Transcripts For CSPAN3 Hearing Focuses On Athlete Safety 20170517

Good morning, welcome to todays hearing. Its no exaggeration to say that americans love sports. We love watching them, playing them, collecting sports memorabilia, and even arguing about our favorite teams and athletes, whether its watching the super bowl with friends, joining an office bracket pool for march madness or stretching out for the turkey trot 5 k races on thanksgiving morning, we love our sports. Personally, im a dodger and a packer fan and some of my best moments have been spent competing in sports or cheering on my two daughters at their meets and games. This committee is committed to promoting american success in international competition, ensuring exciting play in our professional leagues, providing opportunity for our student athletes and maintaining a vibrant sports culture for the benefit of all americans. At the same time, protecting the health and safety of american athletes of all levels, professional, amateur, student and youth, is a longstanding priority of the commerce committee. The issue of sexual abuse within the United States Olympic Movement has received considerable Media Attention in recent months. The troubling nature triggered an investigation for individual sports to conduct impartial investigations into allegations of abuse. Im glad that shelly foal is here today to discuss the centers work to protect these athletes. While i believe that nothing in the current law prevents the usoc and ngb from taking immediate steps to remove a suspected predator from being in contact with athletes, it is also clear that certain stakeholders have at times its own confusion about the legal requirements of the ted stevens olympic and amateur sports act and manufactured am big uties behind which to hide. Im pleased that our colleagues on the committee have advanced this issue and i look forward to working with her to strengthen her bill as it advances to the full senate. Any legislation to address this issue must include language clarifying that it is the responsibility of our olympic leaders to provide an environment that is free from abuse. In the same way congress codified the United States Antidoping Agency to combat the use of performance enhancing drugs in 2001, i believe we should authorize the u. S. Center for safe sport as an independent organization with expertise to investigate and adjudicate abuse allegations as they arise. Speaking of antidoping, im pleased that we are joined here today by olympic medallist and true sport ambassador Lauren Williams who will testify on behalf of usada. The Committee Last reauthorized them in 2014 and has been active on a number of clean sport issues. In 2016 following the revelation of an elaborate doping Program Sponsored by the russian government, the Committee Conducted oversight of the world Antidoping Agencys response, prompting the agency to expand the scope of its investigation. Following a reanalysis of samples collected during the 2008 summer olympics games in beijing which revealed cheating in the mens poll volting, i road to the committee. The issue of prescription opioids to treat sports injuries is another growing concern. In particular because of the addiction and overdose risk they carry. Though Substance Abuse and misuse affects all demographics, athletes are particularly vulnerable. While the media has focused recent attention on the use of prescription oil yoids in professional Sports Leagues, this issue impacts all athletes. While i wish she were here under different circumstances, im glad that we are joined by marine deutscher and her husband jeff of south dakota who will testify about their family tragedy involving the loss of their son nick to opioid painkillers. Marine and jeff, im deeply sorry for your loss, and thank you for your bravery in sharing your story with us today. Finally, the issue of concussions in sports is a longstanding issue that this committee has sought to address. Concussions are common injuries among athletes participating in Contact Sports and are among the most complex injuries to manage in Sports Medicine. The Committee Conducted oversight efforts to prevent and mitigate the occurrence of concussions in sports including game rule changes, coaching and player education guidelines, as well as the development of brain injury and equipment research. Dr. J. Clarence butler of the Alaska Department of health and social services, mr. Scott sailor, president of the National Athletic Trainers Association and dr. Robert stern of Boston University school of medicine will be able to speak to this issue as well as many others that affect our nations athletes. I want to thank you all for being here today and i look forward to hearing your testimony and the opportunity for you to interact with members of this committee and give us a chance to ask questions. With that, i will yield to the distinguished senator from florida, the Ranking Member, senator nelson, for his opening statement. Thank you, mr. Chairman. I think this is an opportunity, as the chairman has said, to start a conversation about what more can be done to protect americas athletes. Obviously we must protect the Young Athletes, some of whom are children. Theyre starting early. Theyre training for the olympics. Obviously we were all shocked by the revelations of widespread sexual abuse in usa gymnastics, usa tae kwon do and other olympic sports, and even more appalling was evidence that responsible adults were indifferent and looked the other way. When so many young victims can be horribly abused by adults for so long without repercussions, its a stain on americas proud olympic heritage. So, we in Congress Need to respond to this travesty. I, along with many others, are sponsors of the act that has the bill that has been introduced, and this bill would require immediate reporting of sexual abuse allegations, require National Governing bodies to adopt strict protocols and measures to protect children, and make it easier for victims to come forward and report to the authorities. We also need, as the chairman has already outlined very well, to examine athletic doping at the interNational Level. There was a time when we thought of the olympics and we thought this is above reproach, and what now when we thi now. When we think of olympics, you think of the scandals that have been revealed in the doping. Over 100 russian athletes were banned from the Olympic Games in rio. We should address clean, drugfree sports and protect athletes who do things the right way. And then the issue of head injuries. Its something thats becoming alarming. Each one of us more than likely has had a fellow athlete friend along the way that has had concussions, and now at our ages later, were seeing the manifestations of those concussions. Concussions and cte are not limited to pro sports. Its about kids and the devastating effects on their still developing young brains. And i want to recognize and commend senator udahl who is with us today, who has been such a champion and a leader on this issue. His dedication to preventing conductions and youth athletic safety is well known to everyone here, and i want to thank him on behalf of the committee for raising awareness about this very troubling issue. Thank you, mr. Chairman. Thank you, senator nelson. I want to recognize for an introduction of one of our panelists today senator sullivan to introduce dr. Butler, followed by senator markey for a short statement to introduced dr. Stern. Thank you, mr. Chairman. Thank you and the Ranking Member for holding this important hearing. I do want to recognize dr. Jay butler who came all the way from the great state of alaska to testify today. Dr. Butler does great work in the state of alaska. He is essentially the states Surgeon General, and although its not an uplifting topic, dr. Butler has committed his time and effort across the state, really across the country, to help stymie the Opioid Epidemic that is raging through alaska like it is in so many of the other states in the United States. His efforts have included education and awareness on the dangers of opioid use, especially for our young alaskans, aiding in the distribution of naloxone and nonmedical personnel and facilities and currently serving as the president of state and Territorial Health officials representing the state of alaska in his position as director of had been health and chief medical officer for the state. I wont go through his extensive resume but well mention briefly, mr. Chairman, my experience with dr. Butler. We worked together last year when we put on a summit, a wellness summit in the state that was focused on conquering the opioid crises. Dr. Butler was instrumental in the success of this summit. Over 500 alaskans with several more online showed up at this summit. He participated in planning on the steering committee. He interviewed the United States Surgeon General for a fireside chat and moderated the ending panel of this discussion and summit, and i just want to thank him for again traveling from alaska. All the work hes doing in our state and participating on the National Level on this important issue that crosses partisan lines. This is an issue thats impacting every single state in our great nation, and dr. Butler is a leading in this not only in our state but in the country. Thank you, senator sullivan. Senator markey . Thank you, mr. Chairman. Dr. Robert stern is a professor at the Boston University school of medicine and is the director of Clinical Research for the b. U. Chronic traumatic enexcept lop thee center, also known as cte. It is a neurodegenerative disease often found in athletes. While a lot of dr. Sterns research focuses on repeated brain trauma in athletes, i know him best through his work on alzheimers disease as he is the director of the clinical core at the b. U. Alzheimers disease center. So throughout his career, he has won multiple national and federally funded grants for his work. Hes published more than 250 journal articles, chapters and abstracts in his field, and he is a fellow of both the American Neuropsychiatric Association and the American Academy of neuropsychology, and i just wanted to thank you, doctor, for all of the work which you have done on the brain and helping to explain not only alzheimers and the pathways that are possible for finding a cure but also what youve done in becoming the center for the study of the impact on the brain that contact in sports has. You have become the national leader, and i just wanted to thank you for that. Thank you, senator markey. Welcome, dr. Stern. I want to introduce again for the panel in terms of the order of presentation, well start on my left and your right with dr. Butler who is the chief medical officer, as was pointed out by our colleague of alaska, of the Alaskan Department of health and social services. Ms. Marine deutscher on behalf of the south Dakota Department of health. Ms. Shelly foal who is the chief executive officer of the United States safe sport. Scott sailor, the National Athletic Trainers Association. Dr. Robert stern, professor at Boston University school of medicine. Ms. Lauren Williams Well save for last, a true sport ambassador and United States Antidoping Agency. If you would proceed in that order, dr. Butler, and if you could confine your oral remarks to as close to five minutes as possible, it will maximize the opportunity that members of the committee will have to ask questions. Thank you all for being here. Dr. Butler. Good morning, chairman thune, Ranking Member nelson, members of the committee. Its an honor to speak with you today. In my role as chief medical officer in alaska, i oversee staterelated prevention preparedness and response activities. During the past three months, in addition to the roles that senator sullivan has described, ive also served as the Incident Commander of governor bill walkers opioid response. In alaska were responding to the Opioid Epidemic much as we would to any other disaster, whether an earthquake or tsunami, use it in an incident command structure to coordinate communication across state government. This response is addressing the three to four fold increase in opioid Overdose Deaths that have occurred in alaska over the past two decades which mirrors an increase across our nation. It started with gradual increases in deaths caused by prescription painkillers. The problem has been compounded over the past decade by the increased availability of heroin and more recently elicitly produced fentanyls. The majority of people who use heroin and fentanyl report that they first became addicted through use of prescription opioid pain relievers. I want to be clear at the outset of the discussion that the Health Benefits of participation in sports and physicaltensive a well documented. Reduced risk of cardiovascular disease, obesity, diabetes, certain