washington journal continues. host: good morning. we are back with dr. patricia turner. she is good morning and we're back of doctor patricia turner. she is the executive director in ceo of the american college of surgeons. good morning >> good morning. >> thank you for joining us, we're going to talk about the coronavirus pandemic and other issues that are affecting the u.s. health care system. let's start off by talking about the american college of surgeons. what is this mission and what does your work involve? >> thank you for having me. so, the american college of surgeons is a large organization, about 87,000

members around the world. we represent surgeons and we enhance the care of the surgical patient by supporting the surgeons. so we have educational component, so teaching surgeons what is on the cutting edge. we have quality programs to enhance the quality improvement process of hospitals around the world, and we communicate outwardly so that patients and hospitals and our members can know what is the right thing to do about surgical cases. >> how is it funded? >> we are a membership organization, so we have members, you may have seen the fac s designation after surgeons name, that means they are a fellow of the american college of surgeons. we also have programs, educational products, that we sell and we also participate in quality improvement efforts. hospitals engaged with us to help them enhance quality improvement. >> you are talking about the quality movement, the american

college of surgeons, i had this report from earlier last month. it says you're driving quality improvements amid challenging post pandemic environment for u.s. hospitals. it's a new campaign that was launched last month. can you tell us more about it? >> of course, so that is in conjunction with our quality programs and our efficacy and health policy branch. we have a division here in d.c. that works on a regulatory matters and -- advocacy team along with their quality improvement team and we have launched a quality improvement campaign called the power of quality. or gauge with hospitals around the country to bring our quality improvement programs to them. it may be breast surgery or geriatric surgery or cancer or trauma. there's some of the well-known ones, but we also have new programs and vascular surgery, new programs that come across

the kind of operation. we have a children verification program or a geriatric surgery program. our goal is to bring the highest quality of evidence based care to every patient in every hospital around the country. and let me give our listeners and viewers a number to call to either share any comments they have about the health care system or ask any questions of you. the numbers to call, if you're in the eastern or the central time zone we want you to call us at 202748 8000. if you're in the mountain or pacific time zone you're numbers 202748 8001. and if you are a medical professional and would like to weigh in, your number is 202748 8002. and can go ahead and start calling now and we will 202-748-8001 get to in just a

moment. how would you define the current state of surgery in the current state of the u.s. health care system in general? one of the challenges and strengths? >> surgeons are so surgical care is the engine that drives many hospitals. the procedures are incredibly important and while we can have many members of the health care committee to spin some elements of what we can do, if you need a sergeant, you have to have a certain. if you have a traumatic experience if you, have a cancer, you have to have a surgeon but there are things that we need is patients that require surgical care. our job as the american college of surgeons is to make sure that our 110 year old motto, to heal all the skill interest, continues to be what guides us and brings us highest quality care to all patients who are cared for by all surgeons. when we think about what are the challenges, certainly

abscess continues to be something we are concerned about. we want to make sure that we bring surgical care and evidence based article cared to his many individuals as possible. and the community in an academic settings. we also want to make sure that we are mindful of the elements of quality because that continues to be something that may not be as talked about, that is essential. >> how did the coronavirus pandemic -- you know, hospitals were such a priority. essential. how did that highlight or exacerbate what issues exist in the health care industry? >> so, one good example from the coronavirus pandemic is cancer. let's talk about cancer. so, we know that screenings save lives. whether it's colonoscopy or mcguffey, we know that screening for cancer is essential and saves lives. in the pandemic, appropriately, we had to channel all of our

resources into management of covid-19. so, the early stage cancers, it might have been discovers on a mammogram or in a colonoscopy, way to put those on the backburner because we are focusing all of our energies on the pandemic. but we know from a recent study that was published is that there were fewer cancers found in the early days of the pandemic. that's an example of where covid-19 pushed off some of the essential screenings and some of the cases or the operations that surgeons would want to do. way to push them off. that has impacts downstream for patits. >> i'm going to show on our screen there is omnibus funding for cancer research and programs that has been requested. tre is 47.5 billion dollars for the national institute's health. seven point 3.2 billion for the national cancer institute, 22.4

million for the national comprehensive cancer control program. 53.4 million for the national program of cancer registries and 1.5 billion for advanced research projects agency for health. which is that new agency that is being established to advance biomedical and health breakthroughs. that was in the omnibus funding package that passed the last congress, so it's going to be implemented. how important is it that this new funding goes in place to address some of the lags that exist when it comes to cancer? >> so, this is essential but not sufficient. these numbers we obviously want more funding for research, more funding to demonstrate what the evidence is that there are other bones that need funding. surgeon should be they should receive reimbursement that is --

