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Letter - Health Updates


May 9, 2024
Press Release

E&C Republicans Question ASPR over Mismanagement of the Strategic National Stockpile

Washington, D.C. — In a new letter to the Administration for Strategic Preparedness and Response (ASPR), House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA) raise questions about the ASPR’s mismanagement of the Strategic National Stockpile (SNS).  KEY LETTER EXCERPT :  “ The Committee is alarmed by a pattern of fiscal mismanagement and a series of failed acquisitions that have left the SNS dangerously under resourced and likely underprepared to respond to future public health emergencies . Over the last year, ASPR let over $850 million in emergency supplemental funding for the SNS go unused. These funds were eventually rescinded by the Office of Management and Budget (OMB) due to a lack of appropriate planning and urgency by ASPR. This recission occurred despite ASPR regularly expressing concerns to Congress about adequately funding the resupply of the SNS after the COVID-19 pandemic. This Committee responded to ASPR’s concerns by increasing the authorization of SNS funding in its reauthorization of the Pandemic All-Hazards Preparedness Act. Similarly, the Fiscal Year 2024 Labor, Health, and Human Services Appropriation Bill also increased funding for the SNS. As such, the failure to commit funds in a timely and competent manner is particularly frustrating. Moreover, the continued procurement dysfunction at ASPR puts remaining SNS funds, as well as funds for advance research and development, at risk of future recission by OMB .”  BACKGROUND :  Assistant Secretary for Preparedness and Response Dawn O’Connell has made it a primary goal to “restore and maintain the public health emergency capacity that has been severely strained by the pandemic including replenishing the Strategic National Stockpile.”  The SNS plays a critical role in ensuring America is prepared against chemical, biological, radiological, and nuclear threats, as well as pandemics and emerging infectious disease outbreaks.  Despite this apparent prioritization, in 2022, the non-partisan Government Accountability Office (GAO) placed the Department of Health and Human Services (HHS) management of public health emergencies, of which ASPR is a leading sub-agency, on its high-risk list of government programs that “are vulnerable to waste, fraud, abuse, or mismanagement, or in need of transformation.”  In making this determination, the GAO raised concerns about ASPR’s ability to manage the SNS and medical countermeasure contracts.  On May 2, 2024, the GAO published a report outlining ongoing challenges for managing the SNS, noting that public health emergency coordination remains on its “High Risk List.”  The Chairs asked Assistant Secretary for Preparedness and Response Dawn O’Connell for answers to a series of questions related to ASPR’s past and future contracting processes, policies, and decisions to ensure our nation is prepared and ready to respond to health security threats. The Committee requested answers by May 21, 2024.  CLICK HERE to read the full letter.



May 9, 2024
Press Release

E&C Republicans to HHS Secretary: What Law Requires You to Hide Sexual Abusers?

