House & Senate Health Services Subcommittee of Public Health Committee

We are going to hear the size face today and I did want to make a comment before Representative bill weights ice pay you could it. Justin you want to go on and make to the title and get your people out there now Alexis lying. Of the attorney general's office called of Justin and I yesterday because they're concerned about any data that might be presented to our regarding opioids that might impeach the AG case of that they have against the opioid of pharmaceutical companies so we won't be taking questions on the is and I think that the AG's office disorder reviewed the presentations that the presenters will be making we just I don't want to any conflicting data that they haven't reviewed that is sort of coordinated with their own data to be presented that money paid cini out lawsuit that they have so with that Justin you're recognized. Representative Boyd us it's like. Thank you madam chair of midtech my mascot for just a second while present this. Thank you for the opportunity to be here stay represent of Justin Boyd at the discuss this interim study proposal on the opioid epidemic so I just I had been had the opportunity to be in in C. S. L. opioid policy fellow man and the third part of that training they really made a point that the legislative branch needs to kind of have our own scorecard and things we've done what we do and what we how are we helping our state with the opioid epidemic and so that's what prompted me to file this and so I just kind of wanted to give a very brief overview of of some of the legislation that I can think of these are just things off the top of my head that that we've done since I started in twenty fifteen but it wasn't just Justin Boyd it was all of us we've made several modifications to our prescription drug monitoring. Prescription drug and monitoring program to make it more robust we have facilitated access to naloxone under state wide protocols so you can come into pharmacy without a prescription and and have access to naloxone if you're on opioids and meet the criteria the pharmacist can even bill your insurance for that we've mandated a prescribing of controlled substances beginning in January first two thousand twenty one we have also worked on crisis stabilization units crisis intervention training mental health court legislation we have mandated prescribers check the prescription drug monitoring program before prescribing a controlled substance we have worked with the nursing board to create an alternative to discipline for nurses similar to what the pharmacy board in the medical board had require health care facilities to notify respective board when a facility believes a licensee is stilling controlled substances and also twenty fifteen we passed the Joshua Ashley poly act with that I'd like to turn it over to my friends here who are going to give you know a brief presentation from the department of health and DHS and board of pharmacy thank you. Thank you I guess they're gonna let me go first so I'm Renee Mallory I'm deputy director at the department of health and I just wanna talk about a few things that that we are doing we do know what they're a grant that we have we do naloxone training for first responders volunteer firefighters crisis centers and shelters and we actually go out and train individuals since September nineteen we've done over thirty trainings in twenty cities and we actually give a dose of nor can to anybody that finishes that training so we get a given out three hundred and sixty doses of of nor can so far we also worked closely with director lane with his peer support peer recovery support specialist and through a local nonprofit we actually work with the hospitals to put it appear recovery specialist and the eighties so that if a suspected overdose comes in the end that those individuals can work with that individual to try to get them off of whatever substance that they're abusing. We also have put you know we have at the health department the suicide call line so we have actually put a purist recovery support specialist in our call center and we we at this point we've had thirty two callers in role in that program we have five currently and we actually have a success story that if anybody's interested I can I can give you that enrolled in that program and now they're they're off alcohol for the most part they're off of that the drug that they were abusing and so that that's really something that's working for us you know there there's some challenges to putting the to putting someone that B. and that has an iffy a drug offense and in a healthcare setting so we you know we're really trying to work with our providers to to be able to get more into to the emergency departments and other places we have a dose of reality program which it provides education to our Kansans on the hazards of prescription and drug misuse it's it's mainly for children but it's also for it can be used for adults we have a web page we that has resources that people can access to talk about the issues and what what they can do individually about the issues Since October of seventeen we also go out we use our hometown health group for the health department that does boots on the ground training we have had four hundred and fifty six training since October of seventeen and seven over almost eight thousand for two serpents in that on we also do academic detail link which is if the physician feels like they need education and help on prescribing practices in those types of things we actually go out and do training for individual providers and of course you know everybody's familiar with the with the prescription drug monitoring program and I'm gonna take this all too because it's a little hide behind it so we are looking at you know one of the challenges that we have is providers have to access the PD MP separately from their electronic health record so we really want to to be able to when they go into their electronic health record in a provider facility then they don't have to do it twice it's right there in front of them when they access up a patient record So. That's about I mean you know that. I won't go into all the details of what we do so that stop points. Good afternoon madam chair Kirk lane state drug director alike thank you Representative Boyd and you all for the opportunity to speak to you today some of the statistics I have a brief A we need to realize that over the last three years counting seventeen through nineteen we lost one thousand one hundred ninety four cancer drug overdose and is Graham is that may be we're seeing some progress that we we are starting to turn the tide up until Covin came in and we respectfully saying in two thousand eighteen we had four hundred and twenty six that is due to a drug overdose in two thousand nineteen we only had three hundred fifty two and I would attribute that to allow the different programs that my colleague from department of health has mention to you and then I a whole series of programs that we've been awarded through the state opioid response grant the prescription drug overdose grant that a lot of the legislators have been involved with an improving funds for treatments for prevention foreign before enforcement education all the way across the board I have a a long list of those programs in if you're interested in getting that if you would email me I'll be glad to email you a short synopsis of each of the programs that we have going. One thing that we realize is that our prescribing rate in Arkansas has been high we're still the second highest prescribing state in the nation but are prescribing rate is down to ninety three point two. He or prescriptions for every hundred people as high as that may sound especially when the national average is fifty one point four opioid prescriptions for every hundred people we realize we have a long ways to go respectfully though in this year or in two thousand nineteen. We are at the lowest point that we have been and are prescribing right since two thousand five. we've come a long way on that averages run from ninety seven point five all the way up to almost a hundred and twenty now down to ninety three point two and we're trending downward and this is based on the PT and peas involvement education for prescribers public education all the way across the board about alternative medications prescribing guidelines that were imposed by CDC for positions to follow what which have been probably a big crux of reducing that prescribing or the or the OVERPRESCRIBING at times in those issues and the value of that P. and P. as we have almost completely dropped doctor shopping wears somebody goes from doctor to doctor getting drugs for illegal means that database that tool of the P. M. P. has been instrumental. And almost knocking that out in Arkansas. but we realize that eighty percent of our when users started by improperly using or abusing prescription medication so that's always been an issue our drug take back program is at a hundred and eighty seven times since two thousand ten that we've collectively and collected and safely destroyed and more likely to go over the two hundred ten mark by the end of the year but the drug take back program really wasn't about how much we were going to collect it's really an education process for every home in Arkansas to understand to safely secure and dispose of their medication safely trying to deal with that problem of people abusing and misusing drugs that we. Tend to rely on and have in our homes. So with that understanding of a reduction and within our state of seventeen percent of deaths from eighteen to nineteen we started looking at Covin when it came in in March we realize that they cove it issue was going to cause a big problem because people were isolated they were suffering from social one and mental in economic anxiety which are which is fuels people that are in the recovery process to use again and so we had to change a lot of our strategies go to social media different programs that we had out there but we also realize the value of that because we realize that our cans became more health minded so was a good time to use those programs to get into the homes to educate our parents our love ones and other our Kansans about good health strategies about the drug take back and all the different programs that we're doing and find ways to connect people in these times of despair. four promising support which helps people through recovery to do that. But we began measuring what was actually going on between March and July and we did some comparison measurements where we could get those numbers between March and July of two thousand nineteen and marches July of two thousand twenty and one thing we found that are death rates in our suicide rates across the board only went up about two or three people per month in those time periods of that and we got to looking at some of the other data that treatment admissions people going in for treatment was almost reduce that house people were scared to go to treatment they were worried about cove it issues some treatment centers were cutting back and not feeling too capacity what they were because of the cold it issues following guidelines they got up from Washington on on how to treat people in this town in this pandemic but one of the startling things that we find is our naloxone in a locked SO in is a opioid antagonize that allows somebody to breed during opioid overdose. we went from in that time period of saving thirteen people a month in two thousand nineteen to right now saving thirty four people a month in two thousand twenty and those five month period so I think the fact that we have built an infrastructure of naloxone whether it be from law enforcement or for fire department or jest every person in Arkansas that wants to have the ability to potentially save somebody from an opioid overdose that infrastructure is really helping keep our death rate down but we understand there's still work to do well our naloxone amounts that we have on hand getting fan we anticipate getting what they call the state opioid what we call SO are to grant that will hopefully come this fall that will boost that that program in there and almost every program that we've had that we've had good measurement of success in that program that probably had a big part of driving these numbers down and two of the two of the items in here are two programs that we really need. One we realize that medication assisted treatment does work and it doesn't need to be a bad word it is a good word and we trying to break the stigma of that which is another part of our program but when we first started this program in two thousand seventeen we realize that we only had seventy five doctors or nurses that would be a waiver to provide medication assisted treatment we build that capacity now the three hundred and eighty two and are more than half of the counties in Arkansas as we speak with the goal of least have one in every county in the state my goal