commitment to quality american college of service that we know are demonstrated to enhance quality to save patients lives, to diminish complications are certain to be paid for participating in those high quality programs because those are better for patients. firearm violence. it is not a political issue just like we do research in the motor vehicle accidents or wearing -- we need to invest in reducing the burden of firearms violence. i'm going to bring up we do have another chart to show what was in the omnibus bill for firearm research to the national -- institutes of health and the cdc to and public health research on firearm injury for prevention -- particularly when republicans

were in control there wasn't as much money for fire arm prevention. what is the benefit for this money and how could it be used? >> this is essential investment firearm. it's a major public health crisis and just like all other public health crises, we have to invest money in the research to figure out how to benefit that curve, how to reduce lives lost. again, i have to emphasize not a political issue at all. this is quite literally a public health crisis. in the same way that we would invest in cancer and invest more and cancer the same way that we would invest more in clean water or seatbelts to reduce death for motivational crashes, both on the quality for the surgeons investment to reduce fire arm -- and investment for cancer and

we are receiving. for you the first one is via twitter -- she writes how do you physician quality reports? our surgeries being denied for patients for fear of impacting physicians quality scores and thus -- that is a great question >> one of the -- compared to some others is that we do risk adjustment. so, we don't just give numbers of complications or that's after certain operation, we incorporate elements that are the patient factors. did that person have diabetes, holds that person, did they have other health issues. we file into that. we're -- able to calculate what the complication rate should be and then what an individual surgeon or hospitals complication is.

. sicker patients will get operated, on its where do you go to get the best care for your personal set of issues. >> here is a question we received by message. ray, in aurora colorado writes i was diagnosed with depression a few years ago. with mental health gaining attention in recent years, what can be said about surgeons in this area. -- on mental health -- all across the country there is a place where surgery overlaps with that and we work with our qualities -- favor to figure out how we bring that together and do the right operation for that patient when it's the appropriate time for them to proceed. >> let's go to the phone lines now as a reminder, if you're on

the eastern or central time zones, 202-748-8000. if you're in the mountain or pacific time zones 202-748-8001 and if you're a medical professional he would like to weigh in 202-748-8002. john in johnstown pennsylvania, what's your question or comment? wait. >> hello? >> you're on now. >> it's about the american medical association. why don't they backup doctors that are being threatened by these governors for not performing certain government operations. the example i'm going to use is the one over the weekend. i was watching this hearing for this girl from texas who almost died because the doctors were afraid to board the baby. she had some kind of situation

where the baby was causing her some kind of infection and they said they have to wait until she starts getting sick to perform the surgery. the doctors from that hospital actually called other doctors and other hospitals and they refused you can see here because of the laws. the american medical association, the ama, as got to step in and start helping these doctors and backing them up and start suing some of these state legislatures. this can go on. women in this country have a higher mortality rate from pregnancy than any other place in the industrialized world. so it's going on here? where to do something about protecting these women, especially the ones that are in danger of losing their lives because of some stupid abortion laws. i'll take my answer off of you. >> thank you for that question, you're right, that is a thorny

issue, i say upfront i can't speak for the american medical association, certainly i'm not representing them, but what i will say is that the american medical association, the american college of surgeons, and in most organizations agree that we have to provide evidence based care of our patients. so that is, i think, the guiding light. as it relates to the specifics of your question about why lawsuits are not underway i can't speak to, that but i will emphasize our perspective on this, which is that we are very much focused on providing evidence based care. so what the science says is what we do. we also believe that we have to take care of patients in a way that does not allow interference between the patient and the physician. that is a private relationship between the patient and the physician and we endorse that. >> all right, our next caller is henry into soto, texas.

what is your question or comment, henry? >> yes, good morning, i would like to know how profound of an impact did the covid-19 pandemic have on our health care system in terms but -- is it understated, overstated, or is it yet to be realized with regards to if negative impact in times of with workers unpaid bills, and the lake. >> thank you for that question. >> it goes without question that the pandemic was of epic proportions and i don't use that lightly. more than 1.1 million individuals lost their lives during the pandemic. just a few moments ago, some of the screenings for cancer weren't done so those individuals may percent now at later stage disease, more advanced disease.

