Public Health, Welfare and Labor Senate and House

Thank you everybody will take your seats we will call the meeting to order. And. Giving comment. Good morning right Sir but shall appear but. The chairs of talked about having meetings because I think information related to the covert nineteen needs to come to this committee first so that the people here that might be voting on things related to that needs to hear all that information so we just want to get as much information as we can today and so that you won't be up to speed on that so let's is my comment thank you miss thank you Representative Ladyman yes my at that same with my comments I mean I think it's really important that this committee add to our work to understand the issues the very best we can and we cannot do that if we eight don't meets and be if we don't have the information presented to us and our ability to ask questions on behalf of our constituents so I appreciate your attendance today members and the people that are presenting today as well I think it's just important that we get as much information and clear information out as as possible because if people don't have clear information then they get frustrated and when they don't have clear information they get frustrated and they throw their hands up in the air and say well I don't know what to believe and I'm just gonna do whatever I want to do and that's not good and and so and trying to accomplish what we're trying to accomplish so I just appreciate and ya coming together and if there's other information that we need to get after this we will be holding probably monthly meetings in addition to the regular monthly meeting where we deal with rules and regulations and those types of things so I would just count on and a couple of meetings per month for the net for the near future alright thank you I with that and without objection. At we will approve the minutes from the last meeting. They're motion. And a second all those in favor say aye in a post right minutes are adopted all right maybe nine all right if you will have of the folks come up and doctor camp Patterson is here and with his whole would just bring as many people up as we can let's just go ahead and start with doctor Patterson. If you wanna bring document up as well yes if I could join me that the correct. Thank you feel the state your names for the record and you may proceed yes good morning my name is sky Kampar son I am the chancellor at the university of Arkansas for medical sciences and the CEO four U. M. as hell and I'm joined here by document. Good morning because seven matter CEO of your best Medical Center. It so good morning I thank you so much senator Irvin Representative Ladyman and members of the committee we appreciate the opportunity to be here and to continue to provide you with information about the U. M. S. and in the state of Arkansas response to to code is nineteen we are deeply grateful to the members of this committee and to the entire general ministration for the seriousness with which you have taken this both public health and economic conundrum that we find ourselves in we have still more work to do to address coping nineteen and to keep the people of Arkansas as safe as possible while we continue to allow our economy to on line from the impact of coping nineteen and we're happy to answer any questions the of the committee members may have particularly related to capacity to our testing the work that we're doing across the state to our projections for the trajectory of Kobe nineteen infection going for them and for how with the healthcare system are leveraging the resources that we get from the state from you to make sure that we are doing everything that we capp three million Arkansans. Great. if you want to just give us a rundown as to how what's happening within you a mass from from your treatment side of covered patience this is what I'm interested in hearing is just tell us how that. You on average how many patients are you treating. House how is how are you dealing with that I am interested in the financial perspective as well and then as I discussed with you I really also want to hear after we talk through this issue about the students and where they're at med students nursing pharmacy all those folks as well yes so I am happy to address those issues so I'll start with how is U. M. S. doing right now when the Kobe nineteen first impacted the state of we quickly mobilized at multiple levels to address cove in nineteen for the patients were coming to our facility here in central Arkansas but also across the state with the the impact that that has had on you I'm assistant several fold. As you know we additionally stopped doing and non time sensitive procedures in an effort to keep our patients and staff save and also to provide capacity for in code nineteen patients that that we may need to hospitalize we did that very quickly we also created additional capacity within our hospital in the event that the number of cases grew in the way that it has grown in and other communities like new law in centroid in and ask in Shreveport is the been hit very hard fortunately for us so for in central Arkansas we have not been passed constrained effect we nothing close to capacity constrained by Hoover nineteen impatience now we we've had to reconfigure our health care system dramatically I know many of you people in your on committees of gone through our tried by truck to testing of service we have set up mobile testing across the state to serve communities where testing is insufficient and that's taken resources that used to be in one place and and our facility and moved them to to other areas for facility by the think we've adopted fairly well to that in addition I would say that our our relationships with our partners across the state on has only grown stronger during the course of this and with the outbreak in northwest Arkansas we are in constant communication with the Larry Shackleford can also and and other members of the healthcare community in northwest Arkansas so the U. M. S. resources can be deployed efficiently to make sure that those communities and those health care facilities to not get overwhelmed. the financial impact across the state for healthcare systems is substantial. and I'm happy that the one of the first financial steps that the state truck. In addressing code nineteen was by providing funding to DHS specifically for rural hospitals on a law that money didn't go to you a massive of our rural hospitals infrastructure has a break in it that impacts us all and and so I I think that that was the right first moved to take but it's going to be difficult for healthcare systems which make the largest percentage of their margin on and non time sensitive elective cases to continue to maintain financial viability is wow we are devoting a lot of our resources to health care that you know frankly is necessary critical for the state but it doesn't financial support itself I said put that in perspective at the height of our pull back from nine times since the procedures UAMS was losing approximately million dollars a day and obviously that's not sustainable over the long term is is we have pulled cases back into the hospital that pain is is little bit less but we are far from being back to a a break even state and and I can say with reasonable certainty that every hospital in the state is is pretty much in and in a similar position and the unique impact that that has on you and us is that we are not simply a hospital we are not simply a health care system we are the the majority educator of healthcare professionals within the state over half healthcare professionals and state train at UAMS we are the entity that does the research to help to understand what we can do to address issues like code nineteen in the state and I I think you've seen some of the results of that we all. Are the entity that is going to do antibody testing across the state of Arkansas with support from cares act funding that will enable us to to understand where the viruses been where it has left us with prince and how we can do things like safely open our schools back up in ways that don't injured in danger either students or or our teachers as we do that these will be important questions that we will have to answer come fall and in addition working with data from the T. H. a R. from that the department of health we you know we are the only entity in the state that has the capacity to to state level predictions for the trajectory of code nineteen using data from Arkansas rather than simply assuming that national data applies to people in Arkansas so I hope that that the center of and that I answered some of your questions but document and are happy to drill down further and into these important issues no thank you and I think that's important and there's gonna be a lot of folks I have questions about the projections the testing site sun and all all Pitsch to some other folks that are interested the mobile testing units I mean just think about where those have been I know you know they've been all over the state so that's something else we can talk about but I'm gonna let other folks ask questions and I may come back Representative Ladyman. Thank you madam chair a doctor Patterson you know we were at a meeting last week and you were there presented the thing that mattered was there's will in a sum of this is going to be repaid you'll get same questions you got last week and hopefully that but at the same answers but many of the folks here some of more there in that meeting but many of more not in and as I said earlier. I take this job seriously and if if I'm on this committee and I think these folks are saying why they were responsible for public health labor and welfare and so we we need that knowledge the people on this committee so you will get duplicate questions on that and just a couple things that I definitely want to hear about is the modeling you brought that up last week I want to kind of get into detail on that and then you already talked about some of the challenges that you face but I definitely want to talk about that so alright other folks as their questions and jumping in later but thank you all for being here absolutely thanks for the opportunity to speak to the committee. Representative love. Thank you madam chair and then Doctor Patterson I was actually on the same wave length is is ripping as chairman Ladyman how do you want to hear about the model and and I really want to get into that eight. One of the extensively so that we can really be prepared because to me when you start talking about the the modeling that you all are doing in actually the number of of patients that we may see. And you talk about you know the number that she put out make it made me nervous and I want to make certain that we all know the number that she that we may we could possibly anticipate but are we truly prepared if we were to see that number of patients and so I didn't want to talk talk a little bit about that yes so for the benefit of the committee members who were not at the meeting that the subcommittee meeting last Thursday if A. please the committee I can give a brief summary of what I share with the committee then in them I can give you update on what we have learned over the weekend and and also put that in perspective with some of our capacity issues and and I'm going to start to amend it help me with addressing some of those issues I think all on all of you know that there are national models for that are used to predict the progress of the code nineteen pandemic and am many of those models give state level data. I think the one that has gotten the most attention is the the Seattle model. and those models are using national trends to predict state level data. that's something that is is not on commonly done but those models don't take into account many of the unique features of the state of Arkansas. Now what are these models with these goals are predictions they're very similar to forecast for lamp all of hurricanes and and I think that we're all used to that that when a hurricane is three days for making landfall there are many different models with predictions and they don't all converge on exactly the same place as the hurricane gets closer and closer lamp all those models begin to come Burch and when you see the models all converging on a single city it's time to get out of town right that's very similar to it to the modeling that that we do when we are projecting the course of a pandemic the models may point in different directions because the use different data and assumptions to a project where the where the the future courses but as those models begin to converge is there a you you begin to understand when The the likelihood that they're correct is is increasing. So let's go back to to March and and look at the Seattle model versus the model that we have developed at U. M. us which uses Arkansas level data to make predictions. On both of those models to Seattle model and the U. M. S. model were correct in predicting that we here in the state of Arkansas would not have the immediate dramatic impact of code nineteen that cities like New York Seattle Detroit Shreveport and New Orleans hat both of them were correct in making the print production that we would not have the immediate wave that those metropolitan areas did there was though a difference at that point in time between the Seattle model and the U. M. S. model they predicted we wouldn't have an immediate big spike but the Seattle model predicted that we would have a small bump and that things we get all better and by this time that the the pandemic would have resolved in the state of Arkansas unanimous model did not predict that the U. M. S. model predicted that the growth of covert nineteen patients in the state would continue. Into the fall. This turned out that that is has so far been a correct projection. The Seattle model has since been revised and they are now predicting. similar to what you I miss projected from the beginning. That we will continue in our state to see a growth in cases it at least into the fall. The difference right now. Between the Seattle model and the UAMS model is that the Seattle model is predicting a five to ten fold increase. And the number of code nineteen patients compared to where we are now in September and October and the U. M. S. model is predicting a thirty to fifty five zero fold increase in the number of cases in the state of Arkansas with a projected peek around September thirtieth. So the thirty to fifty fold increase so the two models are now directionally consistent. The difference is the magnitude and is a five to ten or thirty to fifty fold increase compared to what we have now. Now that raises many many questions but the one that you specifically were raised in the something that we're concerned about is the capacity issue. we've worked with eighty H. to to talk about to pass the but a lot of hospital capacity really needs to focus on how healthcare systems that approximates one another work together to share the resources and increase their capacity and just as an example we can focus here in central Arkansas but these principles are being applied across the state so as doctor meta to talk about how we worked with back to sell a CH I sentences Arkansas children's hospital in. One of our important partners surgical hospital the heart hospital to address America past issues. Right thank doctor Patterson. So as a and I'm sorry if you'll just get real close to the Mike you have masks on so it's a little difficult because we have people listening in to resume so if you'll just get real close. They have thank you is this okay better yet thank you thank you. A so as a eight outcropping of the of Frank Scott here Frank Scott's coach nineteenth has forced the the six medical centers six institutions that but passion just mentioned we convene and committed to of being able to increase our capacity of critical care beds in little rock by seven hundred and fifty above what we currently have so that would be a a surge capacity one that could be maintained for several weeks to several months probably not more than that we can talk about some of the reasons behind that but that we would be able to do so and I I think that the mystery that well hello. Perhaps competing organizations can work together two two out provide resources for the state under a common cause sensitive analysis is happening throughout the state indeed there is a common approach of to be educated by the department of health for the distribution of of patients. Need higher levels of care. Depending on where there is capacity to care that the patients so there's