was the end of the year cove it cannot cramped that a little bit but we're still working towards that deal. The other. Program that has been very successful and Renee spoke to it was that pure recovery specialist and that is a person that has lived experience that has recovered that has committed now to helping other people recover we find those partnerships whether it be in the medical profession law enforcement profession have been very advantageous because who better to lock walk somebody through the fire of addiction or a substance use disorder and somebody that already has and we're finding good success when those people inter relate with each other and provide resources and we've developed probably one of the nation's best training programs for peer recovery as as we're told we have a three level tier last legislative session you defined in legislative act who can and who can't be a pure recovery specialist based on their criminal background so that's been a program that we built from a dozen people now two three hundred and twenty with our training programs now just getting back on foot because of the cold it interference with that we hope to build that two four hundred and we are about sixty percent coverage of the counties in the in the state right now with the goal of a hundred percent so that's to the programs that some of the funding has paid for the educational component that are making the difference. And I believe that's that's my report thank you. Thank you madam chair John currently with the Arkansas state board of pharmacy and anytime we start talking about this is the interesting look to go back just a little bit in history and just cover the fact that you know for for our profession and freshen that we regulate the board of pharmacy we are the the end check over the legal supply of drugs in to the state of Arkansas to our citizens and so we've really focused on two things throughout my tenure at the board and even before that and that is education and diversion prevention. On the education side for pharmacist specifically actually start in pharmacy school specially here you a mass college of pharmacy that's been around for about seventy years or we actually had a required course in addiction we were the only college of pharmacy in the nation with that work our work required course and one of the best tools we probably see in that is having someone with lived experience that was a pharmacist that would come in and talk about their struggle with the disease of addiction their struggle with drug dependence because that in many ways help you see someone just like you human eyes a disease that many people will say very bad things about it shows you how it really can happen to someone who's been through some of the very same things as you. Now going back to about two thousand four. Due to some diversion that had happened in the western part of the state the state board of pharmacy as well as most other health related board got the authority do criminal background checks this is of utmost importance of space when you're talking about prescription drug supplies in the the likelihood of potential diversion or targeting for criminal activity because there's also a federal regulation that prohibits any D. E. A. register on with be a doctor a dentist a hospital or a pharmacy whether business or individual from hiring someone with certain convictions in their past no matter the time period or or any pardons are expungement or anything else from being employed where they would have access to certain prescription drugs such as controlled substances it's something that we believe has kept a whole lot of potentially problematic issues may be the person would or would not divert but if that hospital or the physician had hired them and let them have access controlled substances they would be in violation of the a rules which puts them at very great risk for civil or criminal penalties as well as financial penalties I'm going to a bit later even though we we had that Avenue to potentially block problematic applicants or lease have review by the board from being employed in pharmacies we also saw pretty quickly that even people with no criminal history from time to time would divert drugs in pharmacy so we have had a long term approach to help educate pharmacist on here are some really inventive ways to help track what you actually have coming in and going out because all those it seems very simple it's a little bit harder when you're looking at it with the thousands of doses in the hundreds of different medications that you have. So our board is unique in that we actually built shrink report tools to help pharmacies actually put in a tool what they have coming in what they have going out helps to show them even educate them what that looks like even in graphical form right there on the website you can pull it up it's a spreadsheet any you're welcome look at as well so they can see doesn't look like stuff leaving that should it does look like I'm buying too much of something what is going on as a first investigative tool. These are the exact same tools we use we work cases and what we thought about both the board and our staff was why are we the only ones with this tool why don't we help pharmacist see that for themselves it doesn't need to be Big Brother that comes into discovers this we would rather people help discover it and run that business that way on their own. So those have been very useful with those were brought about due to some severe shortage of drugs found the eastern part of state and a point that out eastern western because it it's everywhere the opioid epidemic the drug pandemic that we have seen is everywhere that we deal with throughout the state. Couple more things when I talk about educational outreach you know we have always done controlled substance talks between the college of pharmacy we try to help show our professions here are some stumbling blocks that you may run into with your physician nurse pharmacist or or any other healthcare professional that you need to be aware of public outreach with that be television printer in person I we spent a lot of time on the road I know the drug director and I have as well as some other partners the A. F. B. I. health department criminal justice institute of Arkansas with the inverse of Arkansas system because we get out there were people are it's hard to say you need to get educated and come to us not everybody's going to come to little rock not everybody's going to come to the capital numbers can come the board of pharmacy or the department health so we've really stretched out and tried to get out there special are college kids are. Through those partnerships CDI drug director department health FBI D. E. A. some of it is showing movies such as chasing the dragon where you try to help especially teenagers and young adults identify that this is something that does happen around them we could happen to them and help answer educated questions about those issues. Other naloxone state what protocol allowing for both positions to directly dispense and FOR pharmacies to directly dispense as part of a state wide protocol naloxone which a life saving drug. We don't know how many people have use that is part of the protocol we hear the anecdotal stories of the people that didn't think they would ever need naloxone didn't think they would ever be at risk for a drug overdose because they're they're medication was prescribed and little did they know that it gets hot outside you get forgetful you take one too many or something happens and then you are in a drug overdose situation. One of things that and the board of pharmacy just a minor part of this but then Arkansas at that you have on your phone state drug director's office universe Arkansas Arkansas criminal justice institute they develop this and it's an app right there on your phone if you run into someone that is having a drug overdose you have that it literally walks you through step by step what to do with the naloxone you have. This is something where we are trying to help train lay people just like you would with CPR how to rescue breathing had to chest compressions that if it is a specter drug overdose you've got a tool in your pocket already one not use it for this instruction how to call nine one one tricks you how to handle that person I and we were rexi talking earlier today we've got a bunch of these refrigerator magnets and I've got some pharmacies that say we want to we want to help distribute these you know they're using this as an advertisement point to help have this difficult discussion about yes you may need this medication but you also need to be aware that there are risks not just you but to anyone else who comes in contact with these medications. We do consistent law reviews an annual basis as all of you can imagine code has made that quite interesting this year when conferences and meetings get get canceled but we also also always publish those on our website so that even if you miss that meeting works live you can see those slides see law reviews what's changed in the legislative session that affects us all or what is trained by rule the last thing that I like to bring up is the prescription drug abuse summits that we've done in the state of Arkansas this year Tuesday November tenth we were hoping to have that held in person in northwest Arkansas but it's going to be virtual. And what I can tell you is we have almost a cult following not just of health care professionals but law enforcement professionals interested citizens in the community you know peer recovery support specialist this is a meeting where everyone from every aspect of life that has any by and into the the potential hazards or trying to help do something about the prescription drug abuse problems or the illicit drug abuse problems we have in our state get together share ideas and have a meeting together I we expect have several hundred people there again this year and it's amazing that in the years we've had it not only do you see repeated faces but it's kinda like when you've got a revival with your little church back home people are bringing their friends to these things so with that I thank you. Is that everyone you wanted to present represented board you have at it just so everyone on the committee knows I hit head of Mister price email all the presenters and so you had thirty minutes for each H. ice petty yet about five minutes left do you want to close with kind of explaining your eyes petty and particularly the committees that you propose forming and why those people and maybe what you hope to accomplish with ice pay in terms of the transfer that to legislation. Thank you madam chair. Again I think the the point of ISP is really to study the issue here what we've done here where we have opportunities to improve as a state specifically in this case is the legislative as a legislative body I think that with this list does if you look at the last part of it is it shows just how many areas of of our state government and elsewhere that are impacted by the opioid epidemic so with that what I'd just like to say is you know first off thank you to the three of you for being here I appreciate it very much so and and I think it's it's clear to me that all branches of our state government having been addressing their help we challenges and have done some great things I do believe there's more work to do and I do believe a lot of our future work in the legislative branch is going to focus on the demand side so what I mean by that is the supply side is okay here's here's access to the OP woods themselves that would be the sole supplier but if you don't have a market for it because we are working effectively to educate people and curb addiction in the beginning and then treat it once it occurs and I do think it's going to take funding in some areas to do that but with that said I I I wish we could take questions but there are circumstances we can't but I just ask that we adopt the ISP. A I guess looking at the committees I guess the only explanation that I sort of had at I'm not familiar with the preventive service representatives you wanna are there more other eight rages I'm not. I'm familiar with all the other groups but I'm not familiar with that group if you could enlighten me a little bit. Which one is that the management review committee have Arkansas a region one in Arkansas a region I preventive service Representative that I don't know what that is. Our prevention and treatment programs are broken into regions in the state and so region one I I I don't know without my map in front of me where those reasons are but we have eight different regions of the state that cover so many counties so when we moved ours and to those counties we have a contractor that is accountable for those dollars and those services that are put their center broken down by treatment and prevention. Yes I get is is there reason there's just one in eight included I guess as. I couldn't tell you that at. I'm a be honest it's