types of cancer, better musculoskeletal strength, improved sense of wellbeing and connectedness to community. Youth who participate in sports historically have been shown to be less likely to use elicit drugs. Unfortunately, athletes have not been immune to the devastating effects of the Opioid Epidemic. Too often sportsrelated injuries managed with opioid pain relievers have been the beginning of a path to addiction. One coach expressed her frustration to me by describing that she had seen too many times an injury leading to a prescription for pills, leading to additional prescriptions for pills, leading to a friends pills and leading to any pills which can be obtained by any means and unfortunately sometimes leading to use of heroin and Overdose Deaths. High profile stories of professional athletes who began using prescription opioids for injury and then struggled with addiction or died of overdose may grab headlines but we need to recognize that the problem is occurring at all levels of competition. One adult recreational soft ball league in alaska with roughly 750 participants has had five players die of opioid overdose. An epidemiological study of High School Students in michigan found that boys who participated in organized sports were more likely to be prescribed opioid painkillers than those who did not. As a result, participation in organized sports actually increased the risk of subsequent opioid misuse. With over 4 million youth sports and recreationassociated injuries occurring each year in the u. S. , theres a reason for concern. So what can be done . There are no easy answers and no magic bullets. We need to be clear about that. But id like to highlight three areas of opportunity. First, we can promote evidencebased Pain Management strategies and more rational use of opioid pain relievers. Opioids can be useful for the management of acute pain, and many people who receive these medications use them without problem. However, opioids should not be the first line of treatment following any sports injury, and these medications are used best when theyre prescribed in the lowest effective dose and for the shortest period possible, generally for less than three to seven days. Larger firsttime prescriptions have specifically been associated with higher risk of longterm use and thus greater risk of dependency and addiction. A school nurse recently told me about a student who came back to school after ar throw scopic surgery for an athletic injury. In line with school policy, he checked in with her and turned his prescription medicines in. She was shocked to find that he had a bottle of 120 oxycodone containing pills. Special care needs to be taken when prescribing these medications to teens. Adolescence is a particularly high risk period and use of opioids, even as prescribed by a Health Care Provider by High School Students has been linked to increased likelihood of subsequent misuse. Second, we can provide more information on the risks of opioid pain relievers for both Health Care Providers and the public, including coaches and trainers. In talking with teens, i frequently hear the sentiment that if opioid pain relievers are really dangerous, then why do doctors prescribe them. In talking to people in recovery, i frequently hear, no one told me, and, if i had any idea how dangerous these drugs were, i never would have taken them. We can do a better job not only describing the risk of opioids but also providing information on what can be done in our communities to address the problem, including promotion of leftover drug return and disposal and talking openly about recognition and management of dependency and addiction as a health issue rather than as solelysole ly a criminal justice issue or some type of moral failing. Theres a role for professional athletes as well as olympians and other high profile athletes to be able to serve as spokes persons in promoting conversations to reduce the stigma of addiction. Theres also a need for better continuing medical education for all Health Care Providers to improve their knowledge and confidence in optimal Pain Management and the basics of addiction medicine. Finally, and maybe at the risk of sounding corny, the Effective Response of this will be a team sport. It will involve coaches, parents, trainers and the athletes themselves, as well as organizations including professional, console assic and amateur Sports Leagues, public agencies, Health Care Providers, third party payers, the criminal justice system, educators, businesses, and lawmakers as well. Working together, Sports Participation cannot only be made safer but i believe can also be part of how we reduce the number of people who become newly dependent on opioids and increase the number of americans living in recovery. Finally, i just want to conclude by pointing out that the issue of opioid abuse is not just an isolated event and not just an isolated topic as we talk about sports safety. Its no accident that we have the broad range of topics that were discussing today. These topics are complimentary and not in competition. Sexual assault is a trauma that ultimately can lead to unhealthy coping mechanisms and increase the risk of selfmedication. Traumatic brain injury is a brain process that can lead to altered cognition, as well as altered Risk Assessment and can also possibly create increased risk of abuse. The question is not to ask one another what are you doing to address these issues, but what we can all do together to solve all of them. I thank you for your time. Thank you, dr. Butler. Chairman thune, Ranking Member nelson, and members of the committee, thank you for the opportunity to provide testimony and our insight regarding opioid use as it relates to the effect on our Young Athletes in our home state of south dakota and around the country. In our 30 years of marriage, my husband jeff and i have been blessed with three wonderful children, jeremy, nick and danny. And today we are here to tell you about our son nick. Kind, funny, happy, uplifting, these were some of the words used in memory of nick by friends and family following his death on july 18, 2015. We would add smart, intuitive, adventurous, frustrating and amazing. Another recurring theme, nick always had your back, he was a true and loyal friend. Were just a regular midwest Family Gathering for meals, enjoying Family Vacations and celebrating special occasions together. Jeff and i have supported our children in their education and activities as religious leaders, room parents, coaches and club leaders. Nick had positive role models and extended family, teaches and coaches. Our parenting style as i would describe it as consequence when called for, praise and always love, and we all take care to be there for one another. So what happened . What did we miss in protecting our son . This has been our daily reflection for the past 21 months and 29 days. We would like to share with you some of nicks journey through the last four years of his life. Nick excelled in academic and athleti athletics. He had many friends. He was a bit of a risk taker. Nicks experience with opioids began shortly after his 18th birthday in the fall of 2011 with his mcl acl injury, second play of the second game senior year with his High School State champion football team. Then the prescribed hydrocodone and percocet or oxycodone through the partial tear, rehab, back in play for the last game of the season and subsequent surgery for the full acl tear. As though it were yesterday, we recall driving to Walgreens Pharmacy directly from the game field for the first of a series of prescriptions. I personally maintained possession and control of nicks opioid prescriptions for his welfare, but my understanding of the risks associated with the medication did not even scratch the surface. We shared an alarm went off in november when nick indicated the hydrocodone was no longer sufficiently addressing his pain. We shared this information with his orthopedic staff, were told they were not concerned with the progression, and percocet was prescribed over the phone and without further evaluation. Following recovery and rehab from surgery through december of that year, the prescriptions abruptly ceased. Beginning in january, it became very clear that nick was struggling. He underwent counseling and through our physicians alternative medication were prescribed to help with withdrawal, culminating in 30 days of residential treatment. Still, nick graduated with his class as a regent scholar. Nick made it through that frightening and challenging time all while under the care of excellent physicians and all with the continued love and support of his family and the support of his high schools principal, coaches and staff. For the next three years, nick attended College Classes and worked, but the disease had taken hold and did not retreat. As he continued to struggle, protecting us, his family as best he could from the fear of what could happen to him and the frustration at not being able to diminish the symptoms of addiction. Still good, kind and fun, nick continued to share with us his hope in recovery. The symptoms of addiction can move a person in directions they do not want to go and often do not comprehend. That happened to nick as he found himself faced with charges stemming from Substance Use in 2014. Nick knew what to do, asked for help. We were blessed to have been able to support him through his work with tall grass recovery in sioux falls between october 2014 and march 2015. Coming home in march was a young man renewed in his recovery, attending meetings, getting together with his sponsor, going to church, working and spending time at tall grass. On may 20th of 2015, we attended nicks sentencing hearing for the 2014 offenses, and on june 3rd, nick checked into the Work Release Program with mini ha ha county for just under four months. July 18th brought a visit by the Sheriffs Department at our home at approximately 8 30 p. M. Nick had died in his sleep having returned to the work release facility after work at approximately 3 30 that afternoon, spending time with others in the program, and laying down for a nap. Nick died an accidental death. Reports indicated Prescription Medications in nicks system all but two prescribed, one of which was oxycodone at an elevated level. Nick was 21. We can no longer experience excuse me. From what we can discern through conversations with nicks friends and investigative findings, nick likely relapsed due to the stress of his situation. We believe the medications were intended by nick for use as a coping tool and to aid in sleep at the corrections facility. But as too many parents, family members and friends across the nation are learning every day, for some people opioids have their own intentions. We can no longer experience the joy of nicks laughter, awesome hugs and genuine goodness. What we hope to accomplish here is to reinforce the need for careful consideration of the effects of opioid therapy in the management of injury as our Young Athletes press forward to perform. To highlight the responsibility of medical professionals in prescribing practices relating to opioid pain medication, and to reinforce the need for education of the public on the addiction risks associated with the use of opioid therapy in sports injury management. In our experience with nick, the addiction hit swiftly and without retreat. Reinforcing that addiction is a chronic disease. Over the past 21 months, we have had meetings and conversations with county and stateappointed and elected officials, members of the legal and judicial systems and to Agency Directors in the very misunderstood recovery. Were currently serving on the south dakota governors opioid abuse advisory committee. Through all of the conversations and meetings, there are key issues that come to the top for jeff and me. Number one, the risks of addiction to opioid medications and the risk of that leading to further addictions are seriously misunderstood and understated. And secondly, the prescription opioid issues begin with just that, a prescription. Calling for responsible prescribing practices and distribution monitoring. As parents, jeff and i feel our most Important Role in life is to protect our children. If only we had known then what we know now. In closing, we are grateful for the current work being done to address the issues at hand. Now we ask for your thoughtful consideration of the information we have provided, experience gained through our journey with our son nick. Thank you. Thank you. Thank you, chairman thune, Ranking Member nelson and members of the committee. Mr. Chairman, im shelly foal, ceo of the United States center for safe sport. Our organization exists to protect athletes from all forms of abuse. We serve sports participants from the local rec leagues to the professional ranks. The Ongoing National discourse around sports has focused largely on two issues, concussions and doping, which remain important topics today. I thank you, mr. Chairman, Ranking Member nelson and your staffs for adding our voice to the conversation. By bringing attention to emotional, physical and sexual abuse prevention in sports, youre advancing safe sports call to action which is to champion respect and end abuse. 