a reasonable approach currently in an organized integrated coordinated approach around the state for distribution of patients and and potentially resources as well. given without the person said depending on which model actually comes a parent when you are likely to have adequate number of of beds depending on hello the question is how long for the duration of of the surge an important with the the resources that go along with the hospital beds namely personnel staff physicians nurses respiratory therapists and personal protective equipment of those are more likely to be the limiting factors we can get into some of the details if the committee wishes. So Representative elect to put that into the numbers and the coalition of central Arkansas hospitals has created search plans that within that approximately seven hundred additional inpatient hospital beds if there is a thirty fold increase in the number of covert nineteen patients that would require almost exactly seven hundred additional hospital bills so the numbers are it it the increase is greater than thirty fold we will eventually had a point where is not tremendous we we're going to be hitting the the boundaries of our abilities to to manage these patients. So but but that thirty fold increase. Is that a thirty fold increase for the state or is that a thirty fold increase just send central Arkansas because it is it's a difference and then what was the difference also when we begin to talk about the bids and so how are coming I really want to drive this point home in regards to number one the type of beads that we're talking about and number two the number of beats because if we're time out seven hundred just in the little rock in the little rock area to take your this they Pulaski County in a few of the surrounding counties we have been county in Washington County this out pay simplicity county dramatically in so if they don't have a search and I and I listen to the the plan from from the other teen. But if they don't have a surge plan like this I'm just concerned that once we get to the now September you know August September any we're in we're region are are put our Max potential. In other states across the south to do on the same there's no there's no other. Ventilators to go get there's no other of manpower to go get in I want to make sure that Arkansas is prepared for this and I I'm telling you I don't want to be the next New York City and and you're trying to grab people from here there and everywhere but there's no people want when we talk about August and September. Yes it does represent. And questions that we are constantly addressing I I I do want to start by assuring you that the hospitals in northwest Arkansas and working with legislators and that is people in the community in an obviously the the senior leadership of of the hospitals have their search plan and you're right will you know when we talk about you know thirty fold increase fifty fold increase in the number of covered nineteen patients they are not going to be evenly distributed across the state you're seeing right now that the peace are not going to happen all at the exact same time and it's absolutely critical that we not only have a central Arkansas plan but that we have a plan to share resources and coordinate so right now to the area in the state that that is in Mostar need is northwest Arkansas on us I mention we are we have been for months and continue to be actively engaged with the healthcare community it in northwest Arkansas to figure out what do we need to move resources from here there and we have a plan for that if that's needed to we need to move patients from the northwest Arkansas here where we have more capacity there's a plan in place to do that if that is needed these could these communications are going on all the time that doesn't mean that that we are you know that we have solved for everything and I am as concerned as you are about that issue but I I do want you to be assured that that you know we are thinking ahead you a message order two hundred fifty dollars two hundred fifty additional devilish the state of Arkansas that will be put in north little rock and could be distributed where they're needed you just saw this weekend we had another big shipment of in ninety five mass that came in that we ordered the. Or in the holding facility in in north little rock ready to be distributed to facilities a healthcare facilities across the state and that's working with the governor's office with you to make sure that you know we are skating to where the puck is going to be and and not simply assuming that the the park is staying where it is right now but I can not under I cannot overemphasize the need for all of us to be thinking about what a situation where you god for bid if we don't do anything else is thirty to fifty four greater numbers of cases in the state of Arkansas that we currently have now. I'll come back to you if you have another question we can you can get back in the queue represented Payton. Thank you madam chair doctor Patterson you've said thirty fold several towns and my understanding is we have over two hundred currently in the hospital thirty times two hundred to six thousand not seven hundred so can you explain what you mad about you know how you arrive at the I need of seven hundred if you take thirty times two hundred yes just let me clarify I was simply talking about central Arkansas as an example okay so I wasn't saying the seven hundred additional beds would be sufficient for the entire state each each geographic area has put together is on search planned so I was just giving you an example and if if that created confusion I apologize for the seven hundred that you expect an additional beds is just central Arkansas yes so that's the that's the anticipated bed needs if there's a thirty fold increase in the number of cases on September thirtieth four four central Arkansas but you're right when you do the math we're going to need that's all across the state okay so if I could ask about the all antibody testing I mean we heard we had an antibody test then we here it's not so accurate. What's the projection on do we have a test or when a we're gonna have a good and I body test and how important is it in your modeling that you start to get that data. Yes so I'll I'll speak a little bit to the antibody tests and and I know doctor meadows on can also share some information about this when we say that there is an antibody test we're actually talking about many different us that have been rapidly move to the market and so I think it's important for everyone especially low peoples and especially you to understand that each of these antibody tests is not the same as the is each other they have different sensitivities in being able to detect they have different false positive and false negative rates frankly some of them are good and some of them and not so good. the the governor and the cares act committee have asked you M. us to develop a gold standard antibody test with the state and to provide the capacity to do three thousand to six thousand and a body to us a day for the state the the kids that committee has been Jenner some providing us resources to to make that happen and we have a team in place that is setting up that capacity and those assets now we're doing this for two reasons actually I was so we're doing this for three reasons one is so that you. The state can have a test of the we have believed in okay that is not a test that's manufactured overseas and bought the and may or may not. The we have a gold standard test for the state the second reason to do this is so that we can to a similar prevalence study to understand work nineteen has left its proponents within the state and. Want to over sample in populations that are particularly at high risk after the Americans Latinos Pacific islanders so that we can understand the penetration of corporate nineteen in those populations as we begin to think about doing things like bringing students from different parts of the country to to be educated here as we pulled out opening up Cape two twelve educational system for education so that's the second reason for doing this the third reason it is as I said capacity so that we have the capacity to do enough antibody testing to meet the needs of the state so that we are in the position that we found ourselves and when the clover nineteen pandemic first at the state and we didn't have a knife PCR tests to loop for active infections document I know you you have some thoughts on this as well. A yes vote the. Go ahead god I think maybe just the the our most important point is that the antibody test will be most useful in understanding the the prevalence in their community I it is not that usefull for making a diagnosis of active infection and that's just the the vagaries of antibody testing per se so what will always be depended on the PC are or the genomic testing depicts the look for the the Ronald genome in the in the sample to make the diagnosis of of active infection so it's good to get an idea of how widespread the the disease is hello of concern about. What really detection in the future. Well so I would think that the antibody testing data would be very of have a very significant effect on modeling if you have that data but I'd like to move on to you know a month or more ago we did broad based testing in the prison systems and discovered a lot of a symptomatic people and I think recently we've done broad based testing in northwest Arkansas I heard this morning on the radio that a Tyson facility had ninety five percent positive mostly a symptomatic so. Where we've done this broad based testing and we found a lot of a symptomatic people have you gathered enough data to be able to know what percentage of the population is basically. Not at risk of an hour to the city seventy or eighty or eighty five percent that are a symptomatic and remain that way throughout the course of testing positive the number of asymptomatic patients is definitely large and if there is depending on the patient populations that are being sampled so for instance the number of asymptomatic patients in nursing homes is much lower than a symptomatic individuals who are working in and and poultry farms of do we have enough information information not yet and examples Washington County where the number of positive tests that are being done has remained greater than ten percent I I believe for the past ten days running be there were not sampling enough in Washington County to know exactly what is going on in that community so yeah we still need more testing in order to understand how the could in nineteen this impacting individual communities tobacco followed just to clarify that question I guess I did a poor job. Wrapping it up there. My real question is of those people who yeah we hear that you did a hundred test and ninety of them are asymptomatic. Today of those people that are testing and are a symptomatic do they seem to remain a symptomatic throughout the course of being positive or do they for later fall you know victim to to symptoms. That the one you wanna. Yeah I I take though we don't know the answer that question of it is widely reported that about nationwide about thirty percent of individuals tested with genetic testing or a symptomatic at the time of test of the tests done but it is we don't have enough information to know if you if you went back a week weather or would they be symptomatic how could we not know I mean don't we track come after the test positive. Well that might be a question for the health department because I mean I can just time in here because I mean they are doing contact tracing and I'm not sure if they follow that or collected that data or not I think it's a good idea to do that at to be able to answer your question to see how all the viruses reacting I think is your question you know in which in what populations you know how is the virus reacting in this population verses that population and those that are a symptomatic how long are they staying a symptomatic I can tell you from one person that I know of it was a husband and wife the husband of both tested positive that the husband's. Showed symptoms and struggled with it had a difficult time the wife never bothered her the entire time she was a symptomatic the entire time and and I understand I have a case where I know the lady that was a symptomatic the entire time. But I would think that the health professionals who have been working on this for two or three months how may I don't know why you'd need more than a couple hundred I mean you know we do a survey to see how on elections going turnout we call five hundred people amounts to a you would have plenty of cases in plenty of positive test to to of track the number of a symptomatic at the time the test positive verses whether they remain a symptomatic throughout the course and so Senator is is correct Senate bill Arkansas department help those contact tracing to address questions went on and I know that they have been constrained and and the amount of contact tracing resources that they have which is what they've been harmed distal contact tracers. And and frankly asking a college of public health Boozman college of public health to to assist with that and and that's the mechanism through which you get answers to those types of questions thank you thank you madam chair thank you Representative Ladyman. Thank you madam chair. Get back to the modern little bit and the Representative Payton may have as part of this question but I want to. Really dig down into the modeling and and ask a few questions about data yes and how this was arrived at because modeling is a prediction you have to make assumptions you know and then it just allows along the way so. A doctor you talked about a thirty. fold increase in patients and then you mentioned cases so is this thirty pole caissons or is it patience is the are. Two fifty four increase in the and the number in patients at peak compare to are present run right. Okay so is it so the closeness Miller that but I'm specifically talking about the number of impatience in the state of Arkansas on September thirty which is when the peak is protected. Okay and and I know what this is kind of a deep data question but. So how many he. Cases with that equate to and how did you start AT impatience. I mean did you use the percentage of people that that into the hospital based on the number of positive cases and did you use the number of tests that are being done on the date when that you understand the question a lot of variables here. You start with and how did you get back to the number of folks that are going to be in the hospital. Someone mentioned in your case and we don't want to go there but if you recall you know the government sent a sure there military hospital ship that was never used at thousands of beds. The two. Two hospitals basically and I think they had seven people use those so you know we wanna and AS represent make sure we're prepared. One over prepare so how was what was the process in setting up this model what was the number one data point that you that was looked at yes Sir I you know I agree we don't want to over prepare it two years ago seems like a long time ago remember I came here from New York Presbyterian Hospital the and you're right the the and the ship was brought in was it utilized in I think we we learn about the limitations of trying to pop up a new healthcare facility overnight this is an extremely difficult thing to do because it's not just about capacity of beds the spot having healthcare providers but make no mistake New York Presbyterian Hospital was completely overwhelmed the parents were set up in the cafeteria and services for shut down hospital for special surgery in orthopedic hospital turned into a complete Kerr but nineteen hospital. Press two in a hospital. Nineteen infections that they required from patients that they manage so it's still coming even if you didn't spiral into those facilities your right uh that we are extrapolating from many different sources yes we. Minor bills and nobody is saying that the model is exactly what's going to happen we made things that change the trajectory in one direction number between now and then we may be making some false assumptions so maybe a lot of factors that impact the trajectory of this that we have not taken into account so we're talking about is not if the a snapshot of the future is best ability to predict the future with respect to how we are arriving at the the they capacity that will need we start with projections on the total number of cases we currently have in our state approximately five thousand active cases we service