Public Health, Welfare and Labor Senate & House

The. There's. Who were I didn't know there was The. There's. Who were I didn't know there was a protest was here to Capitol yesterday. So they were protesting against the. Yeah I just heard a. I school was. Pretty busy. Hi good day. Hi. Yes yes. Because we didn't. Transaction. Just use in the chair so. So. I want to make mistakes. Okay. Our. Okay. In the bill I need to get going here yes. If you would get thank you seats will be start and just just a minute. The stuff kindly Committee meeting to order. appreciate everyone join up today short notice and extra meeting and all that and I know I keep saying that but I know everybody has things to do and I really appreciate members showing up per on schedule meetings are short notice meetings but I thought this was very important I know some of you all had the same thought to get data or to go over data that we received and the information that we get keeps changing almost on a daily basis or maybe more often than that. And I know back at home people in my district. They have a lot of questions and it's very difficult to get them the correct answer so the purpose of this meeting is to go over information get the latest information and give everybody on the committee opportunity to answer questions so that they can answer questions back home so that is my feeling on the purpose of this meeting and I appreciate the folks that are going to be presenting today coming out on such short notice you know this is the most discussed thing in the state and I think affects more people than anything in our schools are trying to figure out what to do our businesses are closed so it's it's a very very important subject and we need to take as much time as we need to together the best data possible. Senator Irvin did you have a comment. Thank you Representative Ladyman I appreciate journeying through this with you you've been a great partner and with me and with with for all of us and so thank you for being in it the chair of public health for the house of representatives you've done a great job and I appreciate that partnership it is important that house chairs of public health welfare and labor committee for the state of Arkansas that we fully engage with all of our agencies in the executive branch so that we can maintain and give our input as it relates to the policy and how it affects the citizens that we represent and how we were elected to represent them I will just reiterate my comments from last week that I believe that policy in approaching this issue in this pandemic needs to be coordinated and needs to be statewide and needs to be consistent and needs to be comprehensive for all our policy must be consistent there needs to be coordination in a concise in a manner that is I have fiduciary responsibility and and fiscal make fiscal sense and it needs to be reasoned and how we are spending our resources and our time and our energy Anne's be targeted with our actions and intentional with our goals and it needs to utilize the our legislative procurement process which includes legislative oversight and auditing capabilities in other words were fighting a war and you can't fight a war if it's not state wide and it's not comprehensive he and there's no strategy there it's just like building a building you hire a construction manager team to build the building the construction manager is in charge of the program in the project we are the clients the department of health is the clients they are issuing that structure in that process it's up to the construction managers to then sub. Tracked and hire the specialist and utilize all the resources across the state to accomplish what is what has been hired and contracted to do it's makes sense it follows our procurement laws and that makes sense it creates consistency amongst what is measured as deliverables it creates consistency and programs and integrity in the program integrity and how things are reported integrity and that all things are executed to ensure that you have an effective program that is how we have always operated and that's how we should continue to operate so I look forward to the discussions that we have to highlight and and former policy decisions I appreciate the people that are on this agenda today that represent of Ladyman worked very hard to put together and so I am I'll yields. Thank you senator. Okay we're we're going to jump right into the agenda here and and I've been asked already how long the meeting my bill and my answer to that is it will go as long as it needs to so we will get through the agenda and get all questions answered hopefully so we'll get started if we need to a break for lunch and come back. first item on the agenda down and items city discussion of governor's executive order twenty dash thirty seven which requires face coverings during a public health emergency concerning code of nineteen. And we have a doctor owes a Romero. acting US secretary of health with us today so if you would please come for doctor. And as he's coming up to introduce itself we were provided that years with the his resume which is quite extensive So it looks like that He should be well prepared for the task that's ahead which is a daunting so if you would doctor please introduce yourself for the record thank you very much the senator when represent Lehman with your permission I would remove this mask because we're socially distance far yes you are socially distances thank you. So it's a pleasure to be here today for the first time I will tell you that this is my first second time actually talking before the legislature but never to this large an audience so let me introduce myself quickly for those of you who don't know me my name is a sentimental I am I have the honor and the privilege of being appointed by our governor Hutchinson to serve as the interim secretary of health after the departure of doctor Nate Smith's to the CDC. I am a professor of pediatrics and pediatric infectious diseases at the university of Arkansas for medical sciences I've been here in Arkansas for twelve years I was recruited to Arkansas from the university of Nebraska Medical Center to head the pediatric infectious diseases section of the university and a children's hospital. I am board certified in pediatrics pediatric infectious diseases and I'm a train virologist my background with the department of health began I guess really initially and November when I discussed the possibility of becoming the the chief medical officer for the department of health tentatively in July of this year during my initial decision to make to decide to become is the the CMO I had the opportunity of shadowing Dr Gary Wheeler who I think many of you know I shadowed him on the first on March eleventh and I think all of you will know the significance of that day that day I received my badge and I will keep this bad forever because it has March eleventh on it the first day of covert with the development of. Covered in our state I was asked to take over the role of the chief medical officer earlier so I became chief medical officer on April first and I think you all know the that date it's it's irony is not lost on me and I have served as a chief medical officer until last week when a doctor Smith left and I became the interim secretary of health. So that's I would be happy to answer any questions you might have about my training I'm a few words about mask because that's what I'm here to talk about so There is no doubt that masks form part of a tripartite. Attack on covert virus we have three simple things we can do to decrease the spread of coveted of the virus in our community. One is the mask. Two is social distancing or physical distancing and the third is hand washing. None of these are onerous none of these are above and beyond the reach of everybody in the state. This simple measure wearing a mask has been shown. Numerous times in numerous studies over and over again to decrease the spread. Of covert. There are now studies that show that by use of this mask we can't prevent infection of individuals that are exposed to persons have active Covin disease. I think that if we all as citizens. Did this simple measure we could drive the rates of cove infection down in our state this is essential to moving forward in the control and mitigation of covert. This is essential in providing a safe environment for our children in schools. This is essential to overcoming the disease until we have an effective vaccine available. So I'll and here. And entertain your questions. I've got a question you may not be able to answer this but nothing is perfect nothing that I've been on is studies or other other studies with these mask and I know you know you can have a leaky drown a mask it depends on the type of mask on the in ninety five is our best but they're only good if you're tested and you get a good seal but is there any data on the effectiveness of the mass coming. What percent of the buyers does it stop or the elements that carry the virus is there any data available can you kind of discuss a little bit sure so so there are there are studies which show and the that show that the transmission of a cost for example or a breath through the mass depending on the on the material and we're not I I I think what I'm going to do is not talk about medical masks right I'm gonna talk about the mass that that is available to us as as citizens right I mean I have my my and ninety fives in the office which I use when when we're dealing with patients that have no coat coping infection so they are effective percentage wise it depends on the material it can be as as poor as fifty percent if you use the wrong material but it could be as high as ninety five percent depending on the type of material you use in general most mass will decrease the transmission of covert disease specific examples are there is a report in the New England journal of strikes me in the more billion mortality recruit weekly report that talked about two hairdressers that had Covin infection and none of their hundred and some odd clients became infected because they wore this they wore the mask right there are many instances of that there are studies from China that show that in a family where one individuals infected they can prevent transmission to the rest of the family and decrease the rate of transmission in that area that is what recent paper which I have not yet read but I was informed of on my way over here that shows that the the rates of Kobe infection can be decreased in a community in those states where mass were mandated so there is an abundance and a growing brands of of of information to support their use so for the people that are out here that might be listening to this for the folks in the room Is there. A preferred mask I mean you know these are easy to put on the cloth thank you talked about and then you have the surgical mask that you can buy at Walmart or whatever is there any is one any better than the other or. Is there any data on that sure we know that for example the in ninety five is the best mask right and the surgical masks the surgical mask we use in the hospital are Ben are I stepped down and so on and so forth so there's no grading to say that you have you know ninety five percent. Let's say the prevention of transmission versus eighty five percent we know that a standard cloth mass double triple ply right folded over you can make one from your teacher if you want to that home is sufficient to decrease the transmission of code. Thank you user Representative Bentley you're recognized for a question. Thank you chairman thank you doctor merit for being here and I appreciate you being here in your time I'm not going to get into the discussions of of the mask in deathly but I you know when we talk about the here dredges to me we want to do a specific scientific. Study than half of those people would have had to not wear a mask and a part of a you know the hairdresser where the masking this is to do a real scientific studies some of them to have some variables in that which we didn't so you know some people are saying maybe they weren't even giving any other bars because there is some to make sure they were sitting in the bars so to me we would have to have some of those people not wear masks and then get the bars to prove that really that was what was stopping so. You know I I hear so much on every side almost all to get together fight is a state to do its best but I think I'm I'm not hearing when I when you open up with the discussion I really miss something in your discussion that was improving our communities to fight this off because we know the children officer you work with children I used to work at children's we know their children on their susceptible so kids have obviously hire immunity than we do so I think we also need to really spread the word that we need to get healthier wanted to eat healthier we need to get out there and get some fresh air and improve our community also to fight this disease offer the thing some states that have not done you know a mass mandate or seen some good results but I want us to really talk about improving remitting getting people healthy things a good opportunity for us to to do to have that discussion you know we all get healthy we can fight things out better as well so I really want to bring that discussion that we're to improve our community as well and I have so many employers that talk to meet their employees are happy to wear this mask eight hours for the day no the we're in eight hours long they're having chronic sore throat their eyes are burning and I feel like you know when we have this on her face are also taking a CO two back in we're not be able to the natural thing that our bodies allowed to get toxins back out we breeder breed all that stuff back and so I'm concerned that if we don't encourage folks at least go outside and take a deep breath and get some fresh air and clean out your lungs as Europe and that's what I'm encouraging all my employers that talked to me that are concerned about the employee's health that we encourage that it is important for us to improve our communities as well as we as we move forward because I don't. Anyway I just want to bring that into this question and I feel to keep hearing that and I just want us to you know as the department felt that we are encouraging folks to improve their image is because we see children are much less susceptible specials we get Ford to move into school time so if you'd give me a response that I'd appreciate it sure the so let me begin of thank you Representative let me begin by addressing what you said about nutrition and fresh air activity nutrition is the basis of all health right and it certainly plays into the immune system malnourished individual or child has a has a lowered immune system so that without a doubt and I support that implied that that that is very important and Trish is balanced diet is important good exercise is important it's been shown that exercise contributes to healthy immune system and so we all should be exercising whether that be vigorously or walking several miles a day or several miles a week that it those are all part of the normal and routine things that we can do for our selves our health and tangentially are immune system. A couple of words about children children are not immunologically superior to to adults so matter of fact you could argue that children actually are immune mission in immunologically compromise when it comes to adults so we know very well that neonates are immuno compromised individuals they don't handle infections very well yet they do very well with Covin we know that babies again infected with code don't seem to do very poorly children seem to do better with Covin for not for other reasons probably the most important is that they don't have the receptors necessary forty for them to become infected and so that may be part of the reason why we don't know anything about their immune response to covert yet at this time and that will be essential in developing adequate vaccines for their use if it's decided that they are candidates for vaccines. With regard to your comment on the study. So I'm. The report is valid in itself because. It has a set of individuals that even if a symptomatic would have been script spreading virus and the close personal nature that you have or that at least I have when I have my care cut means that we have blocked that transmission it would be unethical to do a double blind or a blinded study where we would not allow half of them to have a mask and half of them to have a mask right that's not gonna happen into the system because we have rules and regulations about the conduction of what the conduct of research studies so we can't do that even today if we sit as we sit here right now there is a very significant debate about whether we should in fact intentionally infect recipients of the vaccines that are candidates for release in the in in in the treatment of individuals right should we really test these vaccines by allowing them to be come exposed right so we do that it hasn't even been answered yet and it will be a very difficult decision in the future. I think that it is important to forced to wear this mask many of us who are physicians and nurses you yourself probably wore a mask for prolonged periods of time in the intensive care unit I certainly do because of my work and Studies from Stanford of showing that you do not retain CO two with this mask with these mass even an and ninety five that yes you do breathing you breathe out CO two and it is rapidly to fusible and it's eliminated very quickly at with regard to toxins I'm not quite sure what you're referring to I would be happy to address a specific question that you had about toxins but Thaksin elimination through breath is is generally not something that is done it's CO two and that is probably the toxin that you're referring to if I can if I can infer that a but that is easily really eliminated through a you through even with the use of the mask this type of a mask can be used by athletes they can train with it if they wish. That's all happen now let's get back in the queue the fathers have question thank you Representative thank you of. Well I guess it raises another question adductor mail from me with your background in pediatrics and the schools are getting ready to start up and they're trying to put their plans together and I just heard this morning that the children and it is very low that they might transmit coded to adults. And course when the going back to school younger kids are not going to be required to wear the mask Lee some of them is that true Izard science behind that were so so if that's the case teachers would probably feel a lot better about going back to school so would you address that please sure I would be happy to represent. So there is data to suggest that children under ten do not transmit the virus into the it to the adult population very well I'm and that may also have to do with what we discussed earlier with was represented Bentley is that they don't have the receptors sufficient to get the virus out of your of your respiratory symptoms. When you get above ten then you become a better a better propagator of the of the vaccine and we know that FOR other diseases so for example tuberculosis the older you are the better you are spreading tuberculosis we know that young kids don't do that so definitely that's been shipped that that there is data now to suggest that that's coming from Europe and from the United States is in an absolute protection FOR teachers no it's not but it means that there's less of a chance to be spread and again the issue of of of social distancing using the mass when appropriate masks can be used as as young as two years of age the CDC recommends a for for a down to two years of age our the mass mandate and for most things that we have recommended here in the state children under ten don't need to wear them I'm in part a lot of that has to do with the fact that they won't keep the month but let me say this I'm practicing a pediatric infectious disease a subspecialty so special the matter of fact this afternoon I will see my patients with infectious diseases I have had patients two years and younger up to eighteen months walking around my room playing with stuff with a mask they don't take it all. In my visits are half an hour to forty five minutes with the parent talking to them I examine the child and the children seem to do very well out there are actually and I cannot tolerate this right and you know but but they can't take this they can put it and they can leave it on certainly in school it's a challenge especially for the very young ones but I think it could be done if it was necessary we don't required for kids under ten under ten years of age. I agree with you about the children I've got a three year old grandson he thinks it's cool to wear the mask there you got a seven year old brother done one where the so I mean I agreed one more quick quick question I get back in here but I just I think this is new date I just heard this morning you know we you hear a lot of information out underlying conditions not cove it but maybe war war deaths occur they have some other underlying condition and on respiratory issues is one of those I think heart issues is another one on the card might be the number one underlying condition I heard this morning but the other thing new data that came out was a lease city and they said obesity I think nation wide is number two and in some states is number one. so is that does that fit in your data the agree with that I do agree with that Sir so I I wouldn't say that it's one or two it but we would say that is a it is a risk factor right so if you are overweight right and if your beasts not just overweight obese I'm if you have a cardiovascular problem okay heart disease congestive heart failure if you are diabetic okay then those certainly those are some of the risk factors that will place you at greater risk for for having a poor outcome was covered I believe there's a recent more a recent CDC morbidity mortality risk weekly report that showed that forty six forty eight percent of all persons and died due to cove it had some underlying medical condition that placement risk ages a risk okay I have entered the age group where where Covin has a a worse prognosis. All represented more you're recognized for a question. Thank you Mr chair of secretary Romero welcome it it's good to have you here today and be a part of this hi I guess my first question and then I'll part have to be back in the queue for for additional ones but you really kind of talked about two things one you talked about the masks and you know I think that there's plenty of evidence that suggest master effective in preventing the transmission of covert nineteen and probably a whole host of other viruses the other. Thank you brought up though is the mandate so one of the things that's kinda did it and you know the question that I've had that I haven't had a real good opportunity to ask is yeah we had mandates in place in Washington County as specifically Fayetteville and then one in Pulaski County specifically in little rock but from the outside looking in because I don't get to see all of the data that goes into you know the state I don't know which cities that the in from outside looking in the cases continue to rise in Washington County. Disproportionately where there was a mask mandate and I also seem to be rising in central Arkansas in Pulaski County so. Where they just not rising from citizens of those cities or so what can we talk about that shows the effectiveness not of the mask but the actual mask mandate thank you yes so the. For you to see a change in this is this is based on on what was published in the modeling data from CDC out from you at the U. M. S. you have to have at least fifty percent of population adopt the mass okay so if the recommendation for the mandate is in a localized area and there's influx influx of other individuals to that area that will certainly wash out the effect but we need to do is be able to see a long term. System wide use of the mask in order to be able to gauge what the impact is as I said before their studies now that show that in states where there is a mask mandate in place or has been Mandy has been issued and been employed there is a downward trend but I think it's in it's still too early we don't expect to see and I actually think it's a bit early but two weeks is probably the earliest we're going to see about a change before we can actually give you data and I can't give you city wide that I'm sorry I didn't come prepared to do that but I can certainly look and see if there has been an impact in the cities that you mention. Senate represent born. Okay. Representative Payton you're recognized for a question. Thank you Mr chair sector Romero You're obviously a very experienced highly qualified physician and I'm an auctioneer that's my profession I had to come to terms with the fact that when I got elected now politician and you are now in the executive branch you're the secretary of health so you're bureaucrat. But the. I operating outside of our profession and recognizing that we are members of government. I think it's prudent that we. Begin to ask where are the boundaries. You mention that masking you believe it I believe it to a very effective hand washing very effective social distancing. Are effective. It's been not talk about that diet and exercise and sleep and obesity. Very effective are very influential things in preventing the spread Miller and the infection. Where are the boundaries on what we're willing to mandate. Where do you see the governor's proclamation on giving you the authority to mandate things to stop the spread accompanied. Where are the boundaries on what you can mandate. Are you going mandate hand washing are your mandate social distancing. I'm a we've recommended those things but the mask is the only thing we mandated. But it seems to me that the interpretation of the executive branch right now in Arkansas. Is that the secretary of health shall implement mandate anything. That will stop the spread. I'm interested more those bought boundaries are and where you see your authority being. Checked by the executive branch by the governor or where you see it being checked by the Legislative brands. What things do you see that you would have to come to the legislative branch before you mandated. Or is it just. You. Can you answer that. Thank you for your question that Payton so I am not a politician nor I nor am I an attorney so I will ask our my general counsel please join me here at the table and address that issue. Please include yourself for the record. Thank you Mr chair lar sue and general counsel for the department of health. With regard to represent a Peyton's question where the boundaries on what are we of where the boundaries of what is is that needed to be mandated. as stated in the the governor's executive order he does have power under the emergency powers under title twelve and he is use those powers to direct the secretary of health to order the directives that would have been issued thus far the mask directive has been issued based on scientific data it is data driven and based on science as one of the multi pronged targeted. Pieces of the public health emergency in order to address the code crisis and so the executive branch has used its emergency power and declared the state a disaster under title twelve and directed the to the secretary of health under title twenty to issue the directives and orders thus far if I could follow up. So you think currently in Arkansas code. The authority exists for the governor. To mandate any of these items we've talked about. The in his opinion are properly vetted scientifically proven to be effective. Under title twelve under the executive power and in the emergency axe he does have that power to direct the secretary of health to utilize his public health emergency power and the courts have upheld the actions taken that's far in executing a third a cease and desist order against a book an abortion facility the eighth circuit has upheld our power back in April to do so I understand that. So my question is the other things that we talked about I'm a we have a very experienced medical professionals and they're saying they are scientifically proven. To help stop the spread. So you're saying currently in Arkansas code the governor has the authority to mandate hand washing to mandate social distancing. Maybe even diet exercise and obesity. If he has the scientific data to back that up that it's effective is that right I think the department of health has been issuing guidelines and recommendations on those types of issues for years we have sanitary practices we have rules and regulations. Not what exist in Arkansas code. You're saying that under the emergency powers act the governor has that authority is that right he has the authority to direct the secretary of health to control the disease okay so. What limits on personal. Liberty freedom would exist under that. interpretation of the code. Obviously that would be up to the courts to decide estate interpret the loss so healthy individuals could be quarantined. If it was proven to help protect them that's a that's a possibility so if we declare the emergency on sexually transmitted diseases we could totally wipe them out. By telling people they couldn't have sex Gooden. I don't know that we would go that far well I'm asking what what in the code stops us from going that far their specific statutes that deal with sexually transmitted diseases and we've used those statutes that you all have written to but the statue that is people dealing with sexually transmitted diseases we've also issued orders and dealing with tuberculosis in order to control right was this if we believe this that you're doing is in question is the merger to power to act correct you're not tourney that's been brought to the table to comment on the governor's authority under the emergency powers act. And what you're saying is under the emergency powers act there are no checks on his authority to issue these mandates limiting people's freedom and liberty. I think as long as there's emergency the authority is under title twenty four the health officer the state health officer or the director of the department of health or the secretary of health under twenty dash seven dash one oh nine and one ten well I will get back in the queue I appreciate the liberty let me go on there Mr chair but I find it very interesting you didn't mention the Arkansas constitution at all thank you. Senator hammer you're recognized for a question. Thank you Mr chair and this is for a doctor Romero if you would please and if under over here Sir thank you Sir thank you up. If mash. The purpose where the mask is to stop the spread of the disease or to stop a person from becoming infected with the disease which one or both it is primarily for limiting the spread of the disease the mass these types of mass the the general mass that we are using in public to not prevent infection of the wearer the medical masks that is the in ninety five mask is designed to do that okay and recently I was trying to pull it up I can't find it but recently I think an article came out that as far as contact you know surface contact that they've kind of determined that that's really not an issue what you what your comments on that I'm I I I think that to sort of been walked back that was a I think there was a comment by the by the World Health Organization and that has been walk back and the virus is transmissible through contact that is you touch and environment and then touch yourself and infect yourself so it's it's not the primary mode of transmission but it can occur it's one of the reasons why we recommend and you'll excuse me for touching my mask these mass slip down I know you're not supposed to touch your face but this is why I'm doing this is because I have to pull it back up over my nose We know that the vote that that's why we recommend sanitation that is sanitizing the surfaces. That premise that that idea is not new in many of the respiratory viruses in children they are spread through contact. Okay and so why would it not be and and I thank you know the answer one here your answer why would it not be good enough that if I'm concerned that I might catch it. That I would be required or requested where the match but if I'm not worried about it I would be mandated to wear the mask. I'm sorry Sir I'm not sure. If a general question okay so it. Why are we if I'm concerned that I want to catch the disease then out of my own best out of my own interests from our own health I'm or wear a mask why would it be okay thank you norm going I I know I know it now I understand the question Sir so so the reason why we ask you to please where the mask and and and mandate it is because it is a way of spread of decreasing the spread of the of the virus right it is because forty percent up to forty percent of individuals who have cove it do not have symptoms and you are most infectious in the pre and immediately after the development of symptoms so it is during that time that you want to prove that you want to prevent infection is meant much as possible that's why that's why the the recommendation is there because you want to limit the spread to others your our my wearing of the mask okay is my way of preventing at another individual becoming infected. What what is that time frame you just reference between the time the person becomes Be between the time the person actually contracts it and that most of. Probable time frame that they're going to spread it is it one day to day three day or so so let me let me say the the meat go back in and restate that another way so. You can begin to shed the virus seventy two to forty eight hours prior to developing symptoms. Okay and then remember that forty percent of all individuals have no symptoms whatsoever you can see you can shed the virus. It for as long as fourteen days after infection. Hey if you're a normal individual if you have a severe infection if you are immuno compromised and possibly if you are elderly you may shed at four twenty to twenty eight days. So it's it's not a finite period in which you can shed the virus everyone is different. And so the highest rate of transit of of shedding occurs. Prior to during the first days of of of infection and then rapidly falls off as you develop an immune response and again forgive me this mask is slipping down my face. Okay the last thing I'd ask you use you know at I'm not a medical professional Lehman just try to sort things out. How do we deal with conflicting information even the World Health Organization is flip flopped on some the stuff so much that you know we sit here's lawmakers and policy makers and have these debates and after awhile credibility becomes in question as far as you hold up to reputable physicians to reputable organizations to reputable whatever and you know they don't agree with each other and here we are in the middle spouse decide who to believe in line up behind to take to the point Representative Payton no you know we want to protect the nearest and dearest as far as our constitutional rights so give me a little guidance in response to that who are we supposed to believe sure so I think part of this has to deal with the source itself is the source rep to be reputable and is it peer reviewed as the information you are receiving okay been reviewed by other experts in the field and a word of that in the information age that we exist in where information is virtually instantaneous that is a study or information becomes available and it is rapidly shunted out into the public okay without peer review we can have exactly this issue where we have if you will dueling recommendations. My approach to this is to look for a reputable source that is what our sources that I consider reputable which are scientific sources within the United States and use them as the gold standard for determining whether a recommendation should be followed or not many of us in medicine did not agree with the second group with this recommendation if you're talking about the the World Health recommendation about contact and I think we've been proven correct that you can still spread this virus to contact. Thank you Mr thank you Sir. A Representative Sullivan you're recognized for a question. Yes Sir I. Thank you Mr chair. These kind of follows along Representative Payton is quest line of questioning we talk about