S. Anti-Doping Agency also supports this legislation to keep DHEA away from our children. I urge my colleagues to pass this legislation.

In the highly competitive world of sports, the pressure to use performance-enhancing drugs can be overwhelming. Even though we, as a society, demand excellence from our favorite teams and athletes, we cannot accept this excellence to be falsely aided by a drug. Furthermore, we cannot allow harmful drugs to destroy the health of so many young and promising athletes. We have to continue to curb the use of performance-enhancing drugs for the health of our country and children.

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Mr. GRASSLEY. Madam President, I thank the Senator for his kind words. I have had an opportunity to work with him not only on legislation of this type but a lot of other pieces of legislation, and I enjoy working with him because he is a person of great common sense. I thank him for his leadership in this area, and, more importantly, I thank him for serving in the outstanding position as chairman of the Special Committee on Aging, with a lot of responsibilities in the area of making sure aging problems are brought to the forefront.

This legislation we are introducing is called the Nursing Home Transparency and Improvement Act. It brings to the surface some very important issues he is watching as chairman of the Aging Committee. I have some interaction with it because I am a member of the Finance Committee.

This is a critical piece of legislation that brings overdue transparency to consumers regarding nursing home quality and operations. It also provides long needed improvements to our enforcement system.

In America today, there are well over 1.7 million elderly and disabled individuals in over 17,000 nursing home facilities. As the baby boom generation enters retirement, this number is going to rise dramatically. While many people are using alternatives, such as community-based care, nursing homes are going to remain a critical option for elderly and disabled populations.

As the ranking member of the Senate Finance Committee, I have a longstanding commitment to ensuring that nursing home residents receive the safe and quality care we expect for our loved ones. Why? Because the taxpayers put in tens of billions of dollars--I would imagine over $47 billion or $48 billion now, and maybe that figure is higher than the last time I looked, but it is billions of dollars. Our Aging Committee and all of Congress have a special responsibility to make sure that money is spent well, and one way of spending it well is to make sure it delivers quality care to these people who are in need.

Unfortunately, as in many areas, with nursing homes, a few bad apples often spoil the barrel. Too many Americans receive poor care, often in a subset of nursing homes. Unfortunately, this subset of chronic offenders stays in business, often keeping their poor track records hidden from the public at large and often facing little or no oversight or enforcement from the Federal Government, based on laws that were passed in 1986 and 1987.

There is a lack of transparency, a lack of accountability, and sometimes in our approach to nursing homes, quite simply, a lack of common sense--the sort of common sense the Senator from Wisconsin always exhibits in the legislative approach. These are things this legislation seeks to bring to nursing homes and their residents--transparency, accountability, and common sense.

Let's look at transparency. In the market for nursing home care, as in all markets, consumers must often have adequate information to make informed choices. For years, people looking at a nursing home for themselves or their loved ones had no way of knowing a nursing home facility's record of care, inspection history, or which individuals were ultimately responsible for caring for their loved ones.

This bill is intended to change that and to emphasize this point about why we have to be concerned about the type of facility in which a person is placed.

I have never once in my life run into a single elderly or disabled person who said to me: I am dying to get into a nursing home. This is on the continuum care, the stop where people cannot be taken care of beforehand. We need to make sure that is right.

This legislation requires nursing facilities to make available ownership information, including the individuals and entities that are ultimately responsible for a home's operation and management.

Today when I am discussing this bill with people in the industry, I don't have anybody objecting who actually owns a nursing home. But early on, that seemed to be something that, for some reason or another, did not seem to be anybody's business. Tell me it isn't anybody's business who owns a nursing home if they are receiving $45 billion to $50 billion of taxpayer money going to that industry. That ownership is very important.

How nursing homes are staffed can greatly affect the care they provide, especially when dealing with complex conditions, such as nursing homes. So you go behind who owns a nursing home, who is working there, and that is pretty important. If you do not have all this information, it leaves residents and their families without clear information about who is ultimately responsible for ensuring that a resident is consistently provided with high-quality care.