all cases. A symptomatic symptomatic impatient not impatient five thousand active cases in the state we were projecting that on September thirtieth there will be a hundred and fifty thousand is our mean estimate two hundred and fifty thousand is our top testament for the number of active cases that's what I'm getting thirty fold fifty fold increase in the number of cases now I'm not open you know is is you just pointed out not all of them are going to be in the hospital but we know right now the the proportion of active cases that are hospitalized and that's how we extrapolate the bed numbers that we need as we get closer in time. one. In a better position to to revise those numbers but you know I want to point out to the committee. That six weeks ago we your mess predicted that by the end of the month of June we would have fifteen thousand cases in the state of Arkansas and as you know we just cross that threshold so. Pretty close. Okay you the New York example that you brought up and I appreciate that you share that with your experience. But that raises another question We we we all watch that are many of us watch that they really and had rolled out house you see god in. We learn from that and other practices that we can implement here so that we don't have it because if you have the hallways of hospitals in New York. Patients and have you know a a ship there with thousands of bills on you used or a community center unused. What what's the issue what that work better and did we learn from that and can we have good practices yes so you know I I I think you're asking a great question represent Ladyman we have been in contact with the and I just hospitals in and stayed in New York but hospitals and other areas that have been dramatically impacted because it would be a shame on us if we did learn something from their experiences in addition to that you may recall we and Arkansas children's hospital also set up contingents to New York so that we had healthcare professionals nurses respiratory therapists who directly involved in care under combat conditions and we debriefed with them to understand what we need to do to change of models and how we do this better if we get in the if we are impacted in to waive the it's the sprint project we're going to have to change the way that we take care of patients our newest patient ratios will have to change our position patient ratios will have to change we've made plans for that and and and maybe see a doctor Medicaid explodes to you the some of those changes that would need to be implemented to to search to such a level but these are things that we have learned from the expense of the places and that we have them promulgated across the state to other healthcare systems document. If you'll allow me to first comment on that the greatest reservoir of capacity to the the biggest means of flexing to arise to to deliver take care of the patients is to increase our elective surgery are not time sensitive care so you were just as well as most of the hospitals that that the decrease their capacity in request from the governor where the hell department a decrease their inpatient lands by forty to fifty or sixty percent of that we're going to get the capacity to take care of our patients we were talking about Sir surge capacity that is adding nontraditional benefits in excess of what we are OR license FOR A is so it will be able to have the right number that as alluded to. This lesson for us to learn from New York City and other places like Washington is number one increase your inpatient capacity of elective of our care really so that you are prepared for the onslaught of of patients with the nineteen the second is to protect your staff the biggest resource the in New York was personnel physicians nurses respiratory therapists and and tax not hospital beds as a region that there were hospitals that hardly had any Kobe patients and they're also sever over run but on average it was the the staff of that was in the in short supply that we need to prepare for and get back to represent of floods question on when we look at the overall staffing needs when Arkansas hospitals are up and running and we don't have cleared the nineteen. Limitation for the mass another hospitals in little rock and around the state is not having adequate number of nurses or respiratory therapists that ticker patients we need to be planning in that regard. To answer Dr Patterson's question. with changing the staffing models and I see you nice takes care of one patient or maybe to patients because of their house that they are in the. Might have to have that there's to care for five patients physicians would not be taken care of fifteen patients but thirty or forty patients that's the expansion of of of how we deal other resources we take advantage of of of the telehealth means of monitoring at at distances so that we can supplement that the physicians and nurses expand their the reach of that's not optimal care but when you're in a stress situation that's the way to expand the resources that we have. The. One more question. Yes things that was learn in New York well what they did if I remember correctly when the brought the ship and there they they make those rooms co in nineteen rooms which requires extra ventilation work and some of the things and is more expensive and I think Chris barber from seminars talked about this on the other day because they just both on the hospital there Jones will they get extra capacity for future growth the rooms are not being used will they could use the rules for non covert patients much quicker and much less expensively then for COPD patients your work they they made all the rooms on the ship and then these other hospitals. Rooms in later on they made a change they realized we should use the rules for non because. Patients you know emergency surgeries or or NONEMERGENCY surgeries. Because I was a problem with having the equipment to do that may not be available in those other areas but is that work into your plans to work because that's more of a fluctuation were predicting how many covert nineteen patients we're going to have we're not predicting how many other types of patients that come more fluctuation is that thought about in your plan yes. Yes every. So congregating patients with COPD nineteen makes sense from a safety standpoint to protect other patients from of the the page that would be aggregated in in a year that and also to save personal protective equipment that to the caretakers the physicians nurses respiratory office would be using their equipment throughout the day and not have to the exchange of between patients for instance and yes a part of the modeling certainly here in little rock was to advocate of potentially non patients into facilities to carry on usual care. Thank you I'm I'm gonna get a Senator hammer one of the things that we're talking about those when you decrease your capacity and you at by forty percent of an elective surgery an in patient care as a result of elector surgery but that is also the margins sometimes the hospitals have to operate on financially so you could be at one hundred percent capacity of inpatient kind of it patients and be losing massive amounts of money without a doubt and so I know that the healthcare association is here to talk about that particular probably aspects bow Rollin Jody enter here but I want to make sure that we understand the full ramifications of what we're talking about here and so they're gonna come up and and public can address that and at some point we that's the part we have not had that part of the conversation and so we need to and a lot of the reasons why we were not able to be ready to prepared to meet this demand is because hospitals are not operating on margins that allows us to be prepared for something like this when it comes to the massive amounts of PP that are needed the ventilators that are needed the ability and the resources financially to transition from orthopedic wing to an icy you wing that you don't have that in your budget it's not in any hospitals budget and so you know I want to talk about that at some point but I know that the health care association's here and I've asked them specifically to talk about that because that's being left out of the conversation and needs to be part of the conversation especially with us that our policy makers Senator hammer you're recognized thank you ma'am chair how many ventilators do we currently have in the state. About nine hundred. Does not counting anesthesia equipment that could be utilized to as the letters but active ventilators about nine hundred and nine as I mentioned we have two fifty more that are being shipped to to the state of Arkansas okay. In the projections that you're making who is it that you get to verify your methodology other than those that are within your organization. So this is information that has been generated for internal planning purposes and so it's not been submitted for for peer review. Who do you plan on submitting it to to confirm your projections or do you have plans to have another set of eyes look at it and kind of checks and balances. Are we would be happy to have anybody else that you wanted to look at it this is specified is by compare the projections to what actually occurs. Okay And this is maybe going to get onto center ridge point just saying go ahead a written down how can we get a accurate financial how can we get accurate financial data to know the impact including federal reimbursement or other resources that are received to offset the cost of a covert patients expense and know how that goes into the overall financial impact taking in consideration also loss of revenue from elective surgeries being suspended yes we have ongoing conversations with the FAA of about the expenses that UAMS sensing curled about loss of revenue this all publicly available information and we'd be delighted to share that with this committee at any time if you want to send it to Mister price often it out to members of the committee yes right okay and you receive no financial assistance or do you receive a financial assistance. When a covert patient or a patient is identified as a covert patient and the transition to being treated as a covert patient our our our code of nineteen patients are reimbursed instead of mechanisms. And Medicare Medicaid or private insurance okay and with the projections that you're making in this is just more for educational purposes my Senator hammer may I ask you to clarify on that point the normal mechanisms so there's there is to be specific there is no additional code or anything like that it's part of the normal. The RG. The edges so the the. Best analogous to a patient with influenza on because it would fall in a note the respiratory infection E. RG which unfortunately you know doesn't cover the total costs of managing that patient and sauce by procedures neither DH is the more Holly reimbursed at target thank you senator him or just one sure and that's kinda where is going because a I know on one of the eyes peas were look at I think and with the comments made while ago you're not actually receiving any financial assistance from the federal government or anybody else outside of normal channels if that patient is identified as a covert patient that is correct yes Sir okay so educate me at what point does a patient become diagnosed as a coded patient Nono it may sound simplistic but the transition to where you know there may be in the hospital for something else or they admitted directly as being diagnosed as a covert patient at that point kind of. At what point do they become a covert patient. A it is a special in that they have of nineteen through taking a a history and they have and all those consistent with co red and FOR occur would patient and then there's a confirmatory tests if the test is positive than that sealed the diagnosis okay. All right ma'am check a few more vocal barbecue for now thank yeah and I so we needed okay I'm gonna go to just we've got three in the queue four. and then we're going to go to and doctor Delahaye because she needs to leave at noon so if you want to come up Dr Delahaye and get ready that be fine represent of garner. Thank you madam chair. Thank Patterson I'm a waiver here doctor meta thank you guys for being here obviously we've worked together in nineteen you know that I'm working with northwest Arkansas to try to get that coalition working with that the high numbers that we have obviously it's very difficult to plan while you're dealing with a novel virus but I feel like we've got a pretty good plan the problem is we're not taking care of the basics we're not getting testing done in Washington County worst we've gone from fifty four percent of positivity rate to seventeen is the lowest we've had in awhile so so we're way up there with positivity rate and way below what even what Benton county is in Washington that Washington County obviously if at the highest number so and I've I've reached out to the health department what can we do to get more testing and northwest Arkansas especially in Washington County in these places where we have multi generational homes and poultry plants and but language barriers all these kinds of things where we have got to have more testing yes so I completely agree. And the situation now in in terms of testing is quite different than it was six or eight weeks ago when we were limited by the number of test kits the ability to do the testing itself the problem hasn't entirely disappear but is not near as acute as it were us limitations in testing now are I have had more to do with sites for testing to be done and also social barriers that impact our ability to get testing done and we have the experience that book both in and are testing facility here in little rock and as we've done mobile testing of across the state and I'll give you you know wanting one example of that is been very difficult for us to get Latinos to come to be tested especially if there is security presence on site when testing is being done so there are social determinants of testing that we are beginning to understand the you know that we're going to have to address if county like Washington County is going to be adequately tested. So what what is it that we can do to help make that happen. I I think in terms of of the is the social determinants working with Unity of for instance we work very closely with the Mexican consulate and they've been very helpful to us in our marking communities that we have poor access to thank you thank you represent Boyd. Thank you madam chair Dot Patterson I just wanted to to say I had a experience with rotations and the college of pharmacy handled it very well so thank you for that you that give you up public plug for that real quick so I'm it sounds like a big investment is being made in studying antibodies and doing that in the state of Arkansas it's on I just want to understand. What is the value of knowing the prevalence is that really going to help us with the here and now or is that more academic in nature and something we can report on later and then the follow up to that so the I'm done for now is do we now believe if we have antibodies that that confers a level of protection for some period of time yes so all answer the second question first we don't know where the the presence of antibodies components long term protection we hope that it does this point of having a vaccine is that you raise antibodies that provide long term protection and there are diseases in which we know that that's the case measles. Mumps rubella those are our viral illnesses for which antibodies can for long term protection unfortunately there are of viruses that generate antibodies you that the antibodies to not remain. That they do not come from a long term protection the common cold which unit I'm sure all nine hours we get it. And I feel like I get it three or four times a year before you know went into social distancing so you you don't generate antibodies that come from a long term protection and we simply don't know whether the presence of antibodies welcome for that protection but in trial we start testing people we won't be able to answer that question as well Representative Boyd to address your first question in knowing the presence of antibodies in the community health system now. Because it helps us to inform those communities about what they need to be too low to remain protected but it definitely helps is even more in the future as we think about whether it's safe in a particular community with the given prevalence of because of nineteen infectivity to open up a school or to think about having football games questions like that the