Appreciate it. We are here today to examine the department of health and Human ServicesPublic Health preparedness for and response to the 2017 Hurricane Season. In the last two months, texas, florida, puerto rico and the u. S. Virgin islands have been devastated by hurricanes. I first want to express our heartfelt sorrow for the millions of americans impacted by these devastating storms, and say that all members of this committee on both sides of the aisle stand with those affected by these hurricanes. I would also like to thank dr. Burgess and dr. Ruiz who each recently visited puerto rico to assess the impact these 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 the Public Health issues well be discussing today, but also 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 collone from puerto rico. Thank you for being here at this important hearing. From coordinating the overall federal Health Care Response to ensuring that individuals have the medical treatment they need, to protecting the blood and pharmaceutical supply, to granting emergency waivers and everything in between, 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 treat those in harms way. Yet media reports indicate that somehow 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. Before Hurricane Maria made landfall in puerto rico and every day since, hhs, the department of defense, the department of veterans affairs, and fema have been working with local Emergency Response officials to provide medical care and help reestablish the health care infrastructure. Hhs has worked with puerto ricos dialysis facilities and coordinated with femfema. Similar efforts are ongoing in the u. S. Virgin ids as well. Has the agency been effective from the perspective of hhs . Are the federal policies causing delays, in response efforts . Are we utilizing our resources in the most efficient and effective ways to help our fellow americans in puerto rico and the u. S. Virgin islands in particular. Finally, it is critical that we understand the Public Health challenges ahead. As we have seen after Hurricane Harvey, theres an increased risk for the spread of Infectious Disease due to contaminated water. Media reports indicate that one month after Hurricane Maria, over 1 million americans are still without clean, safe Drinking Water. Rebuilding puerto rico and the 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 still dont even know the full extent of the damage, let alone when our fellow citizens will have electricity and Running Water restored. Were trying to do Everything Possible to address the short and longterm needs of the area impacted by harvey, irma and maria, especially in the Health Results that resulted and will continue to result from these storms. I would like to thank the witnesses for testifying here today. And i look forward to hearing your testimony. And with that, i will now yield five minutes for an Opening Statement to miss degette, the Ranking Member from colorado. Thank you very much, mr. Chairman. 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. And inundated houston and south texas with more than 51 inches of rain. Hurricane irma became the strongest atlantic hurricane on record, before it hit the Virgin Islands and florida. And while these storms have been devastating, 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 thats caused by this ongoing crisis is still coming into focus, but its clearly considerable. Over a month after maria hit, 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 generators in order to keep functioning. Over a third of puerto rican residents lack reliable access to Potable Water. Contaminated is spreading contagious diseases, and while i certainly appreciate the effort by volunteers, including physicians and nurses volunteering their time, with the hhs demat teams, im concerned 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 these Vital Services that you, mr. Chairman, talked about. And i even think as time goes on, we should have field hearings on puerto rico in particular, but also the Virgin Islands, as much of the recovery effort as you so accurately described involves the 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, we saw what happened to those records. When we had our field hearings, congresswoman blackburn was there and a bunch of the rest of us, and we saw what had happened to Small Business people down there in new orleans. You just cannot substitute for that, and as we begin to think about our public response as members of congress, we need to see what were 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 fact that most residents lack power, nearly 1 million americans lack access to safe and reliable Drinking Water, and endless reports of near subsistence living for many, i find that statement to be breathtaking. I hope that our Witnesses Today are better prepared than that to talk about whats 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 concerted effort to understand whats going on. And i would now like to yield the balance of my time to representative castor who wants to talk appropriately about the Health Challenges facing her state of florida. This simply was a catastrophic Hurricane Season. And we have so many challenges ahead. I want to thank our witnesses who are here today. I want to thank 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. And on the island, the Drinking Water issue is simply critical. So i look forward to your expert today and the committees work in the days ahead. Thank you. Yield back. Gentle lady yields back. Now recognizing the chairman of the full committee, mr. Walden of oregon. I thank you, vice chairman, for holding this important hearing. I do, too, want to express my sympathy