45 million youth in the u. S. Play sports as well as scores of adults at the collegiate, professional and recreational level. Athletics offers unparalleled opportunities for personal growth and developing character all while advancing health and fitness. A study of 400 female executives found that more than 90 participated in sports at some time in their life. I can honestly say i would not be who i am today without sports. We never want to see those benefits that i just mentioned undermined by abuse. Sadly, it exists in society as it does in sports. Whether it is an threat bullying another threat or a coach exploiting his or her power to sexually assault a player. While we do not have stats specific to sports, we know that in the u. S. One in five youth are bullied and one in ten will be sexually abused before the age of 18. Fancy slogans are not enough to prevent abuse. We know that best practices and prevention include policies, tools, training that are embedded in an organizations culture. While we are working to get data on how well sports organizations are doing at preventing abuse, we know anecdotally that much more needs to be done. Ask any parent of a child playing sports these three simple questions. Did you or your child receive training on how to prevent abuse . Do you know that what the sports organizations policy on adult to youth interaction is . Would you know who to turn policy on prevention is . Do you know who to turn to if you were concerned about an abused situation involving your child . My guess is they would answer no to at least one of those questions, which is simply unacceptable. Our goal is to establish a safeguard standard. Safe sport best practices, resources, training tools will then help these organizations getd to where they need to be. Safe Sport Council of any organizations in establishing the safe sport code i refer to in my written testimony. From that art action with other professionals, we understand that simply conducting criminal background checks is not enough. Awareness and training are at the heart of a good prevention effort and are essentially to our work. To date more than 300,000 coaches affiliated with the olympic and paralympics affiliate with safe sport training. We must now work to expand that beyond coaches, to parents, to athletes. In addition to our education and outreach efforts, spaf sport is the independent, response and Resolution Office for the olympic and paralympic muchlgts. Including the National Bodies that make up the sports. We are handled by our team of highly qualified investigators. Reports of Sexual Misconduct fall under the exclusive authority of safe sport. If a report is substantiated, safe sport will determine appropriate resolution, which would include a lifetime ban that would apply across any olympic organization. Sports are in my dna. Every person here has a sports experience, either through your own, or a family member. Underscoring the magnitude of this challenge, we have a lot of work to do. Your efforts to priorityize the health and safety of u. S. Athletes goes a long way to making our safe sport call to action to championing respect and ending abuse a realty. Thank you, and i look forward to your questions. Thank you. Chairman, thoon. And other members thank you for the opportunity to participate in todays hearing. My name is scott sailor. Im also proud to be the president of the National Athletic Trainers Association. Nata is a professional association serving more than 46,000 athletic trainers, students of athletic trainers and other professionals. Protecting the safety of athletes is exactly what nat has been doing since 1950. The mission is to foster the continued growth of the athletic profession and athletic trainers. Athletic trainers are healthcare positions they are required to graduate from an agredted bachelors degree program. Athletic trainers are licensed and otherwise regulated in 49 states and the district of columbia. Nata has long been a leader in bringing a voice to the health and safety issues facing athletes. And we provide our recommendations as policy makers at the local, state, and federal levels. Nata fully believes congress should invest to track safety mesh rsz and futalts. Its only collecting this data we will be able to understand the scope of this matter and the best method to address it. We know america faces challenges balancing an active and safe sports culture. I would like to give you a few of the current statistics on athletic involvement and injuries in the United States. There are 420,000 College Level athletes who experience 290 injuries per year. At the secondary level there are 7. 6 million athletes who have 1. 4 million injuries per year. The 1. 5 million children plague sports in our country have 1. 3 million injuries per year. In 2013 there were for injuries related to sport. These injury statistics are compelling. But to athletic trainers the most compelling fact is the the secondary School Athletic population leads the nation in athletic related deaths. Between 2008 and 2015 there were more than 300 sports related fatalities among Young Athletes. Let me underscore that fact. In a seven year period we lost over 300 children who were merely playing sports. As a nation we must do a better job of preccing our youth athletes. We need to improve access to athletic trainers to secondary schools and youth sports organizations. We have a responsibility to provide appropriate medical care. The investment and proper Safety Measures and adequate super vision is not costly when compared to the death of an athlete. The members of the yssa range from advocate groups, research institutioningswreck professional associates, Healthcare Organizations and youth Sports Leagues. Nata and yssa are working to preserve sports. When injuries are occur we must be adequately prepared to respond. In 2013 nata also sponsored the safety Sports School award, a Program Designed to establish a standard and recognize those athletic programs that excel in taking all the necessary steps to ensure athletes safety. To date there have been over 1100 schools that have received this award. We partner to organize Collaborative Solutions to safety and sport. This is an annual event among youth sports leaders from every state who come together to discuss proper youth Sports Medicine policy. Finally over the past nata has partnered to fund multimillion dollar efforts to place athletic trainers in underserved hooiks. With the knowledge and understanding, nata has taken a leadership role within a number of National Coalitions involved in promoting National Physical issues. This week members were there on capitol hill urging members of congress to support the personal Health Investment today act or the fit act. The legislation provides incentive for adults and their children to get fit, which will help prevent healthcare cost relatable preventable disease. I would like to thank chairman thoon to being the lead sponsor in the senate. Athletic trainers are uniquely positioned to help with opioid abuse and successful rehabilitation from injury among student athletes. Nata also supports the student and student athlete opioid misuse prevention act introduced by the New Hampshire senator. This offers new Grant Funding to support students, administrators, and athletic trainers. As the leading organization representing athletic trainers nata supports senator thoon and klobuchar clarity act. The Sports Medicinelysinture clarity act clarifies medical liekt rules for athletic trainers to ensure they are properly covered by their Liability Insurance when traveling with other teams in a another state. This also has the support of Sports Leagues and professional Sports League organizes. I want to join my fellow athletic trainers and the more than 46,000 members of the nata in urging members of the senate, including members of this committee for sponsoring. Thank you for this opportunity to present the views, and i welcome your questions. Thank you, mr. Sailor. Good morning, mr. Chairman. Ranking member nelson and distinguished members of the committee. It is a great honor to appear before you today. My name is dr. Robert stern. Im also the director of the Clinical Corp of the bu alzheimers disease and ctu sector. For the past 30 ive been conducting Neuro Research mainly pertaining to neuro degenerative diseases such as alzheimers. Cte is a neuro degenerative disease that can lead to dramatic changes in mood, behavior, movement, and cognition. Eventually leading to dementia. It is similar to alzheimers disease, but it is a unique disease, easily distinguished from alzheimers and other disease through postmortem neuropathological examination. Weve actually known about cte for almost 100 years. It was originally called punch drunk or dementia pugilist cuin the early 1900s when it was only believed to occur in boxers. But now cte has been found in people who never Box Including former kwugt, college, and professional contact sport athletes such as football, hockey, soccer, and rugby players. At this time cte can only be diagnosed after death through postmortem neuropathological disorder examination. It is very important to understand that concussion and cte are very distinct. A concussion is an acute brain injury if managed appropriately result in transient symptoms without consequences. Cte on the oernd is a neuro damaging disease that begins early in life when a repetitive brain trauma starts to trigger a cascade of events leading to damage of brain tissue. The symptoms often begin years or decades after the brain trauma and continue to worsen as the individual ages. Theres been numerous cases of advance stage cte postmortem in former athletes who had no symptoms of concussion, no history of concussion but who had extensive exposure what is referred to as subconcussive trauma. Several important questions about cte remain unanswered such as how common is cte, why does one person get it, and other person does not . And how can cte be differentiated. To answer these questions the ability to diagnose cte while someone is living is the critical next step. Were actively conducting research to develop methods to accurately diagnose cte during life. Im honored to be the lead investigator of a sevenyearlongitudinal multiyear investigation funded by the National Institute of Neurological Disorders and stroke that brings together a network of approximately 50 scientists from ten Major Research institutions from across the country. The study referred to as the diagnosed cte Research Project is aimed at developing methods of diagnosing cte during life. In total hundreds of former professional football players, former College Football players, and healthy controls will undergo extensive testing and then return three years later for a follow up evaluation. We are wellunderway, and yet nis is just one study. So much more research is needed. In closing, it is imperative that we do everything we can as a nation to continue to reap the profound benefits of American Sports and athletic participation while aalso assuring we protect the health and safety of former, current, and future american athletes. This is a difficult balance and requires a combination of unbiased scientific information and common sense. I want to thank the committee for your interest in addressing this important issue and for your continued commitment toward protecting the heth and safety of all athletes. I also want to express my gratitude towards the senate of approving the fiscal year 2014 appropriations bill including an additional 400 million in funding of Alzheimers Research. I urge you to continue and expand upon that type of support. Thank you. Thank you, dr. Stern. Miss williams. My name is williams. I want to thank this committee in interest in clean sport and for the opportunity to appear before you today to discuss how we can better protect the rights of athletes around the world. When i started running at 9 yoorz old, i never imagined 1 day i would be competing in the Olympic Games much less to compete four times. Yet, i attained the unattainable. I bake the first woman to win the medsles in the cost of olympic achievement is high. Opportunities cost. The pursuit of an olympic dream costs money, time, experiences, your social life among other things. But these expen dentures are not always sacrifice but our choice. We do so believing the basic idea that every athlete deserves to compete on a level Playing