the governor had an emergency order. And then we ended that and started second emergency water which actually extended past the hundred and twenty days are there any limits on how many and it was an emergency order as I understand it was for the same emergency so actively we have an emergency it ended we had a second emergency which was really the first one just to extend those days how many emergencies can we go through to continue to extend the hundred twenty days. Again I will ask I work our general counsel to please address that question. Representative Sullivan it's my understanding that the executive orders are at a time limited and that's why there had to be one issued in March one issued in may and again one issued on June eighteenth which I believe expires in August there are time limits on those in the governor's review they needed to be re issued because of the data and the science and the numbers that he seeing the fact that the numbers are not where they need to be and he's concerned and he's trying to add further directives and guidelines to help get our numbers down well I understand there's a lot of rationale I'm I'm just asking. How many times are we going to experience an emergency is the governor's authority to. Continue to put out emergency orders unlimited. Again I think that's up to the courts to decide I know that and some other states have had some lawsuits that if address some of those issues I want as the let me ask you is it in your views and she would be defending this as the attorney do you think the ability of the executive branch to continue to extend the emergency is unlimited do you believe that not the courts do you believe in this. I would defend are authority thus far I think all of us had hoped for the best and prepared for the worst and had hoped for an end or better numbers at this point I know what we're all agree with that I mean you're you're kind of dodging the point I think you Dodge that with Representative Payton you know the fact is it appears that based upon the letter that I got from the department of health that the director of the department secretary department of health is powers on limited to enforce the rule and it sounds like it's on limited to declare an emergency thank you Mr chair. Representative right you're recognized for a question. There thank you Mr chair of this. I thank my main concern at this point is for the children of the state. basically within a month our kids will be. Either going back to school on no. Mr US senator Ingram an hour's talk about this the other day You know they might not all be able to go back at the same time we don't know. You know these things may have to use some type of a satellite for part of our kids or something like that for a breakdown but let me ask you this Sir. If you can visualize a month from today if our kids were going back to school. What do you think would be the things that we would have to have in place to make things safe and that we would know everything was going in the right direction as far as maybe checking favor a distance seen a script all the things that we would have to do on the school bus in system can you give us a little bit of what you think would happen there. So I will let attempt to answer that is as a hypothetical and again with the the following in mind that this is a fluid situation our numbers today on cove it prevalence in the state may change before that so the a a P. the national a P. the CDC have all stated that children can go back to school if it is a safe environment and that will depend on what the prevalence of the disease is in the state or on the county level that is whether we can make sure that there is appropriate social distancing as necessary whether there is a masking four children where appropriate and transport to and from schools with appropriate safety measures in place. School lunches school meals with appropriate safety measures all of this will depend on what the instance of the of of the disease the prevalence of the disease is in any given location so. Nothing is I think a statewide issue we will have to be determined at a look at a more local level as we go forward and certainly. What happens between now and then we'll have a great impact on where we are the governor has already decided to delay the start of the school year by two weeks in order so that we he you all can have a better idea of where this virus is in our communities at that time. Thank you Sir thank you Mr chair. Representative Bentley you're recognized. Thank you chairman. Doctor Meyer as a Representative of represent thirty three thousand people and on their voice someone as a couple of their questions that they would like me to ask you what have in front of me do you have any plans to mandate a vaccine for the citizens of Arkansas as we move forward. I cannot answer that question because we do not have a vaccine at this time uh vaccines are while off I am hopeful that those vaccines will become available I foresee that at the earliest we would have a vaccine available. The very end of this year beginning of the next let me have also to that that vaccine will not be available to the general public it will be available to the essential infrastructure of our communities and our nation. It may be several months after that before we have a vaccine available so at this point I don't think that we can even consider mandating vaccine because we have no vaccine. Approve. Proven was signed to that do you think the mass government are necessary and you see that in the future I think people are very concerned as well they're very concerned about this mask mandate because of the thank my forced to do something by the state because you St it is scientifically proven to stop the spread of this if you're scientifically proven that you can stop it with the vaccine that you will mandate a vaccine as well so I know it's not I know this is the radical but that's what we do when we set policy as a thing about things in the future so that's that's their concern and I were really like you to redress that that thought there. As I said we don't have a vaccine at this time there are there are at least five vaccines in that works so I can't make a statement regarding mandatory vaccination because I have no idea what is going to come if they have a vaccine that. Doesn't work there's no need to or doesn't work effectively there's no need for mandate so. I'm not dodging your question what I'm saying is that I cannot make a rational. Answer at this time based on the limited information that I have about vaccine development and rex in availability. So we have issue here with this so give us your does this have the authority to mandate a vaccine under statute announces mandated a mask if it's shown to be scientifically affected the taxing again I will ask our general counsel a true please come comment. Under the law now I believe there are some exemptions for vaccines we have the religious exemption then the philosophical exemption so we would have to look and see if those would apply in a pandemic type situation obviously there would be some folks that are that have underlying conditions that would not be able to take a certain cut type of vaccine so there's all sorts of factual scenario that would have to be addressed at that time so again my question though is in direct miss you is it do we have the authority to do so then ask you would prevent have to may present exemptions in there as well but many exemptions in here for the mask mandate do we have the authority to issue a mandate to mandate a vaccine. I miss you would you pull that Mike will be closer. I'd have not research that thoroughly and I would prefer to answer after proper research and thoughtful consideration it's my understanding under the rules as they state right now that the secretary of health has broad authority to control the disease and so that would be something that would be taken into consideration but I had not considered that since that's not an option at this point. I would appreciate it for my constituents to aspen asked this question if you would research then get back to us because it's very important for them to now that's their concerns right now my next question is from another constituent if the mass mandated so effective why do we see this top five states with the highest death rates with a mask mandate night into this top five states with this five states with the highest death rate for code at this point of all had amassed mandate in for quite some time so if the mask is so effective why they still have such a high death rate. So I have without knowing which that you're speaking about everyone asks I can I can tell use a Massachusetts Maryland Connecticut Rhode Island and us see those five. Yeah New Jersey was the other on the top those the fob five states top five death rates in the nation right now with code and I've had a mass mandate in for sometime. So I don't have their I don't have their actual data to date so I can't really comment on that so the mass mandate again you know if. If it's used appropriately you will decrease the incidence of the disease in your state if it is taken asst a foothold in your state that it will take longer for to become effective in reducing the number of cases so without really understanding their their their their death rate per person in their affection rate per person that it is difficult for me to say there are more there are better indicators of whether this is controlling this being the mask is controlling infection and that is hospitalization would be one right and so it would be interesting to see what has happened to the hospitalization rates as well as our community incidence rates so I I would be happy to answer that if I had that that I'm from if you could get back to us with that I would appreciate it my last question chairman I really appreciate your life here allow me to ask these questions this is I want to read you something from another constituent because again their voice here and this is for a woman and it isn't really have to the mass but I want you to hear this woman has to say about her mother in a nursing home and I would like your to ask a question when I get done reading this. Governor Hutchinson my mother is a nursing home and Newport Arkansas she has been secluded in one room for almost five months she's deaf and can barely see I'm asking you to let one person one family in to see her we could follow whatever directors that you ask a mass clubs again anything we want to do it mother has said she's going to die if she didn't get to see or feel her family's touch it is so sad to go look through a glass window at her not being able to hear us she cries while we're at the window she tries not to its breaking or hot hearts and causing us to having citing depression you're hurting her a lot more than the Kobe nineteen being long Senator is a terrible thing when people don't talk to you or interact with you and I know with the nursing home the really busy and we understand but there's no interaction just what is necessary there's thousands of others that are in the same shape as I am my mother can't here I can't call her or anything so please we're asking you to open up the nursing homes in a way that we safe. Would allow to follow protocol whatever so we have so many constituents out there that are just desperate to see their families and I'm asking you just a question I know some other countries are using small doses of Hydroxycut or Quinn was ink and they're at least so that they can be more protected do you see any of the living in that so we can get some help to these these family members of the might be able to see their parents. So the question is the use of hydroxy core Quinn and zinc or anything to have anything that we can do to help these folks give them some hope that they're gonna be able see their elderly family members of that's not answer do we have anything else that's my question yes ma'am so the governor has relaxed the visitation restrictions and those are in place A. I've received and my heart goes out to your constituents I I understand what she's saying I receive calls and brother I receive emails from parents of residence at the Conway human development center where I am the infection prevention physician I can. Probably sense there their desire to see their children and so these rules for isolation restriction have been released okay as regard to hydroxy Clark when in sync these are all anecdotal these have not been supported by medical studies at this point I think that it is unwise to proceed down this line of of of of therapy we have learned. That the use of hydroxy Clark when although touted by many to be almost a panacea for the prevention or treatment of coved has turned out to be the opposite that is it has been associated with increased death. So I think that before we adopt a new therapeutic regimen it needs to be carefully study or S. carefully study that's possible in today's environment. I have been asked this question before I've been asked this question with regard to prevention of disease in adults and I do not recommend that and I would not recommend that we proceed down that line. And you have no other recommendation will be due to help because I know that we we have removed the isolation but they're still many facilities that are not open up we live in a sue happy generation you know and I know that ministers are very leery you know is it to go twenty eight days that I cases before they can see anybody so they're many facilities that are not open many facilities that are not open because that's the case and we know that you know people are soo happy so I know that you not recommending that is there anything else that you can recommend that maybe those weakens. Increased the rate one of these people to be able to see their for their loved ones at this time we don't have anything that it is is planned to recommend we continue to look at options but I think it at this time the governor has relax these these recommendations for isolation. Thank you thank you Representative Representative flowers you're recognized. Thank you Mr chair. doctor amero I just had a couple questions and I want to give a little bit of context I've listened to day and certainly before today and have my own personal experience with coated. And during the time that I was in quarantine for a month sauce so much change in terms of what best practices were and what we were to do in including the our revelations that the virus is airborne and spread through talking and breathing. And And so I can't help but look at I think what matters most in determining what an emergency is and what. You know why you why the CDC and even the who. would prescribe these guidelines as well as mandates that we're discussing. And so I'm I'm looking at. First of all the. The death toll and the the death impact rather. When I was first quarantined it was fought and said that babies who couldn't die and while I was quarantine the first baby died and I most recently saw where research or and data is B. is showing that now more babies are dying. also more recently I saw where a symptomatic people who were earlier thought. To not be a danger and endanger our now considered more contagious and may have a higher viral load. And I guess my question is with all of the sort of growing guidelines and recommendations. And and we're seeing more the death toll reach and cepatlah well Sir pass. for example flu deaths which. This virus and the disease have been mistakenly compare to. For example the CDC has estimated that from October to April the highest range. Would be sixty two thousand and deaths this year which would if you average that out to a year would be about a hundred and twenty four test for the whole year. Whereas in four months or so we've seen a hundred and fifty thousand deaths in the country already and growing. Is this virus mutating that's my first question. So if. The virus has had some viral changes in its. In its constituent proteins but those mutations are not considered significant mutations are expected and and I don't want to get too much into the weeds and let you unless you want me to but this is an army virus and when I talk about our any viruses it to the public into my medical students I would like in our in A viruses to an assembly line without quality control so it is a virus that will make mistakes hundreds of mistakes and that's what allows a virus to shift over time that's what makes the virus so difficult to have a single vaccine to prevent flu. So to expect that the changes yes we will expect them are the changes that have been observed in any way making this virus more lethal or more pathogenic that is the ability to cause disease no they have not been linked to that but you are correct there are mutations in. We represent the. And you have a meeting that you need to go to I just what time I'm if if I could it be excused with your permission I'm at a quarter after I can make that meeting no that's meeting you can't reschedule it's it's with my boss the governor. I would think they could be rescheduled I I I don't know Sir We If I have we have the eight people in the queue I mean is this. Yes. And to this group understands understand if it's something that cannot be changed but. These people here feel like there is a branch of the government just as important as the executive branch understand Sir if I could ask my chief of staff to please it make that call and it didn't you she will in it advise please I would appreciate that but if you can't change it maybe you can come back later in the day I'm so not yes and not to make excuses Sir I have a clinic schedule today as I said before I'm a clinical on a clear pediatrician and I have patients scheduled some of them travel many hours to come to see me I understand that that's mine that's reason for my question yes or that's the excuse I've worked to use I'm sorry okay. A. Yes committee members the please be sure in your questions and the specific go straight to the question if you would. represented flowers university thank you so much if you could just comment to on I know that there's a lot of information out there can you comment on. where we are now with what we know for sure. As it relates to the hospitalization and death of children babies healthy adults because I think that kind of flies in the face of what we think we know and how we've been proceeding. So Let me begin by saying that because this is a new disease and we didn't under we did not exist really until November of last year to reach our shores until January we are learning a lot and learning as we go as on the fly if you will. So at this time approximately two percent of all infections the reported from cove it occurring children. We know that the morbidity and mortality for children overall is far less is in adults. we know that there are now syndromes that we're not described previously and probably will be more syndromes that are described in the future related to this infection. The most recent of which is something called Missy or miss or multi system inflammatory syndrome of children a disease that is like Kawasaki's disease a disease that that we as pediatricians no and myself and my team is infectious disease specialist treat all the time. we are seeing these cases in the United States they occur at an incident much less than callous Saki's disease they actually tend to affect minority children that is African American children and Hispanic children more than they do Caucasian population. We don't know why we know that it may be we think it may be an immunologic response to the virus but we have not seen this who exaggerated numbers in our state in our state the vast majority of infections in children I have been it but nine we've had some children and I think the last number I so we're six admitted for covered related symptoms none of those children have died I think only one or two have been in the intensive care unit and we have not had a case of confirmed multi system inflammatory syndrome in children at this time we are and I've for reasons that I think you will on the stand have a very keen interest on this disease at this time. Thank you and finally I I have seen a number of things that we can do and we all have been privy to that information here through several committee meetings the testing social distancing contact tracing hand washing and of course mask use. And as I you know listen to my colleagues in think about you know many ways in which the government regulates and mandates that we do things from smoking in sexual behaviors particularly as it relates to HIV aids and the possibility of conviction of a crime for example we saw that a lot with it at the beginning of the research and treatment of HIV and aids two the mandate of vaccines which we do today two children who were going to school if they're going to go to school. speeches regulated we're mandated to pay taxes and so. I guess what I'm thinking about as I see and by area where before there was a mandate people did not take it seriously and did not think that it was something we needed to do now Walmart many private chains many private stores are mandating it and I see several more people in my community now wearing masks I don't go anywhere and most people don't have them on. For the protection of others as well as ourselves. my question is is there anything else that we could do that would have as great an impact of prevention as wearing masks given that this mandate was handed down during this health emergency where over a hundred and fifty thousand people in the country have died in four months. So a there is something else we can do but it would probably be very unpalatable. And that is. Self isolation. Right so in countries such as China Corea. Where strict draconian if you will. Rules for isolation in place were implemented the virus is brought under control. In our country in our society with our laws that is not possible. I think that this is at this time. The best chance we have of bringing this under control. And so I think that employing this mandate is a wise decision is not a decision that will arrive that light just to be clear we're going to go down the list we've got a bunch of people and with questions Representative they meant I'm I have a written response from the governor he said to stay as long as our questions thank you thank you Sir A center when you're recognized request well that's that's good and I appreciate that yes if I could leave the table and that way the doctor merit could speak without his yes thank. That actually Missy my question might be for you I'm sorry. At actually for both of you. I know that we have some issues pending before the legislature and I know that the department of health has acted in a intense coordinated. Way to issue contracts for contact tracing. And I know that within those contracts they followed an emergency procurement process is that correct. That is correct and in that emergency procurement process. That this legislature put procurement laws in place we reforms that could be Kermit laws and we put those in place and I know for a fact that that those contracts. Followed those and that that is what you follow it so within that process of the laws that we have on the books for procurement there are deliverables that are measured is that correct in those contracts that is correct okay so we have deliverables that are measured in the contract that went through the procurement process which we have laws on the books that guide that process there's a reason for that procurement process. The reason for that procurement process is to provide FOR integrity in the programs is that correct. Yes the reason for the procurement process. Provides not only integrity in the programs but integrity for the program as to hal reports are coming to you is that correct. That is correct Stephanie Williams is our chief of staff and she's helped oversee some of those right but I'm talking about the correct from but from a legal perspective certainly those contracts follow just like other contracts that you've issued and these two companies have been contracted General Dynamics. And a FMC correct AFMC has operated a call center I believe for DHS for the past four years that. That was part of I think what they presented as to their credentials. But program integrity is important because it has to be coordinated in the house to be consistent. So that includes how things are being reported from the department of health. To those companies. And how those companies are reporting back to you. So that there's a coordination and I understand that there is intense collaboration between you and these two companies on how this program. Is operational. Is that correct that's my understanding yes I also understand that within the terms of those contracts that they were comprehensive and that included statewide coverage and included all populations including minority populations is that correct. It is Senator to be five minutes I think the chief of staff what Williams of the best here at the table because she understands this at a granular level that's fine in San admissions if we make. You're also the director of the department of health and so I also want to make sure that I get answers from you because you're the director now the interim director of of of department of health I fully understood though you are in effect the clients that these companies that we've hired work under and so your direction and your as part of this is very very important and I I believe that this needs to be very court native so that there's consistency but I also want to ensure that there's program integrity and the best way to do that is to operate under the contract that have been executed and the procurement process that was followed that respects this legislative body in this legislative oversight ability and the legislative oversight an audit components and so those are the questions I'm asking it was given in public health testimony that these these contracts we're going to be comprehensive and that they were going to be statewide is that correct. Miss Williams it. Good morning yes Stephanie Williams chief of staff Arkansas department of health yes ma'am when we issued the contracts we issue those in early June they were intended to be comprehensive and serve the entire state and and and all populations yes ma'am so including including minority populations they were all include it yes correct those contracts have the ability to subcontract with people is that correct. If I am I am to remove my mask yes since some distance from doctor amero yes I'm not sure if those entities have the ability I would have to check to see a value okay they do because that that basically is how we operate there's a lot of content they they have for example translation services there have the ability to use what they've already. At contract with translation services if needed if they come into contact with somebody who might speak other than English or other than Spanish they may have that ability to do that so they do have the ability I is also my understanding they have the ability to react quickly and coordination with one another to where they can mobilize and move resources to address a certain area which may have a spike in cases I would assume that that would be something that you would want and demand within those contracts with those companies that they would be able to meet that capability if you have a spike in a certain region of the state of Arkansas or if you have minority population that you have that needs to be addressed that you would demand that correct in those contracts yes but you would that they would have the ability to respond effectively to that assessment in into your to your first point they might have the ability to subcontract I don't know if there's a willingness to subcontract because we haven't had those conversations I get so as I just to be clear in my answer I'm sorry is so yes we do expect them to ramp up when we went before peer earlier well last week now we were asking for a supplemental appropriation and it was with the intention of increasing the contracts to both of those award eighties okay because we now need to create additional capacity to do both contact tracing and case investigation okay so that's what that supplemental request was for put forward by the department okay okay and that's for those two companies yes man right okay and so I just wanted to get some clarification and to be fair I'm gonna ask you. Did you and I have a conversation about this a couple of weeks ago about my concern we've had several yeah we've had several conversations yes I wanted to put that on record we have had several conversations about my concerns about program integrity and how this needed to be coordinated operational and through coordinated and comprehensive and collaborative to for a state wide strategy in a statewide approach because utilizing the contract in the procurement process is the right thing to do and we have the ability to address where we need to address different populations and I know for a fact that one of the companies has already hired several individuals that speaks Spanish which you do I'm sure as well thank you can help in that manner but that that this is a coordinated collaborative efforts and so I just wanted to make sure that you and I had I've expressed my concerns to year for the past couple of weeks about how this is all unfolding thank you for the questions thank senator members to be fair I a cut off Representative flowers so I'm I'm limit everybody two questions and I'm also going to skip over people that have already asked the question so you will be put at the bottom of the king if you've already asked the question. So. Representative della Rosa. A you're recognized. Thank you Mr chair I've I've been writing questions this entire time as people and I appreciate you taking time out of your meeting with the governor I drove three hours myself just to be able to come and answer questions because this is the number one or ask questions because is the number one thing as you can imagine that I'm hearing about I have more philosophical questions than I do medical questions because I I here on from you I hear from the governor all the reasons why we should wear masks. My question to you is do you understand the resistance that there is in our Kansans for wearing masks do you understand their point of view on this I know you understand the medical point if you obviously far better than I do my question is do you understand the other side and if so could you articulate that. My understanding is that it is an issue of personal freedom of ability to exercise your right uh to wear the mask and not before not be mandated to do so that is what I understand is being the primary reason why but I am certainly open to being educators to what other reasons there are that Cause reluctance for the use of mask. So the movie. Take you further down that that logic. When does this and I think that it from from the point of you at least for mine and from what I hear it's not just the mask. It's windows this season at what point do we subjectively decide we are no longer in an emergency. Because that criteria has never been given in fact goal posts have kind of been given across time within the keep changing maybe when there's a vaccine will now we don't know you know because we don't want the vaccines going to do there is there is no end to this and I think that that's one of the biggest frustrations that I'm hearing is we are being told we have to do something not for ourselves but for the good of all which is a very socialist thought process in and of itself which is very scary for a lot of people it is for me I can tell you because once you go down that rabbit hole what should we not do for the good of all you got to remember your representing the state here so you're the state telling people they have to do this so when does this send I mean you're the one now advising the governor on this so I think that's a very valid question at this point time is what's the criteria for ending this would win. When does it send. So the answer is we do not have quite to reform the sentence because the disease has not even begun to be brought under control. And to talk about in and before you have control doesn't allow you to to put in measures that aren't the put in place measures that allowed to mitigate disease so. The simple answer is we can't give you any points because the disease is still in evolution. Okay let me rephrase that a different way than actually a different angle on that where does it end it kind of goes to what Representative Payton was asking. See not only do we not know when this is going to stop we don't know where it's gonna stop by there I mean it once once we get into this territory in this is for everybody else in the room as well because we're the legislative branch this is supposed to be us making this decision I would like to point out. Once you get into this territory where you're managing people's health the a mandate I don't see an end to this as Representative paid so I don't see a boundary to this because you start looking at cancer death rates or heart disease death rates which are far higher than coronavirus death rates are think of all the things that could be mandated for us to control everybody's health it's all for the public good. That's the crux of why people oppose the mask mandate it's the fact that you're telling people you have to do something for the good of others there is no in point to it and there is no boundary to it. And the frustration I think that you're saying from this side I mean I I'm I'm sure you can feel it the legislatures angry we're very angry and I think the very fact that we're having to ask you what law is going to be made regarding vaccines or things like that is the crux of the issue that's our job that's what we do that's our branch of government. It's so there's a tremendous amount of frustration here against the executive branch there's a tremendous amount of frustration from the people against the government and I just wanna make sure that you grasp that because you're the one trying to advise the governor on balancing medical need versus social and economic and and freedom and all of these other things that I don't ever hear these other things being talked about all I ever hear is the number of lives and we can save if we do something. There are so many other factors out there and that's what we do and that's the big frustration in this room is the fact that we do not feel that we are heard. The voices that we represent are not heard I can tell you how many people I've had to tell on the phone sorry there's nothing I can do we don't have special session we can't do anything by concurrent resolution we don't have input on as I can write a letter to the governor the same as anybody else can that's it so we power I have. So I just wanna make sure that you and your boss understand what's really going on on this side of this room and also what's going on with people and you're welcome to respond to that this has been pent up if you can't tell for a very long time. You're getting your getting this aimed at you but there's a tremendous amount of frustration and a tremendous amount of resistance and is going to continue growing I think if we don't start paying attention to what the people are telling us. So it's not the first time that I've said that I've listened to the frustration of of someone parents do this quite out quite frequently to me because they come to me after their child has been cared for for several weeks or months with a serious illness so I welcome that I welcome the education that you provide let me just add this master good for the economy. They are good for schools they are good for Arkansas because if we have a healthy population we can be economically productive so this is not just about health about protecting each other it is about getting us back on the road to economic recovery for we can economic recovery. Thank. Not represent the roasting will pitch in about make you forget further questions. Thank you A okay moving on to Senator Clark you're recognized. All and I have so many good questions limited to to send yes I heard you Mr chair. I'm just. Trying to decide. Director. You just told. Representative. Della Rosa that you didn't know. This is so open ended. Are you familiar with Sweden. I it's a good. What do you mean specifically about so when I know it's a it as a country it's