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WASHINGTON -- Two of President Biden's nominees for positions within the Department of Health and Human Services (HHS) appeared Tuesday to be headed for easy approvals from the Senate Health, Education, Labor & Pensions (HELP) Committee.

"Given the critical work that both ASPR [the Assistant Secretary for Preparedness and Response] and SAMHSA [the Substance Abuse and Mental Health Services Administration] have ahead, we must make sure each agency has a strong experienced leader," said HELP Committee chairman Patty Murray (D-Wash.) in her opening statement. "Which is why I am looking forward to hearing from today's nominees, both of whom are well qualified for their roles as a member of HHS leadership during the Obama administration."

Murray was referring to Dawn O'Connell, Biden's nominee for ASPR, and Miriam Delphin-Rittmon, the president's nominee for Assistant Secretary for Mental Health and Substance Use. O'Connell is currently serving as HHS Secretary Xavier Becerra's Senior Counselor for COVID-19, while Delphin-Rittmon is Commissioner of the Connecticut State Department of Mental Health and Addiction Services.

Sen. Richard Blumenthal (D-Conn.), who introduced Delphin-Rittmon at the hearing, said, "I almost want to say to President Biden, 'Quit taking some of our best people,' because Commissioner Delphin-Rittmon is one of the most valued and dedicated public servants in the state of Connecticut." Biden's Secretary of Education is former Connecticut Education Commissioner Miguel Cardona.

Question on Hospital Incident

One less positive moment came when Sen. Bill Cassidy, MD (R-La.) asked Delphin-Rittmon about a that occurred at a Whiting Forensic Hospital in Connecticut under her watch.

The abuse "was a tragedy and never should have happened," Delphin-Rittmon responded. "Of course the first step was to ensure the safety and security of the patients there at the hospital. Then I also called in the state police because I wanted an immediate outside investigation. Ultimately, 37 staff were separated from state service, and 10 were tried and convicted related to the abuse," she added.

In addition, "I worked with the state legislature around having a law that if people fail to report abuse neglect, that is a crime. I brought in a consultant and reviewed policies, procedures, and implemented other significant system changes within the hospital," Delphin-Rittmon continued. "Ultimately, my aim is to provide quality care to ensure the safety and security of the individuals that we serve, and to help people move into recovery." Cassidy seemed satisfied with that answer.

Another moment of disagreement came when Sen. Susan Collins (R-Maine) asked O'Connell about diverting $250 million meant to shore up the Strategic National Stockpile to spend on caring for unaccompanied migrant children.

"When the American Rescue Plan was being negotiated, the department became aware of how expensive it was going to be to care for the increasing number of minors at the border in times of COVID," O'Connell said. "COVID required that these minors be separated. So the shelters had to be larger, less full, the minors had to be tested -- there were just significant costs that came along with caring for the unaccompanied minors amid a pandemic ... My understanding, after talking to our budget team, is that it was a zero sum ... and that the stockpile has not been impacted."

Collins begged to differ. "I will say that was not my understanding," she said.

Opioid Concerns

The opioid crisis was a frequent topic among the senators. Sen. Mike Braun (R-Ind.) asked Delphin-Rittmon whether she would be a "voice" for alternative chronic pain treatments as a way to stem the opioid epidemic.

"I'm a full believer in the value of using really all that will work," Delphin-Rittmon said. "There is a vast amount of literature on alternative strategies for managing pain; it doesn't always have to be a pill. For some individuals, meditation, or Reiki or acupuncture can make a difference in terms of pain management."

Braun seemed to like that answer and said that drugmakers should be looking at "ways that they need to invest in pain management that don't [have] so much emphasis on opioids."

Sen Ben Luján (D-N.M.) also asked about the opioid crisis, noting that in his home state, drug overdoses increased by 25% last year, "fueled largely by the increase of the deadly synthetic opioid fentanyl."

Delphin-Rittmon said if she is confirmed, "it will be critical that SAMHSA continue to support states in funding, prevention, treatment, recovery, and harm reduction," adding that states can now use federal funds to purchase fentanyl test strips.

"That is a significant change and will be of real value to states in terms of harm reduction," she said.

Sen. Tammy Baldwin (D-Wis.) expressed concern about shoring up the pharmaceutical supply chain, something that the Biden administration also addressed on Tuesday.

"I think you're right on," said O'Connell. "HHS should be charged with monitoring and maintaining a resilient and secure medical and public health supply chain and the acting ASPR right now has been leading an interagency effort with the supply chain coordinator at the White House part of the COVID response to oversee this work ... If I am confirmed, a lot of the work that I will do will be to take on what the acting ASPR has been doing and to make sure that we have a secure and resilient, public health emergency and medical supply chain," she added.

Fighting Antibiotic Resistance

Sen. Roger Marshall, MD (R-Kansas) asked about the threat of drugs to treat infections involving antibiotic-resistant bacteria. "You don't need these medications very often, but when you do, you really need them," Marshall said. "Most pharmaceutical companies are not developing them because they're not profitable ... and yet we need them." He asked about how the Biomedical Advanced Research and Development Authority (BARDA) could be used to help develop such medications.

O'Connell responded that as deputy chief of staff for President Obama, she "was responsible for implementing President Obama's antimicrobial resistance agenda across the interagency. It was called CARB -- Combating Antibiotic-Resistant Bacteria. And as part of that initiative, BARDA took on something called CARB-X, which was a private public partnership to accelerate the development of antibiotics and to try to get pharmaceutical companies willing to begin looking at new antibiotics ... If I am confirmed as ASPR, that's one of the first things I will do, and I look forward to working with you reporting back on where that progress is," she said.

Sen. Maggie Hassan (D-N.H.) asked Delphin-Rittmon where she stood on eliminating the X-waiver currently required for physicians to administer medication-assisted treatment for substance use disorders, noting that she and Sen. Lisa Murkowski (R-Alaska) have a bill that would eliminate the need for a waiver.

"One of my priorities around expanding access to substance use and mental health services includes expanding access to medication-assisted treatment so I can commit to meeting with you and to work in to expand that access across the country," Delphin-Rittmon said.

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