House Public Health Committee Part 1
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Transcript
Bills discussed (5)
| Bill | Title | Sponsor | Status |
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HB1831
· 3 mentions in chapter, transcript
Matched: “HB1831”
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Pre-2017 bill | ||
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HB1985
· 3 mentions in chapter, transcript
Matched: “HB1985”
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Pre-2017 bill | ||
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HB1810
· 2 mentions in transcript
Matched: “…e first on our list is a concurrence in a Senate amendment, House Bill 1810, and Representative Hutchinson, if you will, take your plac…”
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Pre-2017 bill | ||
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HB1475
· 1 mention in chapter
Matched: “HB1475”
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Pre-2017 bill | ||
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HB1855
· 1 mention in chapter
Matched: “HB1855”
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Pre-2017 bill |
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Here sees a quorum. We call the meeting to order. A couple of housekeeping items. This afternoon, or this morning, we are going to adjourn around recess, around 11.15 for lunch. Depends on where we are in the middle of a bill, but around 11.15 for lunch. We're going to reconvene back at 11.45.
We'll reconvene at 11.45, and we will work up until right before session begins at 1 o'clock. We will assess our agenda for a meeting this afternoon. I suspect, given what I see on the calendar, we will come back. If you remember what we've been doing the last couple of days,
we've been taking a recess in the house in the middle of the afternoon and having a second public health meeting this afternoon, and that will be somewhere around the 2.30 time frame probably. It just depends on when we take that recess. But we'll have a second meeting with a new calendar this afternoon, And that allows us then to comply with the two-hour notice to the public that we're going to have a second meeting. So just wanted you to be aware of that.
So to summarize, we're going to recess about 11.15, come back at 11.45, work until almost 1, and then this afternoon come back and work some more on a second meeting. Any questions on that? Concerns about that? Committee okay with that? All right, then we are going to go to our agenda. We have first on our list is a concurrence in a Senate amendment, House Bill 1810, and Representative Hutchinson, if you will, take your place at the end of the table and present that amendment.
Representative Donna Hutchinson
Unverified
2:10
Thank you, Madam Chairman and committee members. I appreciate your first vote when the bill came through. We were going
through the stage of discussing the rules and regs. I'm a professional mediator, and you just have to go through that. And then I discovered that this family that had lost their child six weeks ago, his birthday is this week, and they had wanted to leave town. So we decided to just get everyone together. What can you agree on? We'll have the bill, and later on we can get together an interim study or something.
So the bill basically says soccer goals should be secured. That's what we all agreed on, so I'd appreciate a good vote. And that's it, short and sweet. Committee, do you have any
questions? Anyone in the audience who wishes to speak against the amendment? Anyone in the audience who wishes
to speak for the amendment? If not, then the question before the committee is concurrence in Senate amendment on House Bill 1810. All in favor indicate by saying aye.
Aye. All opposed, no. Representative Hutchinson, you pass your amendment. Thank you. Appreciate it. Committee, without objection, we have a physician here who's going to be speaking on House Bill 1985, Representative Viviano, and because he's got to get back to the hospital, unless
you all have an objection to that, I'm going to let
him sit down and run that bill. So, Representative Viviano, if you will, take
Representative Mark Biviano
Unverified
4:07
Thank you, Madam Chairwoman. Thank you to the committee. I'm here today to present Bill 1985. We've talked a lot about health care in this session, and this is one of the things that is positive in my mind.
We have a growing field in health care called physician assistants, and we're fortunate here in the state of Arkansas to have one of the best schools, university, that has a physician assistant program, and over the last several years has produced a number of physician assistants that have gone on and served many parts of Arkansas and many other areas in our country. excited about that. We want to continue to promote students coming to the state of Arkansas
as physician assistants. This school is at Harding University, but there's plans to actually start an additional program at UAMS. What this bill does is creates a committee underneath the Medical Board of which the physician assistants become members. There will be two members as physician assistants and three of the medical board employees. It gives them certain duties and rights to help monitor their progress, review applications,
and it just allows them to have a voice in the process. And because this is a growing field, it's important that we recognize that they have industry issues that need to be dealt with and responded to all across the landscape of health care. I have with me Mr. Phil Tobin, who's the professor, the director of the physician assistant program at Harding University, and I would like to maybe have him say a few comments on the bill.