location geographically Sir I'm not sure you're going Sweden didn't shut down their economy they were roundly criticized by the media by the world. Antill the World Health Organization came back a month ago and said they were model for the way to do things their their deaths are now down to less than two per day of their think they will probably have heard immunity they didn't shut down their schools that inch they did shut down of meetings to less than fifty. they had social distancing they had disasters and their nursing homes to be fair as well as other places to but their economy has been hurt for less than anyone else in Europe of the and they're now going back to normal months later so there's a time. Of. The. And you're not familiar with that model as the director. Of the health department in Arkansas I am familiar with model Sir. The in my are you open for comment at this time or should I yes I was open okay first of so Sweden has one of the highest death rates in the country in the world all excuse me excuse me. They have ten million. Forty thousand population Michigan. Has forty thousand less and has a higher death rate New Jersey has nine million and has three times the death rate that's just not true the U. K. E. Belgium I could go on and the United States has a heart will not the a size but it is right there with them because of the northeast because of New York New Jersey Rhode Island Massachusetts Connecticut of sold that's just not so. Go ahead. I'm so with regard to economic Sir there is a recent publication in the and then New York times it show that they are still having economic problems they have not recovered they are open that is correct Sir. But I but I'm not an economist and my job is to deal with issues of of health and so I don't think it's in my purview to actually comment about these things but but what you need to read something besides a New York times because that article among others they wrote have been refuted they in fact are doing much better than any other country in the European Union because I get everything that's been written has been from the idea that they that they were doing terribly it's just not so the and that is distressing. Of. But regardless there death rate is now down to less than two a day and they're going back to life as normal so. The so a time can be put on it we're somewhere in between. Tweeting. At an ever place else the. Are you familiar with the New York parabola. Amendment this part of it the important part of epidemiology right I it is okay so are you familiar you know we played in the curve in Arkansas are you familiar with the New York prevalent cases in this I'm not familiar with that term but if you will parabola in math this or you charted and it's the curve. I know what a parabola Sir. Well I didn't know which part of that you didn't. What you said Tara the New York prevalent on but where it looks like a high rise were go straight up. And straight back down so the the curve of of of infections or death Sir this I I I am familiar with their with their Kerr yes okay Cummins prison probability is somewhat similar. yes most prisons. Trouble if not all similar. I I don't know that Sir because I haven't looked at all parabolas for that or let I'm I have looked at a lot of them were you have a lot of people taught we concentrated the Preval has been very much the same. Is there a reason to think. Have we asked for millions of dollars for Cummins R. O. R. C. for treatment. Or pricing. Not to my knowledge that it's all part of the the. Check the contact tracing system that we have hello or the Marshallese different from New York from common's and oversee and why do you think today that were not passed. The mid point of the curve on the Preble within Marshallese. What multi factorial me the they're they're they're family structures are different they're very tightly knit the society is extremely compact we have linguistic differences and difficulties communicating our message to them there there way of looking at a health and and diseases is is different than classic in western countries so there are multi multiple factors it is cultural but see what we're gonna be able to check this later and find out if. Is right are we passed the peak of the core. With the Marshallese or are we not I don't know I have to go look at the curve in we have to go see what's going on but because of our past the peak then a lot of things were asking for is not gonna make any sense and I'm saying we're past the peak and will be able to look in a few weeks and see. On to senator brown. A represented brown recognize. Thank you Mr chair Dr Meryl I really wish the Arkansas department of corrections were here but you are so I'm going to direct this question to you with regards to the prison system because I have a constituent that has a big concern her daughter had served her sentence and was due to be released on the. Seventeenth I believe anyhow she was due to be released a few days ago. And some of the women in the work release program Thanks six of them her daughter was not she was at that Tucker unit but she was not out on work release but six women who work out once work release did contract cove it. They were not put back in with the population where this woman paused at Tucker they were put in a different location her daughter has already tested negative for cope at once she was tested again. Of. On the twenty first and will not be allowed to be replaced until August fourth and She has served her sentence in the end information she was given was that the department of health had instructed the prisons to go ahead and release these inmates. Can you please address that. Well I'd it did so I need to know specific details about her exposure so it would depend on what her exposure was and whether there were concerns that she was incubating her disease but I'm afraid I can't answer that question without knowing more about her circumstances. Well she was not on work release with these other women who tested positive and then. They were housed in a different area. And she had already tested negative. And it was my understanding and and they were told that the Arkansas department of health had instructed that the department of corrections release people who are eligible for release. So I would have to look into the case specifically I don't know if she had contact with these individuals before and also I I think that it is best for me to find out more about this specific case to see what it what the issue is. I wish you would because I think that this is very unfair to continue to house somebody detain them once they've served their sentence when their family is perfectly willing to quarantine at home if necessary understood thank you. Representative Gonzalez you're recognized thank you Mr are really kind of feel like this is a waste of waste of time but I'm all ask anyway just because we're here so I think we've already established that the health department governor's office believes that they have unlimited authority to continue this emergency declaration for as long as you deem were under an emergency I guess Do you believe that we're in the middle of a pandemic and what definition of pandemic do used to to justify that and if not then how do you justify us being under the emergency declaration. So we are in the middle of a pandemic a pandemic and FOR it rippled eyes to an infectious process the rig this is spread around the globe we are currently in that situation. To a large majority of the population right and it spread to one percent of the population of Arkansans but the definition of a pandemic does not apply to an individual state or city it applies worldwide so the infection so what is the infection right work worldwide I did not come prepared to answer that question but it is extensive it is a a declaration by the World Health Organization and it it would not be issued until it was proven that enough countries were involved that was that was why it was not issued immediately it was only after the requisite number of countries were were became involved that size that was placed in in play and remains in place. So you don't know what the what the population is overall population that it is it is the end because I made by definition it's a pandemic affects the majority of the population or a large percentage of the population and the numbers that we're seeing here in Arkansas just obviously don't justify that were one percent the the definition of the pandemic in implies worldwide spread. That is the definition of the pandemic not so much the individual country or numbers and occupation it is that it is a number of countries that are involved and so this is spread worldwide. A it involved virtually every country in the world. And that is why it is a pandemic. Okay. So the there are no measurable metrics that we're using to decide when we stop this or while we're doing this or that so what when do you see this you know coming to an end what we what are we looking for originally when the started it was to flatten the curve so we don't overwhelm the healthcare system it appears that we have we did a really good job of that starting out and by the numbers that I've seen it doesn't look like our health care systems are being overwhelmed so what what are we looking for is there anything that we can say you know Hey if we get to this then we can get past this we get over it we can get back to normal policy making that involves the legislature and not just directives from the executive branch. So again we won't make a recommendation for a pandemic that's not our recommendation. The decision of whether this is an emergency or a national epidemic depends on the number of cases throughout the United States is not just an individual state. We have not brought this under control. you are correct that we have not overwhelmed or medical system but if we do not implement appropriate measures to control and mitigate this virus we will easily do so we will be in the same situation as our neighbors our state neighbors and as New York was previously. The represented Gonzalez yes on my bill and a little bit I used to be a member of the World Health Organization want to work internationally for a large corporation in the death and I can't remember it's been a long time since I've looked at the definition but it's basically based on three things as the doctor said some number of countries. Of the percent of people infected in those countries and the severity which normally I think doctor maybe Greg is the number of deaths I believe but that's a severity so those three things in the world World Health Organization canned the Claire of pandemic which doesn't really control what we have to do as a nation nations can make their own decision on that but it's the local government. A decision as to whether it's a an emergency based on what the the who puts out on with that helps or not but yes it does but just want one more follow up question of something that I think I just heard you say that you won't recommend in this emergency not just one Arkansas when you feel like Arkansas's clear but when you feel like the nation is clear of this I don't believe I said that what I said was that the disease is not an emergency is it what will be an emergency until it's cleared and more than just Arkansas also exactly what were you referring to a national emergency. The decision that we make here for Arkansas is is the depending upon our local status and that is whether this is a national emergency or not so I don't think that we can talk about what the criteria are at this time uh we have a long way to go yet is is is is seen by disease and other states. Thank. Recognized for a question. Thank you Mr chairman Dr Meryl I appreciate you coming day I know with we your two ago you were in I believe talk business and you gave a quote saying that when it comes in mass mandate you wish politics work involved with it earlier in this debate you said that you're not a politician nor lawyer listen to some of your answers I think you make an excellent politician you've done a great job explain the different things what I want to say is I think that's a disingenuous statement for this very reason your in your position because of politics a political leader who was elected by a political process put you in that power position he made a political choice to was executive order to mandate this mass mandate in the a power that is vested in him was done to a political process via the laws that the General Assembly pass in the past when I look at this I sit here and think that this process itself is political not so much that it should be a Republican Democrat kind of debate but whether the people of Arkansas to their political process you have a voice in this thing and so we're not here every time we're legislator would deal with the issue we hear what you all said earlier about the scientific facts this is on their side this is hunter person indisputable you know how it is to be a legislator have an issue one lobbyist will bring use the scientific faxes one number sent must be voted on in the next day the other lobbyists bring you the scientific data facts that it can't be voted. In fact earlier I believe you quoted a study from China about doing this in my opinion is of reviews and such China's data as if the point for how we're going to do this that's of a state but here's my point. This is something that is not just a mandate to me this looks like a law knows represent of flowers mention other things earlier about smoking and things like that that was doing to a legislative process that mandates to people what they can and can't do through that process was there any real discussion. By you with the executive branch to bring in a special session to have a legislative body deal with this legislative mandate and put this on the books because I can see I've heard from dozens of people who have a problem with this not just the masked man it set mandated still but the process is put in place in the confusion and in my opinion poorly written executive order and some of the things that I mean it says an executive order that I please can't detain you but somehow they can give you a ticket at the same time so is there any conversations by you when would you advocate for special session to mandate this in the law rather through an executive order. So I will say that the aid I did not have the privilege of being involved in that and that thank you in that decision because I was not the secretary of health at the time those were discussions that were held with the secretary of state and the governor state of health for you Mister secretary of health FOR giving from speaking so no I I wasn't but I wasn't I wasn't present and will look okay a good answer commercial Thomas move this in the future if there is a massive mandate of this nature say vaccines say another lockdown say another issue that we have not seen on the on the future would you advocate yes or no for the legislative be called in to satiate the session to be put this in the force of law rather than to this back door executive order would you advocate that to the governor's office and in the public. I think that I can't say that I would I wouldn't I you would have to look at the individual situation that's a good politician thank you Mr. Recognize. You missed thank you Mr chair I guess someone of first address my colleagues because I I feel like I understand the frustration that the the my colleagues have. But it's an equal amount of frustration for people in my community and I will tell you this. We do not have this disease. We're in control we have about a thousand cases a day we went from where we were testing very little. To where we are building up by testing in more and more people are impacted with this disease but yet we want to sit up here and are you a doctor Romero about if there should be executive orders or if the this is a pandemic. Three. And so I don't know why we are arguing with Dr Mary role in the governor about what we should do. I mean if we had this under control then I could see if we went from a thousand cases a day to having a hundred fifty cases the day in there stand what we still need to mandate mask but we're going in the opposite direction and we're sitting appeal grin in arguing about it we should be wear a mask and I. I mean is we need to get a grip on some things. Is that a question no I'm I have a question now Mr chair. So we I heard people talking about the Marshallese population what were you doing in that respect. Miss Williams this is what I want to ask. And Dr American remember you can read you can have a response as well so in the supplementals that you said you asked for was this to include the the the peace in which northwest Arkansas council came about the the the the peace and they came about for context race and was this to include that. So no Sir represent represented left we had to proposals that we put forward and and only one was hard we had one in here which was a supplemental request by the department for care spending in the amount of sixteen million okay which was presented that was to increase case investigators and contact tracers with the contractors that we currently have the second request that you're referring to was specific for the Marshallese and Hispanic communities that was actually on the review. Know what I'm getting myself confused but that was that was a separate requests that was on actually was I will say ma'am county yes Sir it was before a LC as a supplemental agenda item and so it was never actually it wasn't presented on Friday because we didn't go to the supplemental agenda items but that one is specific it's a request that is for seven million dollars that was for care spending that proposal was developed by the northwest Arkansas council and they their membership eight hospitals in that area the cares committee has expressed some concerns about their initial proposal and they have been in the process of working with us to refine their proposal to make it more specific to working with the Marshall islanders with the more heavy emphasis on contact tracing instead of testing is still includes both but they've sort of flip to the the emphasis they also at the request of the cares committee broaden the scope of that proposal so that they would not only be working in Washington in Benton but they would also work in severe yell county Randolph County and independence county which all have significant numbers the Marshall islanders okay so with the two proposals that we have it is is that not enough emphasis on or. Do they take into account what is in the northwest Arkansas proposal. Is so I'm just I'm just I'm just trying to figure out is it doesn't take into account what's in the northwest Arkansas proposal because if not then we need to make sure that we're we're either getting ET and are are we getting the supplemental prove one of the two because this disease ravage in that community so so are intended the department is to manage all the contact tracing entities so we can control where their work in and the emphasis that is place so yes Sir to your point we can direct them to work with the other two contractors and we can direct those contractors on how to ratchet up and down their effort based on what the north with counsel would be able to provide. Okay question to the chair the then of the senator Irvin I know that you've been working on this you can kind of working on these proposals is this something that we're gonna be reviewing pretty soon or is this house it how's that working out on or what have you heard about that in regards to these proposals. Representative love my issue is that you have a process in place that is guided by the procurement process through the contracts that were issued with General Dynamics and with a FMC I think the better fiduciary. responsibility for us that provides fiduciary responsibility oversight and auditing capabilities is to manage it through those to existing contracts and then that they could subcontract with unanimous northwest if they choose to do that but that's under the contract that that's already been executed that the hot department of health already has language in place that could have happened yesterday that could have happened last week. So I think going through that process is better and we understand who the fiduciary responsibility an entity is is the department of health working through the two contracts which we were assured have the capabilities of addressing the Marshallese communities and Hispanic communities across the state of Arkansas that is existing in those contracts they have those capabilities I have confirmed that they have done that work that they are working in that process but when you have those two entities they are able to collaborate very closely with one another to make sure that the program is consistent throughout the state of Arkansas so that the contact traces are all following the same script so that they're they're reporting back to the department of health is consistent my fear is when you start popping up contact tracing command centers all across the state in addition to these two contracts the not program integrity is lost and I don't believe that's the right to do it I think they should go through these two contracts and if we need to do more in that community then that. Then we should do more that community that's not dependent upon us and legislative action that we need to take we've already taken that action it's already existing we've given approval we've given appropriation authority we have the except we have reviewed those contracts is written into those contracts it was existent last week it's existing today that's just a phone call that says Hey we want you to work with you and that's northwest that's fine but that creates program integrity and it creates a fiduciary responsibility that's clean it's direct and it follows the procurement process that we put in place and we put aside forty eight million dollars for that effort. And those contracts as you are well aware of Representative love often come back before us with amendments correct through peer subcommittee we have the ability with those contracts to alter them to adjust them right through amendment process we do it all the time. That is my concern because it's the better way of doing it to ensure program integrity and consistency and collaboration and coordination throughout the entire state no matter where people live and no matter who they are and so that that is very important to me so that's you asked me the question and I'm happy to be the answer thank you Mr chair thank you Mr chair thank you closing a Representative love I wanna and on what Centerton said I totally agree and understand what she's saying there if we went through the vetting process the request for proposal we hire to companies to do this state wide. Why do we need a third company that would do the same thing that we cannot that it did not go through the request for proposal didn't go through the vetting process. These ten companies have the option to hire this entity or any other entity to their contract requirements so why would we do this I totally agree with what senator insulin. Representative of you know the question to the bottom okay. Senator Davis you're recognized for a question. Thank you Mr chair and. Well I'd like to say that and first I really just given up all hope that anything we say or ask here matters and that's not directed at you all that's directed at the executive branch and this is been a extremely frustrating process and. Anything that the executive branch does we're the ones that deal with it back home in our grocery stores are kids day cares at our schools were at whatever Aaron were running whatever we're doing we deal with it and so I just we sent to these meetings hours at a time and we ask a lot of questions and it doesn't seem to matter but and in light of that. And I would ask really bag that and during press conferences I do like when you guys give some of the break down information that quite honestly we have I see every day teacher saying that they're being you know and given a death sentence going back to school to teach our kids there and you know you see all kinds of comments people there are people who are truly terrified and they live in a lot of anxiety over this and some rightfully so but what we've effectively done has is turned people against each other and were yelling at each other where policing each other or judging each other nonstop. And some of the information that you've given today even talking about children under ten how you know rarely they're spreading and the virus to adults because they don't have that receptors four in that kind of staff I would just ask that as you guys see that information and. And globally that you would share that information in the press conferences people are I think just and dying for information and they don't know who to trust they don't know who the experts are or what even defines experts in this situation and so as we look at going back to school and trying to retort return to some type of normalcy I would just ask that is you see that information and that it and think that it's appropriate that you would share that with the people of Arkansas and let us know that you know some people feel like they're not teachers are going back to school today I had you know kids aren't going back to school to die that people have some type of comfort in being able to understand what new information is coming out because this does change so quickly and that we can hear it from you and the one who is in charge of this public health emergency in our state and so and at an even going back to percentages of people who are a symptomatic and testing in our state that's a question I asked last week that I know department of health is working on getting back to the committee and but giving those numbers and letting people that when we hear thirty three thousand you know or whatever people in our state and have tested positive and we're arguing about that you know what for eighty percent or a symptomatic is that true what does that mean and so and if you could even share those percentages I think those are important to you three point one million our Kansans across the state and I would just they give you to and incorporate that information and your press conferences. Thank you very much for those comments I I think that he they are. They've landed on on my head well and I think that you we will do a better job I certainly as a physician know the importance of communicating with my patient I now need to communicate with the entire state we will make an effort to make sure that that these little nuggets if you will of information get out to the public thank you thank you senator DISMANG you're recognized. Thank you Mr chairman and. I guess under my two questions of them together real quick and so you know and I guess we'll have the Legislative Council meeting scheduled for tomorrow to take up the contract with the north west Arkansas council I guess my question is this a minute. Is that particular contact necessary to con tract necessary and then why because we did already have to vendors in place that were supposed to be doing something very similar what why was their need for this third party to come in what it was it a failure on whose part the way the original contract written how we were handling Marshallese in the in the beginning and we underestimated what was happening you know what exactly led to the need for this third vendor to come in and become part of a process that that we are heading place statewide in in the the last is my biggest concern when I hear from constituents about two is testing and how difficult the testing is to come by as far as you know depending on where you go you may be waiting for a very long time just to have the test administered and then after to minister depending on where you are you may have a very long turnaround time in the response I know in in parts of my Senate district the hospitals that had bought machines we're able to administer tester now having their orders for the testing kit some term con throng thing canceled that's munching by the federal government so they're you know they're trying to buy test kits from private entities feds are coming in and saying cancel orders because we need those testing kits utilized elsewhere. And so I don't feel like at least from what I'm seeing and I'm hoping for some assurance that we have a good grasp on how to test the state and if we don't have a good grasp on how to test the state that I'm not sure what contract tasting even does mean that if if we can't test in this contract racing process than what we proving or disproving besides just telling people they need to go isolate for an unknown reason or a potential issue that may or may not exist for certain number to I just don't I don't. Again I don't feel like we've got our hands reprimand step one which is the testing an hour into contractor acing spending a ton of money to do that I just don't see the the point two we get testing taking care of an appreciate any clarification. If the chairs would allow me I just need a point of clarification from my chief of staff okay measures you think. The senator DISMANG the the I'll state to the northwest Arkansas council proposal first or I'll just speak to it as the request for the enhanced Marshallese and Hispanic contact tracing when we put out the original or if Q. and the beginning of June in our case rates were not a significant there we didn't have quite as much information about the effect on those two populations as we do now once the the state wide request when out we did have an increase in the cases in both the Hispanic and Marshallese we had issues with some employment based out breaks among those populations to the extent that the CDC came into the state and did some intensive study of what was going on so we now also have a report from the CDC that basically says you have to do really intensive focus to work with those populations and to the extent that they actually said you need to go and do residential testing and is set up in the communities you can't expect them to come out you have to go there so the northwest Arkansas council proposal is actually local providers that are stepping forward and saying that they're willing to go and do that testing and that local work the other issue is obviously with you know you can translate but translation is often you know best done in the local community and and that people that have the ability to also sit down face to face that they're also willing to do that And all that doctor amero Take it and talk about the lab testing because that you're right it does have to all happen it just it just quick make sure I understand Sir just yet for those funds so first we underestimated what was happening. At that time whenever we initially asked for the R. if you're put out or if you're the proposals I think we've been in in the end we could not adjust the contracts that were in place to to be able to cover that population and so we're utilizing northwest Arkansas counsel to do that because they volunteered to do that. Or at least or they submit cemented proposal maybe is what selection sensitive volunteered at to do that and so that's why we're going that direction in this particular population yes Sir okay thank you and just a point of clarification it wasn't so much that we underestimated he was that it that time it had not flared up and and so so it is a as I said and again I don't want to sound like a broken record this is an evolving situation would exist today may not exist tomorrow and and so now we turned it might to your question about testing so. The issue of testing is become again a problem initially was in the it was that we did not have enough supplies and that we do not have enough of the re agents which are the actual the material you need to run the test and then the test to the platform I'm that seem to have been overcome but as mu hot spots a rose large states with large populations they served as a as a black hole if you will a gravitational pull all these laboratory studies into that effort to control it so commercial laboratories which were a part of our of our approach to testing here became overwhelmed with specimens from those high hi a disease rate states and therefore there we have had a decrease in the amount of laboratory testing available to us at the same time the manufacturers that make the reagents have shunted those to those highs hi you states okay we have we the health department have. Adapted to that by increasing our own testing capabilities we went from a very small for most likely they could process only two hundred specimens a day to now we have to active high throughput thermocycler is the compact they can process just short of two thousand specimens today we have a third thermocycler that is about to come online and yet will have a fourth some formal sector we are we are your public health lab is probably one of the best equipped for small state and probably one of the best in the country we will have in a short period of time for thermocycler is to deal with this. So our supplies our supply chain for those particular thermal cyclist is adequate and we see it being adequate for months into the future that is one of the reasons why doctor Smith and I'm having a block director level doctor Baker Dr make a ruling in doctor sacred is as silly came up with the decision to use the the the instruments that are using now what I did I answer your questions or the yes I I think so I guess what I want to see you would have to do right now is what this statewide effort is for testing so I'm I'm hearing that we think the department of health is handled their side so we the department of health is bought equipment the doctor in a department health and do testing and that sort of thing but that still leaves probably significant holes throughout the state that testing cannot occur because the department health can't be everywhere in the turn around time how long the turnaround time for a test on department health so at that we can answer it's it's within forty eight hours repository ours and you have hospitals with that sheen's that are able to have turnaround in fifteen minutes depending on what type of machine that they have I guess what out what I would like to see or like to least feel comfort in knowing is that there is a some type of state wide effort to make sure that. You know we're working together to make sure that all of these even non public entities no not the department health are getting the testing supplies that they need to be able to test their particular communities I guess I'm I will go back you know in part of my district without testing your sensually going to be shutting down businesses for a set number of days because they can't get a result someone's positive or negative which then jeopardizes every other employee that can't find out if they're positive negative and it's just a chain reaction and if we're talking about it you know the the economics of it it's a very harmful one or can be and so if you can just give me the report or whatever it is that we have showing how we're coordinating our efforts who's coordinating the efforts and not just with what department health is doing but what department is doing to help these other entities move along with their testing process and we should do we should do so but that that those are really issues that of supply chain outside of the health department and we're working with the governor to try to get those taken care of okay okay and with some we're gonna have to in this we've got other things on the agenda and the doctor Meryl's been here for a long time I appreciate you staying with this so we will go back to the Q. I'm limited to one question specifically and members if you start. spouting data and and getting off the question I will go to move on to the next person because we need to get out of here and the and get back on the agenda of Senator Irvin did you have a comment. Note just to follow up on senator DISMANG this rule this is something we've addressed to bed areas and depending on machine and capability and if they're dependent on the commercial out of it's not the commercial ups fault there's a there's a huge push and there's a huge demand for testing that they're dealing with but that has cost testing delays up to twelve even fourteen and be on days and so at that point contact tracing is completely