Secretary Becerra’s Extreme Legal Position Prioritizes Protecting Substantiated Abusers Over Victims Washington, D.C. — In a new letter , House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), Representative Mariannette Miller-Meeks (R-IA), and Representative August Pfluger (R-TX) asked Department of Health and Human Services (HHS) Secretary Xavier Becerra to provide the Committee with the legal basis requiring HHS to redact or hide the names of researchers determined to have committed sexual misconduct.  The letter comes following Secretary Becerra’s appearance before the Subcommittee on Health during which he claimed he could not release the names of individuals determined to have committed sexual harassment to Congress because of legal prohibitions. The Members requested that Secretary Becerra provide the Committee with the legal basis for HHS’s decision to redact the names of abusers who have substantiated findings of sexual harassment or abuse by April 30, 2024.  CLICK HERE to read the letter.  BACKGROUND :  The Committee first launched an investigation into the National Institutes of Health’s (NIH) handling of sexual harassment at grantee institutions in August 2021.   In October 2023, the Committee expanded its inquiry to include complaints involving NIH scientists.   After NIH’s failure to comply, Chair Rodgers subpoenaed NIH Director Monica Bertagnolli to produce documents in February of 2024.  Later that month, HHS responded on behalf of NIH to offer a rolling in camera document review to the Committee. Documents presented in the review have been highly redacted, including the redaction of the names of individuals convicted of criminal offenses, public news articles about individuals who have been found guilty of harassment, and redaction of the names of the institutions where the abuse occurred—preventing the Committee from understanding if NIH continues to fund work performed by substantiated abusers at other institutions—a practice known as “pass the harasser.”  FULL TIMELINE :  August 10, 2021 : E&C Republican Leaders Question NIH’s Handling of Sexual Harassment Complaints   August 11, 2022 : E&C Republican Leaders follow up with NIH on Insufficient Response to its Letter on the NIH’s handling of Sexual Harassment   November 30, 2022 : E&C Republicans to NIH: Turn Over Previously Requested Information Ahead of New Congress   March 14, 2023 : E&C Republicans Press NIH for Information on Handling of Sexual Harassment Complaints   October 6, 2023 : E&C Republicans Signal Intent to Issue Subpoenas to Obtain Information on NIH’s Handling of Sexual Harassment if Questions Go Unanswered   January 26, 2024 : Chair Rogers notifies NIH of Imminent Subpoecana   February 5, 2024 : Chair Rodgers Subpoenas NIH for Documents Related to Investigation into Sexual Harassment at NIH and NIH Grantee Institutions  February 20, 2024: HHS Responds on behalf of NIH to offer a rolling in camera document review to the Committee. Documents produced in the review have been highly redacted, including the redaction of the names of individuals convicted of criminal offenses, public news articles about individuals who have been found guilty of harassment, and redaction of the names of the institutions where the abuse occurred—effectively preventing the Committee from understanding if NIH continues to fund work performed by substantiated abusers at other institutions—a practice known as “pass the harasser.”  April 16, 2024 : E&C Republicans Expand Investigation into Sexual Harassment at NIH to now Include Review of HHS Office of Civil Rights Compliance Role  WHISTLEBLOWERS:    The Committee is seeking whistleblowers with knowledge of sexual harassment at the NIH or NIH grantee institutions, as well as those with knowledge of how the NIH handles such complaints.   The right for public employees to communicate with Congress, in their private capacities, is established in the First Amendment of the U.S. Constitution. In addition, various U.S. laws prohibit retaliation against whistleblowers for providing information to Congress. However, individuals still take serious risks when they engage in whistleblowing activity.   To better protect your communications, do not contact the Committee using work resources, work contact information, or while you are working . Further, consider consulting an attorney experienced in representing whistleblowers before you make a disclosure.   Do not submit classified information or other information barred from release through this form or by email. Unauthorized handling of classified information could result in criminal prosecution.   The Committee respects your need to remain confidential and will use your contact information only to follow up with you regarding your submission. You may submit a disclosure anonymously. However, please be aware that anonymous disclosures may limit the Committee’s ability to respond to the information that you provide.   Individuals with information about harassment at the NIH may contact the Committee via email at:   ReportNIHAbuse@mail.house.gov    Individuals with information about harassment at institutions that receive NIH grants may contact the Committee via email at:   ReportNIHGranteeAbuse@mail.house.gov    Additional resources can be found HERE . 



Apr 30, 2024
Press Release

E&C Republicans Press NIH to Confirm Agency Isn’t Funding Russian Research

Washington, D.C. — House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Subcommittee Republicans, wrote to National Institutes of Health (NIH) Director Monica Bertagnolli. In the letter, the Chairs ask the NIH to confirm by May 14, 2024, whether the agency has complied with White House guidance to stop funding projects led by researchers and entities in Russia.  BACKGROUND :  On June 11, 2022, the White House Office of Science and Technology Policy (OSTP) issued guidance stating such projects and programs that commenced and/or were funded prior to Russia’s further invasion of Ukraine in February 2022 may be concluded, but new projects in affected subject areas will not be initiated.   The OSTP advised applicable departments and agencies to curtail interaction with the leadership of Russian government-affiliated universities and research institutions, as well as those who have publicly expressed support for the invasion of Ukraine.  In a statement in an April 9, 2023, article in The Washington Times , the NIH’s Office of Extramural Research claimed that “NIH currently does not fund any research in Russia.”  However, the Data Abyss tracker for the OSTP Russia guidance on federal funding agencies indicates that, as of April 5, 2024, the NIH has potentially 240 instances of problematic research collaborations since June 2022 that do not comply with the guidance. CLICK HERE to read the letter.