Sir, if you will, introduce yourself and the organization you represent for the
Phil Tobin
Unverified
6:03
record, and then you may proceed. Thank you. My name is Phil Tobin, and I represent ARAPA, which is the Arkansas Academy of Physician Assistants here in Arkansas. I've been a physician assistant for 17 years. I'm a retired Air Force officer, and I've been in PA education for the last five years. PAs across the country, there's about 75,000 PAs currently in the United States, about 200 here in Arkansas only.
PAs here in Arkansas are actually going to rural health care, teaming with physicians there and actually increasing the access of care to individuals out there who may not be getting care or may have limited care available to them. So PAs are making an impact not only there but also in the cities, helping orthopedic surgeons be able to increase their patient access. So all around, PAs team with a physician to increase the access of care to their patients
so that they can almost double the amount of patient encachment that the physician sees. PAs do many things that a physician does, but they are not physicians. They actually diagnose, see patients, treat, and if needed, prescribe medications. So they take many of those roles. At schools where there is a medical school and a PA school, many of the classes are attended
by both medical students and PAs, and certain classes are not. So that they have a very similar education as physicians, but a lot more brief. so they are able to get out into the community and see patients. Thank you. One point
Representative Mark Biviano
Unverified
8:01
I want to add, this bill has the full support of the State Medical Board. In fact, we work together on this bill, so they are in
support of the bill. And at this point I
take questions. Thank you, sir. Representative Gaskell, you're recognized.
Thank you, Madam Chair. You're still going to be under the jurisdiction of a of a physician, right?
Phil Tobin
Unverified
8:24
Yes, sir. We are still under the jurisdiction of a physician, and we are still licensed by the State Medical Board just as a physician is.
Okay. I'm familiar with that program over at Harding. It's a very good program, and we need you bad. I just want to be sure where you are legally, okay? And that answers my question.
Representative Andy Mayberry
Unverified
8:41
Thank you. Representative Mayberry, you're recognized. Thank you, Madam Chair. I just want to make sure
that I'm clear. As I understand this correctly, the members of this committee who are physician assistants would not receive pay for that. Is that correct, that they may be eligible for some expense reimbursements as funds are available? That's correct. Okay.
Committee, any other questions? Representative Ward, you're recognized. at the proper time looks like it's
a proper time you're recognized for the motion motion do pass I'm sorry we I didn't realize we had a question representative letting I'll come back to you in a minute representative word I apologize for not getting my
Representative Ward
Unverified
9:32
hand up fast enough I just want to clarify does it have anything to do with scope of practice we had an issue a couple weeks ago with the bill that we thought might touch on that no no we we took out
Representative Mark Biviano
Unverified
9:44
about dispensing and Schedule II pharmacy, so it has nothing at all to do. Okay. Thank you. Committee, any other questions? Representative Word,
you're recognized. Thank you, Madam Chairman. A motion do pass. We have
a motion do pass. Anyone in the audience who wishes to speak against the bill? Anyone in the audience who wishes to speak for the bill? Representative Viviano, are you closed for your bill? We
Representative Mark Biviano
Unverified
10:13
have somebody that wants to speak for the bill, Dr. Mike Murphy.
Oh, I'm sorry. I didn't see a hand go up. Thank you. Yes, sir. You may take your place at the end of the table
Speaker 50
10:26
and introduce yourself for the record and proceed. Thank you, Madam Chair. I am Dr. Mike Murphy. I'm a family physician and a medical educator for 26 years. I am the program director of the program at Harding. And I feel that this bill is a step in the right direction for this profession. The PA profession is something that's recognized nationally. It's fairly new to Arkansas, and as we're moving forward, I think it's very important
that PAs play a role in regulating themselves, just like the physicians do. It doesn't really change anything in the relationships. It doesn't change the profession any, but it gives them a bigger role in monitoring and improving health care for the state. Thank you. Thank you, sir, for being here.
Anyone else wishing to speak against the bill? Anyone in the audience wishing to speak for the bill? Representative Bibiano,
are you closed for your bill? I'm closed.