Field. Sadly, that notion is under attack and with it, the very credibility of the Olympic Games. Why . Because of the use of performance enhancing drugs. Shortcuts are being taken, and perhaps most disheartening the kind of abuse continues at nauseam because leaders around the world cannot find the will or courage. To give your blood, literally give your blood, sweat and tears only to have your dreams stolen by someone willing to cheat, someone willing to corrupt themselves and a sport you love. Its devastating. And clean athletes look to those who are supposed to be our advocates. Clean athletes are left wondering what would my life be like if i had actually competed on a level Playing Field . Did i miss sponsorships and endorsements that only come an olympic medal . Of course theres individual suffering when clean athletes lose their moments to cheaters. But it corrupts the experience for others. Fans, spectitators, sponsors and society as a whole are left asking why play if the game is rigged, if the destination has become more important than the journey . Im not the first athlete to say this on capitol hill. In february, the house energy and commerce subcommittee on oversight investigations heard adam nelson the american shut putter who nine years after the 2004 Olympic Games received his gold medal in an airport food court. Really, a food court. And they heard from michael fellps the most decorated olympian in history still questions whether he competed on a level Playing Field while on the international stage. The reason athletes like adam, michael, and myself speak on issues because we know here in the United States were being held to the highest standard there is. However, whale american athletes are asked to report their whereabouts so drug testers can knock on our door unannounced many athletes in other parts of the world are not. The simple truth is not all athletes worldwide are being held to the same standard we are, and its a really frustrating reality. I was tested 66 times during my athletic career. Thats 66 times that a tester tapped me on the shoulder or showed up at my home at 6 00 a. M. , take my blood, watch me pea in a cup, and no matter what time it was, thats 66 times i bore the burden of proving i was clean, that i was exciting the right way. A staggering 4,125 of those athletes have no record of being tested in the 12 months prior to the Olympic Games match thats unacceptable. So im here today to ask you this. How many more . How many more Olympic Games are we going to allow to be corrupted by performance enhancing drugs . How many more podium announcements need to be stolen . How many more dreams crushed . What kind of message are we sending to the next generation of competitors . As athletes we be a responsibility require our voices are heard and be engaged in a conversation that directly affects us. We are just 266 days away from the winter games and the clock is ticking and the time is now. Thank you for your time. Thank you, ms. Williams. Ill start with asking questions and do the five minutes rounds of members of the committee. I want to thank you again and your husband for being here and express our sympathy to for you for your familys loss. And just looking back on that tragic experience, do you have recommendations for other parents whose children faced sports injuries, and maybe as follow up, are there warning signs you can share with other parents who are in similar situations . Education to me is key for the parents. When that happened with nick, when he said oh, this hidrocor done is not cutting it, we should have just said stop. And that would be the advice i would give to other parents. If it doesnt seem right, its probably not right. And thing is, we had excellent positions. We had a great athletic trainer who was working with nick at oi. So it just seems like education and awareness of this issue is just so key. The warning signs for nick it was the warning sign was when he said he needed additional he wasnt i told jeff, he has his hand out for this thats a big red flag. But he was playing his last game of the season. But i just think education and awareness and follow your instincts. And then following i do have to say, though, the addiction hit so quickly. It just happened before our eyes. We all wanted nick to play football, everybody from the coaches to the other parents to us. So education, awareness. Dont be afraid to raise your hand and say stop. And then once the addiction does kick in, its just a sad, long journey. Thank you. Ms. Williams deric miles who as you know the associate coach at the university of south dakota recently received a bronze medal for his Olympic Games in beijing, received this eight years because the athlete who stood there in beijing tested positive for substance. How many like deric are waiting to receive the olympic medal they earned and what ways to ensure i believe there are many other athletes that are entitled to medal that they did not receive, a moment that has been stolen from them. And the thing we need to do, one most important right now is to store samples a lot longer. So right now storing samples for ten years, which is how adam nine years after his medal was to fiend out the person had used performance enhancing drugs. But the longer we store these samples, our technology is improving, and we can look back. And we can say now we can restore those opportunities. But what we can do now is store those samples and look at our technology now. Yeah, getting your olympic medalal at a food court seems very anticlimatic. Very anticlimatic. In your letter you stated it might include and sudden cardiac arrest. Thats a quote from your statement. Given the diverse and underlying causes that Young Athletes may experience, is it reasonable to single out contact football as the mostfundmental sport that these change . Well, as athletic trainers we recognize the number one cause of death in athletes is cardiac. And the other issues that are killing our athletes today are related to heat stress, heat illness wells issues of concussion, of course. Its important to recognize the response to those situations, within the first new minutes dictates in a large part to their outcome. And its important we have individuals there and a plan in place to care for those athletes when those situations exist. These are not strictly limited to sport of football, of course. We see concussion. We see heat, and we see cardiac in many of our sports. And its important for us to be prepared for those. And do you think accessibility and influence in youth sports is more appropriate solution than fundamentally altering had sports like football, for example . I fundamentally believe in enhancing these issues i think its important for an individual, an adult to be present that is taking into consideration the safety as well as the prep ration for catastrophic injury at that site. Often we have other adults, but their primary charge is things like coaching and strategy and things like that. We need someone thats there, a trained professional that looks at things like draegz affan emerging action plan, look at appropriate healthcare, how do we access facilities in case of catastrophic injury. Thank you. To senator nelson. And ill be quick so we can get onto our members questions. First of all, i want to say ms. Williams, amen. Thank you. You did it the right way, and others cheated. And you still got the medals. So amen. And i want to say to ms. Doucher, i dont understand how you survived. And what i dont understand is when your son was asking for some more oxycontin, what was it that you said you want to stop right there . As i said, everybody wanted nick to play football. Nick wanted to play football. I mean he loved being part of the team. He loved everything about that sport. But when we should have said stop, we should have said stop, reevaluate, is this worth it . He was getting some letters and looking forward to playing college ball. So had we known then what we know now, i would have said stop. We need to decide if this is worthwhile or right, and unfortunately we didnt. You know to all the panel, the chairman and i were discussing we can have a separate hearing on each one of the topics that each of you have brought up. Dr. Stern, i got the impression that you said that a person could not have any concussions and still get to cte. So what is it about that . And if you have many concussions, also, is that a cause of ultimately becoming cte . Yes to both of those. Concussion is a form of a mild traumatic brain injury. Theres no real hard fast line between what is a concussion and what is not a concussion. Right now i think theres 140 or more published definitions of concussion. Actually the one published by the nata is one of my favorites. But its all based on having symptoms, having individual report symptoms or signs of the injury. That doesnt mean that there are no problems to the brain and those brain cells and the brain tissue if the injury did not either result in the type of problem that leads to the symptoms or very commonly the person doesnt report the symptoms for a whole range of reasons. But what our research and that of many others is now showing, is that this subconcussive hits, the one that happen in every play, in every game, of every practice of sports but especially tackle football, do have consequences, shortterm and longterm. Theres no growing evidence that even after just one season of football, of tackle football in high school, lets say, there are structural changes to the brain, physiological changes to the brain, changes to bloodbased bio markers and changes to thinking, memory. Without any symptomatic concussions, and these changes are directly associated to the number of hits a person gets to the head as measured by asellrometers in the helmets. So that would apply to soccer and the headers as well. It would. And thats to me a very scary next part of the journey. That now there is growing evidence that heading in soccer, not the concussion in soccer but heading, does seem to lead to changes just over one season but after a lifetime of heading. And nfgt theres now just recently several casuses of postmortem confirmed cte in individuals who were demeanted at the end of their lifetime who never had histories of concussion or maybe just one concushion through professional and semiprofessional football. But they had a huge amount of heading throughout their career, suggesting the exposure to repetitive hits, whether or not they lead to symptoms of concussion seemed be raising the risk for these later life compication. Are you following our former military members and the traumatic brain injury there, seeing if that produces cte . Our group has sadly found cte postmortem in former military Service Members who were exposed to blast trama, other brain trauma. And its a very complex issue. And its a very, very important one, and one that the department of Veterans Affairs and one that the department of defense is taking very seriously. The symptoms of ptsd, the lodgeterm problems of traumatic brain injury, the difficulties we now see in the tremendous increase in suicide in our veterans, all of those seem to overlap with the symptoms of cte. And were seeing that indeed cte may be playing a very Important Role in the development of these cognitive and behavioral mood changes later in life in our military Service Members. Okay, thank you. We could spend a whole day just on that subject. Thank you, senator nelson. Ter muran. Dr. Stern, thank you for those comments. Youve given me some ideas of things that i need to personally pursue with the department of Veterans Affairs. Thank you. Thank you very much for you being here. I guess i would what you described was very compelling to me because what you described in your familys situation, who you are, the way you conduct your lives, and the way your family lives is the way i recognize so many families live their lives. And im very sorry. I chair the subcommittee and the committee here with professional sports. Senator thoon and i wrote the ceo of the United States Olympics Committee about two months ago raising question of Sexual Activity abuse and harassment within the Olympic Games. And i think kind of a take away of a response we received is that your organization was coming into play, the solution to this challenge is going to lie with you. And i would ask you if thats the way you see it, the relationship between the United States Olympic Committee and safe sport, whats that relationship and who has responsibility for these issues . Thank you, senator muran. To quote dr. Butler, i think its going to take all of us, first and foremost. Like the u. S. Antidoping association, we were formed, birthed if you will in the u. S. Olympic committee. We would not exist without the u. S. Olympic Committee Financial or otherwise. But we