we know that there are people who lost their jobs, we know that there are economic impact as well as the mental health impact as well as the health impact on communities was profound it's hard to say whether it's more or less than what was published because i suppose it would depend on what you are reading. i think that the pandemic was profoundly impactful and an extremely negative way in many facets. >> it received another question on for you on twitter. they write, with a b any discussion of how the affordable care act made already high health care even higher? >> thank you for that question. in many ways, what we want is for individuals to have access to care. that is the biggest priority. we know that if you don't have access to care for whatever reason that your health outcomes or worse. we know that if you don't get

the screenings that we know save lives and your outcomes are worse. so, our goal is to have as many individuals have access to the health care system, have access to the evidence based care that we provide fellows of the american college of certain provide and we want to ensure that all patients are able to receive care i want to ask you, we had a caller bring up the issue of abortion, which is a thorny issue. another one that has become part of the debate in politics care for transgender patients. the american college of surgeons but i have discussions about it on her website. how has your organization navigated transgender care and surgery for people who identify as transgender, being such a hot topic right now? >> it is a hot topic. as you can imagine, there is controversy. there are very strong opinions

on both sides. we always focus on what the data shows. what is the right thing to do? depending on the specialties, for example, we have urologists and gynecologist in pediatric surgeons who are all members of the acs. they are guided by what the evidence suggests. there are states where there are pieces of legislation being considered. we, obviously, abide by the laws. but we really focus on the evidence based practice and what is best for the patient. >> let's go back to that omnibus funding and the discussion. your organization has advocated for more funding for health care workers. can you talk about that as a priority? >> it is a priority. we know that the health care workforce writ large was deeply impacted by the pandemic. we know that we have lost many people from the workforce. not just positions, these

physicians might be experiencing burnout. or those who may have suffered with depression as a result of what they have seen. it is not the physicians, nurses are at an all-time low. in many of our hospitals we are unable to put patients there because there are not enough nurses. that is another priority area we need nurses, tax, and those in support functions. you need all of the members of the health care team in order to run hospital. >> all right. let's take another caller. we will go to oklahoma. jen is on the line. what did your question? >> i, thank you for taking my call. i love c-span. thank you, dr. turner, for being here. i am a first year medical resident. i am in my psychiatry residency. i appreciate the discussions about mental health, especially in the wake of covid. my biggest question, kind of a

global question that i would like to hear your thoughts on, we have, in the united states we have significantly horror outcomes per dollar spend than many other developed nations in the world. some of which, many of which have universal health care programs. we hear a lot about the importance of preventative medicine, shifting our model of care to one that focuses on preventative medicine. we like to think about things from an evidence based lens. i guess i haven't really found the exact framework to back this up but it seems to me that having a universal health care program, something where

everyone is covered, would encourage this type of preventative model which, i think, most experts would agree would go towards improving outcomes, improving -- decreasing mortality, decreasing morbidity. i guess, you know, what if anything do you have to say on this? thank you for your time. >> thank you for that question, jab. i would agree with you that preventative care is the right way to go about improving health outcomes. if we can do preventive care on the front sign, we will have fewer interventions that are necessary because your patients are not sick. we will be able to quite literally prevent disease rather than only treat it. i would agree with that point. we agree, as well, on the fact that the quality improvement notion can help improve the health of the nation. to the extent that we have

individuals who are in the health care system that we can enhance access. and then we can do high quality care. that will bend, in some ways, the cost curve. it is ultimately not more expensive. complications are expensive. if we can spend that money, invested on the front side. do the preventative care, make sure we are doing evidence based medicine have. fewer complication, fewer readmissions. that will help to enhance the care of all patients. to the extent that access can be enhanced, that is also going to be very helpful. up next we have the lion she is in new york city. go ahead delilah. . >> dr. turner, hi. my niece was an emergency room doctor during the pandemic. she stayed with me and worked it to different hospitals here in new york city. are walki

they worked so hard! there is such a, you know, -- nurses are walking away from hospitals. striking. it is deplorable. it really should be branded as the health scare industry. all of the wonderful professionals in this for the good of trying to keep people healthy and safe, i am all for preventative, you know, alternatives illusions. universal health care. we have universal health care in place. it's medicare. why can't they expound on that? make things better? there is ceos that are buying private companies that are buying hospitals. hospitals are shutting down. people are having to drive a crazy amount of hours to get health care. this does not make sense in,

supposedly, a wealthy nation. supposedly the best medical care in the world. it makes absolutely no sense. how can i wrap my head around those who are in the forefront and trying to move this forward? >> thank you for that question. there are definitely parts of the health care system that are a struggle to get through the administrative burden. i think that is what i'm hearing you say. individuals who want to get care, you don't want to have to drive far. want local hospital stay open. anything that we can do to enhance care is a good thing. to enhance access is a good thing. there are some challenges. for example, going through the rigmarole of prior authorization is a struggle. if we could make that process easier so that we could move

