September 26, 2019 - Issue: Vol. 165, No. 156 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages H8032-H8037]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           U.S. BORDER PATROL MEDICAL SCREENING STANDARDS ACT

  Mr. THOMPSON of Mississippi. Mr. Speaker, pursuant to House 
Resolution 577, I call up the bill (H.R. 3525) to amend the Homeland 
Security Act of 2002 to direct the Commissioner of U.S. Customs and 
Border Protection to establish uniform processes for medical screening 
of individuals interdicted between ports of entry, and for other 
purposes, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 577, in lieu of 
the amendment in the nature of a substitute recommended by the 
Committee on Homeland Security printed in the bill, an amendment in the 
nature of a substitute consisting of the text of Rules Committee Print 
116-33 is adopted, and the bill, as amended, is considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 3525

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled.

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``U.S. Border Patrol Medical 
     Screening Standards Act''.

     SEC. 2. RESEARCH REGARDING PROVISION OF MEDICAL SCREENING OF 
                   INDIVIDUALS INTERDICTED BY U.S. CUSTOMS AND 
                   BORDER PROTECTION BETWEEN PORTS OF ENTRY.

       (a) In General.--Not later than one year after the date of 
     the enactment of this Act, the Secretary of Homeland 
     Security, acting through the Under Secretary for Science and 
     Technology of the Department of Homeland Security, in 
     coordination with the Commissioner of U.S. Customs and Border 
     Protection and the Chief Medical Officer of the Department, 
     shall research innovative approaches to address capability 
     gaps regarding the provision of comprehensive medical 
     screening of individuals, particularly children, pregnant 
     women, the elderly, and other vulnerable populations, 
     interdicted by U.S. Customs and Border Protection between 
     ports of entry and issue to the Secretary recommendations for 
     any necessary corrective actions.
       (b) Consultation.--In carrying out the research required 
     under subsection (a), the Under Secretary for Science and 
     Technology of the Department of Homeland Security shall 
     consult with appropriate national professional associations 
     with expertise and non-governmental experts in emergency, 
     nursing, and other medical care, including pediatric care.
       (c) Report.--The Secretary of Homeland Security shall 
     submit to the Committee on Homeland Security of the House of 
     Representatives and the Committee on Homeland Security and 
     Governmental Affairs of the Senate a report containing the 
     recommendations referred to in subsection (a), together with 
     information relating to what actions, if any, the Secretary 
     plans to take in response to such recommendations.

     SEC. 3. ELECTRONIC HEALTH RECORDS IMPLEMENTATION.

       (a) In General.--Not later than 90 days after the date of 
     the enactment of this Act, the Chief Information Officer of 
     the Department of Homeland Security, in coordination with the 
     Chief Medical Officer of the Department, shall establish 
     within the Department an electronic health record system that 
     can be accessed by all departmental components operating 
     along the borders of the United States for individuals in the 
     custody of such components.
       (b) Assessment.--Not later than 120 days after the 
     implementation of the electronic health records system, the 
     Chief Information Officer, in coordination with the Chief 
     Medical Officer, shall conduct an assessment of such system 
     to determine system capacity for improvement and 
     interoperability.

  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
1 hour equally divided and controlled by the chair and ranking minority 
member of the Committee on Homeland Security.
  The gentleman from Mississippi (Mr. Thompson) and the gentleman from 
Alabama (Mr. Rogers) each will control 30 minutes.
  The Chair recognizes the gentleman from Mississippi.


                             General Leave

  Mr. THOMPSON of Mississippi. Mr. Speaker, I ask unanimous consent 
that all Members may have 5 legislative days to revise and extend their 
remarks and to include extraneous material on this measure.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Mississippi?
  There was no objection.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield myself such time as 
I may consume.
  Mr. Speaker, H.R. 3525, the U.S. Border Patrol Medical Screening 
Standards Act, as amended, seeks to build on legislation passed by the 
House in July to strengthen the medical care and attention provided to 
migrants who cross our borders.
  In July, in response to reports of inhumane conditions at our 
southern border and the death of six children who had been in CBP 
custody, the House approved a bill to require in-person medical 
screening by licensed medical professionals for apprehended 
individuals.
  H.R. 3525 builds upon that measure by focusing on improving health 
screening processes and recordkeeping within DHS. The bill authored by 
the gentlewoman from Illinois (Ms. Underwood) takes a two-pronged 
approach.
  First, it requires DHS to research innovative solutions for 
deficiencies in the medical screening it conducts at the border. This 
research is to be carried out in consultation with national medical 
professional associations that have expertise in emergency medicine, 
nursing, and pediatric care.
  Importantly, in carrying out the research, DHS is directed to pay 
particular attention to the screening of children, pregnant women, the 
elderly, and other vulnerable populations.
  Once completed, DHS is required to transmit to Congress information 
on what actions the Department plans to take in response to the 
research findings.