been a little while since address. And I don't know the answer to that okay alright thank you we appreciate it and. Yes Sir go ahead. Thank you madam chair not I'm not gonna ask a question I understand the reasoning for that but they will make a statement. senator garner in the children's and veteran's committee had meetings around the state I think some of you all were at those and sitting on those and I know director lane yet a meeting Jonesborough that I tend to talk about the staff but. So the comment I wanna make at some of those meetings were focused on veterans because that group there that population has a large problem with this drug and I just wanna say that that I think that's very good and these peer recovery specialist that I heard speak are from that community and it's is it really good program from what I've heard and I think that's what we need to do is is find those groups and focus in on those groups that have the worst problem in one of the things I look at this list. a Representative and I I don't see the veterans on here I think that we might be a good addition if if there's room. But but it's a good program and focusing on the veterans is a really good things or projects on them and then. represent lady man that is a great idea I and I tell you where this list comes from is historically since twenty fifteen of run a house Resolution and then last session we actually did a house concurrent resolution and where we asked me about the prescription drug abuse challenges specific so the opioid epidemic has two components one the prescription drug abuse component which is primarily what we discussed today but it also has the illicit drug component you know the heroin the the fin il medications that wind up in appropriately out of pharmacies on the street that component so. When we did the that resolution this is the list but I think that it's a valid point we need to add that group as well it grew a little bit last time but we need to get everybody involved to get everybody on the same day. A sort represent love did you have a comment. Eiji is doing I just. So. So thank you Mr chair when you all discuss current and addiction and and I know this is it this is something in regards to opioids but I mean drugs to Joe's drugs have been ravaged in the African American community for far too long. Up is this going to be any any spillover effect from from what you're going to be doing within curve an addiction that is going to fall into other communities or other drugs. As far as any strategies any any different things like that so some of the funding that we have had in the past was opioid specific that is changing where they're adding stimulants like methamphetamine as you may know methamphetamines the state's number one drug threat fennel which is an opioid more talking about illicit Sentinel that is made by the cartels and by China is being laced and to almost everything that were saying on the street for marijuana two cocaine to methamphetamine so it's all in a related in a lot of people that have a substance use disorder or addiction the they're not just one substances whatever's available so we really need to focus on all substances across the board and that's the direction we're going okay so we may see a ancillary effect in in regards to Kerman not just in duration and appeals but it tension and drug use yes as I understand that we are bound on some of those federal dollars to follow those guidelines and initially it was opioid intensive but I think they've learned from that and are now expanding some of those guidelines to us to branch out into the other direction okay and then I guess I guess my other question I will I guess I ask you just an off line in regards to some of the things that you may have seen in other states that they're doing that we're not doing in Arkansas I guess is what the study is going to be looking at. That that's Margot this is to look at that specifically and ended address your other question. All I'm am concerned with all addiction with Matt you know drug addiction medication or otherwise what makes opioids a little unique is the propensity to overdose it doesn't mean you can't overdose with other medications and die it's just there is a definite correlation between is we've dispensed more opioids are more opioid found the way in the United States overdose deaths have risen in a different way this is my view so okay but all right anything that works on the demand side or substance use disorder theoretically should help all okay thank you thank you mention okay Senator Hickey of a closing comment and then we'll move on yes service board and I was one question the region one in eight my only thing is I wanna make sure that we do have broad representation across the state and not see that it is it does say if you need these people in helping but if you would I'd like in addition to the veterans which I thought was a great ideal if we could just make sure if there are other. Regions that have a prevention service Representative to also include those. I thank thank you senator thank you Sir. Okay thank you all very much will which is no action required on any of these because we've already accepted ISAPI in public health so of. Representative Mickey are you ready to do your three. And and I am going to try to hold up to thirty five minutes and maybe some of them won't take that long what I'm I'm going to actually set my timer on my phone right now. So we're going to cut it off at thirty minutes or will never get out here so of. All right that I will set my timer right now. The. Tell me when you're set okay go. I'll talk for thirty five minutes any politician who can talk thirty five minutes about something so I have would would do these I guess in this order the first is I don't know the number on it. You have the numbers ACT to establish StarClan seizure assistance act of the I did have this in committee last year in there and actually pulled it down didn't run the bill but plan to do it plan to do it this next session of portion of our unfortunate to get reelected just to review with you real quick and see just systems are individuals that attend four years of college and then four years of an Annecy just system school all the schools that train that or medical schools outside the Arkansas Arkansas does not have an anesthesia assistant program but there sixteen or seventeen medical schools across the country that do it we do in Arkansas train some of anesthesia assistance they come in and actually participate alongside the nurse unnecessary children's hospital in some of their training but at the present time they have no pathway to come to Arkansas in practice and so what this bill does is open to a pathway for group of trying individuals to come in who would work under the direct supervision of anesthesiologist they're not infinite practitioners that work in a group practice and direction bridge Nancy I'll just they would fall under the Arkansas state medical board as far as any of the rules and regulations that would be promulgated to to to to for for what they do that's really about all that the bill does we we have had a couple of people in Arkansas that that have moved here particular northwest Arkansas that were anesthesia assistance and not been able to practice because we just simply don't allow it That's what the eyes pay does any questions about that I don't see any questions on the if no one has questions okay okay if not move on to the dispensing bill okay now the next to I have or dispensing bills that have to do with opticians optometry and not the mild G. you'll probably off me with all those guys from the last session and and now but these two bills are really consumer friendly bills one of them allows assistant which one will be the first madam chair the contact lens ones of glasses do the to the act the lasses it looks like a gentle cars you know what this what what this will do at the present time if you. Have to go get new glasses. What you have to do is you have to make an appointment with your optometrist or ophthalmologist who then you go in and they refractor that checking for the five year lands give you a prescription and then you walk out and you can take that prescription and take it to an optician to generally speaking the opticians are going to be located in the optometrist office or there will be a located ophthalmologists office now there are other other. Venues four four to to obtain your glasses you don't have to buy your glasses from the gap the gaping to your look at lady the game to you gave me the prescription if you think you get a better deal on your glasses at Walmart you Miller Walmart and buy and their optician they will feature glasses. That's fitting the lenses measuring your help put him on the face make sure they look okay help you pick of a good looking frame so so event and thank you look goofy with the round frames that kind of thing. What what this bill will do is it will actually allow the optician to refract you so if you don't go in and have a complete eye exam. That not that you don't need to have one but let's say let's say you broker glasses on Saturday afternoon there was not petition to an optician a store open and you had a prescription that was over your old you can't get that field you could go in an optician can be trained to refractor they can't do an eye exam they can't they can't check you for glaucoma and cataracts and all the other things that you can get as we get older and FOR which everybody needs to know if you're over sixty five and you'd have an exam every year like going to your doctor if your name your heart checked but but what they would be able to do is refractor you and actually fit you and sell you a pair of glasses if the safeguards in this is if they could not refractor you to normal what we call twenty twenty vision the. Then then they could not do it and the other is they had to advise you that this is not a complete eye exam it made no way replaces an exam that you need they have to tell you tell the patient you still need to go back to your optometrist or ophthalmologist and have a routine eye exam also you know I'm fits in these classes like say the glasses but but you need to go back and see your optician we ophthalmologists on a routine basis that's what this bill does. Basically. I can't believe it by the see the questions wait record senator Hickey yes Sir who is or anybody that would be against something like this all yes okay what would you explain some of that I want to know how that's going to how that's going it didn't get very far last year not that not. The primary I think the optometrist to be against it I don't think the ophthalmologist who don't drive a lot of their income out of glasses would would would be that opposed to it I have not presented it to them and talk to either group about it this this time around at and I would be in tip fully intend to talk to their organizations before before even introduce a bill if we if we get to that point I mean last time. We read through it I don't think you got out of committee got two votes me and one other Justin Boyd maybe so so unless unless we could kind of get those groups to may I have some agreement probably would not not even run it next year but it's in it is a scope of practice so we have to run it through the scope of practice bill meeting before before you put down as bill. Okay thank you Sir I. Okay saying no further questions you want to do your contact the leaders dispensing that the this will this is what this bill does right now with the mentioned earlier you get your prescription from your ophthalmologists or your optometrist you go get your glasses in you they figured they make your lands is this in your lenses off get a made whatever they do sometimes they don't want our deal make right there on the spot but ammonia and the other great you go home what what opticians cannot do in Arkansas is they cannot take a contact lens prescription and sell your contact lands the opticians in my office cannot sell you a contact lens you could go to doctor Justin boards officer he was not Tom just ophthalmology and get your prescription and they don't get it from him because his prize of two a they come to my office to my optician and unless I'm on premises my opticians can't dispense those. They can't sell. So all this bill does it lets a licensed optician sell you a contact lens based on a valid prescription the other thing that it does is it will open up the door for consumers to be able to shop and be able to find better prices on their contact lenses the a contact means prescriptions typically are valid for about a year if you wear contact you need to get an eye exam every year but what a lot of people do they come to my office. I don't to contact lenses personally but several people in my office do actually have to optometrists that work involved to do most of the contact lenses they come in the office they give you know you got a minus three ACT you lands they gave him a prescription and they can