through the administrative hurdles more quickly that would be beneficial for the patients and the doctors. dhr, if they could all talk to another, that would enhanced the care of the patient and make it easier for the position. there are definitely some administrative things we could do to enhance access and make the system more frictionless. >> up next we have two win and for collins, call relative. good morning, to a. i'm >> good morning. can you hear me? >> yes. >> okay, great. i don't know if this is and dr. turner area but my husband passed away recently. they will not tell me anything about his health care. they talked about hipaa. that once a patient dies then

you cannot learn anything. from what i understand, it protects -- i mean, he is done. what is hip of protecting? why won't they give me any information? thank you. >> thank you for your question joanne i'm so sorry for your loss. what i would suggest is reaching out to the hospital work here was provided. most hospitals have a patient advocate position that person can navigate you through. it hipaa is important for the protection of personal health information. as you said, you would like to be able to access the record. i don't know the details but i would see just going to the patient advocate they can often help you navigate what needs to be done in the medical records

area. >> next on the line is mike. mike is in spokane, washington. mike? >> hello. good morning, ladies. first off let me say that you two are an inspiration for all the young ladies out there. keep that in mind would you please. anyway, doctor, my question is this, i would like your thoughts on the cleveland clinic. everything i'm listening to him in washington here, from what i understand at the cleveland clinic, that was a group of surgeons put that together. from what i understand it has been very successful. understanding what your thoughts around that. thank you. >> thank, you. mike for that question. you are correct, won some surgeons many years ago got together and began, founded, the cleveland clinic that was the beginning of what is a very successful operation. i cannot speak specifically to the details of the cleveland clinic but i would certainly say that when surgeons get

together, we can do great things for the health care system. i encourage physicians and surgeons to participate in hospital leadership. as those who provide care to patients, we are often well equipped to think about what makes the hospital better. what makes it run more smoothly. what enhances the business model and prepares us to provide best care for patients and thank you for that question. >> i wanted to ask you a question now from twitter. how has long covid impact to the medical community? >> thank you for the question. long covid is something that is still in completely understood we are not 100% sure on who is likely to get long covid. there was some thought that we could predict that based on a response to the first bout of covid, or the responsiveness to, maybe even how they responded to vaccines. we do not really know all the details about who gets long

covid, or why. there is certainly an impact. individuals can be deeply affected or more mildly impacted. but if that keep them out of the workforce, or keeps them from returning to their typical activity then that can be a real problem. we also don't have good treatment modalities yet it seems like there are multiple symptoms associated. we are still doing research, not the ac as, but research is doubling down on the impact of long covid. it is something to be concerned about. >> let's go too far rockaway new york now. robert, what is your question or comment? >> good morning. thank you for taking my call. >> hi, we just had a question. the covid-19 vaccine has been shown >> it does not stop you from getting covid. or it doesn't stop you from transmitting it? shouldn't all the officials,

all the fireman, police, nurses, medical staff, shouldn't they be rehired back? that was the reason they were fired? thank you so much. >> thank you, robert. if i'm understanding the question, what i would emphasize is while the vaccine did not, does, not 100 present prevent getting covid, it very, very, much does diminish the severity of covid. it can lower your risk of getting it. not to zero but, certainly, the vaccine lowers the risk of you getting covid. importantly, it lessens the severity. individuals who may have died before have perhaps a milder case. the vaccine is very much impactful, in a good way. it diminishes, not just transmission, but severity of disease. >> our next caller is a retired

nurse. donna, in salem, massachusetts. what would you like to share with us this morning? hi, dr. turner. yes, gosh, the biggest issue is the third degree they are doing on children. those confused about their gender. i mean, my good god. that money, it is despicable. let children be children. let them grow up, with now a major, major, transformation. they are children. i think the doctors that are doing the should be put in jail, it is evil. absolutely evil. as adults, do what you want. i just can't believe how sick this world has become. what is wrong has becoming

right, you know? and vice versa. it is beyond my comprehension. i was a nurse for 25 years. people were so over medicaid id. especially with psychotropic mans. earlier it was called alcohol's own. i don't think doctors, when they are in school, they don't have a lot of hours -- it mimics so many mental illnesses. if they go to a psychiatrist they want to go up a person they. i want to put them on something. it is unbelievable. it is running rampant, you know? alcohol is legal. there is a liquor store on every street corner. yet some people are not able to drink alcohol, at all.