                              {time}  1515

  The second prong of H.R. 3525 is focused on driving DHS to improve 
interoperability among components responsible for the care of 
apprehended individuals. It does so by requiring DHS to set up an 
electronic health records system to track health screening and care of 
individuals in DHS custody. This system would create records that could 
be accessed by all the relevant DHS components.
  The benefits of such a system are unmistakable:
  A migrant's medical information cannot get lost.
  There will be a clear system to track when any followup medication or 
medical attention is needed, ensuring cases will not fall through the 
cracks.
  It will also avoid duplication of medical services and time delays 
due to lost or incomplete medical records.
  As important, all the information gained from the initial medical 
screening will follow the children and adults as they are transferred 
to other DHS components.
  Even though apprehension numbers have recently declined, we must take 
the lessons learned from the poor handling of the recent migrant crisis 
to heart and drive performance improvement within DHS.
  H.R. 3525 represents a step in the right direction, and, as such, I 
urge my colleagues to support the legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROGERS of Alabama. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, here we go again. Yesterday, the majority passed a 
partisan messaging bill to provide illegal immigrants with an 
additional complaint line at the Department of Homeland Security. It 
has no chance of becoming law. Today, they are back at it with

[[Page H8033]]

another partisan messaging bill that will never become law. This time, 
it is a bill to provide illegal immigrants with electronic health 
records.
  This bill before us today requires the Department of Homeland 
Security to set up an interoperable electronic health records system to 
track the medical history of millions of illegal immigrants. The bill 
requires the system to be up and running in 90 days.
  Implementing an electronic health records system is a complicated, 
labor-intensive undertaking. They begin with a configuration process to 
tailor the commercial software to a client's needs and then proceed to 
a site-by-site installation process, followed by workforce training.
  It typically takes a year or more to get new electronic health 
records up and running at a hospital with just one location. Making 
these systems interoperable across government agencies only creates 
more complexity, extending implementation by years.
  If you need a real-world example of just how unachievable this is, 
look no further than the Coast Guard. The Coast Guard spent 7 years 
trying to get an interoperable health records system in place for its 
50,000 employees. But, after all that time, the system didn't work. 
Coast Guard servicemembers are still forced to rely on paper medical 
records.
  The Coast Guard is not alone. The Department of Defense and the 
Veterans Administration won't have fully interoperable health records 
systems in place for another 5 to 9 years, respectively.
  H.R. 3525 also requires DHS to research innovative ways to conduct 
medical screenings on illegal immigrants. DHS already conducts 
thousands of medical screenings on migrants on a daily basis. Finding 
new ways to deliver health screenings more effectively could save time 
and money, but researching innovations in healthcare delivery is not 
the mission of DHS.
  The research mandated by this bill is the responsibility of the 
Department of Health and Human Services. DHS research is properly 
focused on preventing drugs, criminals, and terrorists from entering 
our borders. We should not force DHS to lose its focus on these 
critical Homeland Security priorities.
  Finally, the bill before us today fails to provide DHS with any 
funding to achieve the illegal immigrant medical screening research and 
interoperable health records mandates. We have no idea how much this 
bill will cost because the majority failed to file a cost estimate from 
CBO.
  However, we do know from the experience of the VA, DOD, and Coast 
Guard that interoperable electronic health records systems are 
extremely expensive undertakings. The DOD and VA are on track to spend 
over $25 billion on their systems. The Coast Guard's failed system to 
track just 50,000 people cost $67 million.
  Using the Coast Guard as a baseline, it would cost over $2.5 billion 
to track the medical history of just the illegal immigrants that have 
come into our country over the last 2 years. In other words, without 
any funding provided for the mandates in this bill, billions in 
critical DHS funding used to counter terrorist plots, equip first 
responders, and respond to natural disasters would be diverted to pay 
for a benefit for millions of illegal migrants.
  Mr. Speaker, what is truly disappointing about this bill that we have 