you know frankly are going to become increasingly acute in our state as the summer went down. Thank you senator Caldwell. Thank you Mr chair I want to get off the statistics in fact I know you of or struggling to get this under control in a but I won't go back to the humanity of the the hospitals and no doctor Smith is leaving not here maybe go back to look at some policies what we're doing of this past Saturday and and when we very to a nineteen year old college freshman had nothing to do with the code the he spent ninety two days in the hospital the first forty days his parents were not allowed to go and see. And the you know that that was real difficult for them. and for the whole community to be honest with you not that we want the whole community going hospital but to have a nineteen year old lan in hospital for forty days with those parents been able to be in that room with him is this is a tragedy to be honest with you. Another example had the four year old in the capital. I'm going in three o'clock morning for mercy surgery and a guardian could not go in the not capable of making legal medical decisions. another example by officer one in for three day visit hospital with surgery she has a debilitating disease and no one there to take care of for. Leader facts because the last two were my family. The I think the well we work on these statistics we need to put the amenity back into patient care. And the I will a suggestion implore you and will ask this question again another meeting what are we doing to improve our patient care and and not that everybody needs to be in the hospital they don't. But to to not allow the parents to go in and and see the children. specially when they've been there long term the and in two of the not be prepared for of. Sixteen would circumstances where. People who were not to mentally emotionally capable of making medical decisions are not allowed to have someone there with him and then have people with debilitating diseases not be able to have someone to care for them A needs to be looked at. Delahaye may also you might from the health department may want to also address that question yes Sir I'll addresses briefly and then all of the Jennifer want to make some comments so first of all center call on on sorry to hear about the health challenges of the with among people that you know and within your family obviously in my heart goes out to to you and to everyone who has on this and and and the setting M. in which you're talking about I I don't think is an example of the Not providing a good health care a I think it's example trying to provide the safest health care that we possibly can under the right circumstances I don't know the specifics of the situation that you were talking about I I do know that our our first job in healthcare is to make sure that we do no harm and and also know that there are always needs to be room for for using specific information about specific circumstances to modify principles and procedures that we have in place so that we we remain compassion and and and and I would state that this was not you a you miss yeah so that and but it again this this directive comes from the task force and health department in that choir it needs to be addressed and and again I'm not trying to open anything up for a community to to go into the hospital see people but if if we can test of you know thousands of people for the code nineteen buyer surely we could test it parent to parent in hospital Jennifer. So I take your name for the record and then go ahead this is a Jennifer Delahaye a state epidemiologist at the Arkansas department of health. So I agree with you and with testing capacity increasing the we should be able to address those problems around the state so that loved ones can visit those two they need to be with either under severe illness or end of life we've been working very closely with the Arkansas healthcare association a believe the report today so that we can understand the prevalence of covered nineteen in nursing homes to begin to open those up for visitation and we should be able to do the same with house bill. Thank you. Add Senator thank you senator garner thank you madam chair so backed your modeling I'm over here doctor to your left yes Sir area backed your model year yours predicting that thirty time followed so that in the in the September you have roughly a hundred fifty to two hundred fifty thousand active cases that correct this with model predictions Sir. Some about that you cents mil right make as we look at others areas where we actually had extensive covert at nineteen outbreaks numbers don't even come close to reaching that amount for example Italy which we know is one the first hot spots in the world at their peak only had two hundred thirty eight thousand confirmed cases not active but confirmed and they've been slowly decreasing ever since that active Pete to have about two hundred active cases as of yesterday New York City which has a population in New York I should say has a population of twenty million has a lower numbers in that if you look across the board it seems that even the states with the worst examples of the outbreak don't get near to that mail of active cases and are now on the down sport of that model that bill curves going down now they could have recurrences they could have Oper of breaks. It seems to me that that model in. Is highly irregular compare to actual real world examples we see over and over again and we know here in Arkansas after the initial modeling not knocking UAMS but some has been from Harvard commencement for others a short Arkansas would have this active peak earlier and we have much higher dramatic numbers. It's very suspicious of such a dramatic increase when real world examples don't seem to use to be quite to that can you just discuss how that. The real examples don't seem to match the modeling that you prepared thank you Sir sure so you know I think you're raising a fundamental issue with the faces anybody who who does modeling and you know as I mentioned earlier I hope that the you know that the modeling overestimates the the number back to cases but we have to make assumptions and then rely on those assumptions two to make the miles we can't say that you know these assumptions that one makes when predicting and the impact of a pandemic and then go over the numbers don't look right so we're just going to ignore them and in again I will go back to the in a hurricane forecasting scenario in which you know different models predict a different impact it would be extraordinarily irresponsible for us to have a model that predicts an impact and then to not share that with with people in in the state of Arkansas and you know just go back to your to the fundamental issue of the smell test. Keep in mind that computer to a month ago. We have four times four fold increase the number of patients on ventilators here in state of Arkansas so more month number Bentley to patients which I would like you is the the the most reliable number that we have this increased four fold. In thirty days so if that increase continues at that same rate then yeah that's where we're headed. Manager Matt Matt yes quick follow up I think that's a good example I think the Arkansas did it dramatically great job initially on how we had a pandemic I think that's what the modeling was initially all most other states did you look at Florida you look taxes we will well below the coastal states that were initially bringing the disease from Asia and from other places it seems like now were in that piece that the other states hit earlier and that's why the numbers are going up the way they or but almost across the board once that peak has been reached there's been a dramatic down turn on that curve so it's it's concerning to me because you made a great point we have to make assumptions based on the data and I don't hold you any accountable or negatively accountable for police and that'll as we come to decisions as lawmakers on how we're going to allocate resources how we're going to do things. We have certain something in my opinion such as out liar it's very hard for us to reach those assumptions and make decisions. With such dramatic numbers it's just it doesn't seem to meet that test the as we start doing is moving for that we can hold it to our a real standard but that's my personal opinion if I'm wrong in two months you'll look like a forecaster in the right way is always there to be overly cautious to not but that's my concern so thank you madam chair plans thank you I just wanna comment though I mean you have bottling and and the epidemiologist you might want to speak to this doctor Delahaye I mean. In Madison and as scientist and looking at influence that I read recall attending an infectious disease conference probably fifteen years ago. And these models were in existence then I mean you we had that we knew that this was going to happen I mean if you would actually admit tended the conferences the infectious disease conferences we knew that this was going to happen it's just we really did nothing about it and my opinion as far as health care but a lot of times it was because we couldn't address that but but there I mean there is you know you can't really predict the way of viruses going to re act or until it's here in its present then we study it but I mean. All the scientist I mean back fifteen twenty years ago this was something that was anticipated I mean you have to have tools at your disposal in order to plan and prepare and mitigates and treats and all those things so I want to make sure that we're understanding how we're usually this modeling and that would I mean just like with the flu we have modeling and we have to live through the model and we have to live through the reality of dealing with a high outbreak of influenza and how we manage that and may fours and go about our normalized to so I you if you want to address that and then I want to give you the opportunity just to talk from the health department to find a you have to leave so I'm gonna go to you and then I'll come back to questions so go ahead doctor delay so you know if you pull that Mike up it's really difficult to hear you with the mask on all right thank you so test Patterson's correcting a modeling give us an idea and it's based on assumptions for the way things are now if they continue the way things are now what Italy and New York City did to bring the trajectory down. Based on the paper I reviewed this weekend is they implemented. Mandatory facemasks and that is what change the trajectory of their epidemic. so that something that we may have to look at. A let me do you want you go ahead All right go ahead and speak Senate to what you're presenting because okay I want to make sure we get in I mean we've got a lot of folks and a lot of questions but go ahead because I wanna make sure we hear from a before total essence been talked about already we have close to five thousand active cases in Arkansas four thousand eight hundred and eighty as of yesterday a hundred and ten of them are in nursing homes that we still have the problem in those facilities six hundred and sixty eight were a correctional facility so the congregate living facilities play a role in this and then four thousand one hundred and two in the community we are seeing in northwest Arkansas an increase in the number of cases but also in southwest Arkansas much of it is related to the Latino population and that makes up about twenty three percent of our cases and also we are seeing a disproportionate disproportionate number and our Pacific islanders are Marshallese the numbers are smaller because the population is smaller but it still of concern to us because of the interaction with the work sites and the community and so if a person. Is infected in a workshop right they come home they can infect their family if they're infected in the community than they can infect the work site so we have to work on that whole situation to address it from many different facets. at this point in time as of yesterday we had two hundred and forty four people in the hospital and sixty two on the Vance and the Arkansas department health works closely with the health care coalitions around the state it's our health preparedness and emergency response ranch and we monetary those work closely so that all as okay The doctor Patterson mentioned you know all of the health care so C. M. coalitions have plans as well as the hospitals within their systems have their search capacity and plans as well and it's really important for us all to work together and stay up to date on those so we have been doing that and and just to follow up on what she's saying if you're not aware there's a healthcare coalition and that's divided in regions and it's based on bad capacity so that is a regional map I think they're seven is that correct errors Arkansas hospital association read yes the Arkansas hospitalization and speak more and they can speak more to that but they're having daily meetings they're very engage they have been since day one yes. So I would like to give a little bit of an update regarding testing course testing capacity is really important that's not the only issue is doctor Patterson mentioned it's getting people to the testing can also be a challenge but we are at a point now where you know we can do well between five and ten thousand tests in Arkansas a day of many of those tests are done by commercial labs the you a mass that has capacity that really plays an important role and then also the health department at the end of may we put online a new Perkins Elmer instrument which gives us the capacity to do about a thousand pass a day and we are to receive today if all goes well a second and the components of what we need for second Perkin Elmer in the machine so that will double the capacity at the health department to do those the kinds of PCR testing that are needed for and rapid diagnosis because what you really need is a test that you can get a quick turnaround so that the person can if they're positive the person can be a informed very quickly so that they can isolate and then the health department then does case investigations as well as contact tracing for those cases and we have Not have the capacity we would like in that area we have a right now about a hundred nurses that do case investigations and about a hundred people who did contact tracing but that's not enough for Arkansas so we've been very fortunate to be able to collaborate with us you a mess A and now other entities that can also help with that capacity so just recently we work we did provided training to other organizations that will help with that they include the central Arkansas library system the U. A L. R. school of social work Blue Cross blue shield the New York institute of technology in Jonesborough and AFMC so they have received training so that they can also come on board the training occurred about a week ago and a sense that training they have come online and as of Sunday they had done six hundred eighty five contact traces since a June sixteenth so and and then sat in a volunteer capacity or financial it is the organizations are volunteering but it's their staff right does that make the bill we are contracting with these different entities to do this they are volunteering that is true okay but the health department we need this and supplement to the capacity at the health department and the current model is not sustainable because the staff must continue on with other public health functions so the committee will hear if they are not aware already that the health department is working to put in place a contract up for a Organization or company to a oversee and manage the contact tracing we released a up request for qualifications on June nineteenth we got twenty eight responses they are being evaluated those evaluations were do last night so tomorrow and Wednesday the top six will be interviewed and then a decision was made and we hope to have this contract in place by July one great so they would oversee the volunteer organizations F. hiring of additional staff themselves and then hopefully we can make that more of a sustainable model and then in addition we're working with the universities around the state to to increase their capacity for their students the when they come back into session will we may have spread in the university so we want the universities if at all possible to do case their own nation and contact tracing because right you're gonna need boats on the grounds and at that a university setting right. So there were some question earlier about of how many people remain eight positive are symptomatic or not it's up or