This provides transparency, as well, concerning nursing home staffing and surveys. Homes differ widely in terms of the number of specialized staff available to residents, as well as the number of registered nurses and certified nursing assistants who provide much hands-on care.

Let me say it a second time. How a nursing home is staffed can greatly affect the care it provides, especially when dealing with complex cases. This legislation requires better tracking of this information and requires that this information is available to prospective residents and their families.

In addition, this legislation will help families have a better idea of a nursing home's track record in that it requires better transparency for nursing home inspection reports that are completed on a routine basis.

The Secretary will also now be required to provide consumers with a summary of information on enforcement actions taken against a facility during the previous 3 years.

This same transparency will also provide additional market incentives for poor homes to improve. If customers know about problems, that home is incentivized to improve or face going out of business.

This effort also requires a strong, effective enforcement and monitoring system to ensure safe and quality care at facilities that will not take the necessary steps voluntarily. But even with improved transparency, there are some nursing homes that will not improve on their own.

In the nursing home industry, most homes provide quality care on a very consistent basis. So we need to give inspectors better enforcement tools.

The current system provides incentives to correct problems only temporarily and allows homes to avoid regulatory sanctions while continuing to deliver substandard care to residents. This system must be fixed.

Last year, CMS requested two things: one, statutory authority to collect civil monetary penalties sooner, and, two, the ability to hold those penalties in escrow pending appeal.

To that end, this bill requires nursing homes that have been found in violation of law be given the opportunity to participate in an independent, informal dispute resolution process within 30 days. After that point, depending on the outcome of the appeal, the penalties are collected and held in escrow pending the exhaustion of the appeals process. This will ensure that nursing homes found to be violating the rules actually pay the penalties assessed if it is determined those penalties are appropriate. But we should not have to resort to enforcement. Problems resulting in penalties should be avoided or detected and fixed immediately by the nursing home in the first place. That is why this bill now requires all nursing homes to have compliance and ethics programs, as well as quality assurance and performance improvement programs.

In addition to increased transparency and improved enforcement, this bill provides commonsense solutions to a number of other problems.

This legislation requires the Secretary of HHS to establish a national independent monitoring program to tackle problems specific to interstate and large intrastate nursing chains.

In the case of nursing homes being closed due to poor safety or quality of care, this bill requires that residents and their representatives be given sufficient notice so they can adequately plan a transfer to an appropriate setting.

We need to be very sensitive--and I am very sensitive--to the fact that nursing home residents are often elderly and fragile. Moving them into a new facility is traumatic. So we have to make sure these residents are transferred appropriately and with adequate time and care.

This bill also aims to help nursing homes that self-report their concerns and remedy certain deficiencies, giving those homes that are trying to do their best and find things wrong on their own to get credit for that. By doing so, nursing homes then may have any penalties reduced by 50 percent. This will encourage facilities to take the lead in finding, flagging, and fixing violations.

This bill is also intended to strengthen training requirements for nursing staff by including dementia and abuse prevention training as part of pre-employment.

I am proud to introduce this bill along with my friend Senator Kohl. The Committee on Aging and I have a long history of working together on elderly care issues, and I am happy to continue that work.

I also note today the Government Accountability Office is releasing a report critical of CMS's funding of State oversight entities, such as nursing homes. This report notes that survey activity is sometimes so unreliable that certain homes have not even been inspected in more than 6 years. The report makes a number of recommendations to CMS, and I will be looking very carefully at how CMS follows those recommendations. In the meantime, it is important that we improve transparency and accountability for the inspections that are taking place.

We will continue to do everything we can to make sure that American nursing home residents receive the safe and quality care they deserve. Increasing transparency, improving enforcement tools, strengthening training requirements will go a long way toward achieving that goal. I thank, once again, Senator Kohl.

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