are an independent 501c3 charged with this issue. They all have their safe sport programs by which they are tasked with implementing training, with making sure all of their coaches and covered individuals, as we call them, are certified related to safe sport. So implementing and really creating a culture that prevents abuse is really important. So were absolutely working in partnership with the usoc and the National Governing bodies. We are independent in terms of our investigations. Usoc has retained us, if you will, to investigate all areas of sexual abuse. So any report of Sexual Misconduct or abuse, we investigate those reports. Let me ask then, if youre the investigative arm, whos the enforcing arm . The sanctions if we have a finding, if you will, from a report, a case, if you will if we have a finding, that finding goes to the National Governing body and not only must they enforce, which could be anything up to and including a lifetime ban, not only must that ngb enforce that sanction but it must be enforced cross the olympic and paralimic movements. So maybe your report is ignored or just taken as a recommendation, and who determines what the consequence is . The usoc has created, has mandated, if you will, that the mgbs adhere not only the safe sport code, and part of the code is sanctions must be enforced. So in that case we hand down the sanction and the usoc and the mgbs themselves make sure its enforce said. Is the any different than the way the Antidoping Agency works . Well, its similar. You saw it has the ability to hand the sanctions down and then it goes up to the world Antidoping Agency and the enforcement happens there. Thank you. And it seems to me this may be a false impression but your organization was slow to come into existence. And my impression is its related to fund raidsing, the ability to have the necessary resources to do the work youre setting out to do. Can you assure us, the dollars, the resources are now available . Senator, thank you. I think that is a reason that it has taken a while for the center to be up and run mchg we happened our doors in early march. I will tell you we have funding for the usoc, mgbs and from other charitable organizations. I would ask the committees support and the senates support in authorizing as chairman thoon stated at the beginning of his remarks, in authorizing the center would go a long way in establishing our credibility, our place, if you will in tirls of addressing these safe sport issues. Make nemace take, we have a ways to go. We need more funding. And part pof my job is to go out. No one would object to the legislation the chair man described . Not that i know of. Thank you. Thank you, mr. Chairman. Senator bran, that was a Good Exchange and discussion there. Because we want to figure out that role and make sure theres association there. The cover story this week in Sports Illustrated is the great hall of fame football player. And essentially what it says is that his brain has atrophied to the point he cannot tie his shoes. So can you talk about the warnings youre giving to the country, especially to those who have Young Athletes in their families about injuries that can occur, not just in football but in hockey, in sock, in any sport where concussions are possible, what is the core message youre sending to athletes and especially to their parents . Thank you. Senator, marky, its a complex message. Its one that is hard to always get across because theres many different forces out there that move the message in different ways. One important part of the message is that concussion is just the tip of the iceberg. Weve heard so much about concussion. Theres been, you know, concussion this, concussion that. And thank goodness because there have been so many important changes in the way concussion is being dealt with, is being detected, managed thanks to nata is others. The problems associated with concussion are indeed, i think, moving in the right direction. But for me i think what people need to understand when they read stories about nick and others, those werent necessarily caused by concussion. They were received because of the accumletive amounts of hits they received to the med. The Important Message is just because your kid plays football theyre going to develop this disease. We cant have a knee jerk response. We have to have an appropriate scientific understanding, advancements in our scientific knowledge that can be given to informed parents, ininformed leaders, informed policy makers. But as were gathering that scientific information, people also have to make decisions based on common sense. In other words, our brains are pretty darn important. They control who we are, what we are, how we move. They control our athleticism. They control our passion to participate. They do everything, and they are precious. What happens in that time of childhood when the brain is going through that unbelievable growth and maturation when all kind of changes and developmental milestones are occurring, and if we then say its okay to put our kids in fields and say go at it, hit your head, move that brain around over and over again during those times of potential developmental vulnerability, then we may need to question that decision. So what percentage of your research is funlded by the federal government, doctor . Id say around 90 of my Current Research is funded by the government. So if the nih was cut by 18 , which is the proseal for the next fiscal year, how would that impact . Well, it would be devastating not just to me inally and to research were doing and to future research, it would be devastating to science as we know it. It would get rid of future scientists across all areas. I can speak to scientists of brain search in particular. We cannot move forward even at the current budgets at the rate that is required to make important discovery to alleviate the pain and suffering from all these brain diseases. So the senator is doing great work on this issue. My question is there relationship between the rucher now doing on brain injury and your Alzheimers Research . Can one inform the other in terms of perhaps finding the clues that can help give hope to family . Exactly. Thats why i got involved in the first place because as cte research i realize this is an important disease. And the more we understand about it, yes, indeed, what were gaining is directly informing what we know about alzheimers disease and other related disorders. What we learn about alzheimers disease is now helping us move forward rather quickly in our understanding of cte. Theyre very intertwined. And how much ans paerns would you like to see in terms of all the information of brain injury being put out to the public so there can be a full understanding of this problem . Unfortunately, theres so Many Organizations out there and statements that are made that are filled with conflicts of interest, organizations that are funded directly or indirectly from professional Sports Leagues around the world. Those conflicts lead to, i think, either a misunderstanding or a misrepresentation of what the science tells us. Most importantly, scientists need to be transparent themselves. We need to share data, break down silos, explain our findings in ways that are meaningful, appropriate, and not beyond what the science says. I think the brain health of this generation of Young Athletes is going to depend upon the transparency of this generation of leers who control the information that can help to inform parents in making the correct decision. Thank you, mr. Chairman. Thank you senator, marquee. Senator adol. Chairman, thoon, thank you so much. And you i have been talking a long time about doing a hearing like this. I also want to thank senator nelson for all his kind comments and also senator marquee. The issue here, and i think kind of i want to emphasize i dont think dr. Stern you got a chance to say this specifically. And im just going to read it from your testimony and ask you to talk about it a little bit more. You say its only in the past 55 or 60 years that large numbers of human beings have been exposed to repetitive head impacts. So were talk about, you know, constant impacts to had head. While the epidemiology of cte is unknown, its possible millions, millions were talking about, living older adults arecurrently higher for cte and other cognitive conditions due to exposure of repetitive head impact. So this is something we need to realize in terms of Human History. Talk a little bit about Human History and repetitive head impacts and kind of where we are. Because i think thats where we get to millions of people. And people i think would be surprised and kind of shocked to know were talking here about millions of people with cte, especially if theyve seen the sports figures and seen the deterioration and the kind of things that happen to them. Please go ahead and put that in a little bit of context the. To preface it im not an anthropologist, not an epidemiologist, but im someone who speaks with those experts. And look what the history tells us. Boxing has been around for 100,000 plus years and boxers 1,000 plus years. It changed perhaps the numbers of those types of hit boxers get. But more importantly for thus country, our National Pastime of american football, it wasnt until the mid1950s that hard plastic encasements, these big helmets started to pea used in american football, plus the big face masks. Even though weve been playing football since the mid1800s, it wasnt until leather helmets were used to start preventing skull fractures and the big helmets were there to do a great job to preventing skull fractures and death. Theyve done a good job doing that. But in the 1960s, there was this beginning of ensability, because it didnt hurt to hit your head. And it included these hits, not the big hits, not the spearing, those are important. But iming about just routine hits. It wasnt until the 1970s that pop warner began to become a National Pastime. And our kids, just 16 years old and older were going into fields with these face masks and again hitsing their heads repeatedly. Thats where the concept where we dont know where we are yet with a little bit of fear, or a lot of fear. Those the only experience that humans have been involve said with that really include repetitive hits to the head with the brain moving back and forth with millions of people just in our country alone. Those people who started playing high school College Football in the 50s and 60s, and people who started playing youth football, well, theyre into their 70s right now. Thats the age we see the damage and the instances of cte. All those people who have had the type of exposure to those hits, for the first time in history, i do fear based on the knowledge of what we understand, the risk of drrkste and other neurological problems later in life, were going to see a very shocking number of people over the next few decades. Yeah, and i really appreciate that testimony. And i want to be clear that i think sports are good for young people. I think exercise is good. I think what youre emphasizing, though, is you are talking about repetitive hits to the head. And when you have protective equipment that can make it feel like it doesnt hurt, its okay. But what youre telling us is that we need to be recognizing that this could have a big impact, and we may be on the kind of tip of the iceberg as to whats we start seeing in the future. And thank you for all your work and thank you for being here and being so frank about this. Appreciate it. Thank you, senator udall. Senator blumenthal. Thank you, mr. Chairman. Thank you for having this hearing, which could extend for several days. The topics are so varied and important. As a father of four children who all play sports, i know that we cant protect our children from all sports injuries. But at least we can protect them from some if we are attentive and respectful of science. I want to talk about two areas where i think weve been somewhat less than respectful. One is the nhl in denying concussion science, and i intend to reintroduce legislation that would, in effect, create very strong incentives for improvements in this area. And also includes assault particularly in gymnastics. Im going to ask some questions if i have time about that as well. Let me begin with you, dr. Stern, if i may. Last year an nhl executive made headlines while testifying at a hearing exactly like this one. It shouldnt have been earth shattering news, but it was. For the first time the nhl admitted there is in fact a link between head trauma and cte. And you know how debilitating and destructive that disease is. But reports surfaced last year revealing emails from League Officials recognizing the danger of concussions but also demonstrating a very dismissive attitude in addressing them, and so i wrote to the nhl commissioner. And