walk up to the front and and my optician can dispense those. It now if we're not there they can't spend some that the they can dispensing for our patients they can't dispensing for someone else's patients what this will do is allow the consumer to take that prescription and instead of going online what they do right now. It's all a matter of mark it's all a matter of the the person with the biggest five and get the best prices one eight hundred contacts in Colorado gets a big majority of the business out of Arkansas because the patient in goes online and they send their prescription to Colorado and one eight hundred contacts an optician the company Colorado mills or contact lenses to. What what this will do this will this will actually open it up to patients so patients have a choice of using someone else here in Arkansas easier so I think it's a good bill we did get this one out of committee last year but we didn't run it on the floor I pulled it off on the floor judges didn't that was there and all the other debate we were having and I felt like this is going to meet. So much resistance because of everything else is going on I thought well what is drop this and we'll do it next year but I think this is really I think that's really consumer friendly bill it will allow Walmart's to hire an optician. And run a division in their company were you could mail your prescription to Walmart's in you know for a lot of people of thanks save two or three Bucks on a box a contact lenses that's what they're going to do and that's it it it's it's kind of take money out of the pockets of the op optometrist and ophthalmologist but quite honestly folks you don't make very much money on contact you do it more outpatient convenience anything else and end up probably cost you more money to do that then you have so I don't really care of everybody Baltar Lynch someplace else. Thank getting cheaper. So be it as long as they're getting a it's got there has to be rules with the that that that I would establish as long as they as long as they they're getting it I exam every year and and not just revealed it based on somebody bring in a box and say this is my box of lands is that's what I had no that and work you got to have a valid signed prescription by an optometrist or ophthalmologist. So that's what this bill does. Does anyone have questions at I I have questions opticians is there a board of up to the board about dispensing opticians date under they're not under another board with the but the board members are made up of primarily optometrist and ophthalmologist and one or two consumer members. Senator I think there to. I'm not out of you Gimme tell failed be I can't remember how many of each our own on the board but it but it's pretty equally it's either two or three optometrist and ophthalmologist they're on their board plus a couple of their board members and the consumer individual something like that I guess I'm trying to understand what might happen that we allow one hand eight hundred contacts or send them to dispense for patients in Arkansas are they not required to have an optician on their staff that slot I don't normally do or not. Yes me for most of the things you know if you practice dentistry if you do our telemedicine you have to have an Arkansas licensed that so they're not Rick these days they don't have anything our product and you just mail your prescription and they do it online and fax it to and now what they do they do confirm it. You know he you know patient could actually. Get a prescription pad out of a doctor's office and write something own scribble some name on the bottom and send it in they do they are required those companies are required to confinement with the higher offices that that that's a valid prescription thank you that fax that to us and say is this about a prescription on of Mr Jack Ladyman and we check boxes says yes and then they dispense they'd spends it so they do check with us that their own they they have that obligation. Okay seeing no further questions the the the you have a question I'm sorry thank you yes Sir I struggle with this one a little bit the match will go ahead and start addressing it now so if I'm and I listen to what you said but what I understand whenever you look at page two. Course lines five and six and then fourteen to seventeen. What we're actually doing here is we are now allowing. The the board for the dispensing opticians. Whereas before they may have been just involved in. The medical part of it but what we're gonna do is allow them to start getting into the marketing of this. This way I see that okay totally. It is that your intent now okay but I'm certain willing to make some changes and we talk about it and I guess that's my only thing it just with fourteen it says you know that they shall adopt rules concerning the dispensing selling and supplying the thing is is I don't really like it whenever we say will adopt rules if we want to do legislation that goes ahead and outlines that prior to. So that we know what this bodies passing instead of something that's just so brawl that then you know it goes to goes the rules in just a smaller branch of the legislature but again I just whenever it comes to the session and I know that I would like to see all of that already outlined so that we know what we know exactly what we're getting into. Yes Sir thank you Sir. Good point. Okay seeing no further questions the we'll move on to the next ice pays Senator hammer thank you committee. Can I give you thirty minutes for each one is that did not. Good. Okay sure. So Representative Gazaway and Senator hammer this is. Your plan to be the sponsors of legislation if we move to that point is that my understanding yes ma'am okay you're welcome your bill you're welcome to start thank you Mr chair Kim hammer stay center district thirty three. Thank you member chair and members committee what we bring before you today is a proposed piece of legislation that we know is gonna be a work in progress between a noun the next opportunity we have to meet a par what represented Gazaway and I wanted to do was to put this out in the open so that we can get input from members as far as what would be a good product that we as legislators could present with regards to inserting ourself into the decision making process whenever it comes to a declaration of a state wide emergency I will tell you on the front end that we've already had some really good suggestions which I've got that have been presented to us by members I've got a couple to point out Representative Gazaway has some that have been given to him and would like to do manager if it's all right it's just kind of do a summary of what of what the proposed legislation could look like just hit the high points and yeah that the great I mean obviously we are all been in uncharted territory and I thank you enough to have a pandemic emergency plan would be worth our while yes certainly right thank you Mr chair of so the high points of this is that allows the General Assembly to come together within eight days of declaring an emergency it allows for the event that it might occur during the spring break conference week held during the summer and represent gas which can expand on that more as to the eight days and the reason behind it it allows four to give time for legislators to make preparation to assemble and come together so if the governor declares a statewide emergency it would operate as declared for eight days of which within eight days we would come together Bacall together for extraordinary session one thing was pointed out to me that is not in the legislation we want to go back and factored in is the question what if we're not called in within the eight days what if we're just have that ignored and so what would that. DO as far as the emergency continuing so we're gonna go back and add something in that would address that it allows for immediate termination of the legislature does not agree with the continuation of the emergency it has built in a fifty seven county or three fourths threshold in the event that the governor may not do a statewide emergency but would just one county the time once it reached a threshold of fifty seven county three fourths of the state then it would kick in it has built in a stop gap so that every forty five days after the legislature has initially met being called an extraordinary session it would have to be allowed to continue upon agreement of a LC and the reason put forty five days in there is because that would allow for committees select committees like health committee to be able to meet so that we can have an opportunity to hear open their discussions that we go into our decision the reason and this could be up for debate I guess to be driven by the majority rule as far as why LC and not being called back in we didn't think you'd be wise to keep calling us back into extraordinary session A. L. C. is the body that operates in between and this would give us thank you this would give us the greatest amount of participation with the A. L. C. and so a L. C. would decide from that point forward it also prevents a subgroup of ale see having control over the decision so that's why we put in their full a LC to make sure that you know there's full representation and it also brings the board of health under the same requirements as you would see written into that it does have the severability clause and it does contain an emergency clause and I'll just say this before I yield the Mike to Representative Gazaway at last count I hope I'm not mistaken on this but at last count there's about a hundred and fifteen Different code changes that have been addressed during this pandemic most of these we've had to react to us forge legislative branch being involved in the discussion making process I'm not sure that we've been fully involved in part what this legislation is intended to do is not be adversarial but if this ever happens again that we as a branch would be inserted into the conversation because we're the ones who get all phone calls whenever we have to deal with it from our constituents and this will insert us into the conversation with that manager I'd like to yield to my counterpart represented Gazaway Frank comments venture. Thank you madam chair and thank you senator hammer I guess first of all let me say I appreciate Senator hammer all the work that he's put into this. it just so happened that I was researching this issue and early on several months ago as we first began to see the executive orders come out. And I became apparent that there was no legislative involvement despite seeing executive order after executive order and like many of you I got phone calls for my constituents about why is this happening and when can I do this and when can I do that and I can't believe that you guys did this and I had to explain that I didn't do that these are executive orders that have been issued by the governor and the legislature has had really no vote on any of these things and so I'm sure many of you have those same calls and so. I began to look into what other states do in situations like this and if the legislature is actually involved in this process. And what I'll tell you is is that I discovered that many other states. Involve the legislature from the very beginning of the. Declaration of a disaster emergency by the governor and so this is not reinventing the wheel I think what this is really about is in serving the legislature into the process and providing an appropriate check and balance as we should have between the various branches of government the legislature is a separate and co equal branches branch of government one of the three and we should have a role in this process and currently under our statutes we do not the emergency services act which was passed a believe in nineteen seventy three I don't completely understand why but the legislature decided at that time to give the governor almost exclusive with the authority in emergency situations without any input from the legislature and I find it actually quite shocking that that the legislature was willing to give up all that authority to the governor and not to put themselves to be involved in the process and so as the bureau of they would look to see back in the nineteen seventies while the legislature decided to do that and house and even to check the Arkansas Democrat Gazette see if there's any debate that happened in in the seventies when the emergency services act was passed to see if the legislature or why the legislature felt that that was appropriate but I couldn't find anything on that but now that we have some experience having lived through the pandemic and as this is extended on for months I think we see that the legislature certainly needs to be involved in this process and so again if you look at what other states do in these situations we're certainly not reinventing the wheel by inserting the legislature in the process I just give you a few examples the state of Alaska for example state of emergency may not remain