considered over the last 2 days is that they did nothing to prevent 
another humanitarian crisis at our border. We should be working 
together on legislation that reforms our broken immigration system, 
protects vulnerable families and children from human smugglers, reduces 
the asylum backlog, and expands migrant processing and long-term 
housing.
  When this partisan messaging bill fails to move in the Senate, I hope 
Democrats will finally choose policy over politics and agree to work 
with Republicans on solutions to our border security problems.
  Mr. Speaker, I reserve the balance of my time.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 6 minutes to the 
gentlewoman from Illinois (Ms. Underwood), sponsor of this legislation.
  Ms. UNDERWOOD. Mr. Speaker, I introduced the U.S. Border Patrol 
Medical Screening Standards Act in response to the conditions I 
witnessed firsthand on our border this year: first in April, then in 
July, and then again in August.
  The humanitarian crisis at our border is a problem that we should be 
working together to solve with an evidence-based approach. This 
legislation is evidence-based, and I am incredibly proud that it was 
able to be forwarded by the Committee on Homeland Security with a voice 
vote.
  I also appreciated Ranking Member Rogers' willingness to engage with 
us on this bill, and I am committed to continuing to look for ways to 
work together on these issues going forward.
  As introduced, my bill had three sections, two of which are included 
in the legislation we are debating today.
  First, my bill ensures implementation of an integrated electronic 
health records system, or EHR, to be used by those caring for migrants 
at the border. This is a direct ask from medical officers at the 
Department of Homeland Security who have identified it as a high-
priority barrier to providing care.
  We know that migrants may be transferred between different sites and 
components multiple times while in custody, and an interoperable EHR is 
essential to their health records remaining accessible.
  Immigration and Customs Enforcement has an EHR. The Office of Refugee 
Resettlement has an EHR. But Customs and Border Protection, which 
includes the U.S. Border Patrol, doesn't.
  When I was at the border, I saw busy, overworked Border Patrol 
officials having to keep health records on paper. I also saw how these 
records don't always follow migrants between facilities and transfers 
of custody.
  As DHS works to improve its medical screening of children and 
migrants at the border to ensure there is a minimum standard of care, 
the need for proper recordkeeping on those screenings will only 
increase.
  Furthermore, children can spend days or weeks in CBP custody before 
being transferred to another component. There must be a transferrable 
record of the medical care those kids receive and the medical 
conditions that they report. That is why DHS has already begun 
independently taking steps toward an electronic health records system, 
hiring staff, and soliciting individual component requirements.
  This legislation formalizes and directs that process, setting an 
aggressive but achievable timeline that reflects the urgency of the 
humanitarian situation at our southern border.
  Second, this bill directs DHS to research innovative approaches to 
address any capability gaps in providing medical screening, 
particularly for children, pregnant women, the elderly, and other 
vulnerable populations.
  As a nurse, I believe in data-driven, evidence-based policymaking. 
Data shows that, in recent years, the migrant population arriving at 
our southern border has shifted from primarily adult, economic migrants 
to a large number of families and unaccompanied children seeking 
asylum.
  DHS must be better prepared to respond to these shifts, and barriers 
to providing basic medical care to migrants in U.S. custody will 
persist as our country continues its national conversation around 
immigration policy. The research required by this litigation will 
ensure that we have robust data on DHS' capabilities in order to inform 
our response.
  My bill also ensures that, in conducting this research, DHS 
collaborates with medical professionals who have expertise in pediatric 
care so that DHS is addressing both the physical and the mental health 
needs of migrant children at the border. By proactively focusing on 
children, this research is intended to prevent the care gaps we have 
seen in other Federal facilities caring for migrant children.
  Lastly, I am proud that the third section of this bill, as 
introduced, was incorporated into my colleague Dr. Ruiz' legislation 
that was passed by the House in July. This section set consistent 
minimum standards for medical screening of migrants at the border.
  Proactive, consistent, and timely medical screening is essential to a 
public health response to the humanitarian crisis on our border, but 
effective medical protocols are not in practice right now.

[[Page H8034]]

