Copyright 2000 Federal News Service, Inc.
Federal News Service
June 22, 2000, Thursday
SECTION: PREPARED TESTIMONY
LENGTH: 5311 words
HEADLINE:
PREPARED TESTIMONY OF LORRAINE THIEBAUD RN ON BEHALF OF THE SERVICE EMPLOYEES
INTERNATIONAL UNION (SEIU), AFL-CIO
BEFORE THE
HOUSE EDUCATION AND THE WORKFORCE COMMITTEE WORKFORCE
PROTECTIONS SUBCOMMITTEE
SUBJECT - "OSHA'S COMPLIANCE DIRECTIVE
ON BLOODBORNE PATHOGENS AND THE PREVENTION OF NEEDLESTICK
INJURIES"
BODY:
Good morning Chairman
Ballenger and other members of the Workforce Protections Subcommittee. My name
is Lorraine Thieband. I am a registered nurse and an elected union officer for
Local 790 of Service Employees International Union (SEIU) in San Francisco. I
want to thank the Subcommittee for holding this hearing and for the opportunity
to testify before you on the need to protect our nation's caregivers from
needlestick injuries. As one of the most frequent injuries
among health care workers, yet largely preventable,
needlesticks can transmit the HIV virus, Hepatitis B and C, and
other serious infectious diseases. Health care workers are needlessly dying and
I am here to ask for your help in stopping the senseless use of conventional,
obsolete needles.
I am speaking today on behalf of SEIU, the nation's
largest and fastest growing organization representing health care workers.
Included among our 1.4 million members are 710,000 doctors, nurses, Emergency
Medical Technicians, laboratory technicians, orderlies, nurse aides and other
health care workers. SEIU has worked tirelessly over the past decade, along with
public health, medical, hospital, and consumer groups, and other labor
organizations to get life-saving safer needle technology into the hands of our
nation's health care workers who use or are exposed to needles and other sharps
as part of their job. Little Action Since 1992 Safer Needle Congressional
Hearing Many may believe that this is the first Congressional hearing on the
subject of needlestick injuries among health care workers. It
is not. A US House of Representatives hearing on "Healthcare Worker Safety and
Needlestick Injuries," was held on February 7, 1992. At that
hearing, using the pseudonym "Jean Roe", Peggy Ferro, a certified nursing
assistant and a SEIU member, spoke about how she contracted HIV from a
conventional needle. She testified on the need for immediate action to prevent
others from contracting these deadly diseases. On that day in 1992, many
promises were made by many federal agencies: by OSHA, by FDA, and the by CDC.
Few promises have been kept.
Here we are eight years later. In most
hospitals across the country, needles without safety devices continue to be
used. Little has changed, except that Peggy Ferro is no longer with us. She died
on November 4, 1998 from her needlestick injury. She died
waiting for stronger federal action. We are back here today because I know Peggy
would not have wanted us to give up.
Peggy and all of our members want
you to know: Number one: Needlesticks are not a small problem
-- they are happening at epidemic proportions. Number two: the safer technology
exists to prevent most needlestick injuries. In these eight
intervening years, millions more health care workers have suffered preventable
needlesticks. We must not let any more health care workers
needlessly suffer the same tragic fate as Peggy.
Our Fight for Safe
Needles at San Francisco General Hospital As a registered nurse for over
twenty-five years I have lived with these tragedies every day. I began working
at San Francisco General Hospital (SFGH), a public county hospital, in 1974. I
took care of my first AIDS patient in 1981. The young man I cared for looked to
me like a healthy, very attractive and very funny 30-year-old. Three days later
he was dead and I was stunned. In the next several years my hospital became well
known as a center for the research and treatment of AIDS. However, caring for
hospital workers has been a different story.I have been Chief Shop Steward for
the RN Chapter of SFGH since the mid 1980's and have negotiated nine contracts
to improve wages and working conditions. We have also tried to address the
needlestick problem in our contract negotiations. In 1986 a
nurse who we referred to as Jane Doe #1 - and whom we hoped would be Jane Doe
the last - became the first co-worker to become HIV positive as a result of a
job-related needlestick injury. Through the negotiations
process and with the support of our very active and mobilized membership we
fought for and won true confidentiality for people reporting
needlestick injuries through all phases from post exposure
testing to dealing with workers compensation claims. We also won what would
become a model Post Exposure Treatment Plan that offered AZT free to affected
workers. The outcome was much more accurate reporting and data collection and
better treatment for workers after a needlestick occurred. We
felt we did the best we could at the time, but we accomplished little in the way
of preventing needlestick injuries. In the next four years,
four more health care workers were infected by HIV at my hospital while doing
their jobs. Many more were infected with Hepatitis B and C.