ineffective at virtually ineffective if if it's twelve days out or fourteen days out I know of a case where somebody literally was out at lunch and received a text message that they were positive and that test was performed fourteen days ago or sixteen days ago. And the and then she gets the tax left the same way as she was positive and it's already been sixteen days so you know it I'm. Many of us understand that we need to it except that and so we're trying to make good decisions based on taxpayer dollars and we do have a fiduciary responsibility to that's taxpayer dollars whether their state and federal we also know that the federal government will audit this money and make sure that we spend it correctly because there are call backs in place to make sure that. That is in case the have the fact and so the Kermit and contracts are important to me and how that operates and and and and this legislature has done their due diligence this body has actually approved and has worked very closely with the department of health and with you a mess on everything that you off brought before us and so I mean I want to say that in defense of my colleagues this legislature has been very good at acting. To appropriate that money and to give you does authorizations and to review and authorizes contracts but we also have a responsibility as well thank you okay. Before I recognized Representative Boyd for question there's a handout that just came out that and that information came from the World Health Organization and CDC so that's the source of that information and it's just for your information and Senator Clark was able to get that FOR spreadsheet that in a. This off at twelve thirty with we get through the list or not because we're going to take a break for lunch and then come back and complete the agenda so keep your questions short because if you don't remember twelve thirty was that cut it off so Representative Boyd you're recognized for a question. Thank you Mr chair and and it's a very short question but I have to press it very quickly I'm not going to the doctor but originally secretary Romero we were told Hey we don't know about acquired immunity we we we heard okay well there's HIV aids and you develop antibodies but you you don't clear it will I think at this point time it's it's pretty clear that one we do cleared into we do that we're now asking for convalescent plasma as a potential treatment modality so I think we have some kind of idea and we also know corona virus even though this is a novel coronavirus we've had coronavirus for that we've not a background of ours for a long time so there's been this rule has a tense to give us information about how long a munity my last and I understand you don't have a specific number that you can say with certainty but what can you give us a about how how long acquired immunity might last thank you thank you very much for that question it so we do know something about this we know that it individuals that have mild or a symptomatic infections have a shorter lived periods of immunity. long lived of unity does not appear to exist at this time and it's one of the compounding factors in developing a vaccine. The vaccine trials will look at that issue this may be a vaccine for example like flu where you need to get it periodically in order to continue to boost your infection. We are a number of issues with immunity also which you may be interested in knowing and that is that the immune response of the individual that is a person his immune response could make the next bout of infection were severe and that exists and no is known to exist in relative to the current coronaviruses you are correct we have had for common corona viruses in existence for a long time in their in our diagnostic tests they're the most common cause of the cold. We have had Knobel coronaviruses which is the sars which we people talk about which came by the early part of the of of this century and then we had murders which is the manager that middle eastern in so is of your info respiratory disease and now we have the third so the the newer coronaviruses receipt are more pathogenic and the problem and they represent what we call cross species jump that is jump from an animal to human and in in doing so they they brought their disease to us so answer about immunity we know that some people will not develop long term immunity and that may be very high depending on the population and we don't know what will happen with the immunity when we get a shot whether it will be long term or not and I hope I've answered your questions some degree. Hammer you're recognized thank you Mr chair get quick I'm ation my comments on the lancet report published July sixteenth twenty twenty which basically states that contract contact tracing is ineffective if you don't have test results within a day you would be my opinion that we would rather put that money towards improving our in state testing capability so we have the quicker turnaround time renegotiate to contract which inevitably it seems would be that they did not prepare for dealing with all populations and wonder why we don't void those two contracts on their inability to deliver and reshape the approach of contract tracing once we get our in state testing capability so we don't have to be depend on the commercial labs that said what I would like to issue Dr Romero is this. Based on the current date which the emergency powers is set to expire are you going to recommend to the governor to continue the emergency on the basis of what we have here today with the numbers and the trans. Based on today's numbers yes Sir yes. Tell me no thank you. Senator Clark you're recognized. Thank you Mr chair. Of this sector do you have the chart there. I do. The I was disappointed that you sector had seen to know the negative stories about Sweden of. And didn't know any of the positive but as of a few minutes ago these are the reported deaths per million of the in the worst states in worst countries in the world. The and you seem to find Sweden apparent. although we have ten states and the district of Columbia with works best for me in some with much worse this one million. In the US only about a hundred brought behind and since Swedens best for me and our. This are almost about stopped it appears the US sadly will probably catch Sweden so tell me what's better about our model in our why are we following are we following the New Jersey New York model of versus this weed model and why is it better. What we are not following the Swedish model which is an open model and had no limitations of exposure I believe that our approach across this country is appropriate it is a measure that Can bring this and mitigate this disease and bring it under control I don't think we should be comparing destin who has more deaths or less this the idea is to prevent them and to bring it under control we as the public health I want to try to limit the amount of death in this country it's important to bear in mind that somewhere around forty to sixty percent of all deaths depending on where you're at arise from nursing homes extremely vulnerable populations what you're essentially saying is that there is acceptable amount of death and that that should go forward I don't believe so I believe we should try to protect every life in this country in the in in the state. Smith Mr. Did just make one point in our previous my previous question it was the secretary who pointed out Sweden's death rate is one of the worst in the world is bad and now he says that first of matter thank you. Love you're recognized. Thank you Mr chair I guess and I don't know who who handed out this this death firm million covet nineteen deal but I was looking through it in Senator Clark here's the here's some of the facts about this so we started Pennsylvania we have a five hundred and sixty two deaths per million Arkansas is a four hundred and one deaths from million. Pennsylvania has three times the population of four times the population of Arkansas. You can go up to Maryland the same thing they have twice the population of five hundred and seventy death all these places have mask requirements. And this is why I'm I'm kinda at a. And I'm I'm dumbfounded while we are against the manse when all the states in weird I'm looking at the number of deaths in Arkansas has has almost caught all the states Michigan Eleanor whatever. They all have mass requirements you will so this is something that we have to get a hold of number two Mister chair I just want to ask and I'm going back to this northwest Arkansas proposal because it is it is very is is very serious to me says that diseases ravaging the Martian this community. Are we talking about passing that proposal is there is there a consensus that we're talking about passing the proposal are we talking about is is the Arkansas department of health and want to work with the two contracted agencies soon. Expedite the work in in those communities so that we can we can get a handle on on this I'm I'm just trying to figure out because I'm getting calls every day about about this issue and I'm I'm I'm sensitive to the to it because the the cover nineteen is also being hard on the African American community but I want to make sure that this Marshallese community is taken care of because it's impacting that committee even greater than any is African American so what are we I'm just trying to come to a consensus of what we can do today to to begin to turn around that trans Representative of the maybe I adding answer question that proposal to add that third contract will be on the agenda of council next meeting with to be next month unless something else different happens. Others meeting tomorrow sorry I'm not up to speed on that but the next council meeting but one other thing I want to clarify that you said you said this million in Arkansas I don't think that. And did some sense for that one day total deaths yeah doctor do you know what. Okay in the the Arkansas number of deaths per million is one thirty three I thank you because the total number I just want to clarify that action okay we'll nice I'm glad that you pointed that out the Mr chair. Senate invoking a movie about out of time sorry. Hi Mr chair. I'll go ahead and move on. Okay whose seat number eight okay. Representative flowers you're recognized for a question. Thank you Mr chair doctor Romero and doctor Williams. There's a. A plethora of information that's out there and at the top of this conversation Dr Romero you. Encouraged us to seek out the most reputable. sources in the nation and to Dr I mean to senator Davis's please E. I would like to ask you for my benefit as well as my constituents many of whom are are afraid our include those teachers who believe that returning to schools as a death sentence. What are those in this is for either or both of you what are those Sources that we should use for information outside of the numbers that we get from the CDC and from the health department and terms of studies and trends and death rates and you know group population and best practices and what's happening in other states where the numbers might have declined to be declining what what can what would you recommend that we seek and use. So we have one of the best scientific bodies in the country in the world the national institutes of health. and at the helm is the doctor Fauci and other known well known scientists I would use their information as part of the of the information that I take the city seek clearly is a source of information with that is reliable Information I think from major universities tends to be very good and and vetted before it is sent out because the reputations of those institutions and those of those researchers are at stake so the public health assn which is the state of it health and territorial officers attends to produce good information information that that is vented so I think those are those are well the last one you to pass though a A. S. T. H. O. and I can give you the the the what it stands for but the I I know a private primarily by the acronym and just really quickly could you identify maybe to universities that are doing aligned share of the research and collecting data that we can rely on Stanford University has done a lot of work and on this issue I I tend to read a lot of what they they put out It depends really on on what area would Sanford is one Harvard's cards studies Johns Hopkins in Baltimore is extremely reliable source. Thanks so much all right so we're going to cut this off right now and miss Williams and Mr. And Dr Meryl thank you for being here in France in those questions I really appreciate your your openness and not being able to do that and stand with this. So yes center from the. No I just want to thank you both I really do appreciate you being here for answering the questions operate I believe I appreciate your expertise than what you're bringing to the table doctor Marrone I look forward to working with you as I look forward with you thank you all very good okay members we're gonna take a recess until one fifteen given opportunity and presenters patient journal stay with us we'll be back at one fifteen. All right the get your seats we're gonna start in in a minute. The next item on the agenda. Is the I. Arkansas center for health improvement analysis for covert nineteen data. And we have Joe Thompson. The bill would come on up. In members there's a handout and ace power point this. It's on a power point two. Okay nine. Okay if you all would in addition to sell for the record. I'd like to introduce Michelle kitchen so who's joined our team many don't know her from a decade of effort at the farm bureau but she is our replacement for Suzanne McCarthy who retired last year so if you start seeing her name coming across your emails or you need to get to me her email and contact information will be important if if if I don't respond in a timely way. I want to take just a few minutes of your time today to update you on work at our center has been doing since the outbreak started in March we Redirected our resources to be able to support the health department and other state agencies we've also been really actively involved in two areas one is communications we have a weekly input in a weekly life engagement with the members of the Arkansas state chamber of commerce the Arkansas municipal league the CEO forum we've done Facebook chats with some of you members and and are open to doing that with your constituencies it is something that is really I think important because those members your constituents get to ask questions in a less formal manner than here in the in the formalities of the of the hearing room so offer that you also can join the municipal league or the chamber sue meetings on Thursday mornings and then we put out a newsletter Thursday afternoons it's everything that we've done for the health department or for other state agencies they were pushing out so the communication has been one but what I want to focus on mostly today are the analytics that in a surge capacity way we have been able to support the health department with under the legislation of the Arkansas health data initiative state agencies can share data with our center and under the public health emergency clause this department health issuing with us there cove with test results so that we can use of our analytic efforts with different state agencies to support so for the first thing they want to share with you our heat maps that we do on a weekly basis for the health department this is trying to get more granular then the county numbers that are put out each day this is because local mayors local city officials you know want to know do I have a problem in my area we do this this is week before last this is a partial week last week because we close it off to be able to present this to you here obviously the the brighter that warning is the more concentration of numbers there are we think this is a value I know it is for the health department so that they can anticipate you know where they need to focus some of their contact tracing in. Other efforts is they get those test results we also in addition to the health department releasing the public health regions we have actually started using the trauma system region because this is actually if you remember we developed the trauma system based on referral base and so that the north central refers to Mountain Home north west is to the Bentonville Springdale area obviously west is Fort Smith southwest hot spring southeast pine bluff Jonesborough in the northeast so we took the actual active cases and we divided by the number of populations in each of those RES regions to come up with a rate of infection and so you can see here that right now as of last week northwest Arkansas which was out of control two three weeks ago has actually started to regain some of that control the southeast in the southwest are losing that control with three people per one thousand residents being actively infected at this moment in time. You can take this and actually do a trend line with that which we have you see the top to the southwest in the southeast trending upward you see the northwest trending downward slightly but this is what we're using to see whether we have and maintain control of this virus and I'll tell you we're not in control in many of our communities across the state right now this is growing quickly we're seeing the numbers go up each day on the hospitalizations on the ventilators and and on the death. Early on there was concern about the hospital capacity and I think you know when we look in the money morning quarterback we're gonna say you know this was a virus that came from overseas it hit the coast first we did a lot early but we might should have waited a little bit to do more later to get control of it as it came here we didn't know it's not it's not the judgmental but it's saying let's learn this time for the next time so that we can think that through in a stronger way we actually took you're all payer claims database and we look for the eclipse look for the year two thousand nineteen and we said so he. Got a. Automatic thing here is. We do it this way we looked at Two thousand in nineteen. Usually one second the. We look at two thousand nineteen across the bottom here are days it's the full year and this was a snapshot of who is in the hospital on each day the the the teal number or the elective surgeries that red or the newborns the light or blue or emergencies a dark blue urgent the white line there's trauma on average we had about about fifty five hundred people in the hospital each night during two thousand and nineteen you can see late in March that dropped all the way down to about twenty four hundred that's how much the hospital community contracted off of their elective surgeries and other things that they could so then you'll see each month in the yellow line comes back up you can see of of the overall capacity there about ninety start at sixty five hundred at the top of course these are bids and I know we count bids we count ventilators but it's really people that have to do the work seven days a week twenty four hours a day three hundred sixty five days a year but this is where we're trying to monitor some of the hospital capacity and are you gonna hear from the hospital association has more real time information that we have here. We took the positives and we actually are now tracking the time that it takes you to get to the next one hundred hospitalization so you can see early on you know the virus was not very prevalent it to because forty four days to get to the first hundred hospitalizations we locked everything down and went to maximal you know social isolation it took even longer to get to the second hundred hospitalizations but you see as we have open back up and people are moving around in interacting more it took it's only eighteen days after the fourth of July to get to the third hundred two because twelve days to get to the four hundred hospitalizations and so we're going to be there pretty soon where the high for eighties by the current council I had the fifth hundred hospitalization and again this time to the next hospitalization is clear evidence that this virus is spreading you don't get more hospitalizations because you testing more you more hospitalizations because the virus is spreading more so this is important going for we also looked at who is being hospitalized and who is dying by age. Those that are forty five to sixty four actually had the most hospitalizations and even those twenty five to forty four many are hospitalized there it is the older individuals and as doctor amero said this morning particularly those that are in nursing homes or have some other conditions that make them at risk going for. We'll try to get back on the slide show from current. we took the positives and I'm still do it or not. Sorry. A go back this way we took the pause this in the hospitalizations and I see admissions and we match them back into your all payer claims database to see what conditions they have so that we could be able to we could be able to share with folks that had these conditions or employers who may have employees with these conditions and what we found using some epidemiologic relative risks if you have kidney failure then your eighty percent more likely to be hospitalized you're a hundred percent more likely to be in the I see you you're a hundred plus percent more likely to be intimidated and your seventy percent more likely to die kidney failure is the one with the greatest risk factor if you're immuno compromised during chemotherapy or you have HIV or you're under a high dose steroids treatment your sixty percent more likely to be hospitalized ninety percent more likely be and I see you two hundred percent more like to be in debated and eighty percent more likely to die each of these Asterix is are statistically significant you'll see on the bottom couple rows the intimation the death we don't have numbers yet over time I'm sure we will but you can see these are the top five conditions kidney failure immuno compromised diabetes COPD in Corning are disease that are more likely to have you have a bad outcome if you in the hospital if you end up infected by the novel coronavirus now these are with the health department stated we took the health department's data and we looked at the two largest self insured plans years the state employees plan and the public school employees plan and what we found was you know we're able to do this because we we have a contract with the employment benefits division we match the positive results and we'll look at the utilization profile this is going to be a window into what's happening in our health care system because we get the claims every month so we'll be able to actually track what's going on as a Representative of a group of individuals that state wide because it's all public school employees and all state employees. when we look at the planned to date this is through July eighth because we got jeans data transfer we had nineteen thousand individuals tested nine hundred forty two active cases sixty six of those members had been hospitalized twenty eight in the I see you intent had been into baited the numbers for death to below ten and so you're you're gonna suppress anything below ten over time I think we'll get to ten with almost everything we're looking at but until we get to ten the health department ask us not to share that for confidentiality reasons when we look at the testing it did mir's the state's testing we are clearly increasing the testing were increasing the positive test counts among your A ASEAN PSC members it was the CS this morning you know when when does the parabola come down we're not seeing the parabola come down either on our state's results or on a S. these results are on PS these results when we look at those five conditions that cause the greatest risk these are the percent of A. S. C. population and PSE population with each of those five conditions about one percent have kidney failure about one percent immuno compromised of course because of our obesity epidemic look much larger proportion have type two diabetes COPD corner or disease anyway these are information the board is wanting of your state postal employees plan to be able to opt only manage that plan and we think it provides value four other pieces but other decision makers across the state finally over next to last the telemedicine his sword you know we were I mean telemedicine his made ten years worth of headway in the last six months because then that says city to be able to care for people but not be in their personal space these are utilization among the A. S. C. PSC plans we went from a hundred and fifty telemedicine visits a month two in April we had almost nineteen thousand tell the medicine visits and I think as we come out of this and the emergency rules are lifted you will want to pay some particular attention to how telemedicine is going to be in the future I don't think it. Any of our patients are gonna be willing to sit for two hours in the doctor's office weight and if they can do it by telephone in their home as they're doing now so there's gonna be some consumer demand for more telemedicine there's going to be quality concerns on the provider side and we're gonna need to monitor what did work well and where people had difficulty. these are the paid amount so you can see again. From a few thousand dollars now to over one point five million paid out to in telemedicine visits through April of this year and finally last week in in close work with the health department and in fact because of the weekly calls we're doing with the municipal league the mayor's the police chiefs a those they continue to ask for city specific information and so with the health department support we published any city that had more than ten individuals we publish the number of individuals and then we also divided it by the population that city so we would get some idea how concentrated the city's infections were these are cumulative cases since March what you hear in the news reports the state or the big numbers that come from the populous counties I mean Pulaski County is always going to have a more numbers in some the more rural counties because we have more people the rate when you divide it by the city gives you a better idea of how concentrated isn't actually hit did a population of a hundred twenty five people were my mom happens to have a lake house and I've been going to had twenty five of its hundred twenty five people have been infected so they have a a cumulative infectivity rate of twenty percent a little rock is actually less than one percent so that just it's a way to think about risk in moving forward we're working with the health department to get active cases not just cumulative cases so we know where the active cases are and I think this will be important again information to come forward to give those local leaders knowledge and power so that they can and you are do the local leadership necessary to have people recognize this as a clear and present danger this virus is tricky you know if you could design one this would be one that would cause most damage almost fifty percent of people don't get symptomatic and they're spread it the people who do get symptomatic don't get very sick but when you get sick you get very sick and we're losing too many people in our communities across the state we look forward to being with you and we'll come back or share individually again on offer again. Be glad to do the face time with you the queue in a piece of what your constituents are are concerned about in in the ability have a conversation not just a presentation I think it's something we want to offer each of you she like to take that up thank you to be glad to take questions. Senator Irvin recognized. Thank you I just wanted to tell you thank you for coming before us and presenting this information this is excellent information that I think can be very useful for our constituents and and it and it shows you know just a lot of important data and I I really appreciate and believe that we need to utilize those healthcare regions as by trauma because they are specifically dot designed and dedicated really as to execute a plan right to execute a program excuse strategy and to create the ability to drill down into the specific areas so I appreciate that level of of information that you gave us I appreciate the information that you gave us on the pose that come or morbidities and because I think that's helpful information for people that can they can then. And. Be responsible for their own actions rye and protect love ones that have enacted loved ones right or protected level and they if you give people information then they're going to hopefully you don't use that information add to protect themselves or to protect their loved ones I think this is important permission that we need to be giving out and so the people can make the best decisions I also want to does that tell you and we've visited prior to you coming to the meeting I really appreciate that you all tracking and this through the state self insured plans do you know the testing it how much I'm being told that a tests can cost anywhere between seventy seven dollars to a hundred dollars to administer now depending on the plan some of sometimes you could be eligible for that to be a free test your insurance will cover portion of that perhaps do you know the answer to how much is that actually covered by plans I think my team is looking at that I don't have a specific answer for you today but when we get it I'll be glad to share that okay and I think that department of health have made some testimony or given some testimony that the the cash and tests that are being made available have ranged between ninety five dollars cash to up to I want to say they said three hundred dollars. So I I didn't know if you all were tracking any of that information or not At and then. The the the other thing too is we talked about the telemedicine and and I really appreciate this because this was really really important I think for us to an act and and utilize the existing laws that we have on the books that allowed for a lot of this city ask you on that what what was what was the difference I mean I understand that the policy that would explain the policy and how it works with the current laws that we have but that the payment aspect of it was really what was. The issue at hand Sir so under your in the pre Kobe period you had to have a in person or a personal relationship with the physician to be able to have a televisivo telemedicine visit in the code period many of those rules and the payment as you suggest were changed the rules were effectively suspended so that a a provider could do a telemedicine and include a telephone conversation as in person or equipment in in person visit and the most of the carriers paid the same visit rate they would for an in person visit for a telemedicine visit now I think that's what I mean when we start coming out of the Kobe period I think the carriers are going to probably want as Medicaid will want to reverse back and we need to figure out what worked well and what didn't work well so that you can modify the rules under telemedicine going forward to optimize this new tool I mean it is a new tool that I think consumers are gonna find they don't want to go back to where they never had a telephone call because the physician had to see you to get paid and I think we're gonna be a new space that's gonna be a better space but it's gonna need some close attention well and and to your point a lot of the reason we had to add a telephone with because of access right to use right broadband access limited broadband in ruins or to the state yeah and wifi is also an issue but also it's not a one size fits all depending on what the specialty is depending on you know what that looks like so that's gonna be a balancing act right because you want to make sure you're paying for something that's useful and not over paying for something that per house maybe may not be useful but anyway thank you for that thank you thank you Mr. Yeah I just this is good data and thank you for bringing this and. Maybe comments not questions really but when you look at page three there were you have the active cases per thousand. You know but like you said earlier you look at that heavy population areas or where we say that the hot spot is and you don't think about southern Arkansas is being. That bad but when you look at these numbers those are the cases were really need me some concentration and they're really when you put it per thousand residents this gives you a better feel for okay fine if we see these numbers continue to go up it's those areas that we have the least control of the virus yeah that's a more meaningful number when you related to the population in the area so that's a really good chart of the other one that really caught my attention was on page five. We talk about the hospitalizations and the deaths by age and you know what what I've always heard is that you know if you're over sixty five year in the that's the most at risk group but when you look at this. And I don't know what this is through July twentieth the forty five to sixty four age group. Actually. It has the worst numbers as force hospitalizations and even the death rate is higher than it is in the sixty five to seventy four group. Which is not what no of most people think we are what we hear basically so that's interesting and then also when you look at that and I think this came up in our discussion this morning there are no deaths recorded up through twenty four year olds. So that's also good information that I think that's good I again you know unfortunately this viruses is unchecked in and want to echoed doctor Miro's your encouragement we've got to be successful on the public health interruption of this virus contributing to propagate we got to keep our economy going and we got to get our kids educated and I think it's a three way balance we're gonna have to give up some of our personal liberties on us mall limited time basis to do those three things. And then the charter on the bottom of page five. We have the different conditions of and I know obesity is probably related to diabetes but it would be interesting to know you know this obesity because I think I with the renter this morning when I said what I heard on the radio that that was like the number two. Underlying condition related to go with the S. nationally I think it is Mister chair and and we just we don't have B. city in the paid claims data it's not a it's not a very able that that people reporter on a paid claim necessarily so you can't measures I can't measure it but I have no doubt that B. C. would be on this list and near the top if we did have the ability of A to measure them. Thank you. Senator hammer you're recognized thank you and Dr times what I was wanted for saying is as far as the manpower in the time that you are having to put into this are you receiving compensation to. A gather all this information and share with the other agencies at this time we do not have an external source of funding for this activities of redirected our internal resources to do this in my team has been pretty solid on stepping up to the plate in in doing this in addition to the other things that we have contracts that were required to work on it's not indefinite but I think we're we're we're managing right now obviously the health department ask us for more we might need to have some resources to help support that okay well in with all the money this flying around here would hate for one individual group not to be compensated every else seems to be getting compensated just observation so and may we can advocate for that going for do you. You mention a comment while going it was reference page five and I think it was on the bottom chart to state wide results for just a relative risk of severe cove nineteen you said you don't have any numbers yet but in time we will would you qualify what that statement meant sure on this on this graphic for kidney failure for immuno compromised date for diabetes across all four indicators I have solid confidence I mean statistical certainty that those numbers are right the next to COPD inquiry or disease for the first two hospitalization and I see you admission where you see the Asterix is I have confidence that those are correct for the bottom right for the intimation death for COPD in corner or agencies I am not confident in