then have symptoms later on. And I can tell you that for people who are quarantine that. About twelve percent of the people will be come symptomatic but that doesn't mean they started out with positive pass but we do track those data and we can look at it as to how many people the are a symptomatic when they're tested but we often times don't capture that data about whether they become symptomatic or not for a case that's the doesn't make a difference in terms of how you manage the case if they're not in the hospital so we don't take that step to collect that data does that make sense. I am among the elect represent Payton responded dozen thank you for addressing that all make sure of got clear so. Of the people quarantine which would be that he had contact and they were traced. Of the people quarantine twelve percent become symptomatic yes and then they would get tested in a large number of those quarantine never test positive at all right right to thank you. Great Let me think I wanted to talk a little bit about northwest Arkansas okay Of as you're aware are Marshallese population and are Latino population not my closer which is very up important in terms of the increased number of cases and we see it and severe county also so of the health department has pulled together a team of Marshallese that include Marshallese speakers and we that team works to build relations with communities that have really good coalition there and other partnerships with you a mass and of the consulate the Marshallese consulate there and so we have been able to. Take a teams to locations where many people live like per apartment buildings to do a large scale testing and we have also been able to provide testing through our local health units there now so we hope that will reduce some of the barriers with regard to the Latino population we're aware that there's a number some a significant amount of transmission within the community because there are many children who are positive in that population and we are looking to see what are the The dynamics where is it being transmitted in the community right now we have a team from the US centers for disease control and prevention working with us with that has this couple Spanish speakers and on the team to help us an epidemiologist to help us analyze the data to have a special focus on the Latino population in Arkansas and and they're hosting focus groups this week so if that will give us some idea about what are the messages that they need to hear what kind of information do they need we know there's a fair amount of misinformation what kind of good information today up would make a difference in terms of their understanding of what they need to do if they test positive about isolation and quarantine and how to prevent the spread so let me ask you a question you know in in my area You don't go to the doctor or the hospital unless you're low sec okay did not know this until we moved to Mountain View that this was a term but it's true there are people that do not believe you go to the hospital or to the doctor unless you are dying like low sick it's what they call it I will you know and I think the problem with corona virus and my opinion is that when you first get the symptoms it's the flu and they're like I don't normally go to a doctor or to the hospital if I get the flu I'm gonna ride it out. And I mean a lot of people and particularly in different populations are different areas of the state even or you know we're hill people and the hills that's just the way they are they're they're just I mean you know one time in my husband's clinic somebody we why he walked into the back room and this man was just bleeding profusely and he was like why did you go to the emergency room his eye doctor I'm not dying in I mean we we almost got his arm off but he won Diane doctor can take care of that right here on the front porch so but I'm wondering I mean there's a lot of folks you know out there that really. Tend to say you know I can ride this out I can do this but that's probably contributing to the spread yes hi so I mean I think you know I don't wanna I don't want to simplify things but I also want us just to be realistic about how the different barriers that may be out there just may be inherent to that different group of people that make sense yes it is true and is not in the cultural or social believe Sir understanding of the situation may be something that would never darken the door of my mind that would be an issue but it might be and that's why we have the team they're doing the in the focus groups with that different members of the communities up so that can help us get that information and and forge partnerships and we also need to make sure people clearly understand that because there's large households there and that they if they need to isolate there is a safe place the health department can provide them a place to stay away from their family and that. If they need food that there's wraparound services that are provided so that they don't have to be out of on their own and fend for themselves and don't have support if that's what they need to do to protect their families in thank you I'm gonna go to questions keep your question you got ten seconds ask your question represent a brown. Thank you madam chair I have two quick question okay go head they will take him long Regarding A when you're planning for this surge of are you planning. A way to accommodate non emergency procedures because a lot of the non emergency procedures were really important procedures and people do need to be able to get their screening test or their injections for their knee pain or their cataract surgery or whatever. Yes so I I I would say that we want to remain open to all businesses much as possible and I will point out that we are in in a very different position today compared to where we were two plus months ago where we didn't have the ability to do testing for people coming in for like to procedures prior to the procedure we didn't have mechanisms in place in which we could segregate those patients from more acute patients we didn't have PP that allowed us to manage those patients in a safe way so I I would say where es before our primary concern with doing elective procedures revolved around safety I think that many of those safety issues have been addressed and we will would certainly be able to to elective procedures in a safe way going forward that we couldn't do previously but the the the the issue where we will have constraints on nine times since the procedures will be capacity if we get to the point where we need those per healthcare professionals to be re purpose for something else we need those areas of our health care facilities to used to manage and willing me number of Copa nineteen pasta patients than that's clearly going to become a constraint on nine time since the procedures and I wouldn't say that the safety issues a total will totally go away but I I don't think that you know we will need to make the same decisions would not need to make the same decisions today that we had to make for the right reasons two months ago thank you very much and I do appreciate all you're doing I meant to say that. this is to respond to a constituent of they were wondering how long after a nursing home is tested and all everybody there is scope with free how long before family and friends can go we in it I told her that I thought that was probably dependent upon the nursing home administration not anything this the state had authority over but could you please respond we actually have racial bunches executive director of the Arkansas health care association who can better respond to your question okay thank you okay thank you Representative Gonzalez. My questions for you AM us and I'll yield anyone has questions for ms delay. Or she has to leave it has questions from us for doctor Delahaye. Okay represent of love. Thank you madam chair a duck to deal Hey I want to talk about contact Friesen in also contact treason and the minority community. Are we are we sure how main house contact tracing within the minority community. So we have our challenges and the minority communities where we have Up language barriers you know we have some Marshallese speakers we need more Spanish speakers and then for the black community and we don't have that same language of Berrier but it's more of a capacity issue and then one of the other issues that we have is Identifying when we have a number of cases that are not connected to each other. But are in the same geographic area so there's likely something going on in the community and that is an area that I would like to spend increase focus on because sometimes those would be in minority communities so it's going on but the different contact tracers might not. Be talking with each other to note that to put together that overall picture so we're working to bring on a additional epidemiologist to help us in that capacity okay I'm I'm just gonna make appointed the content transcend into me because she said that we're having a contract come up that's going to be something that I'm going to really want to hone in on because we don't have success of content trance and the minority community then it is in there that's going to be a. An issue there being an issue so with the contract with the contract this coming online I yes I I one of on want to follow their closely regards to that that be great I'm aware that the New York institute of technology especially wants to focus on contract contact tracing in the delta so that may be of good assistance to us as we coordinate with the other groups that come on board that provide contact tracers okay now make no mistake I'm not saying I'm not worried about content tracing from an entire estate but it but I just know that you minority communities this usually is a is a maintenance and so yes so III I'm in a respond to that I had a great conversation at about six thirty in the morning with the folks with and why IT and Jones barrel and what they're doing in the delta and so I plan to have them come up but it's it's a very collaborative effort that's taking place in the really focused on the delta area that was a great conversation that I had with them so they're engaged it's really just bringing all these components together for across the state to build collaborations that we're not you know so that were were able to really get all these pieces of the puzzle together and coordinated and and that's that's very keys so at there's more to come on that I will have them here to committee meeting in the near future to talk about specifically that but I I I can tell you that is that is happening I do appreciate that I'm Representative Ladyman. Thank you Mr. A bill Hanno you've been asked this question many times but I I get asked this question two or three times a day this is the most. Ask question that I get from constituents is about mask they talk about will dismiss work or not and what type of mask you know and you you talked earlier about New York about the implemented masking you you thought. That that brought down the number of cases but do we really have. Scientific. The information analysis that says I will ask better what kind of mask you know where is it protect me it is a protect other folks can you count address that because I'd love to have a good answer to give the folks at asked me that question so there's more more evidence that covert nineteen is primarily spread in it airborne or droplets way so it's the droplets that people give off when they call for sneeze but it's also airborne in that those very very fine particles of of moisture with virus in them that people give off one day call or I'm sorry not cough but at talk laugh seen and those don't necessarily fall to the ground like the droplets would but they stay in the air. And the look the medical literature that I was reviewing this weekend showed that when Italy and New York City implement and required. Mass there was a change from a linear increase. To a decrease and that seemed to be the main the interventions that made that happen and I think that's important because that shows that if you wear mass and enough people to do it then it can have a very big impact on the spread of covert nineteen in the community that help you. Thank you senator hammer thank you ma'am chair. So my daughter had three surgeries after got open up for elective she get tested three times for code. Do do all three of those count as a single test because of it is patient or the test numbers that are being given out how many of those are actually related to elective surgery procedures and tests are given before that. So the total number of tests performed I think or just the individual test reports that we get there's not a total number and is not distinct individuals that's how I understand it I can verify that but that's how I understand it right now I'd like to get that number for the number of test numbers are being given out to pass the we're making a mayor so stayed with elective procedures I don't think we can we don't collect the data for the person purpose that those tests are given so it would have to be based on an institution because we get that lab report from the company that runs a lab and my understanding is that there's not a data field that reports that. All right second thing is on death certificates Of the deficit been identified as cope with this. How many of those had underline circumstances and were they identified as covert desk just because he tested positive for covert or what's the process that goes in to them those death there's been identified as to cope with this so when a physician or another person who's the server fire is fills out the death certificate there's a Instructions for how you do it so a person for example may die of cancer but they had covered nineteen also and the way they feel it as a primary cause of this in the contributing causes of death. And so if a person is known to be a co with positive patient but that's not their cause of death suppose they were already on hospice for example it would be listed as the primary cause of death but could be listed as a contributor story costs does that make sense I think so but of the two hundred of the number of deaths that have been reported as co would debts then the primary cause of death was code nights any any covered associated that any covert yes because oftentimes kinda like a little bit like influenza. It's what. in may precipitate another event FOR exacerbate another event that causes the death but the actual calls might be something else. Manager I know time is short I want to yield might but okay sometime in the future like to have a further conversation maybe thank you. Okay thank you Representative rye. Representative rye here okay if the nun. Represent of garner. Thank you I've got a couple quick questions regular both at the table one is on the modeling again and doctor Patterson when the modeling was done the modeling was done based on what we're doing right now. And mitigation of the disease correct yes ma'am and and and the modeling is revised on a weekly basis so we we will do a look back at how our model's predictive what would have what'd happened over the preceding seven days and then use that information to create polynomials which is a big where that I should use in here to predict what's going to happen in the future but that's independent of interventions that could deflect the trajectory so if we intervened out with some extra mitigating Processes such as mandatory masked we could decrease our numbers significantly yes ma'am income and conversely if we loosen currently existing restrictions on on anything we could make it worse great yeah that's what I thought and one other question on contact tracing most of most of what I've read has said of the experts agree that between five and ten. Contact tracers are needed to per. Her case for. Contact racing within forty eight hours which is basically what we should be doing to to mitigate that the disease so do we have a way to know how many what percentage of contact tracing we're getting done how many of those cases those positive cases are we talking to within forty eight hours and how many of those contacts at the contacts are we talking to within forty eight hours yes yes actually I'm sorry I don't have the data with me but we actually have a quality improvement team that works with the case investigators and the contact tracers looking at the data to see what the time frame is in terms of. Because we we get the positive result course probably there's already been some delay between the time the cats was collected the result then we need to a