My union
local's fight to prevent needlestick injuries began in 1991.
Through a class offered by my union, SEIU, I learned that there were safety
devices on the market that would have easily and cheaply prevented Jane Doe #1
from ever being injured. But these safety devices were not being purchased and
distributed because they were "too expensive". I was unsure how to proceed until
one fateful day a co-worker RN Janet Christensen, who also testified at the 1992
congressional hearing, came to me in a rage. She said that three months before,
while starting an intravenous line, she had turned around in a crowded
preoperative area and accidentally jammed a needle contaminated with both HIV
and Hepatitis into the palm of a medical student next to her. She said she had
been anguished and depressed about the accident but now she was just furious.
She had just learned that there was a safety device in the emergency room that
would have prevented the accident but that Central Supply would not issue her
any because it was too expensive and "anyway, you are not in a high risk area".
She made it very clear she expected her union to "fix this".
Getting our
hospital to switch to a safety catheter took one year. We filed a grievance
under the broad health and safety language of our contract but encountered such
powerful administrative opposition (in the "Best" AIDS Hospital in the country!)
that we were quickly forced to regroup. We went to all the other health care
worker unions in the hospital and for the first time filed a joint union
grievance on behalf of the entire staff. We carried out a petition drive and
collected over four hundred signatures in less than 48 hours demanding safety
needles. We leafleted doorways, made large posters, created a video and
demonstrated in front of the hospital several times. We worked with community
AIDS prevention and care groups and with the press to help the hospital
administration and the larger community understand our just demands for worker
protections from bloodborne diseases.
It took one year to win the system
wide usage of the safety device, the Critikon Safety IV catheter. We also felt
that we had achieved a great victory by forming a Labor/Management
Needlestick Prevention Committee that would be able to
investigate all new safety technology coming into the market and to choose which
other devices might assist us in preventing on-thejob hazards. I was a member of
this first committee for over three years. We quickly oversawthe training and
introduction of the Safety IV catheter as well as a needleless IV system, which
would have saved the life of Jane Doe. We put safety devices on emergency "crash
carts". The committee was able to assist in getting safety devices into four
affiliated hospitals, city clinics and six county jails. Importantly we
developed a core of front line workers well educated on the issues of safety
devices.
However, we were unable to complete the job of switching to the
use of safety devices with all needles and procedures before management's
commitment waned as the hospital faced huge budget cuts during the belt
tightening in the era of "managed care."
Winning the Fight for a
California Needlestick Prevention Law We were jolted by another
wake up call in 1997. Quite casually another RN suggested that I should talk to
a nurse practitioner who had become sick with both AIDS and Hepatitis C as the
result of a needlestick injury while drawing blood. How could
this have happened? Didn't she take AZT after she was stuck? Didn't she have a
safety device? We discovered that the nurse, Ellen Dayton, had been moonlighting
at a city clinic for substance abusers and had not had a simple safety device
that would have prevented an accident. Ellen was stuck by a blood-drawing
butterfly device. After drawing blood from a patient, she was about to dispose
of the used device when the glass blood- collection tubes started to roll off
the counter top. Instinctively, she reached over to catch the glass tubes that
were full of blood. In the process, she sustained a needlestick
from the contaminated needle that she was carrying in her other hand. Ellen
reported her injury and promptly started AZT but the concomitant Hepatitis C
infection meant that her liver could not tolerate any medication. She almost
died in the first few months, but survived with a 60% hearing loss and a poor
prognosis. She would be here today to testify but she remains too weak and ill.
If the needle had been protected by a safety device, Ellen Dayton would not have
been stuck.
In 1997 in a substance abuse clinic in San Francisco,
someone had not provided a health care worker with a safety device! What planet
were we on fifteen years after the recognition of the AIDS epidemic? During
these years we at SFGH had enjoyed some protection from
needlestick injuries, yet most health care workers at other
institutions remained unprotected. How safe could we feel on our little island?