in response he flat out dismissed any connection between head trauma and concussions and cte. In my letter to him i cited research down at Boston University. And beyond the are resistance theres now troubling reports that the nhl is trying even to intimidate scientists using tactics employed in other industries without making unfair comparisons, the Tobacco Industry is one of them. Let me ask you, does it trouble you that leading officials with such power and sway in this sport and in important positions of responsibility actually deny the science of cte and have no apparent willingness to learn more . And have you experienced this kind of intimidation yourself, dr. Stern . It doesnt surprise me because were talking about businesses that have billions of dollars on the line and that if some aspect of the way their sport is played is going to have to change and therefore they may lose viewers or support from advertising, thats a big deal. I understand that. But i think that Everyone Needs to put athletes first. What the nhl did and the commissioners statements have done is indeed sad. I dont agree with them. I find them kind of ant waited, and perhaps they should the lead of what the nfl has done and accepted in my openingiomay have confused the nhl with the nfl. Thats right. It was the nfl who finally acknowledged cte and getting your head hit after years and years of dismissing it. The nhl continues to say theres no information, contradicting the science. You raised the issue of their attempt to get in the way of science. And in fact my colleague and i were subpoenaed by the nhl for a great deal of information that went way beyond any kind of reasonable request within how science is conducted. And in fact a court denied their request. So i cant really get into it because there is this ongoing case. Thank you. Let me ask you, ranly the Judiciary Committee had hearings on sexual abuse in gymnastics particularly the youngest participants in this sport. Statistics from safe sport say that one in ten youth who be victims of sexual abuse. And i think you would agree with me that number is clearly unacceptable. The United States Olympic Committee bylaws require National Governing bodies to comply with safe sport policies in order to remain in good standing. How can those policies be better enforced . Thank you, senator blumenthal. Just a quick note on the one in ten that will be sexually abused, thats actually in the general population. One of the problems is we dont know the true prevalence in the sport. And thats one of the reasons we exist, to gather that data, follow the trends, help our prevention efforts. Thats what needs to happen. So your sport certainly of the u. S. Center for safe sport and hopefully being authorized, perhaps in sf 34 protecting victims of abuse act would go a long way to help us develop policies. We already have the safe sport code that has been taken up by the usoc and the mgbs, but our work goes far beyond all possible doubt the Olympic Movement. Would you support having athletes in court as opposed to arbitration . In terms of what is currently in the s534 we are certainly favorable to the bill over all, and have been providing that technical assistance, so we sport the rights of athletes, period. Thank you. Thank you, senator blumenthal. Thank you. And like my colleagues, thank you theremin, for bringing these topics sbr separate hearing. And every single one we will work in to address. Let me say first of all, thank you so much. I was attorney general of nevada for eight years. I chaired a group on opioid abuse followed by heroin abuse is a problem not just in nevada but across the country. You coming forward telling your story, you will make a difference and save a life. So thank you to both of you for being here. Dr. Stern, ive got a quick question for you. From your knowledge, are the medical resources and the research into cte and other longterm brain concerns equally distributed between males and females . And what would you say their allocation percentage is by gender . Thats one of the most important issues that needs to be dealt with. Cte as a neurodegenerative disease diagnosed only after death at this point has been found almost exclusively in males to date. There have been a small number of women, not athletes. Sadly it includes a woman who was domestically abused and had her head hit repeatedly. This goes along with my testimony earlier about whats going to happen in the future. I think women have been involved now with sports at the level where their heads are being hit to such a degree and for over greater period of time. Again over the last 50 years or so. So, for example, soccer or football, the original football. Women now at least in this country are at the age now where they started back in the 1970s playing at an early age. And playing in club sports. And playing around the year and doing a lot of heading and having a lot of concussions. So i think now as that generation gets older, sadly, would probably be seeing more of this disease. However, just because we havent seen the disease in women, that doesnt mean that the rest of the resources being focused on brain diseases, brain conditions associated with athletic involvement should be focused on men. We need to put a lot of effo effort in fact im hoping to have studies coming up where were actively going to be following women to be able to look at the effects of various sports, various aspects of the sport and the head trauma in terms of later life problems. Its a very big deal. It is. I thank you for saying that. In my own family have a niece played soccer through high school, college. And there are concerns because they have head injuries in soccer just like they do football and other sports. And then as you well know, in nevada and youve said it in your testimony, the Cleveland Clinic, the center for brain health in las vegas is a leader in this research. Particularly when it comes to the brain health of boxers and mma fighters. And we know a lot of women now are partaking in those sports. And so im glad to see that we are actually going to be looking at Womens Brain Health as well. With respect to boxers and mma fighters, do you feel that theres enough being done at the state level to ensure that standardized safety precautions are adapted to protect boxers in every state . Nevada has just recently adopted a requirement through our Athletic Commission ensuring that the brain health of our fighters is tested and were making sure that its being checked. Do you think enough is being done across the country in other states . You know, im not aware enough to be able to answer it about all states. I do know that in nevada thats a real leader. And thanks to the partnership to between the state and the city of las vegas and the commission with the Cleveland Clinic center, theres been a tremendous gain including Great Research being done to look at whats really important. When it comes to boxing and mma, to me i always have to just stop and say what could be done at the state level . What kind of rules and changes could be done when you have sports that are geared toward inducing brain damage . If in boxing a knockout is a way to win, a knockout is brain damage. And i may be saying things a little bit too indelicately, but one has to question how can we really make those activities safe in terms of brain health. Okay. Thank you. Thank you very much for all of you being here today. Appreciate the testimonies. Thank you, senator cortez masto. Next up is senator hassan. Thank you so all the witnesses for being here today. Especially id like to extend my thanks to mrs. Deutsche and for sharing and honoring your sons life and story by being here. I want to focus a little bit on the issue of athletes and addiction. To help address the increased level of risk of opioid addiction that student athletes experien experience. Earlier this year i cosponsored the athlete opioid misuse prech prevention act. It would authorize a Substance Abuse and Mental Health Services Administration or samsa to grant money to help efforts to educate students and communities about opioid abuse and addiction. Has been part of funding in the misuse and prevention efforts. This is really a question to the whole panel. Do you agree that further resources and dedicated funding would help in the work you and others are doing to meet the tough challenges associated with opioid addiction . Thank you. Dont mind if i go first. I just want to agree with dr. Sterns comments earlier about the importance of support to the nih to support new knowledge. In terms of our understanding of pain and also the understanding of addiction. Nih director Francis Collins has observed its amazing when we have variety of pain as a cardinal sign of inflammation that we know so little about it. But i also want to point out the critical importance of education and using the knowledge that we already have. Much of which is implemented through agencies such as the centers for Disease Control and prevention and also samsa. So its, i think, not an either or. We look at knowledge and acting on the information that we already have. But it really is going to require both to address these issues. Thank you. Another component of the bill is to provide funding to state and local officials and coaches and trainers among others to recognize and address substance misuse among students. Would this be helpful in your view and especially maybe mr. Sailor, youd like to comment on that. Yes. The National Athletic Trainer Association is in full support of this bill. And we appreciate that. All right. Thank you. And also to mr. To ms. Williams and mr. Sailor. Although we are starting to have a greater understanding of substance misuse disorders, there is as we all know a lot of stigma attached and one of the reasons im so grateful to mrs. Deutscher and her family is when people stand up and talk about their experiences and help us understand it as a disease, it really makes a difference. In my experience New Hampshire, thats been the thing thats really helped us begin to change the conversation. But i suspect that it may be especially true for athletes who may suffer consequences of being sidelined if they admit to an addiction to opioids or even to acknowledge the injury that underlines the use of prescription pain medications. Does this stigma and maybe the fear of being sidelined prevent student athletes or professional athletes from acknowledging a dependency on opioids . I definitely think the stigma is a problem and something we need to address. I think the way we address it is by outreach. Educating from the Grassroots Level all the way up to the professional level. Starting the conversation before it becomes a problem for people that are not using opioids, getting the conversation going and having it frequently. Instead of oh theres probably this thing we shouldnt talk about. My friend is struggling but im not sure what to do about it. We need to implement that as a standard thing were doing on a regular basis and thats a conversation being had. Thank you. Yes. As an athletic trainer, we believe in Health Care System for our athletes. That includes having access to resources that we can help obtain for them when they are in need of things for them like addiction treatment. Thank you all very much for being here. Ill echo what the other senators have said. We could have a hearing on each of the issues you all spoke about. We look forward to continue to work with you to help make athletics safer. Thank you, senator hassan. Senator young. Thank you. I want to thank you for holding this hearing on protecting the health and safety of american athletes. I want to thank all our panelists for being here today. Its a timely hearing given the scrutiny the usoc has received lately in large part to the star. Im proud to have worked with many of my colleagues in the senate to address this issue and i look forward to working with you, mr. Chairman, as we continue to find ways to address this very real problem. Id like to ask you about the independence of safe sport from usoc. Usoc initially created safe sport and provided its initial seed funding. That they finally needed to act in an aggressive manner to address a serious problem thats been lurking within its ranks for years and ought to be they ought to be applauded for implementing this initiative. I have concerns about as i started independence, specifically personnel staffing issues. Whats your policy on hiring individuals directly from usoc and National Governing bodies into safe sport . And do you have any reservations about safe sports independence if your organization simply hires individuals from usoc and ngbds ngb. I threw a d in there. Thank you, senator young. I have no issues or concerns related to our independence. Our board, we have a nineperson board of independent