Members, the question before the committee is House Bill 1985. All in favor indicate by saying aye. All opposed, no. Representative Bibiano, you've passed your bill. Thank you to the committee. All right. Next on our calendar is House Bill 1831. Representative McLean, are
you ready to present your bill? Take your place at the end of the table,
Representative James McLean
Unverified
11:50
and it's 1831. Thank you, Madam Chair.
With the indulgence of the Madam Chair and the committee, may I have Dr. Tom Taylor with the Arkansas Chiropractic Coalition join me for the presentation of the bill.
You can, Representative McLean. Are you mimicking Doc Gaskell today? Yes, ma'am,
Representative James McLean
Unverified
12:08
for the time being. I think I am. Hopefully,
Speaker 62
12:13
it's a temporary condition. We know that, Doc. Dr. Taylor,
if you will introduce yourself for the record, please, and the organization you represent.
Tom Taylor
Unverified
12:25
My name is Dr. Tom Taylor. I am president of the Arkansas State Board of Chiropractic
Speaker 67
12:31
Examiners, and also I'm representing the Arkansas
Speaker 59
12:36
Chiropractic Coalition. Madam Chair, this bill is a bill that would deal with Medicaid
Representative James McLean
Unverified
12:41
recipients having access to chiropractic physicians. That is why Dr. Taylor is here today, and I ask him to join us to fully illuminate the committee on the aspects
Speaker 59
12:53
of this bill, and he would be happy to answer any questions
Tom Taylor
Unverified
12:57
that the committee has. Dr. Taylor, if you will proceed. Approximately 775,000 Arkansans are in the Medicaid program, as everyone knows now, and by 2014, we're going to add another 250,000 to the rows. That's one out of every three Arkansans by that time. In the early 90s, chiropractic physicians in Arkansas were asked to accept non-provider
physician care provider status in the Medicaid program with referral by MDs only. There was some reluctance by our profession during that time, but we tried it and it did not work. The common knowledge then, as it is now, was that medical doctors don't commonly refer to chiropractic physicians. And as a result, Medicaid patients have been unable to access cost-effective chiropractic care. Today, chiropractic services are less than 1% of Medicaid costs.
With chiropractic physicians used as primary care providers, Illinois' Blue Cross and Blue Shield study showed substantial savings through decreased hospitalization and prescription use. And in the Sarnot studies, led by Dr. Richard Sarnot, medical doctor, in Exhibit A and B that you have before you there, states that the health care system excels in acute and crisis care management, which is trauma care and emergency-type care, but the greater health care burden is the prevention and treatment of chronic and multiple chronic disorders.
That's the kind of disorders that chiropractic physicians treat on a daily basis. And furthermore, the Sarnat studies indicate AMI and HMO-based in Chicago, Illinois, used chiropractic physicians as primary care providers and over a seven-year period demonstrated decreases of 60% in hospital admissions, a decrease of 59% in hospital days, 62% in outpatient surgeries and procedures, and a reduction in 85% pharmaceutical costs when compared to the medical model.
In Arkansas, as in other states, chiropractic physicians are primary care providers in all health insurance programs, including Blue Cross, Blue Shield, and Medicare, but not in Medicaid, and this just doesn't make sense. Since 1971, chiropractic doctors have been licensed as physicians in Arkansas, and the 18 chiropractic colleges are accredited by the U.S. Department of Education. The chiropractic versus medical education chart in Exhibit C that you have before you
shows that there's similar education given now to the chiropractic physicians versus the medical physicians. So this documentation is a public record anyone can verify. There's no time left for kicking the can down the road anymore. The time is to use cost-effective health care is now. Chiropractic care is not part of the problem, it is part of the solution. That access to chiropractic in Medicaid equals decreasing Medicaid health care costs.
Your vote for HB 1831 is a vote to reduce Medicaid costs in Arkansas.
Representative Andy Mayberry
Unverified
16:25
Thank you. Representative Mayberry, you are recognized. Thank you, Madam Chair. Did I
understand you correctly, sir, when you said that other private insurance providers recognize chiropractic care as primary care? Yes,
sir. Is that across the board? I mean, are there exceptions to that in the state of Arkansas?