Apr 17, 2024
Press Release

E&C Republicans Expand Investigation into Sexual Harassment at NIH to now Include Review of HHS Office of Civil Rights Compliance Role

Washington, D.C. — House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Subcommittee Republicans, wrote to Department of Health and Human Services (HHS) Secretary Xavier Becerra.  The letter outlines concerns with the role HHS Office of Civil Rights (OCR) plays—or fails to play—in investigating instances of sexual harassment that occurs at research institutions which receive grants from the National Institutes of Health (NIH).  KEY EXCERPTS :  “There have been several public reports of sexual harassment occurring on NIH-funded research or NIH-supported activities over the last decade, and it raises concerns about what, if any, actions the NIH has taken to resolve these issues. The NIH’s own statistics show a significant problem with more than 300 cases related to sexual or gender harassment since 2018—with about a third of those allegations being substantiated. This also represents hundreds of men and women who may be forced to operate in a hostile or unsafe research environment.”  [...]  “According to the HHS website, OCR does investigate and resolve complaints of sexual harassment in the education and health programs of recipients of grants or other federal financial assistance from HHS—including the NIH. Moreover, HHS OCR is required to conduct periodic compliance reviews of institutional Title IX programs to ensure compliance with the law—including examining the way in which complaints are handled by the institution.”  The Chairs have requested answers to questions about HHS OCR’s role by April 30, 2024.  BACKGROUND :  Based on a recommendation from the U.S. Government Accountability Office (GAO), HHS OCR and the NIH adopted a memorandum of understanding (MOU) to facilitate communication between the two components of HHS as it relates to sexual harassment.   This MOU was intended to clarify procedures on how the enforcement arm of HHS and the grant-making arm share valuable information with one another in an effort to respond appropriately to complaints of sexual harassment and prevent federal grant money from going to those with a history of sexual misconduct.   TIMELINE OF INVESTIGATION :  August 10, 2021 : E&C Republican Leaders Question NIH’s Handling of Sexual Harassment Complaints  August 11, 2022 : E&C Republican Leaders follow up with NIH on Insufficient Response to its Letter on the NIH’s handling of Sexual Harassment  November 30, 2022 : E&C Republicans to NIH: Turn Over Previously Requested Information Ahead of New Congress  March 14, 2023 : E&C Republicans Press NIH for Information on Handling of Sexual Harassment Complaints  October 6, 2023 : E&C Republicans Signal Intent to Issue Subpoenas to Obtain Information on NIH’s Handling of Sexual Harassment if Questions Go Unanswered  January 26, 2024 : Chair Rogers notifies NIH of Imminent Subpoena  February 5, 2024 : Chair Rodgers Subpoenas NIH for Documents Related to Investigation into Sexual Harassment at NIH and NIH Grantee Institutions February 20, 2024: HHS Responds on behalf of NIH to offer a rolling in camera document review to the Committee. Documents produced in the review have been highly redacted, including the redaction of the names of individuals convicted of criminal offenses, public news articles about individuals who have been found guilty of harassment, and redaction of the names of the institutions where the abuse occurred—effectively preventing the Committee from understanding if NIH continues to fund work performed by substantiated abusers at other institutions—a practice known as “pass the harasser.”