nurse to call an interview that case and then a contact tracer two of follow with all the contacts for that case and I think on average is about three context for case. So how timely is that and then how long does it take us to reach them you know right away people might not answer the phone or thank you that don't want to be reached do we need to do for a case for example do we need to do a home visit so there could be a delay and we do look at those state and I apologize I don't have them with me. Thank you if there's anything that you want to send to me then I can send out to the members that would be fine and represent a Murdock. Thank you madam chair of. Cam his ankle a question for you is around the projections that you talked about earlier do you feel that mass could be a could bend that curve. Could that be a catalyst to bend the curve of your projections of the yes Sir since we don't have mandatory masking restrictions in place there that that the there and not having any impact on on our project trees in and simply based on looking at the the data that has emerged not just in one study but but in multiple studies is clear the masking has an impact so yes see you MS you can in our facility much wearing a mask and my my opinion as a clinician as a scientist is that if we Mastin places where people are in close proximity and indoor environments places where people are close together that that would have a beneficial impact on on a monthly well I and I see that in the governor's message a hearing talk about masking and and and and doctor Smith and in yours is way also everybody's talking about this in the state of Arkansas as it being a catalyst to controlling this up hopefully we'll get to some point will we will mandate this if this truly what the conditions are saying it is and along that line real quick and this is for either of you all the mixed messaging my my constituents continue to talk to me about what they see on TV from the federal government down to local in some cases the mixed messaging and I think represent Ladyman count touched on it in terms of the necessity of these the mass Pacific we or other provisions I mean there are people in policy making and decision making positions that feel like that you should do nothing I mean their colleagues. They have told me do we should do nothing and so with how can we are somehow in fate or influence there thank you to make them understand that this is truly necessary outside of what the master showing us what the numbers are showing this is there is there are other some other ways internally that you guys are talking about they could possibly try to influence those of us that are talking to constituents in being axles questions. It is so I can speak to it from the perspective of a healthcare professional it's our our duty to to share what we have learned from the scientific literature Sir duty to it's Walcott and talk it and and it's our duty to behave it's talking no way that where the people like what we hear or agree or disagree with that at least understand that what they were saying exactly what we believe in and nothing more nothing less I do think that there's a lot more that we can do more working with other healthcare entities cross state to create a unified message or around the ways that people can protected cells is not our duty our job to create policy but it is our duty in job to influence policy and and we hope that the information that we are providing you is deemed a trustworthy so that you can make the tough decisions that you have to make we we have people who are in the line of fire who put their lives in danger to take care of patients who who ARE covert nineteen positive and and we reflect on that but I I know that your responsibility is is is greater greater and that's a challenge that we want to be available to help you with. Yeah I think we get so hung up on these you know I don't wanna get hung up on. On this issue it's common sense it really it really of common sense mean if you have the flu you don't want to be around people if you had if there's an outbreak of mono you don't drink it from the water fountains you don't go kissing everybody you don't you know they're there there are times where you need to a pod that I mean yes that scientific data but we as human beings understand the way things are beyond spreads you can you know if you're very careful with washing your hands and using hand sanitizer then the surface issue is going to be mitigated by that action right so you as a personal individual can mitigate mitigate for yourself and and I think that's really the most important thing about any policy decisions that were making having clear information yes this is airborne just like the flu like other coronaviruses right this isn't just a corona virus that we are seen it is one in a series of coronaviruses that do exist and they all have very similar issues right there they're similar in construction they're similar with the envelope there similar with the spikes they they react to inhibitors of different very and kinds of of of inhibitors that may be used and treating this there are pharmaceutical companies that are doing research right now on those and how we actually develop treatments for corona virus as well as a vaccine so we have so many ongoing parallel tracks you've got policy you've got mitigation you've got treatment you've got vaccine you've got testing you've got antibody all these things are run and at the same parallel time so you know I think it's so important that we understand math do work if you're in close proximity now if you're on a lake and you're not around anybody you do not have to have a mask on right so you know we're not going to mandate that you have a may. Ask on when you're kayaking down the White River by yourself or with your family that's ridiculous you know an outdoor but when you're talking about closed ventilation systems when you're talking about close proximity within a group and you cannot maintain a six foot distance I mean I think you have to be real clear about those types of things because if not people get frustrated and they say well I don't know who to believe and so I'm just not gonna do it and that's the point where we don't want to get to that I think that's where we have to have clear vacation I see people driving in their cars wearing a mask and they're all by themselves inside their own vehicle you know. I thank I don't think that's necessary but you know you can talk to that I mean it's just. I think I think you know it folks need to understand how this behaves the time frame the proximity how it's transmitted in carried through the air and perhaps that messages and getting through enough suse center and if I could speak to that because I think that the this ties directly to to the point to represent a Murdock is making if if you are at it in New York City there's no where that you can be outside your house where you should be wearing Maddox is just impossible to to to find an isolated place and and New York City and I agree that you know if you are on your tractor taking care of your land it doesn't make any any sense and and it's just not believable for somebody to tell you that you need to be wearing a mask right then and and that's why I think we need to take the best practices that we learn and articulate those best practices as our Kansans based on what we know about being on our Canson to do the right thing for people but if we give the give you a a an Arkansan with good common sense the impression that that for some reason you know that there are circumstances in which masking is beneficial if we can't make that are can some believe that then we're going to continue to have the problems that we have unless we decide to do this two policy mechanisms represent Ladyman. Thank you Mr chair I like to be back on what represented Murdock in Centerville just said about let people know and not not really Hey you're a science I I feel like I came from the scientific community and you know I can set and and tell somebody the second law of thermodynamics and I know it's a fact but they can look at me like a deer in the headlights you know they don't get it I don't relate to the home they don't relate to what I'm saying so if we know the science tells us that a mask is good then you know we need to win the minds and the hearts of the public so they're looking at their online they're looking at sales at Walmart you know years jumping fences and you got to get their attention you know they they got aunts were guy he goes to a clothing store go to set down is gonna send only it's a song also and he's got on swimsuit you know I mean that gets people's attention so maybe we need a public awareness and that relates to people maybe this is something the task force to look look at something to to to get the message across that Hey this really does work you know and the so that people would would pay attention to that scientific fact I'm is a possibility. Well yes so those kinds of communication are we've been working to address them we just yesterday released a new online video for the black community focus about wearing the mask I think there's more that we can do and we're always open to new ideas and new resources but the social media is important at videos things that require a lot of reading can be helpful and then working with key messages that's why I'm really hoping for the focus groups to help. And I think that made this point but the north. If you talk to the common sense of the average cans and that's that's what we need to do. Yeah I'm I'm gonna get to represent of Gonzalez and then if you have a quick question sorry represent board you can accidentally turned you off you can push again and then I'm gonna bring up Rachel bunch and bow rile and Jody and Trent and then we're gonna go till twelve thirty and then this group of folks are gonna leave so. Quick question represent of Collis was from. At for you a mass and I think doctor Delahaye needs to leave. Thank you madam chair I guess my first question would would be deducted a higher might maybe any of the all now so we we've talked about a symptomatic people a lot that have tested positive so what what's the rate of false positive false negatives on these test are we assuming that these people are are positive but they really were not. So the PCR tests had is very accurate and I don't know the latest numbers on the false positives or false notion that I might be able to do in on the. Hi eight you invests we have had maybe one or two quote false positives meeting our force negatives were patient was tested negative and then a couple days later tests again a positive. The as as Dr Ellie said of the the positive a positive test is positive. What what we don't know is with the person still infectious as you can have virus at no longer rise particles that no longer in fact that can still create a positive test but it need that of ours are in a the genetic code is is there the the false negatives are more likely related to the quality of sampling of whether there was adequate. Sample obtained at the time of the swap set it up with this one or two false negatives other how mental tests were done. right think we've tested about eleven or twelve thousand to send their there are no false positives than that if the test positive then it's motor present Acker I think the the odd the. The R. accuracy of a positive test is that correct ninety nine point six percent system very high okay there are fault there has been false positive so. Okay yes as as mentioned however it could be contamination but it's extremely accurate. Right that there have been false positives in the state that that is a true statement yes but not very many okay my next question will be on the modeling you'll if we talked a lot about the thirty to fifty times that the jaw came up with an early on in your testimony you would mention the Seattle model that said five to ten percent what's the difference and data that one into those models that created that significant of difference is the main difference is that the the Seattle model makes national assumptions about transmissibility within role populations and I model look specifically rule transmissibility within the state of Arkansas to it to make predictions so we're looking at our own data about transmission and rural communities to to make further predictions about transmission and rural communities rather than just assuming that there is a national standard of transmissibility that would apply to Arkansas equivalently to Wyoming for example so it in that did you take into consideration that the rule transmissibility was here in Arkansas was within certain communities of the Hispanic communities Marshallese communities that maybe if they've that those communities of already had that and they're not spreading amongst themselves any more than that modeling could possibly be be wrong I mean or are there I guess those communities would build antibodies have some resistance to to. Getting this the disease again as I correct well the so it's modeling so it can always be wrong so I'm not going to Ever argue with that statement but our modeling is definitely taken into consideration the fact that we have that some of of the outbreak is occurring in confined communities and that the door of the department of health and others that those outbreaks have been contained but you know we have also seen the that you know the the spread of the virus continues it just continues at a very slow rate and I'll give you Representative consoles one example a we were greatly concerned when the Shreveport operate first occurred and we are looking for fingerprints of that al breaks spilling over into the state of Arkansas and for weeks and weeks and weeks we didn't see that well now we can see that and it's just that the waves break much more slowly in a rural environment but they eventually break and I I I don't think that we can make the assumption that just because it appears that for instance the outbreak in Shreveport was abated that that outbreak doesn't alternately have an affect on contiguous communities. Thank you I know that we have a lot more questions I've got I'm going to represent board FOR the last question right now because I want to bring the others up and they need to leave. Thank you madam chair I'm just going to get straight to the point I I just without before say this the health department is doing a great job in my opinion and I appreciate you so that but I'm afraid we've politicized some things including mask wearing which I'm wearing one today by the way so the the question though is is when we talk about wearing masks and we talk about mandating mask the fact of the matter is New York in Italy both have at an astounding number of cases and a big issue so what we're talking about science and we talk about there's you know observational studies and then there's double blind placebo randomized controlled trials right so what's to say that there wasn't and acquired immunity that led to these drastic decreases rather than that just happened to coincide with when they mandated a policy on mask thank you. So we we don't have evidence right now that once by a person has covered nineteen that they won't get it again so we really can't say that's what happened in Italy in New York then the timing is just when the if you look at that time line and the a linear increase and then the change the it fits right when a mandated the mass. Alright thank you I know we have other questions about a minute thank you all very much for coming I very much appreciated I know that long and but as you can tell we need this information in there so many more questions but we so much appreciate your time and you sharing the information with us we have to have this information in order to to best into our jobs and for the people that we represent because a lot of the questions are questions we get from people that give us a call and want to know the answer these questions of thank you all so very much for coming center early we're we're happy to be here we appreciate the invitation to be here that we're happy to come back at any time and I think most of you know how to get in touch with me so if your questions for an answer to you you know that you can contact me directly thank you so much thank you all and as you all thank you doctor delay tell everybody we say thank you at your M. S. and that the department of health we do appreciate that I'm gonna ask rile with the Arkansas hospital association and Jody interests with the Arkansas house bill cessation of Rachel bunch with the Arkansas healthcare association of the come the three of them will come