  By training border personnel in medical screening, the legislation 
provides law enforcement and staff at the border the support that they 
need so that they aren't being forced to deal with medical situations 
that we haven't equipped them for. That is why I am pleased that this 
screening language passed the House in July.
  In addition to these medical screening standards, we need to ensure 
DHS has an electronic health record and close those research gaps. That 
is what this legislation on the floor right now would do: build on the 
legislation we passed in July and implement the remaining two 
components of the U.S. Border Patrol Medical Screening Standards Act.
  Anyone who has been to the border, including many of my colleagues on 
the Committee on Homeland Security, has seen how overwhelming the 
humanitarian situation there is. This committee and this Congress have 
consistently been willing to provide the Department of Homeland 
Security with the resources it needs, but with those resources comes 
accountability and oversight. This legislation is an important and a 
sensible step forward to make sure that both migrants and border 
officials are not placed in situations that are unsafe.
  Mr. Speaker, in closing, I want to recognize and thank Chairman 
Thompson and his staff on the Committee on Homeland Security--including 
Rosaline Cohen, Alexandra Carnes, Wendy Clerinx, Ethan McClelland, and 
Brittany Lynch--for their months of hard work on this legislation, and 
I urge my colleagues on both sides of the aisle to support it.
  Mr. ROGERS of Alabama. Mr. Speaker, I am curious about the 
announcement that the administration is in support of this and is 
working toward this, because they have already issued an announcement 
that they oppose this piece of legislation. So, if it did pass, it 
would be vetoed by the President.
  Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania 
(Mr. Joyce), an outstanding member of the Committee on Homeland 
Security.
  Mr. JOYCE of Pennsylvania. Mr. Speaker, I rise today in opposition to 
H.R. 3525.
  Yet again, I fear that this partisan legislation is a missed 
opportunity to seriously address the humanitarian and security crisis 
that exists today on our southern border.
  All of us here today can agree that every human being is worthy of 
dignity and respect.
  As a physician, I understand the importance of efficient and 
compassionate healthcare. At the same time, I understand firsthand how 
difficult it would be to achieve the requirements that are outlined in 
this bill.
  Establishing an electronic health records system in any medical 
system takes at least a year, in the best case scenario. In the 
bureaucratic web of the Federal Government, this tedious task becomes 
nearly impossible.
  For years, Members of this House have been working to help the 
Department of Veterans Affairs implement its electronic health records 
system, yet the VA won't have this completed for another 9 years.
  Quite frankly, requiring the Department of Homeland Security to 
implement an interoperable electronic health records system for illegal 
immigrants in 90 days--it is simply unrealistic.
  Adding to the problem, this costly project would distract from other 
pressing needs on the border. Our Customs and Border Protection law 
enforcement agents are hardworking Americans who have been tasked with 
an incredibly difficult job.

                              {time}  1530

  While protecting our country on the southern border, they are also 
providing humanitarian aid to an unprecedented number of immigrants. 
They need our help. They do not need Congress to add unnecessary and 
unachievable burdens to their duties.
  It is disappointing, but it is not surprising that House Democrats 
have chosen this approach. Time and time again, we return to the floor 
to debate partisan bills that will do nothing to address the underlying 
cause of this crisis.
  Rather than continuing to grandstand on the House floor, I encourage 
my colleagues to, once again, return to the Committee on Homeland 
Security to work on solutions that will secure the border, end asylum 
loopholes, and protect our country.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 2 minutes to the 
gentlewoman from California (Ms. Roybal-Allard), the chairwoman of the 
House Appropriations Subcommittee on Homeland Security.
  Ms. ROYBAL-ALLARD. Mr. Speaker, I rise in strong support of H.R. 
3525, and I commend my colleague, Lauren Underwood, for introducing 
this important legislation.
  When migrants are in U.S. Federal custody, it is our moral 
responsibility to ensure they are treated humanely and receive 
appropriate medical screenings and care.
  Earlier this year, the House Appropriations Subcommittee on Homeland 
Security, which I chair, appropriated significant additional resources 
to CBP to improve medical care and screening.
  H.R. 3525 will help ensure this care is standardized across the 
Border Patrol by requiring it to formalize the medical screening 
process and to come up with innovative approaches to fill medical 
screening gaps.
  The bill also requires the Border Patrol to have a singular 
electronic health record system, accessible to other DHS components, to 
ensure continuance of care for migrants.
  These are smart, simple steps that can save the lives of migrants who 
left tragic situations in their home country to seek refuge in the 
United States. I strongly urge my colleagues to vote in favor of this 
bill.
  Mr. ROGERS of Alabama. Mr. Speaker, I yield 3 minutes to the 
gentleman from Indiana (Mr. Banks), an outstanding leader in the 
Republican Conference.
  Mr. BANKS. Mr. Speaker, I thank the ranking member for yielding.
  I oppose H.R. 3525 because it is poorly conceived, erroneously 
drafted, and extremely risky.
  This bill would require the Border Patrol to divert resources from 
its core mission of protecting our Nation's borders and create a new 
medical screening system for those who illegally cross and enter the 
country between ports of entry. I believe every part of that is 
wrongheaded.
  However, even if you agree with the policy, this is not the way to do 
it. Handing DHS and CBP a 30-day mandate to put an electronic health 
records system in place has no basis in reality.
  VA is currently in the second year of a 10-year, $16 billion EHR 
overhaul. I spend much of my time in Congress overseeing it on the 
Veterans' Affairs Committee.
  The EHR implementation is a tall order for the VA, which has tens of 
thousands of doctors and nurses, a huge health IT budget, and 
healthcare as its core mission.
  The DHS Chief Information Officer and CBP have none of those things. 
All available evidence indicates giving them that mandate is deeply 
unwise.
  There is no score or cost estimate whatsoever. The score that was 
filed is from the Enhanced Border Security and Visa Entry Reform Act of 
2002, which is completely unrelated.
  We are being asked to vote on this legislation blindly. Based on the 
experience of institutions similar in size to CBP that have implemented 
EHRs, the price tag could easily run into the billions. Five to 10 
years is a realistic timeline, not 30 days.
  Altogether, I think this is a mistake, even if well-intentioned.
  We should be devoting our resources to reducing border crossings 
between ports of entry. We should prioritize getting detainees out of 
Border Patrol custody and into ICE and HHS custody, which already have 
mandates and capabilities to provide medical care.
  I strongly oppose H.R. 3525 for these reasons, and I strongly urge my 
colleagues to vote ``no.''
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 3 minutes to the 
gentlewoman from New York (Miss Rice), the chair of the Homeland 
Security, Border Security, Facilitation, and Operations Subcommittee.
  Miss RICE of New York. Mr. Speaker, six children have died in DHS 
custody over the past year.
  On Christmas Day in 2018, 8-year old Felipe Alonzo Gomez died in the 
custody of U.S. Customs and Border Protection. He was the second child 
that month to die in CBP custody. And after