Apr 15, 2024
Press Release

Bipartisan E&C Committee Leaders Seek Answers from UnitedHealth Group on Change Healthcare Cyberattack

Washington D.C. — House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Ranking Member Frank Pallone, Jr., (D-NJ), Subcommittee on Health Chair Brett Guthrie (R-KY) and Ranking Member Anna G. Eshoo (D-CA), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA) and Ranking Member Kathy Castor (D-FL) wrote to UnitedHealth Group, Inc., CEO Andrew Witty today seeking information about the cyberattack on Change Healthcare. Change Healthcare, which was acquired by UnitedHealth Group’s Optum subsidiary in 2022, is one of the nation’s largest providers of health care payment management systems. On February 21, UnitedHealth Group reported it had experienced a cyberattack on its platforms, and it had taken all Change Healthcare systems offline to contain the incident. As a result of the outage, critical services affecting patient care—including billing services, claims transmittals, and eligibility verifications—became inoperable. Though UnitedHealth first notified users that it expected the disruption to “last at least through the day,” several of the company’s products have now been inoperable for more than a month. “Change Healthcare is a central player in the country’s health care system, which has been upended by the recent breach,” t he bipartisan Committee leaders wrote to Mr. Witty. “We are interested in your efforts to secure Change Healthcare’s systems since it was acquired by your company and the efforts you are taking to restore system functionality and support patients and providers affected by the attack.” Change Healthcare’s platforms touch an estimated one in three U.S. patient records. Its systems process roughly 15 billion transactions annually, and are linked to approximately 900,000 physicians, 118,000 dentists, 33,000 pharmacies, and 5,500 hospitals nationwide. The breadth of Change Healthcare’s infrastructure all but ensures that the scope of the current disruption, and any disruption in Change Healthcare services, will be extensive. “The health care system is rapidly consolidating at virtually every level, creating fewer redundancies and more vulnerability to the entire system if an entity with significant market share at any level of the system is compromised,” the Committee leaders wrote. “In order to understand better the steps UnitedHealth has taken to address this situation, we request information about the impact of the cyberattack, the actions the company is taking to secure its systems, and the outreach to the health care community in the aftermath.” As a result of the system outage, providers reportedly struggled to make payroll while some patients have been forced to pay out of pocket for crucial medications including cancer therapy drugs and insulin because pharmacies are unable to verify coverage. The Committee leaders requested answers to a series of detailed questions by April 29, 2024. CLICK HERE to read the full letter. 



Apr 4, 2024
Press Release

EcoHealth Alliance President Peter Daszak to Appear for Public Hearing

Washington, D.C. — House Energy and Commerce Committee (E&C) Chair Cathy McMorris Rodgers (R-WA), E&C Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), and E&C Subcommittee on Health Chair Brett Guthrie (R-KY), Select Subcommittee on the Coronavirus Pandemic Chair Brad Wenstrup (R-OH), and House Oversight and Accountability Committee Chair James Comer (R-KY) announced that EcoHealth Alliance (EcoHealth) President Dr. Peter Daszak will appear for a public hearing on May 1, 2024. EcoHealth—a U.S.-based non-profit whose mission is to prevent pandemics—used taxpayer dollars to fund dangerous gain-of-function research at the Wuhan Institute of Virology (WIV). During his closed-door transcribed interview with the Committees on November 14, 2023, Dr. Daszak made multiple statements inconsistent with documents and evidence reviewed by the Committees. This raises serious questions about the veracity of EcoHealth’s public statements, including its insistence that the research it funded at the WIV could not have caused the pandemic. The Chairs are calling on Dr. Daszak to address the discrepancies in his testimony and publicly explain EcoHealth’s relationship with the WIV. “These revelations undermine your credibility as well as every factual assertion you made during your transcribed interview. The Committees have a right and an obligation to protect the integrity of their investigations, including the accuracy of testimony during a transcribed interview. We invite you to correct the record,” wrote the Chairs. In preparation for the public hearing next month, the Chairs are also requesting further information from Dr. Daszak about EcoHealth’s communication with the WIV, public health agencies, and prominent individuals involved in the suppression of the lab-leak hypothesis. BACKGROUND: Dr. Daszak told the Committees that EcoHealth intended to conduct dangerous gain-of-function research on bat coronaviruses at a University of North Carolina lab if its proposal—known widely as DEFUSE—was approved by the Defense Advanced Research Projects Agency (DARPA). A recently released Freedom of Information Act document production directly contradicts this statement and suggests that EcoHealth intended to mislead DARPA and conduct the risky research at the WIV instead. Dr. Daszak’s statements require correction and clarification as these documents suggest that EcoHealth intended to conduct research at laboratories with weaker biosafety measures set by the Chinese government instead of at laboratories with higher biosafety standards required by the United States.  Scientific evidence and available intelligence indicate that a research-related incident at a lab in Wuhan remains a plausible cause of the COVID-19 pandemic. EcoHealth’s negligent, haphazard approach to biosafety and grant compliance, coupled with the misleading statements by Dr. Daszak to the Committees, raises serious concerns that must be further addressed at the hearing. CLICK HERE to read the Committees letter to Dr. Daszak.