Change jobs and die? We decided that we needed to work for regulations that at
least guaranteed safety devices within our city and hopefully within our state
of California.
We began to look for support to publicize the plight of
Ellen Dayton. We found two excellent reporters at the San Francisco Chronicle,
Ren Holding and Bill Carlson, who in the best traditions of independent
journalism investigated the story and taught us many things about the forces
that prevented safety devices from getting into the hands of health care
workers. They carefully documented the appalling job done by State and Federal
agencies required to protect workers in three front-page stories.
With
these excellent articles we were able to gain the assistance of State
Assemblywoman Carol Migden who introduced legislation mandating safer devices in
California. Working with the SEIU Statewide Nurses Alliance and with the support
of Kaiser Permanente, the nation's largest HMO, lobbying efforts were successful
and former Republican Governor Pete Wilson signed the bill into law in September
1998 and it went into effect on July 1, 1999.In October of 1999 a front-page
article in the San Francisco Chronicle pointed out that a major San Francisco
Bay Area hospital was being cited for failing to comply with the new California
safety needle device law due to a complaint brought by SEIU Local 250. We nurses
and doctors at SFGH were thrilled. To us it was proof that the law would be
enforced.
Health care workers can no longer wait. The technology exists
today to protect us from deadly bloodborne diseases and it should be as much our
right to have these protections already afforded our brothers and sisters in the
mining and construction industries. The new legislation in California has made
the doctors and nurses at SFGH feel like we are playing in a new ball game that
is fair and just. Since the law went into effect we have worked to re-establish
our Needlestick Prevention Committee that we feel we deserve.
We believe the Committee is critical in helping our employer meet the
requirements of the new law. It has the written authority to collect data,
insure worker participation on release time on a co-chaired committee and
written authorization to make decisions about selecting safety devices,
determining safe work practices and implementing all decisions. We are getting
new and better technology into workers' hands and giving them better training.
Since the passage of the law in California, we have begun to see the costs of
safety devices fall in our hospital, making them cheaper and more accessible.
What is happening in California should be happening in other states, but most
other states do not require the protections that California has mandated.
The Costs of 2,000 Needlesticks Each Day Although we
still have a long way to go to introduce safer devices throughout our hospital,
we know we have made important strides toward protecting workers from the horror
of a lifethreatening disease from a needlestick. But for too
many health care workers this is still not the case. The federal government and
others estimate that there are 600,000 to 800,000 needlestick
injuries each year. This means approximately two thousand
needlestick injuries every day.
It is estimated that of
those who are stuck every year, at least 1,000 workers will eventually contract
a serious infection from a needlestick injury. The majority
will become infected with Hepatitis C, a serious and growing problem throughout
the population. According to the Centers for Disease Control and Prevention
(CDC), 4 million Americans today are infected with Hepatitis C. The vast
majority of them are unaware of their infection, but it will lead to illnesses
years from now. In one study of admissions to the emergency room at Johns
Hopkins hospital, 18% of patients were found to be Hepatitis C positive. Where I
work, the figure is as high as 33% of all admissions.
Behind every
statistic and every needlestick injury is a real person. I have
talked to you about Peggy Ferro and Ellen Dayton. Today you have heard from
Karen Daley who suffers from HIV and Hepatitis C as a result of a preventable
needlestick injury. I have also attached for the record the
story of Cecilia K., a registered nurse at SFGH, who sustained a
needlestick injury while carrying a contaminated needle to the
sharps disposal container in the patient's bathroom, also a preventable
needlestick injury.
The physical trauma a worker with
Hepatitis C and HIV must endure is devastating. The vast majority of those
infected with HCV will develop chronic liver infections, which leads
tocirrhosis, one of the most common reasons for a liver transplant, and for some
liver cancer. These diseases will eventually kill these workers.
Even
for those who do not develop infections, there is psychological trauma for the
health care worker and their family. When a worker has a
needlestick, many nurses and other affected workers refer to it
as the "Year of Hell." This is how long they and their families have to wait to
conclusively find out if they have been given a death sentence or another
reprieve from contracting a life threatening disease. For those workers who have
been exposed or axe suspected of being exposed to HIV, they must take a
prophylactic drug regimen immediately following their injury. These drugs are so
harsh that many actually stop the treatment because of the side effects. One
health care worker described it, "it is like having the flu times ten."