[[Page H8035]]

his death, CBP implemented a new medical screening process for young 
children in their care.
  However, as we soon learned, this process was not adequate, because 
four more children died in CBP custody from preventable illnesses and 
substandard living conditions.
  Even after these new screening processes were put in place, both CBP 
personnel and their facilities along the southern border remained 
completely ill-equipped for months. That is why this past July, the 
House passed H.R. 3239, the Humanitarian Standards for Individuals in 
Customs and Border Protection Custody Act.
  This bill would require DHS to improve screening processes and 
utilize professional medical staff. And it allocated other necessary 
resources to conduct effective initial medical screenings for all 
people in CBP custody.
  Today, I am proud to support Congresswoman Underwood's effort to 
build on that legislation.
  I was honored that, in her first few months in office, Congresswoman 
Underwood joined me on two separate trips to the southern border. She 
drafted this bill as a direct result of what she witnessed on those 
trips.
  H.R. 3525 directs DHS to consult with medical experts to improve its 
medical screening process and to finally establish an electronic health 
record system for people in CBP custody.
  DHS has always been on the cutting edge of innovation, leveraging the 
latest in technological advances to fulfill its critical mission of 
protecting our homeland. And I believe it is now vital that DHS use 
that same approach when caring for the individuals and families in its 
custody.
  The Department has a long, successful history of working with the 
private sector to achieve its counterterrorism, emergency response, and 
cybersecurity goals.
  This bill would require DHS to consult with national and medical 
professional associations who have the expertise in emergency medicine, 
nursing, pediatric care, and other relevant medical skills to make sure 
that DHS is providing appropriate medical care to migrants in its 
custody.
  It specifically instructs DHS to research innovative approaches for 
screening vulnerable populations, including pregnant women, the 
elderly, and people with disabilities.
  CBP is long overdue for an electronic health records system. In 2019, 
there is no good reason why an agency under as much strain as CBP is 
still using paper records. An electronic health record system would 
improve CBP's internal operations and expedite coordination when 
children and adults are transferred to other agencies.
  I would hope that my colleagues on the other side of the aisle agree 
that not one more child should die in the custody of the Federal 
Government.
  This bill should not be controversial. It is bipartisan; it offers 
commonsense solutions; and it will help save lives.
  I strongly urge my colleagues to join me in supporting H.R. 3525 
today.
  Mr. ROGERS of Alabama. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Tennessee (Mr. David P. Roe), the ranking 
member of the Veterans' Affairs Committee, and a physician.
  Mr. DAVID P. ROE of Tennessee. Mr. Speaker, I rise today in 
opposition to H.R. 3525, the U.S. Border Patrol Medical Screening 
Standards Act.
  Before coming to Congress, I was a practicing physician for over 31 
years. I also served in the 2nd Infantry Division in Korea in the 2nd 
Medical Battalion where, at that time, we trained, we spent a lot of 
time in the field training for mass casualties and big events.
  I went to the border; I spent four days down there on two separate 
occasions. The last time was in June of this year, with the Medical 
Director of the Department of Homeland Security, as chief medical 
adviser, and five other members of the Doctors Caucus at the McAllen, 
Texas, Rio Grande Valley sector to see for myself what was going on.
  At that time, Mr. Speaker, there were 1,000 to 1,500 or more people a 
day who came across. As we stood there by the Rio Grande River, 15 
people walked up and turned themselves in while we weren't there more 
than 15 or 20 minutes.
  And we looked at the facilities they had; about how they tried to 
screen those folks; and then how they tried to sort them afterwards. 
And, Congress, it was a shame on us for not providing ICE more beds so 
you could move those folks off of the border more quickly.
  With these folks, they have made--many of them have made long and 
terrible journeys to get to where they are.
  There is some good news, and I want to share this with you now. We 
just had a meeting today that the ranking member on the committee was 
there with the Acting Director of Homeland Security; and daily arrivals 
are now down 64 percent. Attainee numbers are way down, from 20,000 in 
custody at the border, to an average of 3,500 to 4,500 per day. And the 
best news, I think, are unaccompanied children have been reduced from 
over 2,700 to fewer than 150.
  So there have been great improvements, which will actually improve 
the health outcomes when you have time enough to go through and screen 
those folks.
  Can you imagine in a facility that is set for 1,000 people, and you 
have 1,500 or 1,800 people, you have nowhere to send them, and a flu 
epidemic breaks out? It is a very difficult thing to deal with.
  So the folks at Customs and Border Patrol I think were doing a 
yeoman's job based on the situation they were put in.
  The problem we face isn't the lack of adequate care or screening. It 
is due to the previously lax enforcement of our immigration laws, and 
our Border Patrol agents just really being overrun with people 
illegally crossing the border.
  Really, without adding new and impossible-to-meet guidelines for our 
Border Patrol agents, we should look for other ways to intervene with 
illegal crossings, and I have mentioned that.
  These people are often, as I said, escaping unimaginable problems in 
their home country. But once they reach our border, the CBP is doing 
the absolute best they can to help them.
  Now, the bill would accomplish very little but overburdening our 
already-taxed DHS staff with their limited resources. This bill would 
require the DHS to purchase and implement an electronic health record 
within 30 days in order to coordinate care for illegal border crossers.
  Mr. Speaker, I think I may be one of the only people in the U.S. 
Congress that has actually implemented an electronic health record in 
my own practice. It took us a year to do it in our medical practice, to 
put 80,000 charts in.
  Can you imagine putting over a million? And the U.S. military, the 
Department of Defense, right now is spending about $5-plus-billion for 
a million and a half soldiers.
  The Veterans' Affairs Committee, which I am very aware of, and I will 
be going to Seattle, Washington, Madigan Army Medical Center on Sunday 
night and Monday of next week to evaluate their system. We are spending 
$16 billion to implement this.

