Elders Defends Health Views, Her Finances

Surgeon General-designate Joycelyn Elders, invoking memories of her own impoverished youth, made a stirring plea Friday on behalf of the nation’s children and defended her controversial views on abortion and school-based health and sex-education programs.

She also insisted at the opening of her confirmation hearing that all the questions raised about her financial dealings have been resolved.

The hearings, temporarily delayed by the opposition of one Republican senator, turned out to be tamer than anticipated, serving more as a televised forum for her to remind the nation of its worst health failures.

“I have seen bright young people all over this country in an ocean surrounded by the sharks of alcohol, violence, homicide, suicide, AIDS and teen-age pregnancy--while we argue about values,” she told members of the Senate Labor and Human Resources Committee.

The job of surgeon general has no real public health decision-making authority. But depending on the strength of the individual’s personality and convictions, the position can be used as a bully pulpit with enormous potential for influencing the American public.

Most committee members praised Elders for being “plain-spoken” and forthright and said she reminded them of former Surgeon General C. Everett Koop, who was appointed by former President Ronald Reagan. Koop waged an unrelenting public health campaign for the causes he believed in.

Elders promised the committee that she would do the same, describing some of her own early experiences with the health care system that she said formed the foundation for her commitment.

The oldest of eight children, Elders said she had never seen a physician until her first year of college and that she remembered hearing her mother “scream during difficult child deliveries, without any medical help.” Elders said she also watched helplessly as her 4-year-old brother, who had a ruptured appendix, was taken to a doctor “more than 10 miles away on the back of a mule.”

Elders went on to become a pediatric endocrinologist and was appointed by then-Gov. Bill Clinton to Arkansas’ top health post, which she held for nearly six years before resigning earlier this month.

In that position, she was frequently criticized as favoring abortion rights. Elders said Friday that “I have never been about abortion,” explaining that she preferred to teach young people about sexual responsibility so they can make informed choices and avoid unwanted pregnancy. “The only thing that works 100% is abstinence,” Elders said, but added: “We know that our children are not being abstinent.”

“I would like to make every child born in America a planned, wanted child,” Elders said.

She vowed to work to encourage preventive care as the country’s primary public health measure, which she called “the only way to heal our nation.” The most effective way to ensure the future health of the nation’s children, she said, is to provide health and sex education, beginning in kindergarten.

“Schools are the only institution I know where all the children are,” she said. “The best place we’ve got are the schools.”

She stressed, however, that she believes critical public health decisions, including the functioning of school-based clinics, ultimately rest with the local communities, not with the federal or state governments.

“I do not believe that we can dictate from above what local communities need to do to solve the public health problems we are encountering today,” she said. “We must empower each community to design their own solutions.”

She was asked about her statewide campaign to reduce teen-age pregnancies in Arkansas, where the pregnancy rates actually rose during her tenure as health director. Arkansas has the second-highest rate in the nation.

“I’m not proud of that,” she said.

But she said that it takes years for health education to have an effect, and “we have not had comprehensive health education programs from kindergarten through 12th grade” in the state. Also, she said, not all of the schools in the state have health clinics.

She also cited an example of a school that had a high pregnancy rate until a school-based clinic was established. The school now “has one of the lowest (pregnancy) rates around,” she said, reaffirming her support for sex education and condom distribution in schools.

Committee Chairman Edward M. Kennedy (D-Mass.) pointed out that, as state health chief, Elders “almost doubled the proportion of children receiving timely vaccinations” and “increased by tenfold the number of poor children receiving comprehensive health screenings.”

Elders also said that she believes all outstanding issues regarding her financial matters have been settled.

“As to the Social Security, it has been paid,” she said, referring to her husband’s failure to pay taxes for a nurse hired to care for his ailing mother.

Concerns also have been raised about Elders’ service on the board of the National Bank of Arkansas. In a lawsuit arising from a takeover of the bank, Elders and other former members of the board of directors were accused of negligent management, lending and investment practices.

The suit brought by the bank and its parent company against the former directors sought to recover $1.5 million in losses from bad loans allegedly made in violation of the National Banking Act. The suit was settled but the terms have been sealed under court order.

Elders acknowledged that she had received loans from the bank, but said: “Any loans I received were well below the maximum limit and at the prevailing rate of interest and have all been paid.”

She said that she had violated no laws nor was she cited in subsequent investigations for any criminal behavior for her role as a bank director. She said, however, that she and other directors of the bank all received letters of reprimand from the Office of the Comptroller of the Currency.

Critics have questioned whether she improperly received consulting fees for work at the Department of Health and Human Services while continuing to draw her state salary.

She defended the practice, saying that she had used earned vacation days when she had done the federal work and that she resigned her state post when it became clear she needed to remain here full time.

The hearings were temporarily and abruptly halted after the first half hour by one Republican opponent of Elders, Sen. Don Nickles (R-Okla.,), who is not a member of the committee. He invoked a rarely used parliamentary procedure to stop the hearing while the Senate was in session. But the hearing resumed a few hours later and Elders was able to complete her testimony.

The committee is scheduled to vote on the nomination next Friday.