directors. We have independent investigators and outside counsel who meet a high bar of independence. So we really look for those conflicts. I will tell you that we have brought two people from the usoc as employees. These are at least one of them are subject Matter Experts in this space. Not only in terms of safe sport, in terms of the abuse issues, but in terms of how the olympic and paralympic movements are structured. Which is hugely helpful to us. And again, following in the kind of the foot steps of usada, they, too, were born within the usoc. They had Staff Members that came over to the usada. I dont think anyone can question their independence and so we have followed that framework. So these independent investigators who presumably produce reports and various findings to inform your future work, are these reports made available to members of the public or would they be made available to congress . Because i presume they touch on staffing issues, right . If we have a like, the actual reports from victims, if you will, cases that have come in, is that what youre speaking to, sir . Yeah. Also the performance of former employees of the National Governing bodies and usoc. If they are consistently subpar, suboptim suboptimal, or conflicted which you emphasize they are not, that would be a finding that would be of interest to this committee, i know. Got ya. We our jurisdiction lies in addressing Sexual Misconduct and abuse within the olympic and paralympic movements. We would take in reports if we have a finding against an employee of an ngb of the usoc. A coach or anything. Anyone that is a covered individual. That sanction is then handed down, if you will, and it must be enforced across the olympic and paralympic movements. With your permission, i may have a followup question or two. Ill send it by writing if you could respond id be grateful. Absolutely, sir. Because i want to turn to another matter. I know that reporting incidents of abuse is critical to starting the investigation process. And unfortunately our staff discovered a problem here on safesport. Org, that website, theres a link entitled report. Unfortunately that links broken and takes visitors to a page not found website. Moreover, if someone was to try to find more information on reporting confidentiality, those concerns as referenced in your materials to the usoc ambudsman, that website doesnt work either. And i know this is likely a surprise for you. What im seeking from you is some assurance that youll resolve this matter expeditiously and inform our staff this week about its status. Because one could see why you can infer from this from your testimony so far. Well check into it and get back to you. Okay. Thank you. Thank you. Thank all of you for being here today. I come from the state of West Virginia where we have unfortunately some of the largest and greatest statistics of overdose from and deaths caused by drug addiction and drug overdose. We have a lot of good things going on in terms in the sports area. Our wvu Sports Medicine center is i think on the cutting edge of some of the research thats being done. I would like to speak just personally to ms. Deutscher for coming and telling your story. I think it is so important that we hear from you that its a hesitating thing for parents and grandparents to talk about. I read your testimony. Im sorry i wasnt here to hear you give it. Were trying to work with families on certain things, sort of outside the well, actually one of them was an athlete and she had described herself in the hospital as an addict. Her parents said, you know, shed been in and out of recovery. Unbeknownst to the discharging physician who didnt read all through the chart, they discharged her with 56 oxycodone which she melted eight and put into her line and didnt wake up the next day. So were trying to fix those kinds of things so that situation cant happen again. Im curious to know tracing back and looking at what happened with your son, were trying to get to this partial fill or acute pain issue. If you have a wisdom tooth, if you have an acute athletic injury that you dont need two weeks of pain medicine, maybe 48 hours or 72 hours. Was that ever offered to your son . A shortterm sort of treatment or shortterm prescription option for him . Of the initial prescription, i believe was shorter term. I dont have that record. I did get his pharmacy record for the balance of the prescriptions but that would have been offered when he first had his injury on a friday night. Until he got in to get evaluated. And then the other in the series of prescriptions started a little bit later in the season when he was rehabbing to get back into the game. And those prescriptions, if memory serves me correctly, were 40, 50 tablets. Were there ever any divisionary other methods to deal with the pain offered to him . By jeff and i. Tylenol, you know right. But no, there was not that discussion. It went to hydrocodone and to percocet. Right away. Well, thats Something Else weve been working on with senator warren from massachusetts to look at the partial fill and also an acute pain issue im working with gillibrand on to try to limit that lengthy prescription that becomes a temptation in a lot of cases. So i wanted to ask ms. Williams, actually im the appropriator for the general government which also covers the office of national well, no. The u. S. Antidoping agency. And because of that i got to meet Michael Phelps and i get to meet you. So thats good. It was interesting to me. We do appropriate that as a member of the antidoping association of the United States and also try to hep the Worldwide Organization for the elite athletes that are competing on the stage such as you. But it was interesting what he said to me. He said i mean, think of how many races hes been in. He says i dont think ive ever had a clean race. He wasnt talking about him. He was talking about everybody else in the pool. And he still won all the gold medals and you did too. So im thinking to myself, what kind of pressure is that at the elite level because of what the other countries are doing . I think there is a good amount of pressure for athletes. Thats why i think outreach is so important. Educating athletes from the Grassroots Level. Also the Antidoping Agency does a good bit of outreach trying to cross cultures. Theres Different Things different cultures are dealing with when it pertains to win at all costs and these things. But being able to create an example. For example, i didnt use supplements my whole career. Not only did i not use performance enhancing drugs, i didnt use vitamin this or protein powder. I made it to four olympics without any of those things. No multivitamin or whatever the case may be. I think to be able to explain to students from the Grassroots Level to the professional level, its not worth it. That one moment on a podium is not going to be rewarding enough, youre not going to feel satisfied because you did this thing that was wrong in order to get to that point. And really being able to convey that and articulate that in a way thats going to hit home so they dont they arent encouraged to want to try and reach this next level or, you know, win at all costs is really going to be the important thing. Well, thats an excellent point. And thank you for being that advocate. I had the opportunity to meet simone biles just two weeks ago and shes working in outreaching to young people to inspire them on Different Levels. Clean living and staying away from substances. So its so important the work that youre doing. And i appreciate yall working with the next group of stellar athletes. Thank you. Thank you all very much. Mr. Chairman, can can i note my colleague is dropping a lot of impressive names. Gratuitously. You wonder why they all come see me. And theyre out there dropping her name. So thats well, thank you, senator capito. I think senator sullivan is on his way back and would like to ask a question or two. So we may keep her going here for just a minute. But ms. Pfohl, we had talked a lot about the challenges that we face, the problems, and things we need to address in the world of competitive sports. But this is a question. Do you believe we ought to be discouraging participation in certain sports . I mean, are there positive benefits to playing sports including Contact Sports that we ought to be talking about as well . Thank you, chairman thune. You know, obviously i believe in sports and all that it all that comes from it. Maybe the emotional benefits that come from it. The teamwork you learn. The perseverance. The dedication. All of those kind of character building things that are learned through within through sports. Not just talking competitive sports. But just recreational getting out there and having fun i believe are so important. I think all the issues, the safety issues that have been talked about on this panel are also critical. So that we can save sport. Not only for our generation, but for every generation to come. So its absolutely critical. And go packers, by the way. Thank you. I like you more already. Is your focus just olympic athletes or does your work go beyond elite level sports participants and is your focus solely on kids or does your work go beyond youth in terms of the things that youre undertaking there . Thank you for that question, chairman thune. It absolutely goes beyond kids. We address athletes at every age and every level. So again, really from the rec leagues, if you will, or folks just going out and having fun whether thats kids or adults. All the way up to the olympic and professional ranks. So all of the above in terms of our education and outreach. And the training and awareness that we want to get out for sports organizations, parents, athletes, all across the nation. Well, and we appreciate everything that safe sport is doing to stand up best practices to prevent abuse within the Olympic Movement. And as we examine legislative proposals in this area and you heard some of my colleagues speak to that earlier today, weve got to consider how best to craft policies governing oneonone contact between athletes and coaches. We want to avoid situations that put Young Athletes at risk of abuse. At the same time we want to avoid overbroad policies that unnecessarily strain the athlete coach relationship. So question is do you support a blanket rule against oneonone contact or does a riskbased standard like the standard the centers for Disease Control and prevention advocates make more sense . Thank you, again, chairman thune. We really follow the cdc the center for Disease Controls standards and guidelines in this space. We recognize and agree with the centers for Disease Control that limiting those oneonone interactions between adults and kids and making sure that there are two adults present as often as possible is the absolute right thing to do. We also we also agree with their riskbased guidelines as you indicated. Which basically says that hey maybe one size doesnt fit all. There are so many sports organizations are so diverse that there may be multiple options for achieving safety. Are certainly those that we have made part of our best practices. And just out of curiosity, other members of the panel, do you share that view . Anybody else want to comment on that . Okay. Well, look. Senator sullivan is coming in the door. There he is. Senator, you asked we include in the record three items he wanted included. We will do that without objection. And i would say to all of you, thank you for being here. Thanks so much for your thoughtful input and suggestions in response to our questions. These are all important issues. In many cases life and death issues. And certainly when it comes to safety, really critical that we get this right. So we welcome your continued input. I just want to indicate to you that there are members of this committee who will have questions that theyd like to submit for the record. If you could get those back to us as soon as possible, we normally keep the record open for a couple of weeks to allow your responses. So if you could get those back to us as quickly as possible. We would appreciate it. And with that, i will yield to my colleague from alaska senator sullivan. I think hes going to take us out, but let me again just thank you for being here today. I cant tell you how much we appreciate your participation. Senator sullivan. Thank you, mr. Chairman. I want to thank you again for calling this hearing and its a really important issue thats impacting the entire country. So thank you for your leadership on that. And i want to thank the panel. Again, im sorry i had to step out. I had my freshman duties where i have to preside over the senate. If youre a senior esteemed senator like chairman thune, you dont have those duties. But i had those for the last hour. So it wasnt my lack of interest. It was i was over with