Apr 2, 2024
Press Release

E&C Republicans Ask Government Watchdog to Study Threat of China Exploiting NIH Research for Military Advantage and Unethical Use

Washington, D.C. — In a new letter, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), on behalf of the Health and Oversight Republicans, wrote to Government Accountability Office Comptroller General Gene Dodaro. KEY QUOTE :  “We write to request that the Government Accountability Office (GAO) examine the extent to which the National Institutes of Health (NIH) adequately safeguards research funds from national security concerns related to the Chinese military or over the unethical use of human beings in research studies, especially from entities of concern in China.”   The Chairs have particular concerns about NIH funding that is tied to:  Researchers with affiliations with the “Seven Sons of National Defense,” a group of seven universities with historical ties with China’s military defense industry.  Questionable Chinese research entities, including BGI—a firm based in Shenzhen picked by the Chinese government to build and operate the China National GeneBank.  The unethical use of Chinese ethnic minority data in research studies, including that from Tibetan or Uyghur populations.  BACKGROUND :  Recent reports have raised concerns about the NIH’s ability to screen for national security issues.   A six-month investigation by Vanity Fair found that for a decade, warnings were issued by the Department of Energy to the NIH concerning the risk that U.S.-funded biology research could be misused by overseas partners.   Recent reports from the U.S. Department of Health and Human Services Office of the Inspector General and GAO have noted NIH safeguarding problems regarding foreign grant recipients.   Recently, a student from China who was headed to the National Cancer Institute was repatriated at Dulles Airport after interrogation from Department of Homeland Security officials about ties to the Chinese government, Chinese military, or state laboratories.  Concerns about the NIH’s ability to vet foreign collaborators have also arisen from the Committee’s investigation of the origins of the COVID-19 pandemic.  CLICK HERE to read the full letter.



Mar 27, 2024
Press Release

After Uncovering Earliest-Known SARS-CoV-2 Sequence, E&C Republicans Press NIH for Possible Additional GenBank COVID Submissions

Washington, D.C. — This past January, House Energy and Commerce Committee Republicans revealed the earliest known SARS-CoV-2 sequence released outside of China, calling in to question China’s transparency . In a new letter , Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA) have requested National Institutes of Health (NIH) Director Monica Bertagnolli provide the files of all SARS-CoV-2 submissions to GenBank prior to January 10, 2020. Any such data would better inform the Committee’s ongoing investigation into the origins of COVID-19. KEY LETTER EXCERPT :  “We were dismayed to learn that the NIH had received eight pages of genetic code and a nearly complete version of the genetic sequence for SARS-CoV-2, almost two weeks before the sequence was made public. However, the NIH apparently had no situational awareness in early January 2020 about this genetic code while high-level officials in our government were attempting to get the sequence, including directly from the Chinese government.  “The circumstances suggest the possibility that there may be other early versions of the SARS CoV-2 sequence that were submitted to the National Center for Biotechnology Information (NCBI’s) Genbank but were not posted. Since such potential submissions could provide clues about the timing of the pandemic and how SARS CoV-2 was evolving at the beginning of the pandemic, there is a strong public interest to conduct further due diligence to check GenBank for such submissions.”  BACKGROUND :  January 17, 2024 : E&C Investigation Uncovers Earliest Known SARS-CoV-2 Sequence Released Outside of China  September 28, 2023 : E&C Republicans Signal Intent to Issue Subpoenas as Biden Admin Stonewalls Crucial Investigations into Government Health Agency Actions  August 9, 2023 : E&C Presses Unresponsive NIH for Answers about COVID Origins and Risky Research Projects  May 3, 2023 : E&C Republicans Seek Data and Documents from NIH on Early COVID Cases



