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STATEMENT OF

GERALD M. CROSS, MD, FAAFP

PRINCIPAL DEPUTY

UNDER SECRETARY FOR HEALTH

BEFORE THE

SENATE COMMITTEE ON VETERANS’ AFFAIRS

MAY 21, 2008

Good Morning Mr. Chairman and Members of the Committee:

Thank you for inviting me here today to present the Administration’s views on a

number of bills that would affect Department of Veterans Affairs (VA) programs of

benefits and services. With me today are Walter A. Hall, Assistant General

Counsel, and Kathryn Enchelmayer, Director, Quality Standards, Office of Quality

and Performance. I am pleased to provide the Department’s views on 14 of the

17 bills under consideration by the Committee. ...

7. Section 5 would repeal outdated statutory requirements that require VA to

provide a veteran with pre-test counseling and to obtain the veteran’s written

informed consent prior to testing the veteran for HIV infection. Those

requirements are not in line with current guidelines issued by the Centers for

Disease Control and Prevention and other health care organizations, which, with

respect to the issue of consent, consider HIV testing to be similar to other blood

tests for which a patient need only give verbal informed consent. According to

many VA providers, the requirements for pre-test counseling and prior written

consent delay testing for HIV infection and, in turn, VA’s ability to identify positive

cases that would benefit from earlier medical intervention. As a result, many

infected patients unknowingly spread the virus to their partners and are not even

aware of the need to present for treatment until complications of the disease

become clinically evident and, often, acute. Testing for HIV infection in routine

clinical settings no longer merits extra measures that VA is now required by law

to provide. Many providers now consider HIV to be a chronic disease for which

continually improving therapies exist to manage it effectively. Repealing the

1988 statutory requirements would not erode the patient’s rights, as VA would,

just like with tests for all other serious conditions, still be legally required to obtain

the patient’s verbal informed consent prior to testing. VA estimates the

discretionary costs associated with enactment of section 5 to be $73,680,000 for

FY 2009 and $301,401,000 over a 10-year period. ...