another gavel on the senate floor. And i do want to thank the panel again. Questions and read the testimony. So let me just start. Dr. Butler, i want to start with you. Thanks again for coming and thanks again for all that youre doing. You may have seen you were quoted in the Alaska Dispatch news this morning. Front page above the fold. Headline, avrng rnchorage is se dramatic increase in heroin overdoses. So let me ask a little parochial question but still important because i think it could shed light on whats going on in the country. But what do you think is behind that surge in our biggest city back home . And as i mentioned, we held this wellness summit last august in the matsu valley. One of the reasons i hosted that was a warning signal in some ways to our state which was, hey, this is happening in a lot of places. Were not yet hopefully never but this could be coming. And unfortunately i fear that since we held that summit like you were a key participant, weve been focused on this issue a lot in the congress. But i think in alaska its getting worse. I think throughout the country its getting worse. So do you mind addressing the, you know, headline today in the paper the dramatic surge of heroin overdoses in anchorage. And if you want to address whether you think its getting worse in alaska or not. And if any of the panelists just want to talk about it relating to the nation. Because it does look like were not winning the battle in my view. Yes. Senator sullivan, i think alaska really reflects what is happening nationally. And what we have seen in alaska is that while we have had some leveling of the number of overdoses due to prescription opioids, that has theres been an additive effect of increasing number of overdoses due to heroin and also the synthetic fentanyl related compounds. Theres even been some declines in opioid prescribing. So i think its important to note that we may be beginning to bend that trend, but were nowhere near where we need to be. And weve heard a number of stories this morning of where large amounts of opioids have been prescribed and have led to problems or that problems with misuse have gone underrecognized and i think a lot of that is driven bay lay a lack of awarenn the Health Care Provider community and the risks associated with these drugs. Specifically whats happening in anchorage i think highlights a number of issues. At this point we dont know if its an increase in Overdose Deaths. It is possible that we are actually seeing more people survive to interact with the ems system because weve been very aggressive in getti inting nalo kits over the past three months. It also highlights the importance of the inner Agency Communication between Public Health and Law Enforcement so that we are sharing data and able to discuss exactly what were each seeing from our own perspectives. For example, its not clear whether or not this may be a batch of some substance that is much more powerful than the heroin thats been on the street in the past or is it an influx of primarily people who have reduced tolerance . We dont know those degree of details that degree of detail yet. Thats where working together and having our incident command response really has helped to be able to facilitate those communications. We learned a bit of this during an outbreak of spice overdoses of the synthetic drug a couple of years ago where it actually took several weeks to recognize the problem and connect those dots. In this case we actually were aware of the increase late last week and were able to start having those conversations as soon as we recognized it. The final comment i was going to make is that while its important to address the challenge of illicit opioids, we have to recognize that part of the reason heroin found such a ready market when it came in in larger quantities and at much lower prices starting about a decade ago is we had a much larger proportion of our population that had physical dependency or addiction to opioids. And that the way we oftentimes use opioids with good intent and Good Intention theer prapeutica. And withdrawal can be awful even if its not the more chronic condition of addiction, people will oftentimes turn to whatever they can turn to to be able to avoid the rigors of dope sickness. Anyone else on the panel want to comment on what they see nationally as a trend and the reasons for it . And i do want to comment, you know, ms. Deutscher. I was here for your testimony and i really just appreciate it. I know that that couldnt have been easy for you to testify before this committee and recall some things that are obviously incredibly heart wrenching for you personally. And your family. But, you know, unfortunately ive dug into this issue. The story you told about your son, its not an uncommon story in terms of athlete who, you know, has a bright future. High school star and then theres an injury and then, you know, this happens. Have we learned enough more from that . Its a very common story that were hearing and its just, you know, how you talked about you didnt understand fully the risk. Do you think that theres more that needs to be done . Do you think that people are recognizing that . And again, i just want to commend you for being here today. Im sure its not easy. Thank you. I dont think theres enough being done. I think funding is a huge issue to get the awareness out, to get it into the high schools, to get it to the coaches, to get it out of the general public of opioids in general. But also as it relates to our athletes. You know, we had great coaches. Jeff and i are very involved. We have a great athletic trainer. We had great physicians. But as ive told, you know, in a couple of deliveries weve made within our state, it was ignorance that, you know, was part of his death. We just didnt know. And so i think that is so crucial. Thank you. Any other thoughts on kind of the broader trend on the opioid issue throughout the country and what direction you see it going in . This is not my area of expertise, but i would like to add something, senator. Ive lost three of my classmates. I was a graduating class of 88 in my small town in pennsylvania, to heroin overdose. I think its really important here, ive said it multiple times, outreach and communication. What are we not communicating to people that this is getting to a point where there is someone thats more charismatic or theres something happening. These werent the bad kids. These werent the ones headed to nowhere. These were bright students. These were people who had transitioned well from high school to college and gone on to professional careers that we now lost to heroin. So what is being said . What environment is being created outside of the opioid use . What is the gateaway that people are enter into the heroin use . And what can we do to, like you said, be having constant communication, constant outreach. I remember when i was growing up as a kid, there was constantly d. A. R. E. , there was p. A. L. All sorts of songs and raps about not using drugs. Its like we saw something that was working and got away from it. Now its here, there, occasionally. But were not starting at the Grassroots Levels saying this is important. This is the reason to stay away from drugs. At some point the bad guys are entering and theyre doing something that is convincing good people to go down a bad path. I think thats an important point. Were certainly trying to do that in alaska. Dr. Butler, you may have seen the head of the fbi in the state and i sent that fbi video some of you may have seen chasing the dragon which is very graphic, kind of scaring the young kids in hey this could happen to you. Trying to get it to all the high schools just to wake all these young men and women up. But youre certainly correct about the point of how its, you know, some of the best and brightest in the country that are getting, you know, addicted. Let me finish with one final question and again i want to thank everybody for your patience and testimony today. On another issue and dr. Butler you mentioned it, how some of these things are related and ive certainly seen that as well. On the issue of the Sexual Assault and abuse of our athletes, do we have enough safeguards, do you think, in place with regard to our young men and women who, you know, again, are americas finest and some of the most dplined . Its alarmed a lot of us and im just wondering for the expertise here at the panel if you believe we do have enough safeguards, you know, congress always tries to act and maybe its an appropriate role. But what do you think the role of that we should be doing and the role that you should be doing . Ill be happy to start. Thank you, senator sullivan. I think the answer is no. We dont have enough safeguards. That is the reason the u. S. Center for safe sport has been created and the reason we exist and the reason we need to exist. I think you asked what the senate can do. And ill say again i think being able having an authorization again following in the foot steps of usada but being authorized in legislation, certainly we wouldnt turn down but being authorized in legislation goes a long way into establishing the credibility, the need for these safeguards as you said. And it is our absolute goal, our mission to not only address the abuse and weed out the bad actors, but to really get up stream on prevention. To make sure that were educating all parents and youth sport organizers, if you will. The athletes themselves on how to identify grooming behaviors, for example. When were talking about youth. What does that look like . And so all of the education, the outreach, the training that needs to take place that is not currently taking place, we have that is why were here. And we are absolutely committed to creating change. And again, our motto is champion respect and end abuse. That is our call to action. Thank you. Anyone else on that question . I would also say no, that the safeguards that we have in place are not enough. What we need in place is uniform baseline education across all the Different Levels of sport from the Grassroots Level, youth, moving up into the elite ranks. There needs to be something when a coach, when a person thats going to be of authority thats going to be dealing with an athlete wants to enter into this field, what are the baseline requirements to make sure that you are going to do whats in the athathletes best interest. Right now theres no uniformity in all the levels that exist, you can just wake up saying im going to go coach kids. And youre there and coaching and everybody is like, oh, hes nice. Then youre bringing kids home and it just degrades from there. So baseline education and baseline points of entry that are requirements that make sure we do have proper safeguards in place, those are the things to be put in order. Thank you. Let me before we conclude i would like unanimous consent to include in the record letters from stake holders providing additional perspectives on todays hearing including the Sports Fan Coalition and the positive coaching alliance. Without objection, so ordered. The hearing record will remain open for two weeks. During this time senators are asked to submit any questions for the record for our witnesses. Upon receipt, the witnesses are to submit answers to the committee as soon as possible. Again, i want to thank the witnesses for appearing today. These are very important issues. You can see theres a lot of bipartisan interest and i think motivation to address these in a bipartisan way. And were going to continue to engage with you and others to make sure we address some of these in the best way possible. This hearing is now adjourned. [ indistinct conversations ] cspans washington journal live every day with news and policies that impact you. Coming up thursday morning, republican congressman doug collins of georgia talks about how to strengthen the Mental Health system as part of criminal reform. And Matthew Elliot discusses the impact of brexit on u. S. Transatlantic relations. Then democratic congressman brad sherman of california will talk about president trumps first foreign trip. Be sure to watch cspans washington journal live at 7 00 a. M. Eastern thursday morning. Join the discussion. Cspan, where history unfolds daily. In 1979, cspan was created as a Public Service by americas Cable Television companies. And is brought to you today by your cable or satellite provider. Earlier in the month, Homeland Security secretary john kelly called out congress saying that if lawmakers dont like existing immigration laws, then they should do their duty and change them. His comments came as he discussed u. S. Policy toward Central America at the atlantic council. Well show you those remarks in their entirety. Good morning, everyone. And thank you for joining us today. As people are filling into the room, i will start given the