What about the costs to the health system? Based on 600,000 to 800,000
needlesticks annually, with the average costs to test for
Hepatitis C and HIV at $500, it is estimated that the health
care system is spending between $300 million to
$400 million dollars each year on testing alone. Treating each
worker potentially exposed to an HIV contaminated needle with prophylactic drugs
costs between $2,200 and $3,800. This does not
include the costs associated with treating workers who need the expensive
post-exposure drugs, nor the costs for treating those who develop one of the
bloodborne diseases such as Hepatitis B or C or HIV. It costs approximately
$20,000-$30,000 annually for drug costs for a
worker with HIV. The American Hospital Association reported that one case of a
serious bloodborne disease can cost up to $1 million or more in
expenditures for testing, follow-up treatment, lost time in wages, and
disability payments.
Safer Devices Saves Lives and Health Care Costs As
we know, safer devices now exist that would eliminate most
needlestick injuries. The US Patent Office has approved over
1,000 patents for safer needle designs, and the FDA has cleared for marketing
over 250 such products with integrated safety features. The FDA has identified
standards for a safe device that include the following: -- There is a fixed
safety feature providing a barrier between the hands and the needle after use
The safety feature allows or requires the worker's hand s to remain behind the
needle at all times The safety feature is an integral part of the device, and
not an accessory; and The safety feature is in effect before disassembly, if
any, and remains in effect after disposal. Safer devices have been developed for
the most widely used needles and sharps, including syringes, IV catheters, safer
blood-drawing devices, lancets, and scalpels.
The essential feature is
that there must be an integrated or built-in safety feature that covers the
needle after use without requiring a health care worker to move their hands from
behind the needle to activate the safety feature with one hand. (Let me show you
how this retractable needle works.)
Do these safer devices work? There
has been numerous studies, some funded by the Centers for Disease Prevention and
Control (CDC), which have shown that current safer device technology can reduce
needlestick injuries by 85%. We will be submitting to the
Committee a collection of articles that describe these numerous studies.The cost
of safer devices varies. For example, self-retracting syringes costs on average
34 cents vs. 7 cents for a conventional syringe: about the cost of a postage
stamp. It has been estimated by one needle manufacturer that to equip a 300-bed
hospital with safer devices would cost today approximately
$70,000 above current costs. It is widely accepted that with
widespread use of these devices, the costs of the safer devices will become
significantly cheaper.
Using safer devices not only saves lives, it
saves costs to the health care system and for employers. A California study done
by Cal OSHA indicated that while health care facilities will initially spend
more for safer needles, the result would be a net savings of
$106 million annually. This includes savings from reduced
testing, medical and drug costs, and lost work time as a result of reduced
needlestick injuries and the related illnesses, as well as
lower workers compensation and liability costs. A study completed last December
by the State of Maryland found similar cost savings.
Despite the
availability of these safer devices, the safer needles and other devices remain
a small proportion of the devices in use. For example, except in California
where the safer device law is in effect, less than 10 percent of syringes used
today are the safer devices. The actual percentage varies by device. How can
manufacturers continue to market and health facilities continue to buy
conventional needle devices where there are safety devices available? There is
no moral justification.
Lack of Federal Leadership Leads to of State
Laws SEIU and other health care unions, such the American Federation of State,
County and Municipal Employees and the American Federation of Teachers, believe
that the only truly effective way to prevent needlestick
injuries nationwide is to pass a law requiring employers to evaluate and use
safer devices. But we and our members recognized that we could not wait for
federal action. SEIU organized to support the passage of the California law.
Around the country, SEIU, along with other organizations, joined forces with
state legislators, both Republicans and Democrats, to introduce state bills.
Today there are fourteen bills, with different requirements, that have been
signed into law.
The reason this state-by-state strategy has been
necessary is due to a continuing lack of leadership and action at the federal
level. Fifty separate state bills means fifty different standards, timelines,
and exemptions. A wide variety of state bills with different requirements makes
it difficult for multi-state health systems to establish system- wide uniformity
and purchasing. It makes it difficult for manufacturers of safer devices and for
manufacturers of older, conventional technology to convert to new, safer
technology. Needlestick injuries are not a state-by-state
problem; they are a national problem that demands a national solution. However,
to be candid, the response by the federal agencies with a responsibility to act
on this issue can only be described as abysmal.