it sets off a phenomenon crazy. the first drink sets it off. it gets them, you know? one drink is too many. 100 is not enough. their life goes down -- >> donna, donna we are going to let dr. turner respond to some of the comments he made. >> thank you, donna. i'm not sure that i can really respond other than to say that we agree that it is important to try to meet patients where they are. there are challenges, alcoholism meng them. thank you for your question. >> earlier, initially, she started bringing back up the transgender issue. particularly there are people concerned that children are receiving a reversible surgery. is that something you are finding among your members? how are you guys addressing these specific questions about

when, or if, to give surgery to minors. >> i know that across states there are different positions on that. we are mindful of the law. we make sure we are abiding by the law. again, i think there are decisions that are made, in this case, as i said before it is between the surgeon and occupation. and this case obviously they're parents are involved. that is a conversation that would be a case by case basis. >> michael in broward county florida. what would you like to share this morning? >> two things, really. i am an activist in broward county. we have been -- i have been pushing the teachers, we would like to include doctors in this, to stand on their oaths. this is the core principle. when a teacher or doctors made to do something that goes against their sworn oath to protect children, or to protect a patient.

in the case of a doctor to protect their patients, they need prophylactically gordon. also, no one ever mentioned 3% of children nationwide and worldwide are born with ambiguous genitalia. they are forced by law, in most states, to sign on the burst to get whether you are male or female. just pick one randomly. well, what about doing operations on those kids are younger in the operations work better? there's so much there is not discussed because i think we are shy about the. we can't even talk here in florida a woman's menstrual period. it is unacceptable. we need people like dr. than teachers to stand on their hosts when basic principles like this or attacked. you cannot just go when they think principles are attacked. that is what owes therefore. when your foundationally attacked, you need to use your organization please. teachers need support to. support teachers and their office if you defend your oath. your most basic.

people say teacher oh, that's funny. doctor those are respected. please use that. please, a big you. >> i will follow up on your point you are absolutely correct the notion of having ambiguous genitalia is something that we know occurs. that is, again, where to emphasize the primacy of the patient physician relationship. those decisions are best made by the surgeon, the patient, that patients parents and other members of the health care team. and okinawa just, pediatricians. it is a team sport if you will. making these really important decisions around children. >> next up we have danny in farmington missouri. go ahead, danny. thank you. it is fantastic to be with you, dr. turner. i was talking to a girl,

scheduling donations for the red cross. maybe a year ago. talking about the covid vaccine. people were going to surgery who evidently were requesting bled haven't been vaccinated. i was wondering if you had come across that? or if you had come across it if it is still a saying. how much protection could you get from one pine a blonde that had been vaccinated? >> thank you, danny, for that question. what i will say is if you need a blood transfusion you should go ahead and get that blood transfusion. not worry about whether not if the person who donated about was vaccinated or unvaccinated. there is no evidence that you should be concerned as a patient about the vaccination status of the blood donor. we try, in general, not to give blood donations unless they are absolutely necessary. if they are, it is certainly -- that is the priority.

not worrying about the vaccine status of the donor. thank you for that question. >> i want to and, dr. turner, let's look forward what are some additional priorities the american college of surgery it's talking to congress and other elected officials about? >> thank you for that question. we, again, would love to have a conversation about enhanced reimbursement for high quality care. we know that we have programs that enhanced the outcomes, minimize complications, minimize morbidity and mortality. that is something that we would love to have conversations about. we would love to talk about enhancing research dollars for all of the things that we talked about. cancer care, mitigation of fire arm injury, those are important conversations. we would like to talk about learn reimbursement for surgeons. we have an out it's hans talk at all about student loan debt. but when we think about student

loan debt and how it impacts the young doctors who are the future of our profession we should be able to have loan repayment programs for surgeons who can go into these communities so there can be access as we talked about being so important. >> are there other challenges, either politically or day-to-day, in the workforce that surgeons face that you think the public should be more aware of? >> we are trying to provide the best possible care that you can. we recognize, for example, that we need more nurses. we can move patients to the hospital. we cannot get them out of the operating room into the recovery room if there are not enough nurses. we want to be mindful of how the entire health care team works together. we are all part of the team. that is, really, a priority for us. we think about making sure we are emphasizing that looking for a fellow of the college, if you are wondering where to go,

live surgeon to have, look for the f-acs designation. we are rolling out, as we talked about in the very beginning, the quality campaign. there will be diamonds. the american college of surgeons quality diamonds that you can see, you can represent the hospital participates with us. in our accreditation and certification. providing the highest quality care. you can see vascular, children surgery, look for that quality diamond that says the american college of surgeons on it. >> thank you so much for joining us doctor patricia turner. >> thank you so much for having me. >> today officials from the official u.s. drug testify about an ongoing investigation into the agencies 2022 nationwide infant formula crisis response. they will take numbers over the house subcommittee.

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