those numbers yet because they're small numbers I can't reach the statistical certainty that I have for the other cells as we have more patients with COPD in corner already disease catch the cove it we will have more numbers and I'll have a better idea of what those bottom right four boxes should be those of the bottom not Procida shaded the the the minus forty the minus ten the plus fourteen plus twenty in the bottom right is somewhat uncertain but all the other numbers I have a high level of certainty about what those are. So what numbers are you waiting on desks or what number is it that you what is it what is number you got to have to really qualify these number more code positive patients that we look back and see what their previous diagnoses were. Every week we get up feed from the health department this week we'll get another several thousand new code posit patients and we will look back to see how many of them had Corning heart disease and how many of them had a bad outcome and that will add to those numbers to make them more solid. One thing it kind of. All my attention and tell me from looking at wrong is we we've always. Since this thing started we've always had it associate that was respiratory issues that would produce the highest number of death rates and this if I'm reading this right it's actually kidney failure in the and the three on the top of my. I don't know that those are absolute numbers that they're the highest but they are the risk factors to get you in the hospital quickest if you have those conditions that make sense of the words that we have we have a set number people with kidney failure they are at high risk should they get cove it of having a bad outcome that you see listed here the respiratory illnesses are usually the illness that most people end up being put on a ventilator for and have the worst time I think. I think the real message here is that if your body has been weakened by another condition or if you're older in age your ability to fight this virus off is is impaired that's why I think a call for a sold at least think about redoubling our efforts to lead a healthy and active and lifestyle this farcical be with us for awhile so if you are not in a healthy state that put you at a higher risk of a bad outcome. And when you say active cases. Can you talk about that just a bit more active cases defined as so we have to two numbers with cumulative cases this is the number we've had since the very first and those are on some of these and you have active cases which is the health department's definition of active which is the date the been positive or symptomatic within the last fourteen days. Okay. Mister chairman go bump you might want to ask him some questions about death and death rates please okay thank. Bentley you're recognized. Thank you chairman thank you so much this information up Thompson's been great first look at my question is I know we've had some concerns about the city data that you're given and so it was by zip code which in my district is nearly a relevant as have a pre county is on the same zip code with Perryville as as a partner so we've been able to work with I know is talking with us if you want to get that fixed so you can get that more fine tune to city limits so what we've done Janet was hardly at will what we've done in and we the when the health department has a positive case they call the individual to find out the information and find out who the contacts are for that case in the individual gives us their their street address now if they're outside the city limits by a hundred yards or if they're inside the city limits by a hundred yards they give us that city and I don't have a way to draw the line of when they're in route We've you know if we've assigned them to the city they said that they. Resided in if they're just outside the city there still a member of that community and then we did nominated by the city population we're trying to refine that we do have some cities Bethel heights alright Bethel heights got swept in the spring Dale because it's you it was right next to it we got three or four cities the got swept into a bigger sister that we're going back to try to tease apart. I just you know just myself individual eleven twelve miles from Perry but Perryville is my. Mailing address so if I say yes my address some say period the but I'm twelve miles outside of it so is that. So some just try financing first my small your street you would have a street address we did not take any PO boxes okay so none of these are PO box inside of a C. limit this is where the person said that they resided in your case if you had been contacted by the health department we probably would have assigned you to Perryville if you said that your street addresses in is a community in Perryville in so that's we may be able to get more specific with some geo coding and things like that but that's what we did on the first pass okay is in the Senate zip code I'm just saying I have a Perry County list Perryville. On their mailing address was really there. Twelve fourteen twenty miles away from the city limits of reason the population of the city limits is going to really skew that so I'm just Senate because one of the mayor's get. Right over the coals in an article it really wasn't you know that include have the county and city thank you ms information thank you appreciate all the work you do. Your question just the opposite of what Representative Bentley ask what if you have a city like Jones were were either with there's four zip codes. The and you come up with that number for Joe's grow in the person's address what they said if they said they live in Jonesborough any of those four zip codes they would have been assigned to Jonesborough. Okay okay. And and again this was this was a. Pretty strong push by the municipally members because the mayors were saying county level data doesn't do me any good in my local town council because they don't believe it's here and so this was a way that we could respond to that need there is some imprecision in it you know that we will try to work through over time uh but it was very well received I mean yet when we released it last week we had sixteen thousand people hit our website we were down for about three hours. And. Senator Ingram you're recognized. Thank you Mr chairman of and and congratulations on Joe's bar having four zip code sets. We just got one noon that of. I guess it is doctor Thompson with due to a lack of a national strategy to deal with grown virus we basically got fifty different strategies by fifty different states I know what Allen his experience to really positive they they they have come a long way and then some harder model of the northeast what about other states that we might look to that are doing a particularly good job so my team is looked around the United States and and you're right actually some of the research colleagues and I have want to do the study on of the fifty different ways that you could do it which one works the best and I think you are state when we. Came in to the chemist age lot down is what I call it that worked pretty well and getting folk shut down as we come out we've had some of the same challenges that other states and looking around at the other states the one thing that I will advocate to our health department leadership in part of this is getting the data ready and and precise enough to be able to do it but the spring feel county health department in Missouri and I would encourage you to go to their website and look on their code side they have a public exposure history where they actually list every place a code because the person was in the previous fourteen days so it'll say Walmart supercenter there was an infected there was an infected and infectious person who is unmasked between twelve and one thirty Sunday afternoon in they go through I mean Springfield is the capital city for a Missouri and so it's a large population of people that they go through and actually help individuals know Hey I was at Walmart at noon maybe I should go get a test if I start to feel bad so that's that's one thing that I've seen you I think every state is struggling with the testing issues we've got to get the testing within forty eight hours or our contact tracing we're gonna lose the battle and and we've got to get that where it's tested it's reported and we know who the contact is so we we can break this the transmission of this fire us you know the comment earlier today about the European countries you know those countries today all of the European Union I have a third more population than we have and there have been six thousand new cases a day in all of Europe the United States is a thirty two thirds of that population we're havin seventy two thousand new cases at the at ten fold difference and we're not that different so this is something we can control schools for weeks away I hope the mask Requirement give us a bomb to actually shut this thing down so that we can go forward and and do what we need to do for kids but it's kind of do or die time down the control of the stars. It might come as a shock to the people in Jefferson city that that spring feels the capital of Missouri but spring feel county spring feel county okay. Can thank you for thank you for. Clarifying thank you for clarifying that. Right. Okay Representative Boyd you're recognized. Thank you Mr chair up this quick question me you have a lot of data about different you know disease states are things that can affect outcomes and you know so I've was not long and it seems like you know the younger you are the healthier you are but then we'll hear something about you know some athletes that required it in had a rough go with with it in any inside of your what else we might look for besides that sure in in with all serious seriousness I want to thank each of you for your leadership that we're in uncharted waters I mean we've never been here before this is a this is a new virus that the human species has never seen before because of that our immune systems don't even recognize it as a threat when we do get infected and is it spreads affects more people I think you're gonna have. More people come down with it that you wouldn't expect them to come down it's almost like the respiratory when it first started it was hit people with respiratory illness and now as we have more people infected we see it can also hit other things your arteries your toes you're in a different it when you have volume it's going to affect more people in more different ways and I think that's what we're seeing now is the presentation at younger ages in different ways and until we start to be able to control the spread of this it's going to continue to show up in places that previously it did not exist. I would encourage you all we do an update of all our stuff on Thursdays and it's in our newsletter I'll get you the U. R. L. so that the trauma systematically put out each each week so that you could have that if any of this information is available for you know your local consumption with your local city leaders if we can be of assistance Machel is is electronically with you if not personally with you and I will be available any time that you have it and the that we can try to me we've got one more question okay you. Okay Senator hammer you're recognized thank you DO you tracked that on the number of hospitalizations how many occur because the person presented to the E. R. and was hospital lights as a result of the are being the point of contact. Senator hammer we will be able to do that as we get the claims that come in from the paid claims for Medicaid commercial carriers in Medicare there's about a five month lag on on that data coming in so we will you know in a couple more months be able to see what March looked like and then we'll be able to track that going forward we don't have real time information about who showing up in the E. R. today in being hospitalized either today or tomorrow. Okay and you may comment just second about It was but you're up about testing and about contact tracing. And the the comment I interpreted was that if we don't get the testing under control to contact tracing the what I'm plied got front was it is not going to have the benefit or as much that's my terminology which qualify your state your yeah we we have right now we have three weapons in our arsenal the first one or what we can individually do that's our personal hygiene that's are distancing that's or facial coverings the second are public health strategies to try to break the the transmission of ours so we need to know somebody's infected member half the time the person we even know or think that there in fact we need to know that they're infected be able to talk to that person and say who were you around to have those people then go into isolation before those people get it and spread it to the next set of people if if this thing is as as is believe if one person's gonna infect two people on average you can see above one in fixed too that's three if three infects to that six six and fix to that's twelve we're now up in the thousands and yet thousands in effect in two or three people if we don't get our timeline shorter and are precision for getting those people that had been exposed to isolate we don't have a public health strategy to try to break the virus here in is going to continue to grow out of control. Sit on reasonable thank in theory that as many people as and I'm I'm asking based on the statistics on the on the report that that analogy you just use you know the the pyramid or the power multiplication that theoretically what period of time could all our Kansans be infected well I I think we get three million people so that will take awhile I do think there I am concerned because the CDC estimates that between because of testing limitations and because the a symptomatic spread of this virus that the number actually infected maybe ten to fifteen times more than those that we know okay so that means we're even further out of control I said this virus is tricky it it put a Ponzi scheme here in in for us and we're gonna have to figure out how we break the the exposures that are happening quickly and beyond even level of awareness and do you have any way of knowing or the people that are a symptomatic by the time that they are determined to have had the virus have actually already completed the recommended fourteen day cycle. So let me let me a minute back up half a step and take another run at this if the CDC says ten the that the number of infected people are ten to fifteen times more than the ones we know about I will tell you a large majority of people that are infected don't know that they are infected and are a symptomatically spreading the virus for those that we know the symptoms come on if you have them about five days. We do I do not know how many people that should be quarantining or stay in isolation actually are doing that. Okay and last question are you reviewing the death data as far as the diagnosis being the primary cause of covert verses the underlying cause and you have the break out numbers yet of the four hundred and one yes such thank you is that which would divide them into two groups we we will be reviewing that again the death certificates have come through the health department to the to the the allow us to to look at those yet I know in last week or the week before you had some discussions around you know what the diagnosis was on the death certificate what it's supposed to be is the cause of death so if I had cove it nineteen and I died of a respiratory illness it should be cut it coated covert nineteen if I have a co deposit tests and killed in a trauma a car accident it should be coated car accident so that's the way it should be it how the way it's happening you know is dependent upon the. Position that determines the time of death and that's the responsible person for filling out the death certificate because you know there is and make your familiar with a guy named Dr Scott Jensen who is called for Minnesota medical board because she called into question the rationale the CDC and I think they've actually tweaked their methodology a little bit and I think New York in one day about their cases like thirty one hundred because the definition of death and and and so do you have a comment about that as far as the the actual definition the terminology in are we class fine people. Under cover deficit should not be I I don't have actual information or data right now to be able to support either any comment there but I'll be glad to continue to look at that as it comes to bring it to your attention will have personal conversation with thank you thank you. Representative right you're recognized. Thank you Mr chair dot Joe I heard you mention that a person can spread the virus without no one correct okay can they spread the virus without a temperature yes really. In fact forty to fifty percent of people who are infected and once they're infected become infection us never know they're infected never have a headache never have a fever that's the that's the tricky thing about this virus I think this is what we're having a hard time getting the the average our cans and to understand it is a real threat it's out there in about forty to fifty percent of the people who are infected and become infectious never know they were sick. Follow up please yes doctor Joel if you okay under normal circumstances which you say you have a school would check and temperatures things like that how are we gonna wood duck Dutch jail that these children may have this if they're not showing any signs that's why I go back to those three things that are our most important tools frequent handwashing physical distance and wearing of facial coverings we know how this virus is spread it to respiratory virus it comes out of the infected person's mouth or nose it gets close to another person who either gets it in there I where the breed in their nose or in their mouth or the touch something and put it in their mouth that's how this virus gets transmitted I know you were asking doctor amero and he's very I mean we've had two of the most well equipped leaders in the state health department of any health department across United States and doctor Smith and doctor merit with their infectious disease and virology background but on these calls with the chamber members in the municipal league. A lot of this is not science it's just logic okay if you've got if you know it's a respiratory virus how are you gonna get kids in the classroom farther apart and get them to actually recognize the importance of wearing a mask you start to see some innovation with you know plastics you know Plexiglas also SO two PVC pipes in a bath tub shower curtain yeah that that do is split up the room yeah you do five of those hanging from the ceiling you get twenty pods the kids are pretty much isolated in yeah we're gonna see innovation we're in uncharted waters logic rules here sciences growing our clinicians each week or getting more adept at treating people when they're really sick with this virus is spreading faster and and I think we're back to having concerns you'll be able to ask the medical society in hospital association about our capacity issues if we continue on the same growth rate okay. Not Thompson you get real popular go one more last question this is the last question represented Gonzalez you're recognized. Thank you Mr so based on what you said about forty to fifty percent of people have this and don't know it so what would you say that our numbers are that far off on positive. Cases in the statement is it is it forty to fifty percent higher than the thirty five thousand. It really is at least okay. The last last question center. Follow up with you had another question running with all of the sudden of you'll keep up with the overall death rates through throughout the normal gear like for the first six months of last year versus the first six months of this year or are we seeing more death. The health department does publish those both by the number of deaths and types of death somebody county it's a lagging piece of data it comes in six to twelve months after the event happened so we're not in the window yet that we can look at it but I think but by January we should be able to give a pretty good profile of what happened for at least the first half of two thousand nineteen thirty thousand twenty sorry we're in two thousand twenty. Senator thank you I am C. said there were three weapons individual actions the public health strategies and what was the third to third or developing medicines vaccines things that are in the pipeline that candidly you know this is a brand new virus we don't have them right now and so we have to fall back on those first two so we know in the scientific community that we test things we go through may experiment so we test and like you said the sciences catching that but we're having to apply common sense and logic as we deal with this issue soak a little bit of follow up on what represent of Gonzalez asked this morning about what constitutes the end of a state of emergency is that the development and the. of therapeutics and how best we can treat this. Virus or is it contingent on other factors so I think in and again this is Joe talking not the health department and signed her or anybody else I think I would to clear the end of an emergency when you have control of the virus if you're not having growth in the virus if you've got therapeutics the can take care of people when they do become ill if you're able to have your kids go to school and not because a flash point of of outbreak that then threatens to for you to lose control that's what I think the emergency becomes a lease less of an emergency a maybe not an emergency but we're nowhere near having control of our us that that is ultimately the goal for having an emergency be declared over is that you've got control of emergency and so that's how I would define it is is a of a rate that's going down or rate that's low and steady and you have a confidence that you can maintain control. Okay and then back to the testing and the contact tracing in those comments a little bit of follow up on what senator hammer said there is a process there so you get there's delays all along the roads right so. Describe for me and may I have an understanding and you might be able to help me with this but patient goes gets tested so depending on may or may not have symptoms maybe for elective surgery maybe because I'm I do have sometimes or maybe because I'm potentially exposed and they will they just are fearful those are kind of the three scenarios icy depending on how long or where they got the tested they got the test how long this has to is So you know you've got let's let's just say four days on average because right now or it some places twelve fourteen days. Then that has to be reported to the health department correct correct and then there's a delay there then there's another bump in the road because they are collecting that data and then the health department then deals with that information and then they put that information out to the companies I've contracted with and then day then start that that contacting is that correct or if it's internal then it would happen within your staff. Let me share with it again this is a window from the outside and so. You if if somebody gets tested there three or four I mean it's either a commercial lab the health department lab so you a mess let me go with commercial because that's where the volume of tests are okay okay all for the state or yeah thanks to my I mean I mean the capacity of Marshall lapses is far greater than the health department or you and messes up the commercial labs are under the public health emergency required to report all results to the health department whether it's a code positive test or code negative test so they report the code positive the health department in has a name and a hopefully a contact number with the participation the health department's nurse or train staff call that individual to say you're not positive you need to isolate yourself and they give those instructions and then they say and who else have you been within six feet for fifteen minutes or more in the last two or three days and so that's where the you get a list of the contacts right that have to have that phone number track down and called to say you are a potential contact and what actions do they need to take so yes everyone of the steps has the potential to expand in time and let's just take the worst case scenario I find out that I go get a test. But it doesn't come back for fourteen days was no even reason to go talk to the contacts because they've already been fourteen days there through the quarantine so so that's where that's where we ready anything that we can do to shorten that time frame and make it be more nimble is an investment that's work making but I do think you need accountability in that strategy to to make sure that it's work. All right not Thompson thank you all for this data it's good we might want to have you back thank you very much different thank you. Okay we're gonna make a minor change to the agenda here of course some people may have to leave early so I want to move item AF up. And the ask the. Montini come on up in this is fighting for economic survival during code nineteen pandemic hospitality association so we just want to get your input about some of the businesses and the challenges and then hopefully I know that some questions for you so if you would introduce yourself for the record. Arkansas. This is your Mike on there the green no. Nail okay. I don't know whether you've got an opening statement you want to give to us about business I mean we get a lot of questions about restaurants I do how are they handling this and what are some other issues you any comments or just like I'll talk about what you want to talk about I can tell you since March we were as mostly a staff of six but we're staff of three now to working from home I work in the office and have all the calls sent to me twenty four hours a day and I can tell you that I have answered phone calls. Hourly I've had eight calls since I've been here this morning with messages so. Lots of questions a lot of need a lot of a lot of a heart out there we have a lot of restaurants that that are at the end of the road the eight some have not even been able to open some have closed temporarily but they're in great need and but when they call me they've been great participants in this process I can tell you I've only had one person that got upset or acted ugly about anything they listen they're trying to do the right thing they want to protect their staff they understand the masking is imported the distance thing and they want their customers to do the same thing for the most part and that is a problem I can tell you that our association represents three groups in its never I've done this for a long time and it's been easy to manage what's been harder to manage is that they all have different needs now we have a restaurant association you're very familiar with the things that is going on with them now but we have an Arkansas lodging association and then we have an Arkansan tribal council so the restaurants have gotten the most exposure just because they've been brought back and a lot of us go out to eat and and care about our local restaurants but I can tell you that the lodging industry is in dire straits because if you know of their numbers are very low they have a lot of money invested in their properties and it's going to be a much longer period of time before their customers come back. Back in so they're really in a bad way some of them have financing that is coming to an end really saying and then some of them have been able to work things out with banks the third category of the large event places in you know that they haven't been able to do anything their dark the convention centers the big arenas those kinds of things they've had to lay off all their staff they've they're they're really hurting TI so just want to mention that the hospitality and tourism is a big industry we are seven point six billion dollar industry for Arkansas number two in the state we employ more than a hundred and twenty thousand people we've had record breaking years record breaking bringing in lots of of tax revenue for our state so they're very important that you pay attention to them but because a lot of them aren't going to make it but I'll go back to the restaurants because I know you're probably getting a lot of questions I get a lot of questions and they call me and ask me I can tell you the health department has been a great partner to work with they've been very excess symbol for many and easy to get help I have worked with Stacy hers with the department of parks of heritage in tourism we're working on it potential package that may help the industry and she's been great and I have nothing but great things to say about our governor I think I watch all the states work with fifty counterparts and I can tell you what you're doing and I attribute the success to you but what we're doing here even though our numbers are going up. is so far superior about when I hear a band in another state so I'll be happy to answer any specific questions about restaurants. One question I've got and the wind up in our area neck of the woods. I think there's at least three or four restaurants that have closed now that they may not of clothes one hundred percent because of the pandemic but but they weren't able to weather the storm do you have a feel for how many businesses have close in those different groups what percent and maybe what part of the state you get any kind of that information we did a survey early on and one percent of all the restaurants closed immediately and probably will never close we open again and they said within three months three percent would close and after three months it's going to be even worse restaurants typically are very of lean on cash they don't have a lot of money sitting around in the bank and to go the and we've done we've done polls to reset ham ham many weeks can you survive and it literally is someone some three them I'm not some you know six weeks in some say indefinitely you know they're very very stale but they're they're they're living on issue stirring up one of the biggest problems and you hear a lot about this is they haven't been able to bring back staff to and that's been a a real challenge for them because to to find people and train them is a hard thing. I've I've done training with them and believe it or not one of the hardest things to trying staff is about may ask so they understand why they're wearing them why the public should wear them how to how to talk to them when they come in and just say you know we would ask that you wear a mask but there's a lot of training that goes on with new employees so that's a big issue to. All right we have we have some questions here. A Representative Sullivan you're recognized. Thank you I'm over here to your right. Hi matter of fact I'm northeast Arkansas to we've had a number of restaurants closed in the biggest complaint I heard from them was there was not equity and application of the rules big box stores had one set of rules they had another and I just recently the some of the big box stores the walmarts the Kroger's at the big stores said they were going to enforce a mask resolution now I think today they came out and said they weren't going to enforce that. So. I hear you say that you think the governor has done a really good job. I don't hear that from the businesses that you represent hi I'm asking for just equity in the application of the rule has there been equity and application of the rules and they have the governor are you spoken to him about that. No I haven't spoken to him about that I know that the big box stores were deemed essential businesses and that's why they were able to be open they were encouraged to wear masks with the rest. They're open they just have a different set of standards in your as their Representative you're okay with that. Well the for the most part a record at a restaurant is a much smaller place then a big box you can go into a big box and you can hide from people if you really want to we've all on a I don't I'm trying to leave room for the people so I'm just asking you as their Representative you're okay with different standards for big box stores and restaurants that you represent your okay with that. I am in favor of restaurants wearing mask and their customers wearing may ask. The question well I guess I'm saying that I did for Yale okay you're okay with different okay I okay that's the only way restaurants are going to survive is by keeping people healthy and I don't think most of the customers want to go in a place that they don't feel like it's healthy with more I hate to prolong it but we all agree with that nobody is this dissenting there the question is there are two different standards and now the right the big box stores who said they were going to enforce mass are going to do. And restaurants have to do. And you as their Representative you're okay with that. Yes thank you thank you Mr chair. You're recognized. Ms McNulty over here to your left. Your other left of. I was just wondering following on the vine is of representatives of one's question. The mask mandate is it's meant to protect your workers but it also does it give more teeth in being able to back up a business in enforcing that that may I ask in that restaurant I mean is that something that the restaurant see is a benefit to them yes most of the restaurants that I talked to what their customers to where mass and so yes. Date bet eight four Amanda eight four mask they wanted it because it was hard for them to say you have to wear a mask is easy to say it's required we have to require it so it gave them an ally and it became an easier thing for the most part. Thank you. Thank you senator Ingram I'll I'll ask a question while our chair stepped away on what you've provided us this information have you that heavy foot dollars to some of your suggestions one of the things I am concerned about very much so is the lodging industry the hotels the convention centers they're basically shut down this is a huge loss of revenue that I feel like we really as a state haven't done a lot to address and have you put numbers to your and different things of creating a loan fund three add photo with low interest in long term pay back waving liquor permit renewal fees for a period of time and asking State Bank examiners to continue to provide leniency have have you Have have you put a number to any of those I mean the last one doesn't really provide for a number it's just asking for some leniency when I. Have you all acted on these proposals or. Suggestions those proposals are going they are active right now with the federal government okay have all been presented to our congressmen and they are part of what may be this is it the fourth or the fifth package but those are items that the industry is requesting from the federal government but I thought because they're so comprehensive it might help you to see where they're paying me is and what's going on but your point about the large facilities they have not been able to recover many from any place well that's what I'm curious about I'm in ad for the Arkansas department of finance administration that would be something that this legislature could do it right yes and then waiving liquor permit renewal fees for a period that something that this legislature and the state government could do is that correct that's kind of a different lease I just checked that in there because it was so comprehensive now after that you can see ideas that could be helpful yeah no I appreciate that have you look to other states and how their perhaps seven up and helping other state governments are helping yes absolutely we look at the other states and other associations and get their ideas and send them on to we've sent things three to A. B. C. we think Senator three we were in favor of the the wind in the beer being able to be carried out in the governor did that by executive order that was another kind of revenue source for them so you know we do pass those ideas along and I'd be glad if anybody's in particular interested in anything I'll be glad to work it up and put some numbers to it okay now I I think that's important and I. Appreciate that you sharing this with us in this committee today well I thought that something that you can have