No, sir. But the only exception that you
know of is Medicaid? That's correct. Okay. That's
Representative Charolette Wagner
Unverified
17:00
my question. Representative Wagner, you're recognized. Thank you, Madam Chair. I did not have this handout,
was looking for it. Thank you. You're welcome. Dr. Taylor, let me
ask a question, if I may. I know that given the information we've received recently in a presentation that was in public
health, joint public health yesterday, the direction that Medicaid is going is for a, I think it's called
a primary care home in our Medicaid system. Wouldn't this be contradictory to where we're headed
Tom Taylor
Unverified
17:37
with Medicaid? Of course, that's yet to be seen, and the determination hasn't been made on that. So in the meantime, we're having chiropractic patients or doctors who have patients that are not able to access Medicaid
and help reduce health care costs. So with this law being in effect, it would help to, in the event that that does occur, then we can go that route. But if it doesn't, then we have
Speaker 79
18:07
a health care cost reduction in place with this bill. Thank you, sir. Anybody else have any
questions? Representative Mayberry, you look like you have a question, do you? Okay. I can just see that look on your face. That's that furrow in your forehead.
Representative Andy Mayberry
Unverified
18:27
Well, that's there all the time. Have you
been in discussion with those who administer the Medicaid program in the state of Arkansas? And if so,
Speaker 83
18:40
what are their feelings regarding this bill?
Tom Taylor
Unverified
18:43
The thing that we have seen is we have seen that back in the 90s, this is the route they wanted to go. They wanted to use primary care physicians with medical doctors in place, and we are
to the stage now that we have not been able to come up with any solutions between them and us. There is some feeling that when our discussions were made to them was that there is going to be an additional cost, but these studies and these emphasize that it is a replacement. actually replacement of cost and actually reduces cost. So the thing that we have had the option now to do is bring it toward the legislature because
you are the people that are going to have to take the bull by the horns and the responsibility has been left to you all to do something about that. We want to participate
Speaker 79
19:39
with that so that we can help come to that fruitful end.
Representative Andy Mayberry
Unverified
19:47
Question, Madam Chair, do we know if there is someone from the state here? Representative Mayberry, we do
have DHS who's going to speak against the bill, so they'll be at the end of the table in a few minutes. Okay, thank you.
Committee, what's your pleasure? I'd like to at least give them a motion. We have a motion due pass from Representative Woods. Anyone in
the audience who wishes to speak against the bill? I believe we have Rosemary Edwin
with DHS signed up to speak against the bill. Am I pronouncing your last
Speaker 88
20:31
name correctly? I can't read the handwriting very well. It's Edgen, E-G-G-I-N.
All right, thank you. I have a friend that always
said, just think of Ed drinks gin. All right. Well, if you'll sit down and take your place at the end of the table
Rosemary Edgen
Unverified
20:46
and introduce yourself for the record and proceed. Thank you. Chairman, my name is Rosemary Edgen. I work with the Division of Medical Services, specifically in the Utilization Review section. And in that section, we have the responsibility for about 44 programs, and one of those is the chiropractic program. I want to begin by apologizing to the committee and to Representative McClain that I did not have an opportunity
community to discuss with him before we came here. I did try this morning, but it was kind of short, so I do apologize to the committee. Most of you understand that with Arkansas Medicaid, a PCP referral is kind of the gatekeeper for all of our beneficiaries. We feel like the PCP helps us with utilization management, to know that someone is not seeing two cardiologists or three gastrointestinal doctors, and they're just not moving around and around from place
to place. We feel that the primary care physician needs to be intricately involved in everything that's going on with that patient. The PCP governs a lot of our program. PCP referral is required for just about everything that happens with Medicare other than OBGYN for women. So it is a key part of how our program functions at this time. And I personally was not aware that there were some particular issues with the Chiropractic Association.
We would certainly love the opportunity to discuss that. As far as primary care physician, I'm not sure that anything has been done over the years to talk about chiropractic becoming a primary care provider for Medicaid. Again, I think that if we could have an opportunity maybe to discuss what the issues are, hopefully we could resolve them without legislation. The other thing I'd like to speak to is he had indicated that PCPs were reluctant to
refer their patients to chiropractors. I think that's a – and personal opinion – I think that's a discussion that needs to happen between the chiropractic community and the physician community. there are some barriers or some issues there that perhaps they could maybe talk and resolve some of those issues rather than Medicaid trying to resolve those issues for them. And I'll be glad to answer any questions if I can. Representative Malone, you're recognized. Thank you, Madam Chair.