in effect longer than thirty days unless extended by the legislature by a concurrent resolution the state of Georgia which I thought was a good example on which this is somewhat modeled off of and we saw the state of Georgia and during this pandemic operate. it exactly as their statutes required. As a condition pre seat at to the declaring that a state of emergency or disaster exist as a result of a public health emergency the governor shall issue a call for a special session which convenes at eight AM on the second day following the date of the declaration now what you'll see this bill does is it actually put eight days in between of the get the declaration of the governor and the calling of a special session so we actually have more time to look at and think about what was done that's not necessarily set in stone several states do it differently just in our discussion Senator hammer and I sent just settled on eight days but it could be sooner than that. I'd be later than that but as as you can see the state of Georgia report requires that the legislature be convened on the second day following the date of the declaration the purpose of the special session is to concur with or terminate the public health emergency the the Georgia legislature hat in in this case the Georgia legislature had a special session. To comply with the statute back in March and then George of a statute continues the General Assembly may terminate a state of emergency by concurrent resolution any time and we have that in the bill that we're currently proposing I think Senator hammer did a pretty good job discussing the specifics on not going to go back over but I will say some of the other points has been mention to me by other members which I think are excellent points as we continue to look at this and I would encourage if anybody has any ideas I'm sure all of you do to you know this is this is something we should all collaborate on and hopefully. Canda can craft a piece of legislation that works but I thought these were some good ideas that someone mentioned that any emergency rule making of the department of health and the so bill also would applies the department of health as it does to the governor but we need to consider provision about any your emergency rule making the department of health shall comply with the emergency rule making provisions of the administrative procedures act which of course involves the legislature. If the department of health already has rules and regulations in place to deal with public health emergencies those rules should not be considered promulgated unless they have been previously promulgated under the standard rulemaking procedures of the administrative procedures act so we need to bring those back to the legislature for us to consider those before we start. operating in accordance with those and then there needs to be a provision that would provide for legislative oversight of the spending an appropriation of any federal emergency relief funds in excess of a certain amount. And I think there has been a very significant amount of money to the state of Arkansas is received and I understand that there is a carriers that committee but the kids that committee is not the legislature elected by the people and of I think we need to be very cognizant that because we are answerable to the people and so those are just some other suggestions and been made to me as we go forward and certainly would look forward any suggestions that anyone else we have on this issue thank you very much. Absent the board you're recognized. Thank you madam chair I don't really have a suggestion but I did hear an argument put forth on why the legislature should should be limited in its input and I'm just curious as to how the two of you would would respond so constitutionally speaking it was very it seems to be have been very deliberate that the in our constitution that we were limited to sixty days and we have a provision to extended another thirty days every other year and so knowing that how how does that fit in with that and how how can we move forward feeling like we're still being constitutionally sound thank you. I'll give the first run and it and represent Gazaway can correct me where I'm wrong first of all if we are in session where that be the general session special session or fiscal session we can take the matter up within that this is to frame for work for what if were outside of those times and that's why this is crap to the way it is so if were in session already this is for those times when we're not repealing Gazaway. I agree and I'm not so sure that I completely understand your question but I do think with regard to calling the General Assembly back if that if that's exactly where you're going with that I'm not exactly sure but it's not practical I think to have the General Assembly the full general simply come back every thirty days for example I think that we get a little onerous if we if we continue to have to do that and so that's why we ins another reason why we inserted those provisions about council because I think it's more practical and and makes it easier but I don't see any constitutional limitations of a having the governor call a special session of the legislature in the in the event that there is a public health emergency is just a trigger at that point. I think that what last point was what I was looking thank you. Representative Ladyman you're recognized. Thank you manager of resent gas way when your research that you did maybe I maybe you said this not misunderstood it but there are other states that are like us and have no rules or limitations or requirements is that true. Well I didn't ask the bureau to provide me with a list of the states that didn't have any rules or requirements I just asking to provide me with some examples of other states that did. And so I can't really tell you what the other states don't have anything it wouldn't surprise me if there are other states that don't have statutes or have statues they're similar to what we have but the bureau did provide me with a list of I think it was at least thirteen other states not just looking Alaska. Arizona Connecticut Georgia I would Kansas Louisiana Utah there are several others that do have that do have and again so we certainly wouldn't be reinventing the wheel or doing anything that would be out of the ordinary to insert the legislature in this process and I certainly think again just as a separate and co equal branch of government that number one we should be in the process and number two when the executive has that kind of authority and power it is the legislatures roles to serve as a check on that power just as the executive services check occasionally on the legislative power and the judicial branch serves as a check on both the executive and legislative legislative should serve its appropriate role in an act as a check on this executive power and I think that that's wholly appropriate. Could have follow up. My second question I understand the need for the executive branch to have the task force and I understand that these task force are appointed based on their experience you'll have expertise in the area that they're working in whether it be wrist starting up our economy or the health and other whatever I understand that but I didn't read everything in your proposal here but. Is there anything in here that talks about. input of the legislature into those task force the governor has the right to appoint those exactly branch does and pick those individuals but I just feel like that the legislative branch and equal form of government should have a some input I mean I think those groups in my opinion should be more advisory in nature. Rather the and recommending and then we approve so I mean the do you understand my question are what can we put something in there to to have the input into these groups that are formed by the executive branch. Absolutely I think that's an excellent point I think that's one area where you do see the legislature in some instances serve as a check on the executive branch for example with certain appointments they require the Senate to approve and I'm sure that there could be some type of provisions that if the governor is going to appoint a committee maybe requires the approval of the Senate but I think there's certainly weight of fashion that now certainly think that that the appropriate. Madam chairman. But that is because of the members know that's exactly what we wanted to present this in the format that we are is because all the good ideas that are being given we can tweak the bill and come back you know before the committee of called to bring back what would be the adjusted product so that by the time we get to the next time we're in session we could have that finished product so you know for everybody that's weighing the and then there by that sending us that's part of the reason for the platform we exercise doing this. A I do have a question it it seems like the bill primarily is to involve the legislature in the process you know we've seen a increase in pandemics over the last decade and to mitigate any future human and financial loss hit you considered maybe requiring the state to have a pandemic plan as a part of this. I have made the suggestion that when this is all said and done in speaking you know what some members of the administration that there ought to be of a follow up as far as how do we handle this moving for right now that is a suggestion I'm not sure that that would be covered under the prerogative of this bill as much as maybe a separate piece of legislation if we're going to put together a plan moving forward for how to deal with what hopefully will never happen what is repeat and maybe this could be supported for that you know to to assure that what you're suggesting would be have some weight behind it. Sure I think it's a great idea I'm just yeah I mean I don't think we need to be naive or at the signal made the last payment they make if you look at the last decade and we need a plan. Egypt would of them will have one but in the. Still on your committee coming manager I believe well I know that there is a pandemic plan already it seems like years but back when this first started before it was declared a pandemic I ask the ask the department health for that and if I remember correctly four five months ago I got a copy of that and they do have a plan but it needs to be tweaked in my opinion but just one layer there is a plan there but it's very general and it definitely with our experiences that we've had these between I have my the public health we ought to have them come. Discuss it I'm a certainly like I said I think we've learned a lot from the US that probably needs to be incorporated in that but yeah I would be interested in hearing that public health. Of Representative love you're recognized thank you mention a I think it's in a emergency preparedness plan I think that the Arkansas department of health hands and and I think they go through with the with all the state agencies but I think you meant man Gilmore's back there so he's listening and he can he can bring that information back to us but I think it's an emergency preparedness planning the Speaker section. Okay so House. Yes Sir the mist let me start here with with with what you ought to propose and so it in in in your arm. In in your annum study state that within eight days they will they'll do a special session on a special call. One this now is the is the emergency declaration going to be the only thing that will be listed on the call or or can it be opened up to. Anything that the legislature wants to bring so I'm just trying to trying to get to where where you all are you at the thoughts are around so Representative Gazaway are a Senator hammer can you can you speak to that. Just in this piece of legislation that the emergency call would be specifically for the purpose of concurring with or terminating the emergency but I think the governor under the constitution has the power to call a special session and and add certain things the call so I and I I'm just shooting from the hip here but my thought is that the governor wanted to. put something else on the call in addition to whether or not we concur terminate with his emergency probably could do that but that's just my guess. I was just. Want to know if if you get either limited or okay are my next question is is in regards to the I guess the the the process when you all begin to talk about the the task force and I think Representative Gazaway you you made the statement in regards to the task force that the governor put together is not kind of the elected body that was elected by the people. However I my question was is is it not in. All the proposals they go through the gears committee they are reviewed by a I'll see. Which is the body when when were nine session so can you speak to that as far as is is kind of you thought your idea behind that little piece that you were that you were discussed in the in. At the end just to be honest