  Let me say this: The DOD and VA spent a billion dollars trying to 
implement a system where the electronic health record at DOD and VA 
could talk to each other, and they failed. So it is a very difficult, 
complex situation to put an electronic health record in.
  I think it is a noble goal, and it should be looked at. But it is 
just something not doable in 30 days. I absolutely guarantee you it 
will fail. These are labor-intensive, and many of them fail.
  I know, as I was saying a little bit ago, that the Department of 
Defense and VA are currently implementing this program which will--the 
total cost of that will be $25 billion.
  And this legislation gives DHS a colossal, unfunded mandate and it 
has no expertise or capacity to handle this, and would consume all of 
the supplemental that we have sent them.
  Further, implementing a new health record at a hospital takes a year 
or more, not 30 days. So it is absolute folly to think that DHS could 
do this, contract it, figure it out, train the people at all these 
ports of entry, and do that in 30 days. It can't be done.
  The Coast Guard, a DHS component, had a disastrous experience trying 
to implement an EHR in about 40 clinics between 2010 and 2015, and they 
spent $67 million and gave up.
  So if we can't deliver a modern healthcare record system to our men 
and women who put their lives on the line without spending billions of 
dollars and the better part of a decade,

[[Page H8036]]

why would we rush to develop one that is doomed to failure for people 
who are knowingly breaking our laws?
  Until the VA and DOD have secured a fully interoperable record for 
our servicemembers, we should not divert scarce resources and time 
creating one for illegal immigrants.
  I do want to say that I am willing to work with the other side in any 
way, in all ways, to improve the health care of the people who come 
here. We are Americans. That is what we do, and we are the best in the 
world at it.
  So if you want to sit down and work out an issue and a problem with 
me, I am more than happy to do that.