to the table they do have a handout members that that you can look at and The healthcare association does so I'll let one of y'all y'all decide he wants to speak first we'll go to Mr rile. Thank you madam chair by Reille presidency of the Arkansas hospital association Preciado opportunity to be here and and share some information about the finances of hospitals during the pandemic and also how we dealt with it responded to it. Obviously on president unprecedented challenges but I want to say that our hospital employees in leadership have really gone gone above and beyond during this time we really appreciate all that they've done they've worked tirelessly to equip themselves with technology facilities. And supplies they needed defaced pandemic had on. They've taken a central measures that have required a monumental investment in financial and human resources for facilities throughout our state in the first six weeks of the declared pandemic our members spent thirty four million dollar state wide to order PP testing supplies set up testing sites it's centers center. On April third the Arkansas department felt very correctly issued a directive that ensure that hospitals postpone non emergent procedures in order to preserve scarce resources and limit the viruses spread this reduction coupled with the forty seven percent decline and emergency room usage for the same time period as last year resulted in an enormous financial blow to hospitals of two hundred and seventy million dollars. That's just over the first six weeks of revenue losses and expenses have not stopped. AS PP is begun testing has become more widely obtainable the health department is rightly allowed to collective surgeries and and other things to continue so that has helped the situation but we certainly have a message to to the public out there do not put off your procedures we're we're saying sicker patients come in so that's requiring so please please if you have put off your care please get into hospital and get your care taking care of. First the federal cares act is provided some relief for hospitals and certainly our own Arkansas cares acts during committee and the Legislative Council recently approved a hundred ten million for cave covered related expenses for hospitals thank you so much that is going to be very helpful to hospitals we appreciate. There's also this perception that Arkansas hospitals are receiving adequate infusion of dollars from federal sources that is not the case there has been seventy seven billion and general and rules specific funding distributed from the cares act so far seventy of Arkansas hospitals have received two hundred and eighty one million other types of providers have received additional resources as well and before surgery centers doctors clinics hospitals nursing homes whole long list of other providers two hundred eighteen million dollars so of Arkansas's allocation so far though seventy hospitals account for fifty six percent of the funds that have been distributed through the federal cares ACT thus far. The methodology that they have used at the health and Human Services really helps the bigger states instead of a small state like Arkansas hawk like Arkansas we have lower reimbursement rates from commercial insurance and government payers so the formula they've used reward those hospitals that charge more and are paid more so that's been a big concern of ours additionally there was ten billion of the seventy seven billion in federal funding that was targeted specifically for rule and critical access hospitals. We seek inequities there although those rule hospital certainly needed it we see a gap there between the smallest of the small hospitals in the largest for these medium size hospitals that were serving coded patients there's a big gap in the money that was received in there so we're working to try to fix those those kind of gaps there was also recent federal distribution that the scent only money to twenty hospitals in Arkansas. Well we certainly appreciate those funding coming from the federal government to just say the twenty hospitals needed funding at this point that's not that's not gonna be good enough we want to keep a healthy infrastructure we want to serve during this pandemic innkeeper hospitals open keep them up for providing all types of elective procedures but also served in this kind of impatience and and also we hope to eventually get back to where we are we're we're and the economic impact a hospital's eleven billion dollars so we want to get back to those times that be happy to answer any questions about those numbers. I'm gonna go ahead and go to miss bench and the mistress if you have anything. Thank you I'm Michael Benson the executive director of the Arkansas health care association you should have a hand out in front of units on the screen with the things that I've got the most questions about related to long term care lately and I've talked to several the about constituent issues but I want to just cover quickly some of the numbers about cases in testing today you will know that the virus has disproportionately affected long term care facilities and by that I mean nursing homes and assisted living facilities third doctor Delahaye mentioned earlier at the health department is currently following a hundred and fourteen facilities that means that a hundred and fourteen facilities at some point have been affected by the virus they don't all currently but that's the highest number that we sing ninety one facilities in Arkansas have active cases twenty three have cleared and no longer have active cases an example of that would be the Briarwood nursing home here in little rock that was in on the media a lot the very beginning had a large number there being followed but don't currently have cases. Five hundred sixty nine current total positive residence two hundred twenty recovered residence we have eighty four patient deaths three hundred and eighty nine positive health care workers from long term care and a hundred and seventy have recovered. If you go to the next slide on our hand out as this is the national comparison for this is only from C. mass for the federally regulated health care of the nursing homes and this is as of June first of these numbers are a little bit different than the previous slide but people ask me a lot how does Arkansas compare nationally to other states when you're looking at long term care and the answer is that what we're doing pretty well as a comparison see see here on these columns the number of cases and the number per thousand residents number of deaths at just for national comparison. Next a quick update on the statewide testing initiative the statewide testing initiative for a long term care as been going on during the month of June for a little bit over half way finished with this the goal was to establish statewide baseline testing of our entire long term care population and the goal was to identify those positive but a symptomatic residents and staff members so that we can act accordingly and finally the main goal that people been calling about is of course the path to re opening so that we can do that safely and thoughtfully in a way to allow people to see their loved ones. To date on statewide testing of the numbers I had as of last night we have tested completed testing of twenty four thousand five hundred and fifty seven people with a hundred ninety eight positive results forty three facilities have positive results and total facilities are a hundred and eighty four now these numbers the number of facilities being tested include the human development centers in the state run facilities so there some it's right over three hundred total facilities that will be tested three this process and we've completed all the way to one hundred ninety four I'm proud of how fast we've been able to accomplish this and the number of facilities that have quickly agreed to participate in this process. Next on the re opening plan this is what I'm getting the most questions about right now this is a joint effort between our association the health department and DHS we've been talking a lot about this process what makes sense looking at what some other states have done looking at the CMS memos other information the way that it will work and represent a brown I want to answer your question to in just a minute but the way that will work for the health department will give a clearance letter to every facility when they're ready to re open when CMS announced options FOR states about how to proceed and how to re open and looking at different ways to do this they gave states the option to do it individually or work all facilities would open at the same time we have advocated for it to be an individual approach because we think some parts of the state and some facilities are ready and others are not. this will be a lot of work going forward our goal is of course to strike a balance between the safety of the patients that are in our buildings and they are vulnerable people that live there and people sing their loved ones that they care about miss so much the ban on visitation came from the health department and from CMS back in the middle of March instead it's been that long since people haven't been able to come in and visit. Facilities that meet this new criteria will be eligible for a limited re opening on July first this includes expansion of visitation communal dining activities and barber and beauty salons within the facilities facilities that have active resident cases cannot accommodate visitors until all cases are cleared. And I've spoken to a lot of you about end of life visits when you have a situation with the resident who is at the end of life and family members want to come in and see that's a decision that individual medical directors make case by case basis A bill or happy to accommodate those as we follow that guidance that will continue. And again this will be an individual facility approach we're not everyone will be able to re open at the same time. And when we say re opening it's not re opening back to how it was going to look much different I anticipate lots of questions what the phone calls about this because it will be so different than it was before all this started visitors will have to schedule times to visit masks must be worn during the visit maintaining a six foot distance a maximum of two visitors per resident at any given time there will be limited visiting hours and different facilities outdoor visits will be preferred but indoor visits will be allowed when the weather or the resident's condition prohibits that. And so I'm sure back to represent around question about when would that occur and the answer is that it depends unfortunately every facility is going to be a little bit different a lot of facilities are spending time right now. modifying both indoor and outdoor spaces to meet at the details as the back part of your hand out here's a copy of the directive that came out the end of last week from the health department that covers the details of the re opening plan for a long term care and so there are a lot of things that have to be met here including adequate hospital beds in that region and that something that we work with the hospital association and that's something where if a facility depending on what part of the state that they're in they might complete testing and be all negative and might have enough staffing enough PP but if there are adequate hospital beds in that region that facility might not be eligible to reopen yet. So that's that that covers what I prepared I'm happy to answer questions yeah that makes really perfect sense and that goes back to the health care coalition and the regions my maps in the back capacity which is so important I think I think it's moving for we've got to merge those those maps know what I'm talking about as far as emergency response and the health care ones does the visitation policy reflect the same with hospitals that an individual. Or is that how is that progressing I think you heard senator Caldwell class I did I'm Jedi entered on the executive vice president for the Arkansas hospital association I can tell you that we hear that from our nurses and doctors here on the front lines and they're really struggling with how to communicate with people who really it is it safe for them to be with their loved ones for a variety of reasons and they're struggling with those things too we've really stepped up a lot of things that we can do using digital media the federal government has allowed us to do things like face time that normally you shouldn't be able to do in a hospital setting to communicate with care takers and family members outside but our heart absolutely breaks for those kinds of situations it is all on a limited basis most of the time our hospitals have a policy in place that would allow a care taker to come to the hospital and stay with that patient the issue is the coming and going that presents the issue so if you're a care taker and you're going to come and stay with your loved one you can stay with your loved one with you kind of have to stay the whole time so that's part of the issue I think many of you who've had relatives in our eyes to use of known for a long time we've had to limit visitation and and I see you setting for a variety of reasons and this is just exacerbated because of the amount of PP that it takes and the more folks wear masks in the community and do what they're supposed to do the more that there's a last spread within the community the faster it'll be where we can allow visitors to come back and in their kind of regular setting we do definitely agree with Rachel when people come back to CS on a visitor basis it's going to look a little different at least for awhile until we get a good grasp on how we can keep people as safe as possible there is no question in our minds that safety of our patients is paramount and safety of our employees is second to none. Thank you and can you also just talk about the cost I mean I really want to know the details of note treating and dealing with a patient's that's an in patient has pneumonia. Is very very different than dealing with a patient who has cove it that that's correct last week at the hospital Medicaid subcommittee meeting three of our hospital CEOs Troy wells from Baptist Larry Shackleford from Washington regional interest barber who's the HA board chair from Saint Bernards came and spoke along with doctor Patterson he really tried to go through some of those expenses and and the things that make make hospitalization hospital care for Kobe patients so much more expensive the very first thing is every patient who walks in the door we have to assume their covert positive so PP our emergency departments are incredibly more expensive now because of the equipment the testing the other things that we have to do we have to assume when you walk in the door with the amount of community spread that we have right now that those patients are could be positive therefore the expense for non Kobe patient in an emergency department is the same which is exponentially larger than it was in January or December of last year to your point about a pneumonia patient versus echo the patient absolutely those things are different the types of equipment that we can use to make sure patients can breeze are different for an ammonia patient and they are co the patient not only to protect that patient him or herself but also to protect the staff in the room we definitely have increased our negative pressure rooms we've converted some of our I see you rooms into negative pressure rooms we've added ventilators doctor Patterson was absolutely correct earlier when he said there's a way for us even to make anesthesia machines little makeshift ventilators for awhile luckily we haven't had to do that yet our hospitals are working in partnership with one another across regions and frankly across the state to increase surge capacity doctor Patterson told you all that he believes that there's an additional seven hundred beds in the central Arkansas a region we believe that across the state we can surge up to close to. Eighty five hundred so anywhere between twenty four hundred and thirty four hundred with a lot of estimates and cap the odds are in there but you also need to keep in mind that not all of those will be I see you beds with ventilators because those are very expensive and they're hard to get and frankly we get into arguments with not arguments but we get into fussiness and fights with other people who also need ventilators and sometimes Arkansas isn't prioritized and so we've got a supply chain issue and how we get supplies into our state and