with you I'm not Extremely familiar with how that process works I'm not on a LC Senator hammer may be able to speak to that better than I can okay. Represent love your corrected it comes before a LC for the approval of the funds I think the goal here is to insert the legislative branch sooner than later and yes we recognize that there are six legislators that are on that but that no disrespect to the selection process of the committee of that is heavily weighted one side versus the other and I think what we want to see here's a level eyes Plainfield especially when it comes to incertae now I mean I've sent let recommendations to the steering committee as far as areas you know that I think need to be addressed I'm sure everybody has had the ear of those legislators who represent us in that committee but the final authority of that dispersal is yes going to be by a LC approval thank you and we've seen some strong ale see meetings in the past and I think that if we had a had a stronger place on the front end so that might be worked out that's not criticisms of as just observation and I know when you're dealing with an unusual pandemic like we've got now the wheels have term pretty fast as part of the reason why we're doing this now so we get ahead of the next one and we have a lot of stuff worked out before it happens I don't know if that satisfies you but not on the innocent and I look forward to on the court you finished product thank you thank you both thank you. A Senator mark Johnson you have a question you're recognized thank you so much madam chair for allowing me to ask questions of. Senator hammer and Representative Gazaway first of all thank you for your work on this I just really have have you considered something that would not just authorized legislative actions but perhaps prohibit legislative functions being a delegated to non legislators lack task forces and and other such organizations that may or may not include people in government of people who are appointed by the governor as well as lay people and I'm not comply there wonderful people willing to step up and help and I'm I'm grateful to all of them but again we get in some separation of powers issues that are very problematic to me and you know I worry about it I realize we're we're sometimes and I think our representing boys question diluted somewhat to the fact that we're we got in eighteen seventy four constitution that we're trying to apply to the the world of cell phones and internet in and pandemics coming from the other side of the world and still hitting is where that happened a hundred and seventy five years ago with a private taken a year to get out here but in any event I am hoping that. Whatever you come up with. Not only if a points out the importance of of all three branches of government being involved just like they should be and all things but also prohibiting the other branches from. A creating quasi legislative organizations that would in effect at least potentially you Sir the authority that we have so I I just commend you on that and and one mention that as a as a possibility and we and again back to put to represent a board said I was thinking about until a few years ago when the constitution was amended if the governor went to Memphis the lieutenant governor was the governor of Arkansas not the act together he was the governor and we even had one of president pro tem who got to move up and he fired the governor's chief of staff so there's a lot of you know shenanigans that went on we kind of fix that but you know as we move into the the the twenty first century way of doing things I hope we don't lose sight of the fact that you know the there were some protections that we we had in place in eighteen seventy four those guys weren't as stupid as some people think they are but thank you for working on this but I I asked specifically ask that you consider something that is not just a that shall but also maybe a couple of the house shall not thank you thank you madam chair put on the list A certainly of. Representative della Rosa you're recognized. You madam chair eight I tried to keep up with everything that the you were listing you know as the ideas for this and I didn't hear anything. Regarding the extensions of the emergency I'm hearing Information regards to what we could do with the beginning of a declaration of emergency but at the beginning of a declaration of emergency I don't think any of us necessarily would have disagreed with the declaration I think where you're where we're running into issues is when the legislatures been left out of it and it's perpetually being extended and there's no end defined to their there is there's no metric that's been provided that says when we hit this number or when we do this certain thing it's over it's very subjective it's open ended there's no definition so I was just wondering if you had any ideas on how the legislature could be involved in extensions of of these emergencies. Take a run at as far as the way the bill is crafted now governor declares that emergency within eight days would have to call send for extraordinary session to concur with that and to move for the one thing that's on the list of somebody pointed out it would require a joint resolution and the question was raised what if we don't get a joint resolution does that mean automatic continuation of the emergency or is that termination of emergency we've got to go back and work on that if it clears after eight days and we can Kerr that yes this is a it rises to the level of a statewide emergency every forty five days it comes before a LC LC chooses not to renew it it's done and over and so within that forty five day period between and that cycles every forty five days so so by design what could happen is we could say at the end of the second forty five day period no and it terminates and all emergency powers cease at that time the idea again behind the forty five days is it would allow for public health or any other standing committee to be able to be meeting to receive information so we can be listening kinda like what we've been doing the last sixty days very aggressively and having that platform to dig down into the weeds and I would. And and maybe we could adjust the bill to bring a greater level of assurance that you're expecting but during those standing committee meetings we could we could be bringing out things like is contact tracing we're really working is testing really working and all the other things that we've been asking questions about and I'll defer to represent Gazaway if he had any thoughts on that it just adds a little bit I think the way the bill is designed it and Senator hammer said requires every forty five days for the legislature to refer the eight frail seat to concur again now that's if we're not in session obviously if that happened when we were in session the full legislature would be here. But if the legislature is not in session then a LC has to concur every forty five days in one way that the emergency terminates is just very simply bail C. doesn't concurrent. And that doesn't mean that they have to vote no. That just means they don't concur. Whether that's they don't show up for however that may happen but if they don't concurred in the lead then the emergency terminates. So I'm I don't know if this is feasible or not but just to make this suggestion speaking on behalf of those of us who were never on a L. C. will never be on a LC especially if you come from a county that has a high population there several of us that will never get on a LC will never get to represent our constituents in that and they'll see is a tremendous amount of power especially in in regards to this but one consideration could be over a long period of time you know maybe it's three months or something like that maybe it does require everybody again so A it doesn't just revolve around the few people that are on a LC but bring because again it's the entire legislature representing everybody I'm much happier to have a subset being involved in this because then at least part of the legislatures involved in Corsica talked my colleagues. But just remember not everybody's on LC and there's several people that are going to be represented that way but I I really appreciate this legislation a lot will and and point taken because that's part of why we want to have this dialogue is if we wanted to you know this is an extended. Pandemic yell reset every every three months we're just trying to be conscientious to the cost of doing that but point taken. Thank you and I agree at and it goes back to Representative boards point there some balance there I think two five if it is in any number of days that you could make it some states are thirty summer forty five summer sixty but if you're talking about bringing the entire legislature back every thirty days and if that continues for four five months and that's a lot of uh in you know meetings of the entire legislative body I'm not saying that that's not the way to do it and I think that the certainly something to consider but just the way we decided ultimately and again we're gonna take in we wanna take input from everybody was to allow a LC just to reduce that burden of bringing everybody and potentially multiple times but I agree with you and this inner hammers a point well taken so all perhaps another alternative would be to change the way a LC is run not necessarily change this. The idea. Senator Hickey you have. Yes thank you the first one really is just kind of clarification on my up my port there may be a good point I notice that we've been very careful throughout this whole thing that one where we would say the like declaring a state of disaster emergency right after it we always say related to public health is there a reason that we put related to public health because in my mind I keep sitting here saying well is there ever going to be a time where we're going to have a state of disaster emergency and it wouldn't involve public health and maybe we would want the same power for the legislature so I guess that's my first question and again if that's nothing that we can discuss that later but. One is response is up perhaps the focus is on public health now we I think we actually did talk about what happens that doesn't affect public health in that cast a pretty broad net but I mean me personally I wouldn't mind expanding it just do a catch all but part of this bill also specifically deals with the authority of the health department and so there is some continuity between what's trying to be achieved but I speak on behalf myself I want mine going in there modifying that I'm not sure it's been done in other states represent Gazaway he's been more diligent about other states maybe I just something research of it yes Sir so just yeah just to try to address that briefly and I I certainly don't have all the answers but I will say that the. We did put public health emergency in here the emergency services act applies to. lots of emergency so you know you can have a tornado you can have an earthquake you can have multiple things a lot of those things don't and FOR don't affect the entire state. and so then that's where we had some conversation about if it's if it affects more than so many counties in the state and you know it would trigger the us but to call the legislature and when there's a tornado in Jonesborough for example would be a good use of our time and would be I don't think that's what we would want to intend to do but I certainly all take your point that limiting it to a public health emergency when there are other types of emergencies that can affect the entire state means that we definitely need to look at and I think that there are a different subsets of statutes and saw given example there's the emergency services act and then there's I think the governor's power to declare a disaster area state wide disaster area and I've been told that that may be a different set of statutes and in one other state it's my understanding where they had statute similar this I think it may be on. Maybe it was Wisconsin Wisconsin but it may be another state but the governor there were two sets a statutes and under the one of the emergency statutes the governor had to involve the legislature and under another set of emergency statutes like declaring the state a disaster area for example the governor did not have to involve the legislature and so instead of declaring a public health emergency and having to involve the legislature the governor in that state declared the entire state a disaster area and they're and avoided having to involve the legislature and so I think that my point yeah I think your point is very well taken that we have to be mindful of looking at all of those to make sure that there's not avenues to cut the legislature out of the process because we are a very vital institution in branch of government should be involved in this these processes and that kind of leads me to my second question which you already really kind of answer little bit represent