back home in case you get I ask my the hotel industry convention centers you kinda know what their their interests ours so and I think it is the thing yeah thank you miss McNulty and I also think that it highlights where there's a glaring needs and what potential things that we could actually address and do about it sure thank you sure. Senator hammer you're recognized thank you Mr chair do you miss Melty do you represent the event then use under your job type part of the Arkansas travel counsel and I've actually worked with the group in your your district and help them with the event center and also some of the large events coming up with ways to work with the state and helped with the directive so my yeah okay and you mentioned the three percent the the number of restaurants that would be closing how many of those are independent verses chain restaurants that have a national presence. I would say probably most of a more independent however some of the franchises in China and franchise fees of some of the big chains I know have closed in is particularly in smaller cities I've seen in our. Well because the if the greater portion of the three percent are your mom and pops in your independent social ones that poor money back into local economy verses taken off to a corporation of state somewhere so I just want to know if that was the greater percentage relates the greater percentage but we have an we have a lot of small franchisees in our state and their local people that just own a franchise to so they're not an independent restaurant that they keep their money for the most part okay and then with regards to. the feedback that I'm getting is that the convenience stores rich maybe don't represent but the the restaurants are finding it difficult to be the enforcer state law because they've asked to be the sheriff inside the building and what I have a problem with is if the health department comes into a restaurant and they want to find fault with the restaurant because the employee is not wearing a mask for maybe something in the kitchen that they have ultimate control over and they get written up that's one thing but when they get written up as the health department is doing going out riding up restaurants and others because the public is not wearing the mask and they are put in a confrontational situation that's what they're having a problem with there being asked to be the police of something that they had no way in in the process of getting there what would be your response to those comments I had received phone calls from restaurants saying you know what we do if they. And I say just hand him the napkin say put this over your face to you get out of here. Just do your best to do what you're thank you can't be confrontational they can't get hurt over whatever they just gonna have to do the best they can and I believe the health department will listen to that today. And I understand they are and they say that they just do the best they can. This is not an easy thing for any of us. understand but we don't need to make it harder either what stood out of time and so I'm just wondering your organization would advocate for that to be removed as a reason for the establishment to be written up so that it wouldn't because once sums in your file it's in your file they shouldn't get in trouble for for trying in not succeeding in getting a customer to do something and I don't think they would I think they would look upon that is they did the best they could he was the customer that was being. At of line but once it's in the file and it's in the file. Go to bat for them okay that's well on here thank you all right A did to end on that question that Senator hammer answer and asked about small restaurants being the one to close at. I got questions from a couple larger corporations that have restaurants in our area and I talk to their corporate headquarters and one was in taxes every within was. One of these corporations actually closed a restaurant in northeast Arkansas. because it was not doing good no they they have quite a few restaurants in the state but but they're closing those that are barely making a profit I guess so this is an opportunity to close them down are you hearing that are seeing that is that a big dealers is just one instance of that. I have it heard it wide spread but you know it's going on if it you know if they're not making a profit that goes on even with that of a cove it yes this is the last. Well they'll they'll shut it down but that hurts those local. Economies in the smaller towns. Okay we will no no question here. since eighty four. The four. Okay. You're recognized thank you Mr chair of Mister Nolte ugh can you tell me of. What percentage of our Covert nineteen cases have come from restaurants. No I can tell you that according to the health department they have not attributed restaurants is being a cluster of sorts That the. They may have someone who works there date is diagnosed with it but they don't attribute it to the restaurant that they got were ill they attribute it to getting it someplace else so I have never received information that restaurants are a problem in spreading code. Okay a talk to the health department and they told me about one. one particular restaurant restaurant where people were dancing and of hugging on each other and had some cases but you don't know of any the health department is not made you aware of any. Of. Where people have gotten that from eating at a restaurant. A no but when I say no I have heard the same thing about maybe I didn't even hear the name of it but that they identified a restaurant where they were allowing people to sit at the bar for too long or or like you said dancing and dancing is not a part of what they're supposed to do I heard of one restaurant that was basically doing everything that they shouldn't have been doing and those ought to be dealt with by the health department but I have it I don't think that's any widespread thing and I don't think the virus is being spread by restaurants will meet me here or there and what a course but the our in Lester's evidence to the contrary and if there is I would certainly accept that evidence it seems like we put a lot of uh. Restrictions and what'll restaurants if that's not where. Of this bridge coming from. Well I think maybe it potentially could if you let people linger there and congregate more they are I think that they're they're trying to keep it from being a hot spot area and we would love to see I think we might have been able to move to the next level had the viruses kind of taken up tick and I think that they want that is just going to have to be at the right time to allow. a hundred percent occupancy. Okay but. Regardless of what happened with the virus in a course in the health department can tell us differently of doesn't seem to be coming from restaurants. Well I don't know if I'd say quite that I'm sure I'm sure there are restaurant people that are being diagnosed with the virus but I don't think they are true beating the hot spot to the restaurant they're getting it some place else and they happen to work in a restaurant right no I know it I know restaurants that have closed I mean I went to one last Sunday evening and they had a sign on the door that that they had closed because an employee had been a test positive so they closed but as far as I know there have been no cases traced to that restaurant as you said. More of so all right thank you. Thank you Mr chair thank you. this monopoly thank you for your input appreciated thank you. Okay so we're gonna move back to Adam ET. Concerns of the medical society and capacity of Arkansas hospitals during the pandemic so if you all would come on the. And we've got representatives from the Arkansas medical society the Arkansas hospital association. You want to search here together Mister chairman. When a new business yes. One of these microphones yes. Joanne would you come up a set one these other microphones if you want to hear. Right here on the corner B. find. Nobody puts baby in the corner. Okay alright feel would introduce yourself for the record thank I'm David roton executive vice president for the Arkansas medical society doctor Chad Rogers our president was here this morning unfortunately he is a practicing pediatrician and had a room full of patients expecting to see him this afternoon so he beg your forgiveness your your forgiveness in your pardon. rile president CEO Arkansas hospital association. Okay number not push the yellow button. All right you should be on. Technical thirty and tread executive vice president of the Arkansas hospital association. We should just leave your green button on is it yes. Okay right We all had a comment you want to make before questions we we really wanted you to come here just to answer questions that we're getting from constituents. It up the medical community and the hospitals in general so this could be could be very wide broad subject if you don't wanna make a comment let me start over here if you want to did you have anything you want to come in yes Sir David wrote I'll make just a brief one cents since March our primary function if medical society has been working with the state to try to distribute PP to our private medical clinics we have to date that actually in our office right now my staff is working on a distribution of about four hundred and fifty thousand pieces of PP we have made about six or seven distributions of of the supplies are clinics still are having a hard time getting what they need two weeks ago was in the very first significant shipment of in ninety five masks and I want you to think about that for just a minute this is been going on since March we're just now getting the in ninety five mask that are clinics need to protect their patients and to protect their medical staff to protect their staff their doctors and nurses and others who are taking care patients and in many cases they're testing and screening and they've been doing so without A ninety five mask up until just recently so we've been doing that that is been the largest thing we are up to about two million pieces of PP. that has gone to private medical clinics doctor clinics nurse clinics of community health centers rural federal qualified rural health clinics up mostly your private independent practices we of let the hospital association take care of most of the the hospital clinics I think that's worked out pretty well for them and and for us we have tried to publish on a if not a daily basis at least two three four times a week a covert nineteen update for physicians around the state to keep them up to date on the latest health department directives the numbers advices on how to take care of if you've got someone in the clinic a healthcare worker who test positive or has been exposed what do you do how long do they have to stay away from the clinic so that's what we've been up to since March we're still hard at it we will continue to be hard at it and uh we also the governor asked us to serve on his economic recovery task force so we've been working with that prime provide is whatever guidance that we can whatever input that we can so it's it's been heart warming for us to be able to help those that are helping your constituents. Thank you. Thank you I'll just make a few brief brief points here of appreciate the opportunity to be here we have always been concerned about the distribution of patients as we have seen different regions of the state surge at different times we saw the hospitalizations reach a high point in northwest Arkansas about a week and a half ago and those have been slow decline the hospitals in that region I'll say it is an excellent job of communicating with each other and load balancing those patients over that time period the decline in hospitalizations that we've seen in the last week or so have been welcomed by those hospitals and health care workers there who have done an excellent job and and very difficult times. The number of hospitalizations has remained high and steady in central Arkansas over the last two weeks we've seen increases in other regions southwest southeast Fort Smith and northeast Arkansas and hospitalizations. We're continuing to see issues with testing and supplies the turnaround times on testing from the commercial labs can very from three to fourteen days which causes inefficient use of beds and supplies the long waits on results and testing has also caused. Re testing of patients needing procedures thanks re testing of duplicate testing and waste needed supplies. We continue to hear from hospitals about staffing it's very challenging employees are quarantine daily with covet symptoms or suspected cases and this has affected small and large hospitals the stress on those who are able to work in the hospitals is causing extreme fatigue across the state as we continue to see these new hospitalizations. I'll Allen would just we in the Arkansas department health monitoring the capacity of hospitals daily to see where they stand obviously the hospitals are managing that but also there looking at it regionally within their regions within the state and when working with the Arkansas department of health but again our primary concerns other than that continue to be testing and staffing. Thank you. A journey and you have anything to add to that okay. All right what we'll start with some questions in a. The I have a question that and this is a difficult subject and I realize that but this is a question that I get quite often. There's people out there that are very concerned about the way deaths are coded. With patients who have kopen and you all probably know where this in and the question that I get is and I I could take you two or three stories of people that have called me in and their their loved one has passed away and they get a certificate this coded as code of nineteen and they say that their loved one didn't have cove in nineteen. So my question is. Who makes that decision. And you know what how do they how do they do that what what criteria do the use if a person has multiple. underlying conditions and code red how is that decision made can you give me some insight on that Well I was gonna say DMO do you want that one. Because we have the right people there than any deal well I wish I had doctor Rogers here he might could have answered that I know that you typically physicians and nurses can pronounce death in a hospital they both can fill out death certificates so what criteria for example most of these deaths are occurring in hospitals so what criteria the hospital has for how they how they code that I don't know. Are you on there yes okay Jody internet with the Arkansas hospital association we get that question a lot too so consumers call in to the hospital association task as this the determination of cause of death which is what is reported on the death certificate is absolutely a clinical decision made by a clinician to Mr rodents point it's usually a physician in limited circumstances a hospice nurse may filled out that cause of death and a local corner canned I also agree with doctor Thompson and till we have that lag time to where we can actually get the death certificates themselves and look at them it's hard for us to know what's happening we certainly don't have that data in real time there was a piece of legislation passed and I believe it was this past session but honestly twenty twenty has been about forty five years long so I could be wrong about when the when the session has passed and that requires a death certificate once it's been initiated so once the the a death itself is reported as someone has passed away the time of death if you will then a clinician has three days to enter all of that information into the E. rave system at that Arkansas department of health that's an electronic system that then captures the those information and those data pieces so our physicians sometimes the physician who is determining the cause of death is not the same as the physician who has done the pronouncement of death and those are two very different things I will tell you we have lots a palette of care physicians around the state who work very diligently with the health department to create even strategies for the health department to train physicians and others how to complete that death certificate in a timely way and to use the right system it can be clunky for some it's really easy for others who are more tech savvy. So the health department in consultation in collaboration with the physicians who are working very diligently to create the cause of death and make it as accurate as possible for all of our health the to statistics not just right now during this pandemic they work very collaborative Lee together and it's very important for all of us that we get those data correct there is no incentive for a hospital to code someone a Kobe positive death if that person did not pass away from Kopet. So there is eight guidance on how to determine that so the clinical decisions that are made are done at the clinical level a hospital doesn't have other than medical staff bylaws that are used for a variety of things the clinicians are the the individuals who create the cause of death on the death certificate or the corner okay. Thank you okay I have one other question before I go to the the list here and and I'll give you the situation I I got a call from an emergency room the lady was upset her husband had had surgery here in little rock went back home to northeast Arkansas two days later he had symptoms similar to cope with a fever stomach Neri and so forth so she took him to the emergency room. they tested him with the two day test so they do have the results back on any other bacterial infection they're going to keep him overnight with IV. And her or the reasons he was so upset is they told her that they would put him on the wing with the active covert patients even though they didn't have the results back and she was very concerned about putting him on that winning when they didn't know whether he had that case or not so is that normal or I mean can somebody talk to me about that that does that happen a lot of hospitals it may was such a success back did Kobe patience worth someone has all the symptoms and seems like they do have it they don't have the test results back instead of exposing them to the general population of patients that would put them in the cove it wing in order to not infect others but but they suspect that he has that they had no idea that he did not at the time. Well I understand that but. If it was your wife. Would you like for her to go to that when when you don't know whether she has it or not and she's going to be on a wing where everybody has it the doctors and the nurses are going room to room I mean it seems to me you're exposing those people you're putting them more at risk you know when I'm I know about risk management your ex your the more at risk I mean it should there be a third holding area for someone is just staying overnight rather than the middle wing I don't know I'm just. As possible you know I'm not sure at that they beat the bed capacity of the hospital and and certainly how they're set up. Right I will add that to again Jedi entered with the hospital association I'm our UV eight areas within the hospital or some of the safest places for patients because of the additional PP because of the additional separation of patients from one another and every precaution is being taken by nurses physicians and everyone else to make sure any direct contact they have with one patient is that one patient contact going into the next room requires donning and doffing taking on and off appropriate pre PP and getting new new PP on before they have interaction with that secondary patient unfortunately if we don't have cove a positive or covert negative test for patients we have to use the same amount of PP and precaution assuming that everyone we're coming in contact with actually is Kobe positive that's one of the reasons that so much more expensive to take care of those patients in a clinical setting our ratios of nurses and doctors actually goes lower so you've got more people more staff for you then you do for three or four patients somewhere else and we're very very particular about sanitized ation and about how those rooms are set up about the privacy that we have and those kinds of things. Well I understand the logistics problem that you have. But. I'm gonna ask you a personal question you know if if this was your children or your mother and father. That was going to go into that environment. When maybe they could be kept in the emergency room area or whatever you deal with that. In cases where we can keep patients sequestered from one another better we absolutely want that to happen I can tell you from my I don't have personal experience with someone being Covin positive in my family thank goodness of but if I did I absolutely would trust that hospital to take care of me and my family members in that same safety sanitary way using the appropriate PP to protect the staff of the hospital and my my loved ones. My question was not if they if positive they were still not determined to be prized there even if they're negative so when patients present in the emergency department to begin with we treat them with our appropriate PP and appropriateness of taking care of a patient in interacting with the patient as if that patient is positive already so yes I would be okay with that even if the patient were negative because we're a step up in sanitation and a step up in personal protective equipment use for even suspected patients but I'll ask the same question that represent della Rosa as this morning you do you understand the concern of people out there that are in that situation I don't have the knowledge that you all have you understand how. Scared and FOR apple A. R. in this one I can give her any advice other than I would go to the other hospital that you have available to you I mean you know there it's life or death to these folks you understand their feelings yes and I think you said it you said it right early on when you said if it was your family member and the benefit that we have and most of you have is that you do know what's going on you understand it better but for the vast majority of our candidates that don't leave this every day like we do they're scared and they're freight and they're worried and I think we have to be empathetic with them try to help them understand I I agree with what district said that section of the hospital that set up for covert nineteen patients is probably the safest place on earth that you could be right now even if it's just for one night but you've got to take that extra step to make sure in the case of the the constituent you had I would hope that who ever talked to them in the hospital would try to explain that to if it was my child my grand I've got a four year old five year old grand child just turned five and I would feel the same exact way even knowing what I know I have to stop myself take a step back and going away minute David you know this is the best place for them to be because your other option is to put him in the general population of the hospital and risk infecting a lot more people if they do in fact have it but that's another reason we've got to have fast turnaround test that is our biggest other than PP the testing is the other big issue for doctors offices that is one problem that would be sol with faster test thank you. Hammer you're recognized. Thank you Mr chair first questions to you David if you don't mind yes You're talking about the cost of PP use as it relates just to the medical field you're not referring to any of the cost of PP is like to public schools or other state entities that are having to purchase PPVs is that correct of I am only referring to the TPP that the governor has purchased through at the emergency finds that he has of I've talked to so I've talked to school nurses in the last week they're all struggling with this something needs to be done to help them out. Well let me ask on that point you guys pay taxes on those right. You pay taxes on the PP we we don't buy PP what where do you get your supply line is who her supply line is the governor's office okay all right because I know a lot of like to schools for example I've got one of my district they had to order and I didn't get the impression that they had any trouble getting it from a go back and check with the superintendent but they had to order a hundred fifty thousand dollars which PP say paid fifteen thousand dollars towards taxes on it and I know that kind of recycled back into the community to get that picture but I wonder if it's something legislative branch how to look at doing is drafted piece of legislation to waive the taxes that are paid on the purchase PPVs and that money be re directed back into of be re directed back into the To the entities are hammer by those PPVs and if we can get that done as quickly as possible that be money back in the pockets what do you think about that I think it's a great idea let me also though go back to something you started off saying If they were able to buy a hundred and fifty thousand dollars worth of PP and plan on having that delivered by school. Good for them because or clinics there are let me let me be careful how I say this there are a few clinics in the state that I don't know how they've done it they've been able to buy PP. A the vast majority of clinics particularly small ones you know they're able to go online and make an order but the delivery date maybe three or four months out. And so that's you know the. But it's a very difficult situation and anything that you can do to help again I've got a five year old grandson and it's he's got a start next Monday. And we're nervous about it as you might guess and I think the schools need help getting PP you know. I can't let me let me just take a step back and come back to the table is David roton grandfather of the five year old child I would love to see you all do something where money is spent providing PP to the school systems. Well and I'm a way had visit because based on the content of what you're testifying to today and the start date of school and can we even start if our schools don't have the PPC and PPVs and they've been mandated to have if those delivery times so so I wanna go have a sidebar conversation because of perspectives cools to start back and have a personal opinion about that but then they've got to have those PPVs if they're all able to get him to wear school can start up but you're not able to get him to keep the hospital facilities in the clinics going we've got a great disconnect somewhere and I will go back heather conversational circle up with you one on one but legislation that would take that tax revenue that we didn't plan on to be in the state budget for this year anyway so it's not like we ought to be counting on it Let me shift over to you both you don't mind A got word well go and and I don't know if anybody you a message here Jody and maybe you can answer this what is you AM **** I see you bet capacity is today do you know where they sit net maximum do either of you all know or what's the capacity the bed passive I see you units in the state right now and and how much breathing room do we have. I don't think I know you and missus capacity today about do you have a. Our lead in and we don't necessarily know individual hospital capacity at any one given time today our hospitals enter information in to the health department this is so we're not being able to see you I apologize Senator hammer much swing around yeah so we we we enter in information each individual hospital enters an information at least twice daily so that the health department can see the capacity and the surge that may or may not be occurring so we know and as at a snapshot in time how many ventilators you have available and now sometimes that gets a little hairy because just because you have a ventilator in an icy you room available does not necessarily mean that that room and that particular ventilator is able to be staffed so sometimes your percentages can look a little funny we have a snapshot that we kinda look at for our own internal purposes and again many times what we see early early in the morning is different from what the governor says at his press conference not because either of us is incorrect but because it's literally a snapshot in time with what's available and what's not so if something has happened to you I am S. since you know nine twenty this morning we're not going to have this ability of that where the health department would have the visibility of that and be able to inform the people who needed to know because one of the things that drives a conversation it feeds the fears that we're going to run out of then later is we're gonna run out I see you bids and I'd like to just maybe get CC then to know at any given time how may I see you bids to we have because if we've got enough to expand and I know you and Mrs put not projection that we're gonna be forty thousand cases are twenty thousand cases a day or whatever that astronomical number was and I'd like to see the the data that deals with how much breathing room do we have or do we not have just as a personal thing and. Then the second thing to you by was this the Becker's hospital review are you familiar with that. Okay in your opinion is that accurate source of information. Or S. acrid place to get information from appointed ACT richer okay so I noticed in looking at that that it's all over the place as far as how much I think was hospitals are getting reimbursed or states are getting reimbursed per cove aid patient not death but per co with patient and it's tied into the Medicare rate historical data of what you know states get for and and there's controversial war that's a fair system or not it it is what it is so how does that equate into money into the state that's going to come down to the hospitals and does all that money go to the hospitals or is it shared among the providers or how's that play out. And we're in like two hundred eight thousand per patient I think consent so there's a couple different formulas that the. Health and Human Services are using to distribute money to hospitals and one of those is based upon revenues so revenues based all revenue so not just Medicare but commercial insurance as well all the revenue sources of a hospital get paid so we're not one of the highest paid states in the union as far as what we get reimbursed from Medicare Medicaid and commercial insurance so we're to disadvantage to some of these larger states that have multiple insurance companies that have a higher Medicare rates so we're getting less. We need more insurance companies not bill Medicare then if that's the case but could I want to work with you all and see how that translates down to will that be broken out to each one of the hospitals that that number company in and will it translate down to actual dollars to individual hospitals. Right health and Human Services has a website that they have listed by hospital how much money they received in these different pots were trying to track that as well but it's out there on health Human Services whips so so when you all talk about hospitals losing money and and and granted I mean the the you guys not being able to elective surgeries I get it was personally affected by get it but do you calculate when you say house bills have lost money do you calculate in money like this it that is referred to on this backers healthcare report. Senator hammer let me answer what I think you're asking so at the federal cares act and other sources all put together did try to give some relief to hospitals and other healthcare providers early on so to date as of and I looked at the at the website before I came because I had a feeling you're asked me this question as of July the twenty third there have been four hundred and forty nine million dollars come in to Arkansas hospitals. There were six hundred and ninety two point five million to all health care entities so not just hospitals but also some clinics some durable medical equipment places some pharmacy some nursing homes okay so sixty five percent of those big federal cares that dollars and other sources have come that are allocated for Arkansas have come to hospitals there are a variety of distributions and and those formulas like Mister Ross said the very very first one was a portion of the fifty billion dollars that was allocated out of the corona virus relief fund and it was the distribution to each individual hospital was based on how many traditional Medicare patients that particular hospital had seen in the previous twenty eighteen I think is the date eight use and so that's where things get confusing because they use that as a formula as a proxy for how to get money out really quickly to hospitals there been other formulas with the same pot of money that true it up or make it look a little bit different but overall four hundred and forty nine million as well Arkansas hospitals have received from those funds at the federal level to date there are a lot of attestations that have to be done we are not sure yet what those streams look like for us for clinics for pharmacies for anyone else but we know that it will have to be covered related we know that does dollars can be used to back fill lost revenue which is a really great thing for us because of the elective procedures that we did put off and we also in Arkansas we work really diligently to try to track those dollars as much as possible if we see a hospital on a particular list in one week and we go back and look two or three days later at that huge HHS spread sheet which is cumbersome at best to get through and we see that a hospital hasn't ACT tested that it also should have received money from a different formula we try to reach out to the hospital to let that hospital know that they've either left money on the. Able or that they didn't qualify for certain things and Mr rile and I talk in office quite a bit the distribution and the formulas have not served all hospitals equally some of our rural hospitals have finally been able to be reimbursed or at least receive dollars that they've been meeting for a long time some of our larger tertiary hospitals have been left out or have gotten a very very small amount of money even some that early on saw lots of prisoners and had lots of code load early on they've been disproportionately not given the same kinds of dollars that some of the smaller hospitals have. Mister chair. I wish sometime we'd have a meeting on this issue alone because it could might be a little late fee to get into the nuts and bolts in the dollars and cents and get to supporting data that just be request here we could add that and may be of specific item talking about the deficit you brought up and bring in some other state folks are folks that could shed some light on that thank you. In consideration. Right. Representative Bentley you're recognized. Thank you chairman thank you guys for being here today can you tell me right now we still have a house was have page that have staff this furloughed. I think there are some hospitals that still have furloughed staff I know there were some maybe two to three weeks ago that furloughed some of their staff so yeah I was still happening up until about three weeks ago. Some furloughed okay this was a lot of people can't understand all those we see so much health issues going on or having staff the skin for load at that time so Mr wrote no we hearing of any clinics that are closing or doctors offices that are on the brink of closing at this point would you hearing from your phone out they have it heard personally of any that it had to close I know that there are some that have been struggling some of those for Lloyd hospice for lower furloughed hospital employees are actually physicians so it even it's affecting physicians it's affecting the people that they work for most clinics now there early on. There were a lot of clinics that really had to cut back on their staff. A lot of that's open back up asked we've been able to get more PP out there to them they've been able to do more things but been able to bring some of those people back of most clinics you go to you know you you walk in each chapter checked and you got a mask on and they've rearranged their clinics their spacing people out you go into a waiting room and I've got chair's turned around they're doing things like that so they're not they're still not seeing as many patients as they