OSHA's Compliance
Directive On November 4, 1999 OSHA issued revisions to their bloodborne
pathogens Compliance Directive. We applaud this action. Clearly, the revised
Compliance Directive has provided much needed guidance to inspectors and has led
to more citations for violations under the currentbloodborne pathogens
regulation. This is definitely a step in the right direction. But the Compliance
Directive is not a substitute for federal legislation requiring the amendment of
the current standard. Let us remember that the: Compliance Directive is not a
regulation; it is a guidance document for inspectors. It is not intended as a
document to instruct employers as to how to comply with the standard. It should
not be how employers learn what their obligations are. There are important
components of effective programs to limit the spread of infectious diseases that
are not in the directive and that need to be included in the standard itself.
For example, the standard should be updated to include necessary record-keeping
requirements that are particular to the needlestick problem. In
addition, the standard must require the involvement of frontline health care
workers in the evaluation and selection of the safer devices. There should be a
meaningful opportunity to participate in a public rulemaking process where all
involved can provide meaningful input to OSHA so that the best new technology
available is reflected in the standard.
It is important to understand
that others have also echoed similar questions and concerns about the need for a
stronger standard to address the needlestick problem. The State
of Maryland's "Health Care Worker Safety Act Study Group," a tripartite group
from industry, government and labor created by a law enacted in Maryland
concluded that the: "OSHA compliance directive, although acknowledging the
importance of engineered sharps injury protection and instructing enforcement of
provisions for the use of engineered devices, may not be adequate in
guaranteeing the sufficient use of engineering sharps injury protection. The
Study Group agreed that a clear, unambiguous revision of the Bloodborne
Pathogens Standard is warranted and is necessary to ensure the widespread
adoption and use of engineered sharps injury protection."
Need for
Federal Legislation In May of last year, the bipartisan Health Care Worker
Needlestick Prevention Act, H.R. 1899, was introduced. Today
there are 180 cosponsors on that bill. The bill enjoys broad support from the
American Public Health Association, Kaiser Permanente, the Consumer Federation
of America and many other groups representing health care workers. H.R. 1899
contains the elements of what we believe are critical in terms of federal
legislation aimed at preventing needlestick injuries. Federal
legislation must: Require the amendment of OSHA's Bloodborne Pathogens Standard
to clearly require employers to use needleless systems and sharps with
engineered sharps injury protections, with provisions for exceptions related to
patient or worker safety and the availability of the appropriate safe device.
Require health care workers to be involved in evaluating and selecting safer
devices at the facilities where they care for patients. Require that a sharps
injury log be maintained by employers on all potentially contaminated
needlestick injuries. Extend the requirement to use safer
devices to the public sector. Federal OSHA jurisdiction only covers private
sector workers except in 22 OSHA State Plan states.
Therefore public
sector employees with on-the-job exposures to needlestick
injuries in a little more than half the states where there is no state OSHA plan
are not covered by OSHA protections. Therefore, under HR 1899, Medicare funded
public hospitals would be required, as a condition of participation, to use
safer devices. This would cover most public sector health care workers. Require
that the Bloodborne Pathogens Standard be amended within a year of passage of
the new law. Health care workers cannot wait for a protracted political and
administrative process to conclude. A national consensus must be reached through
federal legislation that directs and allows OSHA to conduct a streamlined
process.
Let's work together to immediately take action to pass federal
legislation that will make needlestick injuries an occupational
hazard of the past.
Working together, we ended the epidemic of Hepatitis
B among health care workers. Thanks to the Bloodborne Pathogen Standard of 1991
which requires the free availability of the Hepatitis B vaccine, CDC officials
report that Hepatitis B infections among health care workers have declined
nationwide from 17,000 to just 400 -- and worker deaths from Hepatitis B
declined from 250 per year to an undetectable level. SEIU is proud to have
petitioned OSHA for this standard in 1986, which has now proven to have saved
the lives of thousands of healthcare workers.
In every case, epidemics
are solved -- not simply through science -- but through political will. They are
solved by the concerted, joint efforts of concerned workers, responsible
employers, dedicated government officials, and committed elected officials.
When I leave this hearing, it will be my duty to go back and tell the
members of my union what was said here and what was done. I hope I can go back
and tell these workers that the members of this Committee listened carefully and
took the necessary actions to protect them.
Thank you, again, for
allowing me to testify. I would be happy to answer any questions.