                              {time}  1545

  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 3 minutes to the 
gentlewoman from Texas (Ms. Jackson Lee).
  (Ms. JACKSON LEE asked and was given permission to revise and extend 
her remarks.)
  Ms. JACKSON LEE. Mr. Speaker, thank you very much for the leadership 
of the chairman, and I appreciate the ranking member on the floor.
  I have had the privilege of traveling with Congresswoman Underwood to 
the border in some very challenging circumstances, and I appreciated, 
as a nurse, as a trained nurse, as she is a trained nurse, I 
appreciated the astuteness with which she viewed this matter.
  Let me say to my good friend, the doctor, we are always looking 
forward to trying to work with our colleagues on the basic humanity of 
every person, recognizing that this is not about healthcare for 
undocumented immigrants. It is about individuals who are in the custody 
of the United States.
  Just picture for a moment, having gone to the border now for almost 
two decades as a resident of Texas, just imagine that there are moments 
when there is an influx of individuals fleeing for their lives. It 
happened under President Obama's administration in 2014, and we managed 
it. There was no hysteria. There were facilities that were built. There 
was medical care that we were able to access.
  In this instance, it did not happen. And the glaring reality of 
children who died and those who were working hard, the law enforcement 
personnel, I saw them trying to do as much as they could, but without a 
structure, we lost lives. So the importance of this legislation is 
particularly one that I think is important.
  Picture for a moment, when we were in the midst of the crisis, Coast 
Guard medical personnel, doctors with a table, some medicine on the 
corner, their medical paraphernalia out in the open where files were, 
no place to deal with the medical needs of anyone. That is not 
American.
  We are not asking to provide healthcare. This is not Medicare or 
Medicaid. It is a basic dignity of protecting the American people by 
ensuring that these people are treated for whatever might be necessary.
  So the e-record process is powerful because it allows the accessing 
of medical care by having a record system and also by having that 
system being accessed by all DHS components operating on the border. It 
is just a simple case of protecting those of us in the United States, 
protecting those who are in our custody.
  Why not? Why not be proactive and positive for dealing with fellow 
human beings?
  Let's get away from this undocumented and realize this is a land of 
laws and immigrants. We all, collectively, together, want to abide by 
that.
  But we also realize that, when 9-month-old Roger is in my hands, and 
he crossed the border in the arms of his sister, that 9-month-old 
Roger, even though I saw him in one of the HHS centers, probably needed 
care.
  Or the woman who had given birth 45 days earlier and holding in her 
hands a 45-day-old baby who had not seen a doctor, she had not been to 
the hospital. This might help give aid to those individuals.
  So let me be very clear: This is an important initiative. It is an 
initiative that I think most Americans will support.
  I rise to support the gentlewoman's legislation and thank her for her 
courage and astuteness in bringing this to our attention.
  Mr. THOMPSON of Mississippi. Mr. Speaker, how much time do I have 
remaining?
  The SPEAKER pro tempore. The gentleman has 13 minutes remaining.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 4 minutes to the 
gentlewoman from California (Ms. Barragan).
  Ms. BARRAGAN. Mr. Speaker, I rise today in support of H.R. 3525, the 
U.S. Border Patrol Medical Screening Standards Act.
  Mr. Speaker, I have been to the southern border a number of times. I 
have seen the cold concrete holding cell where Felipe Gomez Alonzo, an 
8-year-old boy, spent his last days. He was apprehended on December 18, 
2018, and did not receive proper medical testing, screenings, and care.
  Six days later, on Christmas Eve, while Americans were celebrating 
family and a holiday, Felipe would go on to suffer from a 103-degree 
fever. Felipe would also start vomiting and become weak, then die while 
in custody of the U.S. Government.
  I wish I could say that he was the last child that died in U.S. 
custody, but he wasn't. In the 17 months since the Trump administration 
implemented their zero-tolerance policy at the southern border, 
inhumanely jailing migrant children and cruelly separating children 
from their parents, six--let me repeat that, six--migrant children have 
tragically fallen ill and died in Federal custody:
  Darlyn Cristabel Cordova-Valle was 10 years old;
  Jakelin Caal Maquin was 7;
  Felipe Gomez Alonzo was 8;
  Juan de Leon Gutierrez was 16;
  Carlos Hernandez Vasquez was 16; and
  Wilmer Josue Ramirez Vasquez was a 2\1/2\-year-old baby.
  The death of these children demonstrates the dangers faced by 
migrants at the hands of the very government they hoped would save 
them. The inadequate medical recordkeeping is dangerous and is a huge 
gap that we must fix.
  How many more kids will have to die before DHS makes effective 
changes in the way they improve medical screenings and track medical 
records? How many?
  Ms. Underwood, a nurse and the author of the bill, has been to the 
southern border with me to see the problem firsthand. It is her medical 
training and background that led to this bill so that we could research 
ways to improve medical screenings and improve the tracking of medical 
records, something that is not happening right now.