were. one of the one of the big concerns about that and that's another reason I wish doctor Rogers could have been here as a pediatrician they're concerned that we're getting way behind on our childhood vaccinations. Because kids aren't able to come into the doctor's office or the pharmacy for that matter to get their childhood vaccination so and I know that they've got a proposal before the cares committee to do something about that try to get get a handle on it but it hasn't been as profound as what we hear with some of the hospitals most of the clinics have been able to make it even though they're struggling. Thank you so I have chairman thank you. Sullivan you're recognized. Thank you Mr chair doctor Thompson just testified a few moments ago about there were New World and things are changing rapidly and we're talking you talked about telehealth we've tried to pass as you all know several sessions and the hospital association has not weighed in on that formally medical society I don't know if they have but if we have not had the support that we need to change that so what's changed. In the governor's executive order that now you support the. Let let me go first so the the governor's executive order deals with using the telephone only to establish a doctor patient relationship we have not changed our position on that we do all we also do not believe that that portion of the governor's executive order has had much of an impact on what is happened in the state what has had the biggest impact on the state as far as telemedicine is the carriers paying for telephone visits for established patients that is where the ninety five percent of patients who were using telemedicine the state today that's what they're using it for to see their doctor with an established relationship over the telephone that was not part of the governor's executive order requiring insurance companies pay for telephones but they are doing that in fact all of the carriers in the state even the state employees association has they have all voluntarily done that and they've said they would do it as long as the as the emergency is declared we've we've we've never been opposed to that of the insurance carriers. In a non covert situation have not wanted to pay for telephone calls I don't want to get to a prolonged discussion so I just assuming if we go forward with telehealth legislation that we ran before you'll still oppose the it is far as establishing a doctor patient relationship by nothing but a telephone yes okay in the hospital association. Well you're right certainly things have changed so we would certainly have to look at that with the different nine now because of because of the doors that have been open that's the question I don't know about the different I are you going to answer that you are you going to be support of our neutral are where you're gonna be if we run the same legislation that we have in the past and you look at that point in time with this is that point right. This is the point and we're asking you right now we have the legislation if we have a special session next week are to Morrow that religious station may come up so are you going to be favorable or unfavorable. I can answer this time we'll just have to look at in center thank you thank you Mr chair. You're recognized. Mr Joanne I just I'd like you to clarify something for me in very simple terms that you had on earlier you said that there is no incentive for hospital to code a code patient at that didn't have code as a covered death right but there are incentives for hospitals treating COPD patients correct so can you tell me the the difference there yes I sure can't can you hear me OK I'm Medicare is the payor that allows a once a patient has tested positive for cove it Medicare will give up to another twenty percent on top of their regular diagnosis related group or DRG payments so for example if a patient comes in with simple pneumonia with no complications right now the Medicare DRG which if you don't wanna make sure you pure fact checking me it's D. RG one ninety five that particular D. R. G. would pay a hospital no matter the link to stay or anything else forty one hundred ninety five dollars okay no mon you with no complications with an additional twenty percent that would be an additional eight hundred and thirty nine dollars for that particular the RG so the total payment for that Medicare patient who had simple pneumonia with complications who is not cove it would be forty one hundred dollars forty one ninety five if the patient work cove a positive the reimbursement would be five thousand and thirty four dollars Medicare is the only pair that gives an additional add on for that we I did spot check with some of my hospital so we did not do a full statewide survey but I spot checked with some of my hospitals who had a higher a number of Kobe positive patients that we know of coming to visit with them to ask them Hey what your average additional payment for your medic cart Medicare discharge regardless of the DRG and they said anywhere from two thousand to about forty five hundred or five thousand dollars is there additional payment. Over and above what they would have been paid otherwise. So if they are Medicaid than there is an incentive for them to code that is coded even if they didn't have code would not medical not Medicaid Medicaid Medicare Medicaid and traditional Medicare not Medicare advantage so just that Medicare population so there is an incentive for them to do to do that in a certain population groups so how do we know that that's not happening well good and bad news for us is Medicare is awfully stingy with their dollars and they're happy to come back and review charts and do a lot of other things to us after the fact to not only take back the dollar that we have maybe inappropriately coated but also charges penalties on top of it so the incentive for us to do it isn't absolutely not at all outweighed by the fear from Medicare coming back against us with their recovery audit contractors and all of the other contractors that come back and take dollars back from us that they paid us in one particular year in another year when they've had time to be a Monday morning quarterback okay and I think it's important for people to know that that's why I'm I'm asking that question because I hear that all the time so what just like your he's he mentioned earlier these patients that the family says I didn't have cover they never been tested for it and all the sudden they show up no code on the desk of get your people assume that the hospitals are being reimbursed more for that patient because I caught they coded it is as covered so yeah I think the people need to know that that's not worth the risk for the hospitals if. They're doing that anyway thank you. But now to add on to represented Gonzalez question there there there are funds from the cares act they go to hospitals direct care and I know that can be a different definition and every hospital because I've talked a couple hospital administrators about who direct is and and they get funds and then that those funds are an incentive to direct care workers so I don't know how that shakes out but that hospital is getting extra funds for treating COPD patients. So I don't know that's an incentive or not but I know it's extra money that the hospitals are getting is that that's correct is an in kind of an it it is it's granular really correct so the department of Human Services had two different funds available for direct healthcare workers in emergency departments in inpatient settings for hospitals and then in long term care services all of those dollars were a hundred percent pass through dollars so the hospital did not get to retain or keep a single penny of that and as a matter of fact we've got to get major credit to the department of Human Services because they worked diligently with us to make sure if there were portions of retirement benefits or other payroll taxes that the hospital would have had to have paid on that back on behalf of the workers who we were serving as that pass through for they worked with us to make sure that we got those dollars backing could reimburse us for those two there were two different methods for that one is called an eleven fifteen waiver which is the state waiver that lets a state do something a little differently in Medicaid and that went to long term services and support so thank your nursing homes assisted living some of your hospice programs they receive direct care dollars through that waiver at the federal level the department of Human Services rightfully recognizing that hospital employees also were kind of in the same predicament. Requested and received money from the cares act that would then be passed through for our direct in into care in direct care workers so that are carriers funding provided the pass through dollars for our hospitals working in an emergency department for an inpatient setting only who were either directly or indirectly in contact with those particular patients so you say it's pass through but this is going to the workers it's going to the workers and you know I've got calls from workers and hospitals that say I should be getting that extra money okay because I work in this area or whatever so that money is going to those employees. so does that affect some of the decisions that's I mean because we're talking direct care we're talking doctors and nurses and so these doctors are getting this total actually go into any of their decisions that they're making when it comes to cope with or non coated so I didn't interrupt you forget that go right but that physicians actually were not part of the group that were allowed to receive those dollars it went to nurses and social workers and folks who came in in direct contact janitorial services as the indirect care kind of workers so the department of health was super stringent about who could receive those funds recognizing very rightfully so that there are limits there's a limited amount of dollars for all of those care workers so physicians did not receive those funds the other thing that apartment of Human Services did when we and and PS that program is over there's no more money coming in for for those I director Inc in direct care workers but the other thing they did is retroactively pay so there wouldn't be in and and necessarily an incentive to come forward there was a pretty strong arduous process of making sure that once a week we would send information into the direct care worker program email it had information on it an aggregate of how many don't how many people were in certain areas of the hospital at certain times and how many hours they work to make sure that all of that was done correctly and the same is true for the long term services and supports workers okay thank you. Bentley you're recognized. You should be on I thank you chairman I have a lot incisions are concerned we're looking at our hospitalized rate of Kobe patients there and sometimes we know that that patient may be tested positive for cover but they're not being treated for code because they're a symptomatic maybe they're having a delivery may be there for C. section whatever's or anywhere for us to segregate that numbers of folks you know what patients are actually get treated in the hospital for cope eight nineteen is anywhere for us to do that. I don't know that we could get the health department to get down that granular data I know that the and resources where they enter this state of the hospital does each day just has so many categories are they would have to build a whole new system there and reporting to get to that so there's no way for you guys to enter and that this is a patient that is tested positive but they're not being treated as a covered patient at this time. Right I do not think that's available on the in resources right now that's correct okay thank you. Hammer you're recognized thank you Mr chair and up I just wanna make one statement with her I support all hospitals and I don't see house bills go away or doctors or any health care providers we need to get off the number forty seven get number one so just all the questions I have I want to understand I'm for you but at same time. We don't want anybody taking unnecessary advantage of the situation you want to come to resources so defending the numbers is about as much protecting elves integrity is anything that to that let me ask David when it comes to the PP you you talked about the network what what suggestions you have for how we can improve getting PP ease into the state no matter who it goes to our or who get some do you have any suggestions for what we could do improve or do you think the system we have in place is sufficient it's just a supply demand because there's not a another. Coming because everybody's competing for I think the the first excuse me the first way I would answer your question is it's a supply chat is a supply line problem. They're still not death PP being developed and I would say the same about about testing and re agents we really need the president to to use the the federal law at his disposal to get this stuff ramped up. A I don't think we've seen the P. I don't think any of us think we've seen the peak in Arkansas we're going to get a lot more and we're gonna need more PP E. as we go through until the supply lines and. In April when we made our first group of deliveries I would have told you that well we think by June or July the supply lines the companies that manufacture this stuff will be producing enough the we don't have to to use the governor's purchases anymore that's not happened I get calls every week from clinics that cannot buy in ninety five masks some of them struggle to buy gallons thank shields are pretty easy you can yeah we got three four companies in Arkansas making facials I've I've told the department of emergency management don't send me more facials I can't use of the the three ply mass like this we unloaded two hundred boxes of this at my office last week that we're distributing right now. The supplies of that are big they're just not all coming to where they need to go but when it comes to in ninety five mass gallons and even gloves there's just the supply line so. We've got open up those supply lines that is in and unfortunately you know we're competing with the rest of the world for purchasing this stuff and it it it first right it frustrates me to no end and I know a lot of you all do to we see these boxes coming into our office not my staff goes out to a flatbed truck or an eighteen Wheeler that the department of emergency management has brought over and we go out there with dollies and carts and we will all this stuff up to the medical society office we start to look like a warehouse no we do look like a warehouse and ninety percent of these boxes they're made in China. And and that's just where it's coming from now that we got the three the in ninety five mass that we have right now with fourteen thousand of them about probably ten thousand those of already been mailed out to the clinics were picked up their three AM. That's the first three AM mass that we've seen since we started. So that's not a good answer to your question but unfortunately I I I think the problem is the supply line okay so are distribution methodology in the state is sufficient it's just re I get the items into the state to distribute is that fair that that that's fair as as far as hospitals nursing homes doctors offices maybe dentist I think dentistry in on it now but when you're talking about schools. It's a different story. And they're not part of that process at least not right now. Will move this conversation we've had to. A okay offline thank you Mr. All right that is all the questions that we have in the queue SO one thank you all for being here. And provide information thank you thank you. All right we'll move on to item G.. Miller any. We have one more question maybe you know one second I'm so sorry and. And and I apologize it's really for Mister right and and and and Jody and thank you Mr rile appreciate your very much appreciate the comments and the questions and the discussion is very thorough I do know the hospital clinics are also struggling and I know one system that did lay off twenty five percent of their work force and and not furloughed but laid off there's a difference between those two things so they had been on for a load and they had to make the very painful decision to lay people off completely so those were doctors nurses physical therapist lab technicians respiratory therapist janitors all the way down that did get laid off and which you know we haven't we haven't needs to make sure that we have ample of people and health care infrastructure to take place to be there to take care of our patients one of the things is attestation that is very tricky and so the the Medicare dollars did come in you may have already said this but the Medicare dollars did come also to clinics but pediatricians for instance actually don't see Medicare patients so I just wanted to if you had any additional information on that an attestation I know you're looking through the database and see and who has a tested and who has not are you all also doing that for people. We are we are not we've not been asked by any of our offices to do that okay well I know it's a tricky situation and you have to really want your emails and there's not a lot of heads up on that so I just wanted to make sure that we have that out there and the other thing I wanted to ask too is do we know how many are you reporting your testing turnarounds to any place in the state. Whether it's coming through clinics or hospitals that being reported. Or S. suggestion tracked we we give our information to the health department and with secure messaging we follow their guidelines a hundred percent and to make sure that we're giving them get information on when we collect the sample and then when results come back if they're done in a private lab those private lab results go to the health department and they're supposed to also come back to the provider who collected the sample and submitted in the first place okay so so is is the time frame being reported this is when it was collected this is when the results is that being reported department of health yes because it's time and date stamp to me collect the sample and scented and through their secure networking system. Okay so the department of health should be able to run. Analytics to figure out what the average testing time would be across the state that right. Main part of health is here I was gonna say you might ask you might ask them and and I can only assume that testator samples that are taken in doctors offices follow the same same requirement and you know if you stop and think parties I know that they're doing that as well you know early early on during Arkansas's experience with the pandemic you know it was the routine turn around time was four to five days it got much better and then we started doing more testing and when we really ramped up the testing is when the lab started getting behind the glee the commercial labs yeah and they are also you know here recently they've had to cut back on that you know testing whoever wants to test right that is kind of come to a screeching halt in large part because of the lack of free agents and I think that was brought up this morning right it's not necessarily a money issue it's really and supplies this is to apply issue again and again we we really need it would really be helpful if the president would use the war powers act to get people to make those things for us because we need him and we're going to continue to need them for the next for foreseeable period of time right thank you can you answer my question Mr Gilmour. Thank you. Cal. Identify yourself please back in one part of health I'm not the expert on testing but from what I understand as Mr Rhodin said I think they do tell the lab when they collect the test. We get the results back directly from the lab sometimes all that information is not correct as far as I say correct complete as far as you know we get a name I don't know I haven't seen the exact list we get but sometimes we don't have that date the what was actually collected on there from the freshman of the commercial labs now I think through some of the legislation some of the lab legislations gone through the federal site I think there's requirements to do that but I think sometimes there's a. The information we totally get from the commercial lapses and have always have that information on there. We do get some okay okay but if the house if the hospitals are reporting the date of collection to you as is that coming to you you should well if they use the commercial lab if they sent off to a commercial lab will get the results from the commercial lab. We don't get it directly from the clinic or the doctors of now they're doing their own in house testing yes will get that information but if there's an off the commercial lab that's where the issue of it getting the exact time that the test was collected and so forth. So it so is there a requirements that exists to report the date of collection from what I've seen on the city's website there is some documentation that that says they should be doing that but. I think it's a volume issue right now as far as them getting all that information there's my people to intestate across the country as far as you know what they're able to report we're getting what we can get I guess is the best answer for him in a bit what okay can you check into the department of health for me and then if the hospital physician if you all can check to see I'd like a clear answer senator how that's being reported how that's being collected and how that's being utilized by the department of health thank you. We have a question for you Absent Gonzalez you have a question. Yes thank you Mr my lawyer appear. the the test from from the rapid tests that don't go through a commercial lab how how do all collect results on those those are turned into us we have that information what were discussed and I think is the commercial lab results the slave Matt Gilmore's clinic or hospital since my results to the. X. was a commercial lab that information so how do we know that you're getting all of those from from the. Like a fifteen minute immediately. Test prep and test well they're required to submit those to us so we have to take all right to the honor system yeah just one of the things so it was announced today that that the health department had purchased two hundred point of care Kevin nineteen test so amend is at two hundred test or is it two hundred testing machines that can go out. This or that the house with you so I don't okay I just got I don't have I don't understand so apparently was announced in my press conference so strong for your what exactly that meant thank you. All right we have another question. Senator Clark you're recognized. Yes I'd like to ask the same question S. the sector. The. We didn't ask for more money. For testing. And trace Senate Commons or or see. Tell me long that were not past the top with the parabola. On the Marshallese and headed down and that by the time the money gets there. The situation will be mostly over. A thank you heard the secretary and doctor Thompson earlier I mean I think we're. We haven't seen the end of this year that if that's what you're asking hundreds of say the end of it we I mean Arkansas as a whole flatten the curve and we seen this sweep up. So what we have way less desk the New York or New Jersey except for a we we sing the sweep up but New York had this parabola which is looks like the Empire State Building to school up and down that's what Commons looks like that's what most prisons looks like. Anywhere we have a tight puppet of population that's really close together and so but we didn't ask for more money for Cummins we didn't ask for more money for a war C. and so asking. For somebody to tell me that were not on this parabola of the Marshallese which is different from the rest of Arkansas. That were not pass the top of that but because of that population density and that by the time we get there were at the tail end of it. But will continue spend the money anyway. I think the we don't know what's going to happen I think I think as they both said this is a virus that has a mind of its I'm I'm paraphrasing and mind of its own as far as when you know we're gonna see a peak or a. Curve or whatever you know. I do I don't know the I mean we have to plan for the worst hope for the best but it epidemiology we look at these cars wrecked and so just I want to be a record here today one John appeal record because I'm going to ask for this Carruth. This group and see where the top was and if it hadn't already occurred and where it comes down and when the money came in and so because I. Because there's a point where Matt the petitions come in and I think it is predictable but y'all don't well I think as we go as a. We haven't reached the top yet I think that's a bigger one said that and I think that as we you know as as as we move forward the closer to the you know the flu season I don't think we know exactly what it's going to look like it. Okay with with the Commons and oversee to. I mean we don't I don't think we know I mean there's been outbreaks there but I I can't I don't have a crystal ball I guess that's what I'm trying to okay so if we haven't reached the peak there. We haven't reached the peak and I don't I don't know I don't know what have what we asked for millions there. I mean if that is the theory that we don't know that that that we may have this big. Of spread in Cummins and oversee why are we asking for bunches more money there when you talk about millions what what millions are you referring to I mean it are you talking about a specific. I'm Tom but all the extra money that we the we think we need. Of FOR the Marshallese I think we're chasing our tails what I'm saying. I think that we should have done a lot more but I think at this point that we're going to we're gonna get money there for a because what we did amended New York. This solve their problem the virus just rampaged through the New Jersey solve the problem to the barges rampage through that we solve the problem at Cummins or did it just rampaged through and so and if the answer is the second which I'm pretty sure it is then that's what's happening with the Marshallese and by the time we get the funding there. Which yeah could have already done what every thought needed to be done. The it will have rampaged through and then we'll for the money way anyway. So you may want to put that on a later meeting in and maybe get some other folks here to. Answer will be voting on it tomorrow okay thanks thank you thank you Mr. one minute I get one more question your sorry. Representative Penzo you're recognized. Yes Sir. Or. So with antibody testing it is not as accurate as the typical what PCR type test that is happening state we do track it but as far as a a marker or a something we would use to say look you have cove in nineteen need to quarantine whatever. That is not what's use for that so we do if this happened the state there is some of that going on we don't. Yes you're not on there Penzo pushing in. I'm on a the other. A understand that it's. Not gonna tell you if you have covert now it's gonna take you've been exposed over the past reason mask and some states have done some extensive or they're working on doing studies on anybody testing to see how much of the population actually has had Covin there was a symptomatic and their extrapolate net that in coming up with I mean a doctor Thompson mention that there's possibly ten to fifteen times more people out there was code then actually shown up with the nasal pharyngeal or the nasal swapping. So my question is because if you if you look at those numbers I guess. I'm trying to say is if you look at those numbers. Ten percent of the people. That possibly have code are shown up. With the nasal swabs. So there could be ten to fifteen times more people out there with colder than we realize. And we're basing all of or statistics on. Only the nasal nasal pharyngeal test to see actively if they have it so. The numbers are. Accurate as far as the death the mortality rate and things like that. If we don't know how many people actually have had. So that's I guess my question is because of if you go to. Thousand people which is round number. Let's say ten percent of them have gone in and had the test. So the one that had nasal tests. Fifty percent or a symptomatic they didn't know they had it they were just in for procedure something got tested exposed to somebody they get tested. So you get. Just a handful of people of the total this is the statistics are being based on that small amount is there any focus to do any testing so we can get accurate data I guess is my question sure so like I said we're doing by so we there's anybody testing being done the state now we're tracking that we we we have a. There's a number I don't have out of my head but there with we do have a number in my tests being done the from my understanding I'm not the testing expert but from my understanding that there are anybody testable come out or in the works now Indian develop some come out later the contract back further but what we're what we've got now just shows if you've got the antibodies in there so we are tracking and I think will will be able to use that in the future but I think the focus right now though but cross the state department is is let's let's figure out you know who's got it right the moment I don't know if I'm answering your. Question. Yes yes and no I just it seems to me like if only it based on the numbers that were just thrown out there felt Jeez it also said the the ten fold cases I mean that's that show in like ninety five percent of people that have code or a symptomatic. Amendment two is that an accurate well I think doctor Thompson mention your little while ago that I think you said around forty percent no he was saying forty percent that going to get the nasal swab. Forty to fifty percent of those people were a symptomatic they had no idea they had it but they tested positive many said the ten to fifteen percent or ten to fifteen times more people have it. Then testing positive. So that would mean like ninety five percent of population this would be a better question for sector Romero yeah I think we need to Mayberry asked this question later when we get the other folks here from department hell we're on the air professionals to go man thank you all right these rules quest thank you. This ma'am. Alright we're going now of remember we've got to more items on the agenda and like to get out here before dark so. Stratton keeper question short so the next item is G. covert nineteen impact on various population groups some on the left we already there okay senators yourself for the record. Surround the lead director for the Arkansas minority health commission you may proceed there's a hand that with this yes you should have a hand out it is very similar to the one from last month the only difference in our activities are ark here's proposals so I am going to review our process for that and then just briefly go over our standard coke at nineteen activities. So the Arkansas minority health commission has agreed to work with organizations in relation to their caters proposals we have been able to do that because we already have a grant funding process so we have adapted that process to make sure that that Kearse proposals applications are cobit related that they will have to submit an itemized budget we've worked to with and receive advisement from legislative audit as Willis R. AG ladies online and adapting our policies an application there will be a quarterly or for part disbursement they will receive the first disbursement if they are able to provide that accurate documentation receipts in accordance with the FAA policy then they will receive the subsequent disbursements and they will be able to do that up until they have exhausted their funds for a total of four disbursements and again we are working directly with the department of finance and administration to make sure that everything is in alignment with state procurement guidelines So the reason the minority health commission has been agreed to work on these proposals as because they're specifically minority related proposals and what we are seeing is that there is an increase incident in death rate and minorities for co that cases specifically we're seeing and what twenty five percent and and African American and I'm sorry. Twenty nine percent in African American twenty three percent and Hispanics other is eleven percent Asian one percent and Pacific Islander seven percent what we know with minority populations represent about twenty eight percent of our population but forty eight percent of code that case. So are out reach includes adept in our website so that we have a web page with Kobe resources that are both state and national rep resources we are also providing presentations to community based organizations faith based organizations and non profits as it relates to code it making sure that we're providing accurate factual information in this banning minutes we also develop health backseat that are culturally competent and in print plain language at a fifth grade or below reading level and in English and Spanish we also have media campaigns for TV radio and social media in an effort to get information out throughout the state we are seeing As of may we had seventy three hundred page bees for our co that web page twenty four hundred and sixty of those were unique meaning that they were able to get ark code that link from somewhere else and click directly on it to go for that information we also had fourteen thousand Facebook impressions and thirty eight hundred Twitter impressions. We have been working with partner organizations in an effort to make sure that we are sharing co good resources as well as developing a centralized repository for information that can be shared brought. We have been participating on the health equity response team I specifically work with the community community health workers subcommittee we are we work between the department of health and you a MS to look at four subcommittees one including vulnerable populations one that looks that state guidelines for healthequity one for data and then the other for community health workers. We have experience and challenges due to co that specifically our standard sponsored activities in grant activities a lot of them have been canceled due to cancellations within our partner organizations as will ask cancellations with partner meetings are mobile health unit has not been able to be on the the road because as mentioned here earlier TV E. has the band and an obstacle for us being able to access P. E. P. E. we also do not have access to the test to provide co that testing we have limited staff as will the minority health commission submission usually focuses on chronic disease versus infectious disease and so having trained staff to be able to address infectious disease have been a challenge for us and so we are in need of additional training to be able to address that and we have several staff members who are in the high risk population as it relates to code that and therefore it makes them susceptible to the disease. But with challenges there also always opportunities and so we have been able to you learn and move into the the virtual packed platform to D. virtual presentations we've also been able to partner with that department helping UAMS testing opportunities specifically working through you are one hundred and fourteen pardon organizations in sixty six that a seventy five county so that we're able to recruit and get and individuals to participate in testing as well as working with national partners like the minority the national minority health office as well as the mobile health map organization and the mobile help organization and national arm we have also been able to have focus groups to work with specific and minority populations in an effort to you just find out like what their concerns are and how we're able to more directly provide access to information for minority populations and we've been able to you partner and work in on efforts to see how we're able to you last community health workers within the state. All right. Well that was your last line that was my last one thank you very much we've got a couple of questions here so Senator