by the way I hope my mom's not watching because I'm gonna get in trouble for use in the technical term fussiness. But yes it any any kind of information that you'd like to know by region we can try to get it for you we're looking very closely of course at northwest Arkansas when we talk to Larry Shackleford last week you said you know what today were okay our concerns are what happens to three five weeks from now if our supply chain issues come back in hand if we're not able to attain the resources we need and he said I've I was lucky enough to get to valet am here and there when we were having good chats he's a dirty and my biggest concern right now is that my health care workers are exhausted he said healthcare workers by definition are sprinters we're really good at taking care of you when you have an acute situation an emergency situation with an hour facility it's really hard to run a marathon when you're sprinter in my health care workers are tired so we really need to come up with a way to make sure we train folks as quickly as possible we get new students ready to go to take care of patients we've been really proud of many of our hospitals who have taken the opportunity while they're nurses were not doing elective procedures to train them to do other things so bed side nurses could be trying to work in the I see you regular I see you nurses could be trying to also work on a ventilator its header and so forth so there's a there was a huge cost associated with that that we know we're and will never get back but the good news is the acuity and the ability of our health care workers to take care of patients has done nothing but risen during this time and that goes for doctors to yeah absolutely an orthopedic surgeons probably maybe trains on that during medical school perhaps residency but now they've been out for twenty years or so I mean they're not really up to up to speed on running the ventilator and taking care of an infectious disease patients there carpenters. The two ladies saws and hammers and tools are carpenter my dad the orthopedic surgeons so you know that the whole difference way of of dealing with the patient that they're not used to or may be out of the game so to speak for awhile that need to be retrained yes and physicians trying to with telemedicine so that they could monitor patients from a distance if they needed to if they didn't need to be right and side with the patient on a ventilator but they could offer assistance even if it wasn't in their area of expertise and just the cost of testing somebody if they're coming in for an elective procedure or anything like that that that test is not included in the reimbursement is that that's correct as doctor Patterson said the DRG the diagnosis related group how we get paid from commercial pairs at center and so forth for those procedures there's not an extra cost all right extra reimbursement if you will added in to help defray the cost of of testing that particular code patient about the only way we get reimbursed from commercial insurer for testing a patient is if they're an emergency department patient with the physician signed order or I have physicians on order in another setting and you can get a reimbursement from a commercial payer but otherwise it's just kind of business as usual right and that is a huge concern for me get moving forward is you're going to have to test patients I'm sure that's going to continue to be the case if they're gonna do any type of elective procedure the cost of that is not a included and hospitals are having to eat that I think that's a simple policy issue in my opinion and this but have you all lost any health care workers to date to date we have not lost any health care workers in Arkansas and in long term care we do have several several that are that are sick that are out right now but we have not today okay Senator hammer. Thank you madam chair let me ask first vault Rachel the eighty four deaths that are shown on the handout. Where they were they diagnosed by the physician of the facility or where were they who did the diagnose who did the certificate of death on them. it that's that's going to be a combination said the facilities work with that closely with the health department but that would be mostly the look local medical directors and those cases so do you know did they die from Covin or they die with covert. I'm that's probably more of a health department question then for me and they make that decision there those are all people that had co that it some point or another but the doctors to one or if it's a hospice patient the nurse they're the ones that are the attendant at time of death and they are the ones that are to determine where that patient died with covert or from covert right correct that's not the nursing home okay so why would the health department having influence over the determination of how the death is recorded. I'm not sure if the the health department the medical directors at the health department have been working closely with the medical directors at the facility on those things well let me ask you the same question of the deficit have been recorded that have occurred in the hospital. Is that the physician that determines whether the patient died from covert or died with co would. I'm not though I'm thirty and I'll answer that and yet yes that's that's the answer the physician determines that and signs the form at to doctor deal Hayes point earlier she's correct on the form that to use there's a primary cause of death and and other factors as secondary causes that are listed and I believe what she is saying is when we are reporting those who have passed away in Arkansas with Kobe related illnesses whether it's the primary or secondary cause of death we are including that C. can get a good picture of folks who have the disease in a who have passed away but as far as the vital statistics go you would have to ask the health department how they're reporting it for their purposes with primary cause of death to relieve my concern because now we're having deaths reported and the way it's put out over the media's these are covert deaths but based on what you just said you may but not be the cover the cost the death it may have been a contributing factor could been that they had co would but to me that just kinda misrepresents what could be reality well it does it doesn't it doesn't so I'm not to get too technical and I'm not a clinician this is when I wish doctor Patterson doctor matter were back up here and but if someone has cove it a lot of times the disease of code itself causes other diseases and someone for example you might get sepsis or you might have kidney failure the so in order to do to make that determination the physician has to decide do I believe the primary cause of death was Covin or do I believe the primary cause of death as sepsis and that is an individual physician's. Order an opportunity and his cause of death on that form okay so when the department of health reports the number of deaths do you know if they've ever changed what the doctor who pronounced sent in to the department of health I certainly would hope not and I bet they would not but that would definitely be a question for vital statistics at the Arkansas department of health okay and we will I'll get that question answered if So well let me ask you this when the decision came down to limit the elective surgeries. Were you involved in that decision initially or did you all just have to live with the decision that was made. Well we try to provide input to doctor Smith and the and the visor committee but we're we are part of those discussions within that committee no but we want to provide input and and as they came out with different iterations we provided input back to them feedback hindsight twenty twenty looking back could you have done those elective surgeries with PP is that you had in stock and it not have interrupted the flow of elective surgeries to continue even if at a limited number. Welcome back to to then PP was very very limited right at that point and we were burning through it when we would have a kind of a patient and we would burn through the PP and that such a high percentage rate that probably at that time it was best to stop elective procedures but as PP is become more available now the right time to continue with that and hospitals will flex up and down and I asked doctor deal Hey the question of and I cited the reference my daughter who since elective surgeries have been opened up she's had to have three major surgeries so do you know the number of tests that have been issued a as a result of having it as a pre qual fire before the elective surgery can be done no Sir we do not have that information sure would like to get that because of the I think that's just a key number to throw in the mix of things that of all the tests are being taken they are being taken not necessarily because somebody's presenting as a symptomatic or with any issues at all but they're being given the test as a result of that not them saints bad thing but I think for a look at numbers in gonna have honest evaluation let's look at all the components to go into these numbers that were presenting even the issue of the death certificate being issued that may not be that it was a covert death but code was was present thank you ma'am chair. Thank you and now to your point on testing you have people that are testing because they've been exposed you have people that are being tested because they're symptomatic you have people being tested because they're trying to have an elective procedure which doesn't matter if you're symptomatic or not. So that's you're exactly right if you're not tracking that. Your numbers are going to be. It's gonna be a skew. Sure I can tell you that you know there is there I can tell you have at least one instance where somebody went in to have a procedure they were tested it came back positive they tested the entire family that was negative. They retested everybody and it was a false positive. So. It's happening we have to under net understand the acknowledges so it it definitely needs to be part of the conversation madam chair yes I'd like to issue some for we really says FOR launches request but also will give represent paid some credit for that question asked because he helped me framework in on the death certificate one so thank you thank you Representative Penzo. And then we're going to lunch. Okay just real quick point of clarification lot of talk was on the DR Jeez an owl. Code patients are get reimbursed more adult thought Medicare patients in the carriers act had a twenty percent add on is can you talk about that because it sounds like there you're not getting more money but as you did nope you're exactly right and Medicare D. R. Jeez do have an additional twenty percent if you're D. R. tease a thousand dollars that means you get twelve hundred dollars for that patient instead of the thousand dollars and so the question then becomes and would that cover the PP that patient time the extra nurses who were needed the testing supplies and all the rest of that for care so you are correct that Medicare under the cares tech FOR certain patients will allow for an additional twenty percent over and above your regular DRG for that patient only Medicaid does not have that commercial payers do not have that and obviously any sort of uninsured patient doesn't because nothing. Okay thanks for clarifying that is it was that was brought up several times in I was looking for use of thinking there was little extra money not totally understand it doesn't cover the increased costs you're right but what hospitals doing with its Medicare and Medicare only in your correct the cares that does allow for that the methodology for the payment the coding that we do all the rest of that is is the same so doctor Patterson correct that the methodologies the same but you're right that the add on comes later okay thank you and and I I think it's important to a if you'll get information I want to because PP is dramatically increasing costs because of lack of and because of high demand lack of supply so it would be nice to know what additional costs that you're incurring per patient I think that's the of I think that would be good information to have okay last one Representative Ladyman. Thank you. Right to have a question for you you talked about the test and then in the long term care facilities and you've done more than half of those. Is the percent of positivity cases. Is that track the general public is it higher or lower do you know. The number at its it's right around one percent so far but that number is a little bit misleading because as the statewide testing that's going on right now is going on in facilities who haven't otherwise been tested so if you have a facility in a part of this they haven't had a covered case no staff member and no resident to back up a little bit what we've done this entire time in Arkansas than really unique on this in long term care if a if a staff member or a resident become symptomatic we test that person and that person's positive under that roof in that facility we have an usually within seventy two hours tested everyone and that several hundred test all at once of mostly people that are a symptomatic that has allowed us to quickly find people who are positive and make decisions accordingly so that's been going on so the number that I presented here that's on the hundred and fourteen facilities that have been affected those facilities because they're already testing and they're in a plan in a cycle those weren't initially included in the statewide testing plan so the rest of an that we're testing right now that they're already testing on that track the rest that we're testing right now through this state wide initiative are those that haven't been tested aren't aren't currently at testing for those purposes so it is around one percent but that one percent is of the remaining facilities out that makes sense yes thank you Julian I have a question for you you talked about the number of bids in the state and the different numbers in different regions northwest northeast central and My question is are there areas of the state that are lacking those bands like certain southern Arkansas or north central Arkansas where they don't have a large hospitals like we do northeast northwest so are there areas that are really lacking and if so do you have a plan or to someone have a plan in order to how to your address at. Sure the Arkansas department of of health actually has planned so twice a day all of our hospitals put in information so that the health department can see our bed capacity at the time how many patients are on ventilators how many patients are and I see you bet it cetera so when the health department sees that we're having at the dental surgeon a particular area they activate they'll call other hospitals in that area they'll call us we'll get folks kind of motivated to see what we need to do to transition patients back and forth we have a really close relationship with ambulances as you might imagine because they're also our frontline folks to help us get folks from place to place but we have a plan we've got lots of different plans in place both regionally and state wide that can be activated at any time to make sure we get patients to the right place at the right time we've built very much on the trauma systems and are going to continue to build off of those kinds of communications that we have among facilities so that we can get patients to the right place. Thank you you welcome. Yeah and that's a whole nother can be a whole nother meeting is to really understand how the health care coalitions exist and how the maps are drawn and why they're drawn in the coordination with trauma calm and that dash board you know there's a whole command center out there that is happening and functioning that we don't know much about but it is on going so thank you all so much for coming at I know it was long we're gonna come back members at one thirty but I really want to thank all three of you for being here and stay in this entire times really critically important information for the people of the state and lots of questions and lots of answers that we need it so thank you so much for providing the information for all the dollar doing please please go back to your members tell them how much we appreciate what they're doing and said contact us and reach out to us because we we have to continue this and continue the conversation because we have a lot of decisions in my opinion policy wise that need to be made between now and the near future thank you. We're in recess members to one thirty.