Representative Stephanie Malone
Unverified
23:11
I'm just curious. This bill has been on our agenda for almost a month now. Why is it you didn't meet beforehand? I mean, we've all been seeing
Rosemary Edgen
Unverified
23:19
it on here, so. Right, and we had made contact and were told that it probably wasn't going to run and didn't particularly want to have a discussion with us at that time, but would let us know even when they decided to run the bill. And then, unfortunately, we found yesterday that it was going to run. Okay. So we did make an attempt.
Speaker 90
23:39
We just couldn't coordinate things to work out.
Okay, thank you. Yes, ma'am. Thank you, Ms. Edgen, for coming before us today. Anyone else in the audience wishing to speak for the
bill? Yes, sir, I see a hand in the back, if you will. Take your place at the end of the table. Introduce yourself and the organization you represent.
Before you start, if you will take your tags off, I would appreciate it,
thank you. Introduce yourself for the record, please, and you may proceed.
Speaker 100
24:32
Thank you, Madam Chair. My name is Dr. Sam Haley, and I'm with the Arkansas Chiropractic Coalition. And this is a patient of mine, and I'm going to let her introduce herself and tell her story, and then I will come back and have a few comments.
Paula Williams
Unverified
24:48
Yes, my name is Paula Williams, and I'm a migraine sufferer. I've had migraines for around 20 years. I've been treated by my primary care physician for almost that whole length of time. I was referred to Dr. Haley by him. And in October, I began to see him. And for about the past four or five years, I've had migraines almost every day.
I've taken medicine that's around $600 a month. I've taken migraine medicine specifically. I've taken muscle relaxer, taken anti-inflammatory. I've tried everything. I've taken all kinds of medicine. But I began seeing him in October, and the migraines have lessened in severity.
And I don't have them every day anymore. I don't have to take as much medicine anymore. I'm getting my life back, and I'm getting my health back. And it's because of what he has done for me. And I appreciate your
Speaker 99
26:19
time. Thank you, ma'am, for being here. Thank you, Paula. Now,
Speaker 100
26:21
just a couple of things that I would like to add is this is Paula's first time to ever be to the Capitol.
And she brought her mother and her aunt with her. And we're going to have a little tour when we're done here. And she's from Heber Springs. and one of the things that she wrote that she didn't say is in the last six weeks she's had three migraines and her monthly dollar amount has went from $600 a month to less than one-third of that is what she says. So we'll put that number at $200 a month. And I spoke with her family physician on the phone and told him we would be here and he was very supportive
and he said she takes more than $600 a month because when she runs out of medication that she receives, she comes to his office and receives samples. And he said the results that he has seen have been remarkable. So, you know, we're here today to kind of explain just a touch of the program, and that's this. When you receive a referral from a family physician,
that family physician can give you up to 12 visits per year. And in most situations, 12 visits a year is not enough to stabilize the condition. You may see some results, but you certainly won't see a stabilization. Now, in Ms. Williams' case, she started with me around the 1st of October after this referral, and she has received 40 visits to date.
And she is presently on once a week and we can definitely see the light at the end of the tunnel and we can see that she's going to be able to be dismissed soon. If you look at the cost on that, 40 visits, Medicaid approves $28 a visit, that's $1,108. And she was taking each year over $7,200 in medication. And if we reduce that to $200 a month, that's down to $2,400 a year in medication.
