Florida, puerto rico and the u. S. Virgin islands have been devastated by hurricanes. I first want to express our heart felt sorrow for the millions of americans impacted by these devastating storms and say all members of this committee on both sides of the aisle stand with those affected by the hurricanes. I would also like to thank dr. Burgess, both members of the subcommittee who each recently visited puerto rico to assess the impact the hurricanes have had and continue to have on our fellow americans. This committee has been conducting oversight of the federal response to the recent hurricanes since shortly after harvey made landfall in texas. Unfortunately, i expect that our work here will continue for years to come. The committees jurisdiction involves not just Public Health issues but rebuilding the electrical grid, addressing environmental cleanup and restoring telecommunications to name only a few. The people of puerto rico and the u. S. Virgin islands continue to face a long road to recovery and many are living without power and Running Water. I believe we are going to be joined today by representative Jennifer Gonzalez from puerto rico, someone who knows all too well about the difficult challenges her home is facing. Thank you for being here at this important hearing. From coordinating overall response to insuring that individuals have the medical treatment they need to protecting the blood and pharmaceutical supply, to granting medical waivers hhs has been working tirelessly to provide medical care and services to individuals affected by the storms. The overwhelming majority of Health Care Facilities in the impacted areas went above and beyond to protect and cheat those in harms way yet media reports indicate that some Health Care Providers failed in their duty to protect their patients. There was a tragic situation at a nursing home in florida where 14 residents died after the facility lost its air conditioning. And this despite a hospital across the street that never lost power or cooling. The response in puerto rico and the u. S. Virgin islands has involved numerous federal agencies working together with each other and state and local officials. For example, before Hurricane Maria made landfall in puerto rico and every day since hhs, the department of defense, the department of Veterans Affairs and federal Emergency Management agency have been coordinating with local Emergency Response officials to provide medical care and help reestablish the health care infrastructure. Hhs has worked with puerto ricos department of health to prioritize resources needed for dialysis facilities and have coordinate would fema to help ensure critical supplies are delivered where they are needed. Similar efforts are ongoing in the u. S. Virgin islands, as well. Many questions remain. Has the interagency response been effective from the hhs . Are we utilizing our resources in the most efficient and effective ways to help our fellow americans in puerto rico and u. S. Virgin islands in particular . It is critical that we understand the Public Health challenges ahead. Mold formation is likely in nearly all the effected regions. As we have seen after Hurricane Harvey there is increased risk of spread of infectious disease. Over one million americans are still without clean, safe Drinking Water. Rebuilding puerto rico and u. S. Virgin islands will take years. The Health Care Systems are in dire condition and most of the operational facilities need some degree of assistance. To make matters worse the electrical grid has been devastated which has significantly hampered Recovery Efforts. We dont know the full extent of the damage let alone when we will have electricity and Running Water restored. We are trying to make sure we do Everything Possible to address the short and long term needs. Especially in the face of the Public Health risk that resulted and will continue to result from these storms. I would like to thank the witnesses for testifying today and i look forward to hearing your testimony. I yield five minutes for Opening Statement to the Ranking Member from colorado. This 2017 Hurricane Season has been one of the most damaging on record. Hurricane harvey broke the record for the greatest amount of rain recorded from a single Tropical Storm or hurricane in the United States. Hurricane irma became strongest atlantic hurricane on record. Hurricane marias impact on puerto rico and the u. S. Virgin islands has been nothing less than catastrophic. Mr. Chairman, as you said, the scope of potential health risks caused by this ongoing crisis is still coming into focus. The infrastructure on puerto rico and the Virgin Islands remains decimated. Nearly 80 of puerto rico still doesnt have power. Hhs reported that a substantial number of puerto ricos hospitals are either nonoperational or require diesel to run generators. Over a third of puerto ricoen residents lack access to Potable Water. Contaminated water is spreading contagious diseases. While i certainly appreciate the effort by volunteers including physicians and nurses volunteering their time with the teams i am concerned that poor management of the hurricane response at a federal level may be hindering response efforts. The federal government i believe probably does