Mar 21, 2024
Press Release

E&C Launches Bipartisan Oversight Inquiry into Organ Transplant Contractor and Implementation of Bipartisan Reforms

Committee seeks to save lives and ensure proper implementation of new bipartisan law Washington, D.C. — Bipartisan leaders of the Energy and Commerce Committee launched an investigation into United Network for Organ Sharing (UNOS), the sole contractor responsible for operating the Organ Procurement and Transplantation Network (OPTN). The Leaders are also seeking information from the Health Resources and Services Administration (HRSA) regarding ongoing reforms. The effort seeks to examine issues with OPTN’s prior operation and ensure proper implementation of the bipartisan Securing the U.S. Procurement and Transplantation Network Act , which was passed unanimously by the Committee and by Congress and signed into law by President Biden on September 22, 2023. The inquiry is led by Chair Cathy McMorris Rodgers (R-WA) and Ranking Member Frank Pallone, Jr. (D-NJ); Subcommittee on Health Chair Brett Guthrie (R-KY) and Ranking Member Anna G. Eshoo (D-CA); and Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA) and Ranking Member Kathy Castor (D-FL). The Committee Leaders wrote to HRSA requesting information on how its OPTN contract solicitation plan will support fair and competitive practices during the contracting process, promote data transparency and patient safety, and ensure system security and operability. KEY LETTER EXCERPT: “ Errors and inefficiencies in OPTN management can have deadly consequences . A HRSA-funded study found that, while Americans die each day waiting for organ transplants, as few as one in five potential donor organs have been recovered. The Committee wants to ensure HRSA’s ability to manage the successful implementation of the OPTN Modernization Initiative to improve accountability and effectiveness of the system that does not currently meet the needs of patients .” The Committee leaders also sent questions to UNOS Chief Executive Officer Maureen McBride regarding UNOS’s system security and operability, issues with patient safety and equity, and conflict-of-interest concerns. KEY LETTER EXCERPT : “A 2021 report, by the United States Digital Service titled 'Lives Are at Stake' found myriad problems with UNOS technology, concluding that ‘[t]he OPTN contractor lacks sufficient technical capabilities to modernize their systems,’ ‘[t]he core systems are fragile,’ and the system uptime is ‘insufficient’ for a life-saving system that depends on consistent operation. “An August 2022 report from the Department of Health and Human Services (HHS) OIG found multiple, basic cybersecurity failures by UNOS. The OIG report noted that UNOS’s policies and procedures for access controls, risk assessment, and system monitoring ‘were either in draft or did not exist.’ Given the highly sensitive nature of the personal patient data UNOS keeps, it is vital that strong and enforceable security measures are required and consistently met under any OPTN management contracts. “ UNOS has been the sole organization managing the OPTN, during which time concerning reports have emerged that the organ donation system has become unsafe , inequitable , self-dealing , and retaliatory . The Committee supports HRSA’s proposed reforms to make the contracting process truly competitive to help ensure patients are served by the best contractors for each function.” BACKGROUND : The OPTN is a unique public-private partnership that links all professionals involved in the U.S. donation and transplantation system.  Since its inception, the OPTN contract has only been awarded to a single contractor—UNOS.  To address concerns with the donation and transplantation system, Congress passed legislation led by Rep. Larry Bucshon (R-IN) and Rep. Robin Kelly (D-IL), which was signed into law in 2023, to modernize OPTN and allow HRSA to run a competitive process to choose the best contractors for different national OPTN functions.  Additionally, HRSA has also announced a Modernization Initiative to improve accountability and effectiveness of the system in order to better meet the needs of patients.  Alarm over ignored patient safety concerns suggests that both HRSA and UNOS systematically downplayed or ignored critical patient safety concerns, risking lives and undermining trust in the national organ transplantation system.