hammer you're recognized. This chair and thank you miss love and appreciate the work you do question we have before us or head before she may be coming back up forced a three hundred thousand dollar requests from the Arkansas black hall of fame to help with covert related issues what are you doing or not doing that would either support or do away with the necessity of that grant given the fact you serve the minority population so the minority health commission has agreed to work with that black hall of fame ask the or state agency that provides oversight and we will be able to utilize our granting process that allows for legislative audit and DFA state procurement guidelines to be utilized within the year here's proposal activities. Then what would the money be used for are you aware to you know of what the money would be used for that you are not currently doing yourself in your out reach programs and what are the on related issues that that would be required that are not already related issues being addressed by your group sure so they are requesting funds to assist with housing which is something that the minority health commission currently does not do you as well as looking at utilities and or helping to pay positions in doctors bills hospital bills through the subgraph team process and those are activities that the minority health commission currently does not participate in but would be able to support them through a sub grant team process and the structures not a place for you to do what they're asking to do so it could just be under your umbrella alone currently we we we don't provide access to those services and they will actually be be happy doing the grant submarine team process themselves and so it is something that my office will provide oversight border and checking to make sure that is within state guidelines so they will have utilized their current partners I believe they said they already have like a hundred and fifty applications that they would be processing. You know if the expectations are have been put out there that that money's coming or why would those applications be that high if the expectation was not very put out there that the money's coming I'm not sure the expectation is already been put out that the money is coming but I do understand that they have already done some sub grant team through their own foundation dollars and this would allow them to be able to assist those that they could not with their foundation dollars for thank you Mr. Representative Bentley you're recognized. Thank you thank you stronger for being here today just back on your cares proposal did you receive a certain amount of care funds for you to give out and grants when you're doing your grants or explain that to me so the Arkansas minority health commission has not received any grant for tears funds to date we have there have been several proposals the that it and the minority health commission was contacted to see if we would be willing to work with those organizations and so if the cares committee approves those organizations like the black hall of fame then those funds would come three to our our office should be to be provide it back out to those organizations okay one which are much your mobile health and I'm disappointed that it hasn't been able to get out there and do some testing in some areas where you're already trusted and people know who you are and DO es the governor's office FOR PP here so yes we have we have talked with the governor's office and the department of health and and that has been in the the process we just have not received it and then in addition to that like I said we are trained in chronic disease and so there's also going to be training needed for my staff to appropriately care for the community as well less as themselves and protect themselves so it Representative Bentley I think it is in the works that just has not happened to to this point how many staff members you have strong on the mobile unit we only have three. Three yes we have we got a driver another's and our our coordinator but the the coordinator is able to provide health education and and so it would be the the nurse to do the slobs our driver happens to be an LPN so he's he's trained both and never seen and he's a CDL driver okay. so you have reached out is for is your much use it with the Marshallese committee have you done anything with that that community there so we we have you know as the the minority health commission we are always working with all minority populations within our state and so we have had regular were working relationships with the Marshallese populations and to you of the proposals well I guess the review consider the northwest Arkansas proposal B. specifically working with those with that Marshallese community and the minority health commission would also is this in the year cares proposals if they are ward it. Okay thank you. The pain you're recognized thank you Mr chair miss love I can't read this third slide and While you were on it it's the one that says minority health disparities for your on it you said twenty five percent black but I don't know what you mean there are you saying twenty five percent of the code cases are black people yes Sir and then you went on to name some other percentages with other communities and I can't write that faster less than that fast but the can you email me this slide in a way that I can see it yes Sir I can definitely send that out to you it is a slap that we update daily and so I will make sure we get that. She is in the price and the included on that slide does it. I think it says something about. A by age so I mean we know senior citizens are also in the high risk group so is that on there yes Sir it is listed by age race and ethnicity and gender okay but in all of that twenty five percent of the code cases are from the African American community and I actually misspoke asset twenty five initially and then when I look back at my slides it is twenty nine okay and what were the the percentages you said they're Hispanic is classified as twenty three percent other please I'm sorry yes Sir okay go ahead other eleven percent. Asian one percent Pacific Islander seven percent. Okay thank you Mr chair. All right seeing no more questions thank you for your print what. Center you're recognized thank you thank you miss laughter van here and I appreciate the steps that you to to go through and and my question is and why would we not just give the Arkansas minority health commission a portion of of money to ramp up your mobile unit. I I think that that would definitely be something that the minority health commission is willing to you to do I do believe that we currently only have three staff members and to be able to reach all of the areas within the next five months I would have to hire a lawyer significantly probably more staff two D. so the testing and and so being able to you support those who you have boots on the ground and or if they are able to provide us with the additional for time and effort ceded able to reach those needed the minority health commission would be happy to work in coordinate those efforts okay what concerns me as you know the minority health commission does very good work across the state you do and and what concerns me with the proposal from the black hall of fame is. It's delegating down to a group of individuals that none of us really know who those folks are to determine where those monies are going to go. Is that correct. That's kind of the way it's set out. In so I have a little bit of an issue with that just because normally when we do grants or anything like that eight you know there's a process so that were where of. That that is correct however we are currently working with the Arkansas black hall of fame to see it to make sure that their processes within our guidelines and one of the things that we're working with this is that the minority health commission also receive all of those applications and that that process is the standard asked process one that everyone is evaluated online and selected with and with in accordance within guidelines and so we're going to do our best to make sure that there's fidelity and that it is something that when when and legislative audit comes to review they are in agreement with and so I have been advised by legislative audit as it relates to the requirements that we are implementing as well as the state guidelines and so far they they think that what we are implementing will make sure that every team cast the deli so we we can sense the federal guidelines allows us to pay for utility bills well being and send the food and security and I'm not sure I don't know the answer that question I guess Steve and I would have to answer that question but the other thing is you know under that there's a lot of folks that are suffering because of covenant and. Is the is there value and making sure that these are state wide opportunities for people. Is there a value to that I I I agree with those states is that yes ma'am for people everywhere well DF eight actually was meeting with the black hall of fame today at three o'clock in Salem I was here in unable to attend that meeting that I did get that set up so that we are able to like I said and the guidelines one of the things that they did ask about was the utility bills and so they are addressing that today because I do believe that there are some guidelines as it relates to it in my office is there an attending and recording and I do agree with you as it relates to you this needing to be a statewide effort but I do think that the black hall of fame has a state wide reach okay thank you for answering questions thank you. Okay. Couple more questions here Senator hammer you're recognized thank you is the Arkansas black hall of fame of five oh one C. three non profit or which organization. It is a five oh one C. three. Sorry about that hit the wrong button thank you thank you. You're you're talking about being proactive in checking with legislative audit as far as setting up how it would look so that would be distributed correctly on the front end right yes Sir but if something goes awry and maybe senator Hickey or somebody else that has legislative audit experience legislative audit can't go in an audit of five oh one C. three can they so if once the money's out the door there's gonna be is gonna be very difficult audit where the money goes however your organization is under the full purview to be audited by legislative audit correct yes Sir Senator hammer you are correct and that's why we are sitting in the in a matter of disbursement so that they will get their first disbursement and as long as they provide all of the accurate justification resource receipts and documents then they will be approved to receive their second disbursement however if at any point that information is not appropriately provided they will not receive future disbursements and that is in accordance with what legislative audit has has guided us what's the first dollar amount that would be allotted out we are doing it and FOR it so they would get one fourth of the total cares approval and for disbursements of one and one quarter okay a just so there's no misunderstanding by anybody in the room or watching live I'm all about helping people in need I don't I'm all about helping people that have legitimate needs so I want that on the record but also about trying to make sure that we don't hurt somebody by trying to help them because it comes back later when the feds come in add Senator Irvin was mentioning we don't even know for sure how all this money is going to be accounted for and it would not be a very good environment if they come back later and say we. Could do this and I'm not sure that even DFA or leg audit knows at this time what all that's going to be because the feds have not come down with clear guidelines that's why some states haven't released hardly any of their money at all so I just wanna be very protective because it would not be a good environment if that happened for for anybody I would like it you are the point person and point agency in the state when it comes to assisting minorities with regards to resources and assets is that correct yes Sir I'd like for you to prepare for me if you don't mind may be an overview of all the entities that help minorities and to identify where there are not overlaps or where there are overlaps of services just we can get a holistic view of all the entities that help and what areas they help in just for future references if you don't mind please. Says Senator hammer just to make sure that I have a clear understanding of your request are you asking FOR state entities or entered entities in general because I can provide you with the organizations that we work with on a regular basis that I'm aware of but I'm not sure that I have a statewide list of all organizations providing resource okay a to what you're almost next last time when you get up to walk outcome have a side bar with you we don't take up the time but okay alright thank you. Representative Bentley you're recognized. Just a real quick question Sir on the back on your on your slide with the numbers of I wrote down correctly you said that of the code cases that we've had positive twenty nine percent were African Americans. Twenty three percent Hispanic eleven percent or other. One percent Asian and seven seven seven percent Pacific islanders sekarang that is correct that add up to like sixty one percent so that true that sixty one percent of our cases are minorities and so date it's forty eight percent I should say that ethnicity is classified as Hispanic it is not classified as a brace currently in accordance with the twenty eighteen and senses and so Hispanic is not considered a race the one we're looking at racial make up that's forty eight percent. So remove the twenty three percent when you total the numbers. But if I add that twenty three percent that sixty one percent correct. Wow okay thank you. Absent a Payton you're recognized thank you Mr chair of so I figured out how to use the camera my phone the to blow up this picture on that slide number three okay okay so it says new cases in the past twenty four hours. So that's not twenty five percent or sixty one percent of all the cases that's that's talking about a twenty four hour period can you I can't find it on here can you tell me what twenty four hour period that was so this is when this law this light was prepared by my office and like I said earlier we update this daily so I will send you are right and corner that slide excuse me for of them but in the upper right hand corner this is thirteen thousand nine hundred twenty eight that would indicate to me that this slide is couple weeks so it it it is the slide that I presented last month well and that day. So I was twenty five percent that we're not home at twenty five percent the cumulative cases from the IT ons that we're talking about that day correct. So now. Has anybody taking into consideration the. Conditions that may have existed. Of that drove. The percentages for that day I mean maybe there was a protest a week earlier or something I mean do we have any information or we just. Can the slide from the day that serves our narrative. Actually I you ask that's stated that I utilize the slides from my presentation last month this is the slide from last month and I will provide the slides from today as I previously stated and the numbers will have increased because as you are aware they have increased in our state in general and with that being the case I am sure that potentially the numbers that I have stated it may be larger than than what I have from the previous lights which is what I presented last month that I stated earlier yeah I'd suspect on a daily basis those percentages change up and down. Many of them I don't. I don't argue with the fact that one community may be more at risk than another age bracket. Ethnicity I think we're all of the same race which is the human race but the I I just a would appreciate when you bring information before us that you present it for what it is because I mean I was under the impression and evidently others that you were talking about cumulative cases and that's why I questioned it because I thought twenty five percent sounded. Strange for cumulative cases but thank you thank you Mr chair. Senator you're recognized yeah just want clarification so this these were grant with these would potentially be grants for only people that have had cove it sat correct. For the black hall of fame it is my understanding that it is for it we hope that are key our covert related request so I don't think it is specifically only for those live because of it but those who have been impacted by because of it so maybe they had a family member of mine who also. Echo that. Okay okay I mean I know that we had talked about it listed in here were that they had per provided grants for cities and things like that so just just for. And. That cities and and different entities and so I would just you know we have set aside a hundred fifty million dollars for cities and counties and we have also set aside we've spent I think around a hundred and forty something million for the ready for business program the food and security in the housing the household finance relief. those are issues that I think are probably statewide and impactful everywhere I am sympathetic to the Marshallese and the two proposals that are still pending which total about five hundred thousand dollars which I I a because they do not qualify for snap and they do not qualify for Medicaid and that is not because of a decision that was made at the state level but that a federal decision. So I I guess I'm a little more sympathetic big cat to to that issue under the two proposals that are direct assistance to the Marshallese that we have not taken up But I think food and security is something that is it's like I said statewide so I just wanted to see if those like that were house scene or utilities are feet in security was more specific to a an individual and if so if that was an individual that had either a family member or the them themselves have been impacted by it. Correct and at. As I stated earlier the DFA is the meeting with other black hall of fame today and they are working out those logistics because there were some guidelines that DFA is that had to be implemented and certificates ability at they are providing those today and my office is is the or to to take note on that so that we can make sure that we comply in accordance okay great thank you so much for the information thank you all right looks like that's all the questions we. Thank you when it when moved him. Senator hammer do you know what the administrative cost on the three hundred thousand dollars is going to be. So at my office is taking on this because we currently do you grants and it's something that we already have within our our capabilities and so we're we're doing that with our current staff no no additional staff with there being a reason why we can just give the money to you then I may sound like you're doing all the work is very reason we couldn't just give regular grant just granted to you. I'm like I said that black hall of fame already has the applications and and they've applied to their organization but the minority health commission is willing to to work with with the as it relates to that thank you thank you Mr for lead to. Representative Dotson you're recognized thank you Mr chair over your right uh so. Just come back to something you'd said just a minute ago with regards to the the grants and things that they would go to anything code related. Would this be with someone be eligible if they were unemployed due to covet nineteen to get assistance with one of these grants FOR unemployment in addition to going and getting unemployment insurance. You know I would I would have to look at what DFA is recommending but I. That may be something that they are able to apply for yes what would you be able to get that to us before because I see it's on the agenda for tomorrow morning but I don't have any details on that request other than and it's three hundred thousand dollar request. And it be good to get some details on that before we. We consider it thank you okay thank you. Senator Hickey recognized thank you Mr chair and I'll be quick I just want to kind of piggy back I think we will need some more information to more because as with the ready for business programming that grant there was a lot of questions about how those grants will come we're going to be divvied out because some of it was was it on a first come first served basis how many individuals are here. You know I will is it going to be spread out equally you know we don't want to pick winners and losers here so I think we will probably need some details on that to more I'm sure there be forthcoming so just says where we have a meeting tomorrow on it I just think that would probably be a. Noel proactive on those part to have that said that the bureau of legislative research center requests earlier today ing and Mister Charles Stewart he's the president of black hall of fame is intended to attend that the A. L. C. meeting I will be here in in addition but he's going to attend the meeting server and then also I think Senator hammer at a very good point with the five oh one C. three you know if we're not able to audit that or or you know I don't know so it possibly we may need to look at if if the body wants to most of fund that may be that the money is get given to you all so that we would have those audit capabilities you know whenever we need to show the feds were went so that may be something we need to look at before going to before tomorrow's meeting to make sure that we do have those capabilities three you okay I will be happy to go back to my office and gather that the data for questions asked today and send it to Mister price so that he can board okay again just to just since that's going to come up to more and that was thrown as honest today that we're going to have that meeting we didn't know it was forthcoming either so probably be good to have thank you ma'am thank you. All right thank you miss the repressed this. Engine item H. update on the federal cares ACT. Mark component. Please enter so for the record. Thank Mister mark what was party was services. Right. All right thank you Mr chairman members you've got a couple of pages in front of you and I know the hours late so if it's alright I'll just give you a few highlights from those pages all right let after questions on of the first page of one look at is the one that at the top says carriers act funding award directly from the act these are dollars that Congress provided here for the care is act or families first when the other piece of legislation they passed over the past few months that flows directly to specific purposes in other words this page this is not the one and a quarter billion that steering committee is responsible for these or other dollars that Congress has provided to the state related the pandemic answers get the how if you these the ones at the top under division of aging dole payroll services these are all the funding categories that typically flow to our area agencies on aging and so Congress provided additional dollars to go to them for those same purposes and so we're in the we've our starters during the dollars through the same allocation method going out to the triple a is in the same proportions that that our standard federal and state dollars go out to those triple A.'s. Up below that we have some items in our division of child care and early childhood education let me spot lot childcare development block grant you member with some discussion it's been a month or so back where we announced a program to provide free child care for children of essential workers this include health care workers daycare workers can you include truck drivers people in the supply chain in what is essential worker we of may this available so they can access free child care for a temporary Tom pay through these federal funds I today we've had as of today twenty three hundred families who applied for we still have a good amount of capacity there so if you had no of any families in your area who need childcare and who are central workers would encourage you to refer them to us and they can apply for that program. There also some additional funding for several different nutrition programs. Similar to the triple lays these are dollars that go to the existing programs flow through the same pathways that the regular federal dollars flow for into the same organizations so they have more resources to help meet food needs for the community for your food pantries as well as in child care is around the state. We have a small amount of that is going to child welfare and we are working to finalize the plan for how those funds will be distributed and then the last two division of county operations by the first of these emergency solutions grant these are dollars that are primarily intended help with homelessness and help with housing issues we did a request for applications we received a number of applications in from around the state and hopefully if not today then tomorrow open to finalize a decision on those grants and then release those to those organizations we do know that we don't have enough applications to fully use this funding so we're going to have another application round for those funds and so if you have an organization's either local governments are non profits A you think you might be able to assist in that area please having in touch with us and we'll explain to them the process for applying for those funds. what exactly were those again that was the emergence emergency solutions grant program there near the bottom of the list. And that's the sees a total of twenty three point seven eight million dollars part of the issue that was when the federal government initially announced it they told us is much smaller amount about seven million but after that the fence up the amount we got quite a bit more than we were expecting and so that's part a reason why we're going to have the second application round to help give more opportunities to spend those dollars so that was answer I'm so sorry that was for the homeless to provide a place for them to stay in Senate segregate and that sort of things that what that was for more it can be for a variety of things that can be to help provide housing for individuals it can be for individuals who are at risk of losing their housing to help them with to stay temporarily you can also be for the call street outreach other several different buckets that that can fall into but it has to go through local government order I guess a five oh one it be a local government of five oh one see three those are those dollars flow through those local agencies. Senator been recognized so so twenty three point seven million is available for housing. Yes for utilities all that stuff. Correct a work so and we've reached out to some of the groups that have some carriers ACT proposals to see if we can help steer them this direction to get them involved in this right so what so what I mean you have twenty three point seven million dollars available. That that five oh one C. threes could apply for and could have applied for already. Yes so why are we. Okay and then also with food and security so you have that amount money left in the emergency food assistance program. Right of those dollars those go to the the existing great teams that are already receive those dollars for that program and that includes food pantries committee organizations and others okay so again that that addresses food and security issues yes. Twenty three point seven million to know when those applications that application process is going to open. Of full age for the merger solutions grant that should be fairly soon were were finalizing the decisions on the existing right of applicants so I'm I'm hopeful of me today I haven't heard back yet it may be tomorrow but I would expect us to open up another round I would expect within a matter of weeks if not days. Okay thank you. Sir. Right. All right. Hey if no the questions the first page the other pain which is we we did have a couple questions sorry. Payton. Thank you Mr chair so senator Irvin ask ninety percent of my questions there but the what the ten percent that I have left is. Do the minority communities and the Marshallese qualify for that twenty three point seven million. Potentially so now I'm motor stands out I know their proposal thank has a number of areas are trying to address and I all right I'm just saying though we know that the Marshallese don't qualify for everything correct me is nothing that would exclude them from this portion of money I don't believe so I believe this could be a a piece of addressing those areas thank you thank you Mr. Senator hammer. The the begin the yellow button no I'm I'm laid up over here green okay. I want to say first of all thank you to the chairs because I probably learned more through these meetings in the last week then a thing else I just wanna thank the cheers for having the format to have these discussions. With regards to the homeless population. Is that. Just as long as they're diagnosed with Covin or what's the time frame upon which we are providing housing for them. I believe it's more open it than that I think it's it's so what is the food out food integrity items it's a recognition that with the pandemic in the economic and security that's attached to that they're just they're greater needs there around housing around food and nutrition and so my stands the that it is not restricted to just those individuals who have in house these issue directly related code. So does rent subsidy fall under that I believe petition potentially could. Okay I'll thank you Mr. Came. All right you go in DO page one if you will. Okay. The other page this is funding allocated by the carriers acts during committee to DHS and just walk through these there's some discussion earlier about the direct care worker payments the been made to nurses and others in hospitals and long term care facilities of those of those post first two columns there we've paid out the vast majority of those few applications there still the pipeline bond large those have been paid out now care committee emergency response these were grants for medical providers including independent doctors dentist EID T. and AT T. clinics to provide them grants to help with some of the expenses they've incurred because the pandemic as you can see there we've not had a lot of applications on that so far we distributed over one point oh nine million we do have some other applications in the pipeline because so little that has been distributed we're going back to the cares exterior committee and asking them to do an extension with these dollar for a limited to things that were expenses the record up through may thirty and we'd like to extend that date for September thirty to provide greater opportunity for medical providers to access these dollars recognizing that there expenses have not and it's no sense may we seen what's happened with the pandemic and they continue to have those expenses. We have the forty five million those allocated for nursing homes that's take some time working with the nursing homes to get all the data this needed and to do those calculations but that's the end is in sight and those dollars are starting to flow to them. Same is true for the two categories of hospitals we've been working with hospitals to make those calculations and current how that's going to be allocated among them I expect the first payments to those to be going out this week a hospital's. EMS worker payments again these are similar to those direct here payments but for ambulance personnel for paramedics and empties that those dollars are starting to flow. And then the last autumn there is some dollars allocated to make payments to our foster families are recognizing that they've encouraged some additional expenses related to the pandemic in caring for this foster children we made a payment of five hundred dollars per family out to all of our foster families as a total two thousand one hundred seventy five families for that total of loan for one point await seven million dollars. and that represents all the funding there's been allocated for DHS from the cares acts during committee. Mark I asked this question earlier made. I'd like to know if you can answer this but we're talks about hospital workers. I was told by hospital administrator that the doctors direct care doctors would get that money but earlier the hospital association so they didn't yes they should not receive those dollars we specifically excluded doctors and also the advanced practice nurses physician assistants those Haas level of individuals who are at the heart of the pay scale we specifically excluded them from eligibility okay thanks. Representative rye you're recognized. Thank you Mr chairman of mark you know folks had called on this yesterday let's just say that There's a company there's actually health plans with the elderly folks I agree to get them to different supplies like to take them to Walmart to take you know back and forth the nursing home things like that does qualify for this right here. Let me think just among you know that that now this what they tell my A so you know we have some folks that have come over okay so I just wonder if if if we can get some help on these folks is salaries right it does not apply to them and and we've heard customer concern from other folks because the there are lots of workers in our county right now who are deal with that of course get nurses and doctors clinics at the drivers in in those cuts this substituent sins in the folks working the grocery store or have an increased exposure and we recognize that and we don't wanna minimize that all I'll tell you the the the thought process we had in recommending these to begin with is we're more focused on where the patients most at risk where is it most critical of those employees reporter work is that's why we picked those most critical environments of hospitals nursing homes in in home care thousand barrels of thought process behind what we recommend what we did. No follows Mister chairman please yes yes so if they were driving like a van or something like that for senior citizens you don't think they would or do you know what you think law under the under the current proposals they would not qualify for this okay four eight No. Thank you Mr chairman. Recognize Mister Moore going to go back to your comments about the emergency solution grant and I came if it was represent Payton or who raise the question you heard the conversation earlier about the three hundred thousand dollars will be taken up tomorrow I Nailsea. What it what's the protocol that just a entity has to meet in order to be able to access that money other Burch C. solution grant program. I don't have the application back in front of me I can get that to you so you see all the records in detail I'll tell you generally they just they needed to outline a plan for how they're going to do it they need to provide a budget and then we funding on a reimbursement basis so as they incur expenses will reimburse those reimbursements dollars okay so if it involves of five oh one C. three how do you as an agency make sure that the money was properly spent. Because is that reimbursement basis miss so we would expect to see receipts and other documentation to show that those expenses actually were incurred any course it's always subject to review on the back and as well if we have any concerns or if Leslie water who ever raise concerns about that so pay as you go approach verses here's the money shows how that you actually spend yes that's my understanding of it you know what the balance available in that program is now is of that twenty three plus million what's the balance available you know I don't know yet because that they'll depend on how many of those after exist applications we approve I'll tell you I think aspect is going the significant amount of those dollars but I say I don't have exact figure yet I'd like to know if you could before the morning see if there's some latitude in there for for what's available if you don't mind please. And. That's it for now Mr for now thank you. Thank you. All right seeing no more questions thank you for that information thank you and that's all on the agenda so we are adjourned. Thank you Mr white this was excellent information.