not have a complete picture of what Health Care Challenges exist because frankly most of the island of puerto rico lacks adequate communication. I think that this committee needs to hold further hearings to address the status of all of these Vital Services that you talked about. I think as time goes on we should have field hearings on puerto rico in particular but also the vergeant islands as much of the recovery effort as you accurately describe involves jurisdiction of this committee. I cant stress enough how important it is for us to send our staff down there to investigate this and how important it is for members to go and investigate this. I was part of a group of members that went after Hurricane Katrina to new orleans to observe the Recovery Efforts. What we found through years of oversight on this subcommittee was that washingtons understanding regarding the situation on the ground was very different than we were able to observe firsthand when we went into the basement of Charity Hospital and we saw what happened to those records. When we had field hearings and we saw what had happened to Small Business people down there in new orleans. You just cannot substitute for that. As we begin to think about our public responses, members of congress, we need to see what we are doing on the ground. Mr. Chairman, last week President Trump said the administration deserves a ten for its response to the devastation of Hurricane Maria. Given the fat thakt most residents lack power, nearly a million americans lack access to safe and reliable Drinking Water i find that statement to be breath taking y. Hope that our Witnesses Today are better prepared than that to talk about what is really happening on the ground and what we can do to address this unfolding crisis. I hope it will be the beginning of an ongoing and concerted effort to understand what is going on and i would now like to yield the balance of my time to representative caster who wants to talk appropriately about the Health Challenges facing her state of florida. I thank you for yielding the time. This simply was a catastrophic Hurricane Season. We have so many challenges ahead. I want to thank our witnesses who are here today. I want tothank all of my colleagues for holding this hearing. Hopefully this is just the first of many because this is going to be a very long recovery period. After 75 lives lost in texas, 75 lives lost in florida including 14 related to a nursing home that were completely avoidable, we need to discuss that. We know that we have about 50 deaths in puerto rico so far with the threat of bacterial infections growing. Im very concerned about puerto rico and the whole interplay between the folks that live there and the u. S. Virgin islands and their migration and what that means for the health needs of everyone. On the island the Drinking Water issue is simply critical. I look forward to your expert testimony today and the committees work in the days ahead. Thank you. Now recognize the chairman of the full committee. I thank the vice chairman for the support. I want to express my deepest sympathy for those impacted by the horrible storms particularly fellow citizens in puerto rico and the u. S. Virgin islands. This committee stands ready to assist in whatever way we can. We will continue to be diligent in the oversight in the work that the agencies are doing and the needs of the people. I am pleased that dr. Burgess has already been to puerto rico, visited some of the hospitals and looked at the health care issues. We know we have much more work to do and we hope to hear from all of you today about what is out there ahead, we need to uncover and get better solutions. Today we are examining continuing efforts to protect the Public Health in texas, florida, puerto rico and u. S. Virgin islands in the aftermath of hurricanes harvey, irma and maria. This is the first of series of meetings and in the coming weeks we will hold hearings before the energy and environment subcommittees on these matters. As vice chairman stated this committee will be conducting oversight of the rebuilding of puerto rico and the u. S. Virgin islands for years to come. The Public Health risks typically associated with Natural Disasters are vary skpd include heightened incidences, diminished access to medical care and Long Term Mental Health trauma. These risks can be particularly dangerous especially for vulnerable populations such as infants, dialysis patients, individuals who may be immuneo suppressed and the elderly. We saw this in the after math of Hurricane Irma where 14 elderly residents lost their lives as a result of heat induced death issues after the facilitys air conditioning system failed during the storm. Last week this committee sent a bipartisan letter to the Nursing Homes owner requesting information on the facilitys Emergency Preparedness plan, inspection history and steps it took to protect residents after the air conditioning system stopped working. We will hear while three major hurricanes to impact United States in 2017 were distinct events that present and continue to present their own unique challenges, many protocols necessary to conduct effective Public Health response are federal agencies responding to disasters must be able to communicate