  Mr. Speaker, this body and this Nation has a moral obligation to make 
sure that no more children needlessly die in detention at our southern 
border and, in doing so, to perhaps bring some measure of meaning to 
the tragic deaths of those six children.
  I urge my colleagues to support H.R. 3525.
  Mr. ROGERS of Alabama. Mr. Speaker, I note several Members across the 
aisle have talked about the need to improve our health screenings. This 
bill does nothing to deal with that. It is about requiring the 
installation of electronic medical records.
  I reserve the balance of my time.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield 2 minutes to the 
gentlewoman from New Jersey (Mrs. Watson Coleman).
  Mrs. WATSON COLEMAN. Mr. Speaker, I want to thank the chairman for 
yielding, and I want to thank my colleague, Ms. Underwood, for her work 
on this very important issue.
  For nearly a year now, we have watched with growing horror and 
outrage as the cruel and inhumane combination of xenophobia, malicious 
policy from the White House, and indifference to people in need has 
built into a crisis at our southern border.
  We have let this come to a point where children have died, children 
fleeing violence and persecution and horrors in their home countries 
seeking to come here, the land of opportunity and promise, children we 
separated from their parents and loved ones, children that we failed 
entirely here on our soil and in our custody.
  We cannot allow that to continue, and this measure that we are taking 
up today will take important steps to address gaps in medical screening 
at the border so that we don't fail any more children. It pushes us to 
find new ways to handle the unique needs of health screening at the 
border, with special emphasis on children and vulnerable groups.

[[Page H8037]]

  Just as importantly, it mandates implementation of an e-record system 
so that we are not letting anyone slip through the cracks.
  An e-record system is not something we have never heard of before. 
What has happened at the border thus far, including the tragic deaths 
of the children, those mentioned by my colleague like Jakelin Caal 
Maquin and Felipe Gomez Alonzo, is proof that we are not doing enough, 
and that is not because we can't.
  I am grateful to Ms. Underwood for stepping up to ensure we do more, 
and I urge all of my colleagues to support this important bill and its 
passage.
  Mr. ROGERS of Alabama. Mr. Speaker, here we have another bill that 
demonstrates just how disingenuous Democrats are about securing our 
borders and fixing our broken immigration system. But in a new twist, 
today's bill shockingly prioritizes illegal immigrants over 
servicemembers and veterans. They are going to send another partisan 
messaging bill to the Senate, where it will promptly die.
  When Democrats are ready to legislate real solutions to the problem 
that this country faces, Republicans stand ready to work with them. In 
the meantime, I urge all Members to oppose this bill.
  Mr. Speaker, I yield back the balance of my time.
  Mr. THOMPSON of Mississippi. Mr. Speaker, I yield myself the balance 
of my time.
  Mr. Speaker, in the last year, six children have died after being in 
CBP custody. This disheartening statistic demands our attention, 
especially when you stop to think that, in the entire decade preceding 
these deaths, not one child died in CBP custody.
  Processes for the treatment of migrants crossing the border clearly 
need to be improved. H.R. 3525 does that by forcing DHS to look at its 
medical screening process and come up with ways to improve it and 
address any performance gaps. It also helps move the Department's 
recordkeeping into the 21st century.
  H.R. 3525 is one step we can take to ensure that the money that DHS 
is already spending on screening and caring for apprehended families 
and children is done wisely.
  And I might add, Mr. Speaker, all of us saw the conditions that 
children were kept in along the border. You can't put children in 
fences. You can't give people inadequate healthcare. You can't do those 
things.
  Most of us in this body are either parents or grandparents or we have 
relatives who are. For us not to care about children is something that 
America should never be proud of. We are a nation of values. Our values 
have to say that children matter.
  Ms. Underwood's bill clearly says that children in the custody of the 
United States Government matter. Not only do they matter, but we have 
to keep up with them; we should not lose them. If they are sick, we 
need to have copies of their records accessible so that our 
professionals who are tasked with the responsibility of taking care of 
them actually know what is going on.
  So I am clear about the bill. If my colleagues on the other side are 
not interested in helping children and solving this problem that we 
have along our borders, then that is too bad. Democrats are prepared to 
work with them if they want to. If not, children do matter.
  Mr. Speaker, I urge my colleagues to support H.R. 3525, and I yield 
back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 577, the previous question is ordered on 
the bill, as amended.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. Pursuant to clause 1(c) of rule XIX, further 
consideration of H.R. 3525 is postponed.

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