Gazaway was on page three of. Lines ten through fifteen we did have a state disasters or related to public health and then we got we have the were right there I don't know if we can maybe corrected. You know whenever we figure out what number of counties I know you all have fifty seven maybe this is where we could corrected that it could include all type of emergencies or things like that and my last question and of course it depends upon the whole body and what you can do to get the votes whatever is time but that's a that's a pretty big number with the county's fifty seven I don't know if this legislature would to like to look at lowering that are doing half of the counties within the state or. Someone of that nature but again from my standpoint it's a. Three have bore I wouldn't mind seeing that be less and the reasoning behind that and this is not this comment is not a reflection of the current governor we were trying to think like our forefathers did and try to figure couple your hundred years ahead what a of but if the governor was of a mind to work their way around the legislative branch they did it one county at the time what would be the threshold that we would want to see that because you know possibility yes would hope it would happen so that's what we said fifty seven but we we can start the topic of working down is the better option to go then A I mean not being open to it and it's kind of hard to come up with that I understand I'm sitting here thinking will should we do should we do a percentage of the population of the licenses or something like that but again there's going to be all type of different to. Different things right there that may unfairly effect little rock in northwest Arkansas if you know they had some issue up there so anyway thank you. Representative Boyd you're recognized where where where we've used the time but since McGee was so efficient I'm gonna let you come over. Le let me get let's you know let's limit under one question the next couple of questions if we can you thank you madam chair this very quick question I think you've answered it but I'm an I don't want to come across as like I'm opposed this idea but I think these questions are going to be asked I feel like they should be asked now so that you thing if there so one of the arguments that's been made to me about not limiting the governor's executive power in this is and heat of battle you know there's got to be a general there's got to be somebody in if we all of a sudden and Sir one hundred thirty five of us into the decision making process what is that duties that actually count it is that a negative so. One is correction worry inserted anyway because my call volumes going up through the roof as has everybody I think we're all in this together this is an us versus them nor should be perceived as that I I think that's part of the reason for the X. the forty five day I'm not sure but I think represent Gazaway some states are even more stringent than what we're proposing we felt the forty five was was a reasonable time frame this doesn't mean that decisions can't be made it just means that we are inserted into the decision making process at incremental points so if there is something like this and we're able to get this through in the next pandemic comes longer statewide emergency it's something that can be prepared for the expectations are set because right now we're reacting we're trying to anticipate what the next one could look like to where we could be inserted into it. And. And I think your point is well taken I've heard that argument to one of the counter arguments I think to that which I find persuasive is that take forest fire for instance you need immediate action and the governor as the chief executive can take control until somebody immediately go put out that forest fire in use all of these efforts in order to do it we don't have time to assemble the legislature that's the point that's the purpose and the true definition of Amer an emergency we don't have time to assemble the legislature we need immediate action I'm the governor take care of the emergency. In a public health emergency such as this pandemic. We're in the fourth or fifth month of the pandemic at this point and we're here today and on a L. C. weeks half of the legislature is in little rock meeting and that they have been. For several months and so the idea that the governor ACT has to act under emergency powers is certainly understandable in certain circumstances if there's a forest fire that needs immediate action there's an earthquake or tornado this taken place and we need immediate action to to get emergency help in because the legislature can't be assembled immediately to respond. But when you're talking about a situation such that we have now where we're in the fourth or fifth month of this the legislatures regularly come into little rock a frail see meetings other meetings of the idea that that the executive has to continue to operate under emergency powers in my opinion is. Is a. Not well taken. By Representative Ladyman you're recognized. Yet you should be. Thank you madam chair of I have a question but also comment about what Representative Boyd sit there and and I agree with you representing Gazaway Speaking as someone that I've served in executive job and I understand that if the house is burning you have to put the fire out you know it's immediate response and and the governor needs that authority and he needs to be able to act quick but it's just like if you're leading the charge you go you fight the battle after a period of time you go back and regroup. And you talk to the troops and I think that's what we're talking about here after the initial emergency is over we need to talk to the folks involved including the executive branch legislative branch so I I agree that the governor needs that power to act quickly and that may be over a period of time but at some point the we need to be included and the sooner the better but depending on the emergency that may be a little longer time that's not a question is a statement that my question actually is back to what senator Hickey was talking about we may need to looking at population centers rather than the number of counties of the kids if you had emergency that affected you know northwest Arkansas little rock in the other it may be only see our six most populous counties but it might be a bigger emergency. Because the population so I don't know whether you can work that into the bill but if you understand what I'm saying it could affect the big part of the state population without affecting very many counties and and will work on it come back on that again that's what we want to have for one thing we want to be transparent about this we wanted it open where remember could have that opportunity to have this discussion I do remember one of the things that was discussed as far as how do we arrived we thought about the flood started in Fort Smith and it followed all the way a diagonal across the state involved a wide number of counties and so we we kind of factor that into the scenario that maybe is the last close to state wide disaster we had of major proportion was the flood and A granted the governor need to act and act quick. But also we see that there are a lot of people affected along the line of so point taken as far as how and we'll come back with some suggestion representatives wing and. Three with you I think it's a great point. I don't see any other further questioning closing comment Sir. A my part I appreciate the opportunity to come before you because you guys have been a wealth of information invaluable ideals and represent Gazaway and look and I appreciate represent Gazaway he's put a lot of deep thinking in this there's been a collaborative effort and we want a good finish product when when it comes time for us all to get to vote on it we we hope that we get the vote. Okay Comment just just in closing comment My interest in this A is not a critique of our current governor I'm not suggesting that he has done anything wrong or that don't agree with how he's handled things I have the utmost respect for governor but this is about the process and I think that we need to have appropriate checks and balances and ends and it's not not certainly directed at anyone whose work in the administration or anyone that's been appointed capacity appreciate the jobs that everybody is done but again for me and I think for many members of the legislature this is about the process this is about appropriate checks and balances in our function and system of government Sir and we don't know who the governor of a next time right tackle of are you ready to do your next ice petty object to run I will not be thirty minutes I promise you. Well I don't know may I may have some questions. Figure there would. The. Thank you Mr chair We come into session. And I don't remember session since I've been down here fact the based on the previous center studies or discussed today kinda you know solidifies the point that every time we come into session down here there seems to be one or two three big challenges on scope of practice issues of the one thing that I've noticed in the time that I've been in the legislature which is you know for years in the house my first terms Senate is that often times or seems to be a lack of point of reference as far as how this fits into the overall picture of getting us off number forty seven in the nation in getting us closer to being number one when it comes to healthcare and just to be to the point respectful of time what I'm asking the committee to consider is to authorize the request for proposal and manager I'm doing this in the manner in which I am because I know scope of practice is a contentious issue and everybody has an opinion and there are so many scope practice related areas that it is kind of difficult to get our mind around it and that's one choosing to do it through the committee process like disorder but can weigh in and hopefully come out with something we could agree on to move forward I've actually taken liberty of working with bureau to develop what would be a a proposed request for proposal other question was raised when this was presenting committee was do we actually have the authority to do this and we went back and researched it some of you all may remember when represent then Representative Westerman now congressman Westerman went before executive and a LC and requested money for the Alexander group study if you all around back then and actually A. L. C. was able to authorize the dispensing of the money and just to kind of give you an idea of is this unique and actually. It's not when it comes to the idea of hiring consultant the Alexander group was one we actually hired a tax consultant which would turn around fired the highway when you when you think about the discussions about the highway in the consulting group that is helping guide through that process adequacy study we have consultants working in that area healthcare task force we hired John C. even back then to help guide us through the decision making process broadband and if you remember back to came or what year was two thousand thirteen I think teacher health insurance hiring consultants is not new is not different it's not a unique idea but we're going to what I'm asking for is to apply it to the scope of practice setting because I think what would be good for us to have at least as far as a point of reference is to have consultants who don't have a dog in the fight come in and look at all of our current scope of practice areas and see where a realignment might be possible based on what our national standards water allowed nationally and where maybe we as a state are very prohibitive of certain scope of practice and to bring forth the document that we could use as a point of reference you know this part of it shouldn't be the fight where the final comes when they come back with it and people begin to line up and say they agree or disagree with that but if we hire some it'll come in and present some sound data and what's being done in other states and how it has help advance them toward number one I think that's a fair and reasonable request we spent a lot of money a committee meetings listening to scope of practice and then we come in we spent a lot of our time especially on public health when it comes to DO scope of practice and it's it is a battleground every time and it's too entities but their head but who ever said well you know what here's the overall picture of how if we did this we could improve access to care we could make it better for the citizens of Arkansas you know how long we've been at the number that we've been at and when was the last. Time we did a hundred thousand foot view and say if you realign this based on what's been done in other states and water best practices this would be a pathway for so what I'm asking for is for the subcommittee to approve or the and and here's the thing one thing was brought out in a question if you look at the page