effectively with each other and local, state and territorial officials to identify areas of need, insuring that individuals have adequate access to basic necessities such as food, water and medical supplies. As we head into recovery phase it is important we also carefully monitor patients as they transition from hospitals or under medical supervision back to their homes. News reports indicate more than 60 of puerto ricoens are now homeless as a result of the devastating hurricanes. We need to make sure when patients are discharged from hospitals that they have safe places to go and dont end up on the streets and back into the hospital. Following Hurricane Maria various media reports called into question whether the federal government is adequately meeting its obligation to protect health and welfare of american citizens. On this matter i look to gain perspective from witnesses who have been on the ground in the areas. Making sure the americans in need get the assistance they require cannot and should not be a partisan matter. Certain agencies arent pulling their weight we want to know. If there are federal laws or policies that are impeding the Recovery Efforts we want to know. We want to hear about any best practices that can be gleaned from ongoing Recovery Efforts to utilize in response to future Natural Disasters. Thanks to you and your teams for being on the ground trying to do the best you can in these orable circumstance horrible circumstances. We need to know the facts. What are the Lessons Learned and where do you need additional help. With that i yield back the balance of my time and look forward to the testimony of our witnesses. Before i do that, i would also like to welcome our newest member to the committee. I was just approved by the house conference this morning. And we are delighted to have you on board the committee. Thanks for being here today. I yield back. Thank you, mr. Chairman. Recognize Ranking Member of the full committee. Thank you, mr. Chairman and thank you for holding this hearing on this critical issue. I hope this hearing is the first of many hurricanerelated hearings as Congress Needs to hear further from hhs and other agencies regarding ongoing response and Recovery Efforts in all of the effected areas. I would like to take a moment to recognize the federal, state and local responders who are working hard to address the many Public Health issues which exist as response and recovery continues in all areas that were impacted by the three major hurricanes. I know firsthand of the tragic devastation caused by such immense Natural Disasters. In 2012 my district was hit hard by hurricane sandy. For many the storm was a worst case scenario, lost lives, homes flooded and businesses lost. The fifth anniversary is coming up this weekend and we still have a lot of people not back in homes or businesses. Our nation is experiencing historic levels of destruction and loss in puerto rico and Virgin Islands as well as florida, texas and the gulf coast. While no two Natural Disasters are alike the areas have unique needs and challenges. While Congress Continues to address the response in florida and texas must work to ensure that puerto rico and u. S. Virgin islands receive full and immediate support. I recognize a number of ongoing challenges facing the residents of south florida and the gulf coast but much of the hearing will likely teed laly need to situation in puerto rico and Virgin Islands. Hundreds of thousands of americans continue to meet day to day needs. Im particularly concerned of reports that residents do not have access to food or medicine. In the areas effected paint a dire situation that completely contradict often rosy stories from the president and the white house. Hurricanes irma and maria caused widespread flooding and destruction including Critical Damage to electrical grids, Drinking Water systems and transportation infrastructure. Virtually all residents of puerto rico and the u. S. Virgin islands have been impacted and these infrastructure failures create acute Public Health issues. We have seen and heard reports of death, dehydration and desperation as residents continue to struggle where fundaMental Health needs remain unaddressed even a month after Hurricane Maria and almost two months after Hurricane Irma. The list of serious needs and challenges is long. Many hospitals do not have reliable power. Many communities lack safe Drinking Water and people have resorted to drinking to questionable water services. Residents are still unsure if the water is safe and recent epa briefing we learned crews going into communities to test for Water Quality were arriving to find that people still lacked adequate food and Drinking Water. Congress must provide ongoing support in the aftermath of these hurricanes to restore and rebuild. I hope our witnesses will help us understand what needs to be improved so that congress can more effectively provide assistance and understand the impacts on Public Health not just today but in the months and years to come. I wanted to Say Something about the fact that many are coming from the island to our states in particular new jersey in my district. You know, my mayors and my elected officials locally are saying is there any kind of help for us becaus