*****
Testimony from Cecila K., RN
My name is Cecilia K., and I am a
registered nurse who has worked in direct patient care for the last fifteen
years. In 1987, I incurred the first blood-contaminated
needlestick in my career and became ill shortly thereafter.
Testing confirmed that my illness was the result of the Human Immunodeficiency
Virus infecting my body. Six weeks after my needlestick, I
learned that I was HIV-positive. I was twenty-five years old.
The shock
of learning that I had contracted a likely fatal disease while doing my chosen
work has taken years to digest. My most personal challenges have included
informing my parents and family, relinquishing the dream of beating and
breastfeeding children, and facing the reality that potentially I could transmit
this deadly virus to the person who is dearest to me. Professional challenges
have included facing potential discrimination based on my serostatus, fighting
for a workers compensation process that would safeguard my confidentiality, and
continuing to watch my colleagues work with the profound risk of contracting HIV
and now Hepatitis C in the workplace. Concern over discrimination, either at
present or under future legislative or social climate changes prompts me to
provide this testimony under a pseudonym.
It is the reality of the
ongoing risk to the millions of health care workers in our nation that leads me
to address you. At the time of my accident, my exposure may have been prevented
by a needle safety device, categorized as an "engineering control" in
occupational safety and health conceptual terms. Such a device existed on the
market but was used in very few hospitals. These devices have grown in number
and effectiveness, but institutions have been slow to employ them and
manufacturers have not met strong demand and incentive until recently to improve
safety technology. Even an institution with a developed consciousness about HIV
and Hepatitis C prevalence may be hindered by bureaucratic entrenchment and the
ever-existing concern about costs. One contributing factor to my life-altering
needlestick was the location of the sharps disposal containers
in the patients' bathrooms, away form the point of use. Despite San Francisco
General Hospital's institutional shock and expressed grief over having "one of
their own" become infected on the job, it took three years for the sharps
containers to be relocated to the patient' bedsides where the needles are used.
One may presume this delay was a result of a bureaucracy meaning .no harm, but
it is precisely this bureaucratic drag that can lead to the loss of life. Add to
this factor a resistance to investing in safety or responding to workers'
concerns about the hazards of the workplace, and the results are ever more
deadly.
The cost of needlesticks in the nation is far
greater than the statistical chances of becoming infected with HIV or Hepatitis
C suggest. Each exposure results in a traumatized worker who now faces the
decision to begin anti-viral medications with side effects, at least a six month
wait to learn if an infection has occurred, and the possibility of exposing a
significant other to this infection should a seroconversion be happening.
Regardless of whether an exposure results in a seroconversion, the post-exposure
medication and counseling may amount to as high as two thousand dollars per
exposure. In this time of nursing shortage, this occupational field must be made
as safe as possible or our nation will face a recruitment crisis with profound
ramifications.
You as a Congressperson are in the unique position of
providing life- sparing leadership in strengthening the requirement that health
care employers provide the engineering controls, the safer needle devices, that
could reduce significantly the number of needlesticks and other
bloodborne pathogen exposures that threaten workers lives each second. You would
be following the example of several states, beginning with California where AB
1208 required Cal/OSHA to mandate needleless and safer needle devices in all
health care settings. The effect of this bill, now law, has been to place safer
equipment in the hands of the workers who face exposure to blood daily. Since
the implementation of this law, a shift in cooperation between management and
workers at San Francisco General Hospital toward the mutual goal of meeting the
letter of the law and the ethical mandate to protect workers is palpable.
For myself and my family, I cannot put a dollar amount of the cost of a
momentary, preventable occurrence that will haunt me for the remainder of my
life. As you read this, please remember that I could be your mother, daughter,
sister, partnersomeone close who chose to go into the medical field for hosts of
reasons and who has worked to care for your families and to provide the best
care possible. I am the young nursing graduate, hardworking and hopeful, and the
janitor who has put in a working lifetime of keeping a hospital clean. I am a
surgeon with my hands immersed in blood in an effort to save lives. I am the
staff who wait at our nation's trauma centers to be part of the miracles of
resuscitation and reconstruction. Our millions of lives are at risk each day,
and unless we are protected, you will be part of our needless death and
suffering. Please join us in safeguarding the lives of those who safeguard
others.
June 2000
END
LOAD-DATE: June
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