for those impacted by these horrible storms, particularly our citizens in puerto rico and the british Virgin Islands. We will assist in any way we can. We will continue to be diligent in our oversight that the agencies are doing and needs of the people there. Im very pleased that dr. Burgess who chairs our Health Subcommittee has already been to puerto rico, visited some of the hospitals, 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 to see whats out there ahead, where weve made progress, where there are still problems we need to get Better Solutions to. Today were examining the department of health and Human Services continuing efforts in texas, florida, puerto rico and Virgin Islands. This is the first in a series of hearings on the preparedness for and responses to hurricanes harvey, irma and maria. In the coming weeks well also hold weeks before the subcommittees on these matters. This committee will be conducting oversight of the Reed Building in puerto rico and the u. S. Virgin islands for years to come. The Public Health risk associated with Natural Disasters hold Infectious Diseases, longterm Mental Health trauma, just to name a few of the concerns we all need to be aware of. These risks can be particularly dangerous. Especially for vulnerable populations such as infants, dialysis patients, individuals who may be immunosuppressed and, of course, the elderly. Tragically we saw that in the aftermath of Hurricane Irma where 14 elderly residents of the Rehabilitation Center in florida lost their lives as a result of heat induced deaths after the 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 the steps it took to protect residents after its air conditioning system stopped working. While the three major hurricanes to impact the United States in 2017, continue to present their own unique challenges, many of the protocols that are necessary to conduct an effective Public Health response are immutable. Federal agencies responding to disasters must be able to communicate effectively with each other and with local, state and territorial officials to identify any areas of need, ensuring that individuals have adequate access to basic necessities, such as food, water and medical supplies, critical in any Public Health protection effort. As we head into a recovery phase, its important we also carefully monitor patients as they transition from hospitals or under medical supervision back to their homes rather than longterm living arrangements. News reports indicate more than 60 of Puerto Ricans are now homeless. We need to make sure that when patients are discharged from the hospitals, that they have safe places to go. And dont end up on the streets and back into the hospital. However, following Hurricane Maria, various media reports called into question whether the federal government is adequately meeting its obligation to conduct health and welfare of american citizens in puerto rico and Virgin Islands. Im here to gain the perspective of the witnesses who have been on the ground in the areas that have been affected by the most recent hurricanes. Making sure that 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 as well. In addition, we also want to hear about any best practices that can be gleaned from the ongoing Recovery Efforts, utilized in response to any future Natural Disaster. Again, thanks to you and your teams for being on the ground trying to do the best you can in these horrible circumstances. We really need to know the facts, whats working, whats not, where there have been shortfalls, what are the Lessons Learned and where did you need additional help to help our citizens. With that, mr. Vice chair, i yield back the balance of my time and look forward to the testimony of our witnesses. Before i do that, id also like to welcome our newest member to the committee, mr. Duncan. Just approved by the house conference this morning, Steering Committee last night, replacing dr. Murphy. And jeff, were delighted to have you onboard the committee. Thanks for being here today. I yield back. Now recognizing mr. Pallone of new jersey. Thank you, mr. Chairman. And thank you for holding this hearing on this critical issue. I hope that this hearing is the first of many hurricane related hearings, as Congress Needs to hear further from hhs and other agencies in the Recovery Efforts in all of the affected areas. I would also 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 of the areas that were impacted by these 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 of the ive never seen worse storm damage in our area in my lifetime. Many of the storm was the 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 that are not back in their homes or their businesses. Our nation is now experiencing historic levels of destruction and loss in puerto rico and the Virgin Islands, as well as in florida, texas and along the gulf coast in the wake of hurricanes maria, irma and harvey. While no two Natural Disasters alike, there are unique needs and challenges. Congress continues to address the response in florida and texas, we must also work to ensure that puerto rico and the u. S. Virgin islands receive the full and immediate support of the federal government as they recover. I recognize there are a number of ongoing challenges facing the residents of south florida in the gulf coast. Much of the hearing today will likely need to address the situation in puerto rico and the u. S. Virgin islands. The reports coming from these areas indicate that hundreds of thousands of americans continue to struggle to meet daytoday needs. Im particularly concerned there are still reports that residents do not have access to food or medicine. As many as 1 million americans lack reliable sources to c