three of seventeen. I actually intended to file this earlier in the year but pandemic hit. If you know some page three those dates are not realistic to achieve. And and to be realistic this probably is not going to get done before we have to take up scope of practice issues which the deadline for that is December first am I right on that that I at the. That is thirty days for the sessions right so realistically this would not be able to be done before our next general session I'm I'm not trying be pessimistic come try to be realistic. But at least we could get it started so that when we do come back into session in twenty twenty three we would have a working document that we could refer to is pry too late for this general session to be honest we're going to have some we're gonna have some battles but it sure would be nice to have something to look forward to and as far as the money I've been reasonably sure we have the money within the bureau but you know we put this out for request for proposal before it have to go before LC to be approved and we would have the final say so that it could be stopped there if the price tag comes back to high manager I can't give you an idea what the price of this is going to be because this is a pretty unique approach far as I can determine is not been done anywhere I would hope Arkansas to be a leader and say you know what we did this another state would follow suit and I'll be glad to take any questions well I have a question and those senator Irvin had a bill last session to create A task force to look at scope issues in your pose that so why would you. B. for this but were opposed to her having a group a task force to study it I think because task force can be easily influenced consultants would be placed under very strict guidelines that would have penalty clauses if they violated it and I think we would probably get a of no disrespect I think we would get a truer picture unbiased by looking at national and the other thing is as we do with all those other areas you know I'm not no disrespect to our staff we got a great staff but coming up on a general session the way we are it would be a pretty heavy lift I think of our staff alone that doesn't mean that the consultant could work within groups within Arkansas but I think we need that fire wall of so that when that recommendation comes back it would be in the peers to for. Bill no madam chair. When it comes to scope of practice round here we get a lot outside influence from individual provider groups and we've all represented in probably we get a lot individuals you know input from provider groups but the lobbyists come pretty hard and heavy to this would remove that element from it so that it could be appear form when it came to us. Representative love you're recognized thank you madam chair and sent Senator hammer I'm. I appreciate this bill because I've. I thank in public health how to recommend something like this but I'm curious because it I thank you have a different take are you talking about someone looking at all the scope of practices or if we have specific we have specific a scope of practice bills that they can action look at all the information and then just presented to us on on. One a you know here's here's the scope of practice here's the pros in here's the cons in regards now you all do with information which you may. I am not this is not written with the intent of bills that would come say through this general session that we would have them look at that I'm talking about all the scope of practice related to medical help there are a lot of scope of practice at I mean there scope of practice for plumbers electricians everything that is a term of art I think is what the lawyers say but this is limited just to public health scope of practice so you would not be just looking at the bill's like if we wanted to say the Optum ophthalmologist optometrist issue that was referred to earlier it would be that the consultant would come in and look at that one specific issue what the consultant would do come in and say we're gonna look at all scope of practice we're gonna look at what everybody is allowed to do at a national standard because part of what we deal with the think are straight our state restrictions that limit the movement among the medical providers and that they would bring forth a document that would show this is what you could do based on national what is allowed nationally. Okay alright thank you. Senator sample yes you're recognized thank you Mr of Senator hammer this section house I like your idea. And it's not Knobel. and I may be the only one here that was around one lake view happened. And you forgot that that's probably the biggest one that we ever had. Well how do I think that this is the one to take in hand over one of the scope of practice issues that would come up with we spend hours and hours and hours dealing with them is to have a consultant taken and give a both sides. Rather than listen to different lobby groups. Thank you thank merger. I heard like few before thank you the. As senator Caldwell you're recognized thank you madam the chair of the Senate hammer you started to to mention about the money that moneys dollars available did mention about what you thought it would cost which account of what type of the account is this money coming out of an do you have any idea about what we will spend a day to the question of what we're gonna spend no I think you know as a set a LC would have the final check off on it because that's where the money would be coming for just like all the other consulting contracts that we as a branch you know authorized of I think the the benefit of this is that we could get it up to that point if it exceeds you know what's allowed at that time that we would be able to stop it at that point. Manager yeah and you have a question senator Hickey yeah and I don't see any further questions from the committee I guess that I do have a question about going forward with an artist petty of will these different groups that obviously have scope issues have improved and to have a support of the questions that are asking are iffy and I was pretty involved in the dental managed care are iffy and it's in some I think it will be important to for those questions to be asked of the different groups involved in the scope process before the art piece written so we know the questions to ask is that would that be a part of the process for. Madam chair and this may be a little bit unorthodox the way of going about it but because the sensitivity the subject matter and that sometimes defensiveness that can occur that's why I'm trying to do is open format and I would like to request that this actually be held over to next month and not be moved out here today because now that is had public hearing now that we've had this conversation I would hope that individuals would contribute ideas that could be factored into this and I'll be honest with a major having heard the discussion one thing I will go back to staff and ask is would be better if we did our of Q. instead of our of peace so we could have that format for all those things to be submitted so I want to go back to staff and talk to staff and reserve with the chairs permission A to be put on the agenda for next month to come back and continue this conversation yeah and I think it would be interesting to have a list of what scope different scope issues I mean are we talking about. Medical nurse which I'm a pharmacy retirement dental and you know dental you know dental management company I mean there a lot of scope issues that there be nice to define what we think those are well and the chair brings up an actual point that actually had a conversation of forgot about so thanks for jog my memory went when we put this thing out and we get we get the vendors that we come back in a bit on this this may be something we take invites it's this wall knelt and a whole time because there is such a long list of medical scope of practices we may want to tear the approach to which we do this and because again I'm not looking for get it done quick I'm looking into done right and we're not going to get done before the next general session and if this is a one to two year process I think it will be good as we you know as we progress along with people knowing that it's coming. A don't think it's a bad idea but I guess that made the question I would ask for you whatever route the consultant says it is that can change your vote. Depends on I think what is going to do madam chair I think it's going to give me information again made sorry It's going to give me information is sometimes is presented to me. From a biased point of view on all sides of the issue and I as a layman not with the medical background of which represents a large portion of think of the legislative branch have a document in hand that we can see has been arrived at through the pierced the processes. A just concerned we're gonna spend millions of dollars on a consultant it's not gone changing based but. Of well I think the citizens would at least have something that to which will make you saw more accountable. Ladyman you have a comment and share in your your question about the input is is is really good and and and let me just say aye aye. I push for this subcommittee meeting to meet and based on a regular basis to to have these discussions because I don't believe in the past in in the recent past at least that we've use our subcommittees in an effective way and I I think this meeting today shows that it can be used effectively and have a lot of good input and when we have I. S. P.'s that are discussed here that are on going and changing during the process is this one is going to be senator I think it can come before this committee it can come before the full public health committee and have input along the road so that you're not working behind the scenes and you come up with something and bring it in here and it's in the west order so I I think that's the purpose of going through this process the these ISPs like this one and maybe the previous one that there were all involved in this discussion along the way and we can have input step by step by step so I think that's a good question that you asked. But may I respond manager sure include any closing comments their number questions okay and and that is that is the reason for the methodology musing to do this is because it's transparent it's out in the open hopefully by the time we get the product finished we're able to move forward with the with the smooth their process and and so thanks for the comments because that's what these two were intended to achieve an option I'm sure all the others that were present hang tight senator Hickey decided yet the quest idea of and I'm not saying how I feel about this yet I was more time to think on it however of this body does go through with this or if the I'm sitting here trying to go through it did we did we include. Any factors in here that would Keep any undue influence being transferred to whoever the whoever would win the Conn this contract if we were to go through with it because I'd want that in there in the beginning because I know you mentioned that a second ago that you know sometimes were afraid that if we just did a task force here that we we may get some outside influences I just want us to look into that to see how we would need to write that to make sure that we don't get those outside influences through this through this same process which is going to be tough because I know they're going to have to work with our professionals to actually see the. What our current scope of practice is all or and and probably have to be in discussions with them so anyway just something to consider as we go forward and and I had the. Hey Jill helped draft this and so that is in here but I'll go back and strengthen it because I understand what you're saying it it it's really a mute point in doing it if we're not gonna have some safeguards that you know prohibits the consultant from being heavily influenced by individuals or associations at least seven in writing this and penalties or something so that we could if that ever transpired we found out about it we could at least to pursue it best I remember from our conversation this will carry the full weight and you know of civil penalties of up well in there yeah I think there was something in there about those the. Civil penalties but I don't know that it went as far as the actually limiting you know. Some type of conspiring together and things of that nature okay thank you Sir I'll go back and make sure and bring forth the at the next meeting I do have a question it if if we did have the consultant and date with the report public health is that where the reports would come the way I think the ISP and if not I'll speak to the intent is that it would report to the to public health public health would be the the custodian of the. Okay. All right saying no further questions thank everybody were dismissed thank you Mr chair members committee.