And that's a savings of $4,800 just in medication. so the beauty of this particular program is that we have a family physician and a chiropractic physician that developed a relationship of mutual cooperation and we received a referral as a test case I guess you would say and we were able to make a difference now if we can save that kind of money
in today's health care environment, this is what it's all about. You know, we read in the newspaper and see on the TV that we're at the tipping point. So we've got to find ways to save money, and we've got to find ways to get along and work together. As a rule, medical physicians simply don't refer to chiropractors. We want to see that get better. I welcome the comments from DHS in that there needs to be some dialogue,
or perhaps you, Madam Speaker, said that. But I think probably DHS is going to have to, they're going to have to probably be the middle person in this, the mediator, because sometimes it's kind of like the Hatfields and McCoys. You know, there's two sides to a pancake no matter how thin you cook it. and traditionally medical physicians won't refer for a variety of reasons and I think most people in the room know that. But what we've got to do is we've got to find ways to save money
and we've got to find ways to benefit the health, welfare of our citizens. So in the bottom line, when you take a lady like this who's taking less medication, she's not a zombie she's able to function at a higher level than we've done something so I welcome the opportunity to make this presentation are there any questions Doctor I believe we
have a couple if you're willing to take questions Representative Mayberry you're recognized
Representative Andy Mayberry
Unverified
30:54
thank you ma'am first of all I want to thank you very much for coming here and sharing your story with us we certainly
appreciate that But my question for the doctor, you had mentioned that you had spoken with her family physician and he was very supportive of this and that he actually has made that referral to you. But I guess the problem in this particular situation is that he is limited to 12 per year. Is that correct?
And she is in need of more like
Speaker 100
31:27
along the range of 40. Right, right. Instead of 12 visits a year, we would have liked to have seen medical necessity based on documentation. Which would
Representative Andy Mayberry
Unverified
31:37
have given us more visits, obviously. As a follow-up to that, would
that lead to the possibility that instead of this proposed legislation of direct access, that instead the change that might need to be made would be to put it back more into that primary care physician's hands
to be able to have more flexibility for
an increased number of visits rather than the
Speaker 114
32:04
direct access? Well, that's certainly something that needs to
Speaker 100
32:09
be studied. But I'll give you another example. I had a referral from a medical physician yesterday, and he said three visits. And this medical physician has sent me patients before, three visits. So, you know, I think the gulf, the divide between us is so great, I don't know if it can ever be bridged.
I think the best avenue for everybody is strictly to allow direct access based on medical necessity and documentation. because we have the training to recognize when a patient needs to be referred. And so I think it would be more cost effective. I think it would save time, energy, that we simply approach direct access. Now, remember, we had direct access at one time,
but then our health community fell into this cost-saving thing, we thought, several years ago, and everyone went under a gatekeeper. Well, we slowly have evolved away from that, you know, with almost everybody now. But yet we're still stuck in the past, and we just want to bring this thing forward with an understanding that we feel like, based on her testimony, that we're not being utilized. If we're going to save money, and if we're serious about saving money,
and quite frankly, we don't have a choice anymore, then we have to at least
Speaker 115
33:50
give us the opportunity to prove ourselves, which we have in the past. Thank you. You're welcome. Representative
Lovell, you're recognized. Thank you, Madam Chair. Ms. Williams, are you on Medicaid now
for disability for migraines? No, sir. No. So I'm on Medicaid now
Paula Williams
Unverified
34:16
for a disability for an injury I had in 1992, not relating to the migraines at all.
Okay, but I may have missed it, but actually
if we get more than 12 visits a month from Medicaid, then actually it's going to cost Medicaid more dollars. Is that correct? Just
Speaker 100
34:42
year that we get, not 12 visits a month. If we had 12 visits a month, we probably wouldn't be here today. Okay, well. But in all due respect, on the surface it looks like it will cost you money,
but as the facts I just gave you were based upon the number of visits and the amount of medication she was taking and the amount of dollars that DHS was putting out for medication of $7,200 a year for sure for the last five years, but these migraines go back 20 years with her. So in the last six months of care, and we've reduced her daily migraine medication, or excuse me, her monthly, to less than $200 when she was over $600,
dollars. We can save the program money.
Paula Williams
Unverified
35:38
If I may, to say the least of the visits to the emergency
room to be knocked out. Okay. So the 40 visits you were talking about, that would be on an annual basis?
Speaker 100
35:52
To the 12, that would be 40? Well, no, sir, because when we talk about medical necessity based on documentation, You know, I take care of some children that are under our care that receive referrals, Medicaid,
and, you know, they're a basketball injury, they're a football injury, they're a fall, and there are four, five, or six visits. In her case, we're presenting the facts on care since October the 5th of 40. Now, she's not been dismissed yet, but her future is looking bright. So if we're going under medical necessity based on documentation, it might be 60 for some people or it might be 20.
But in her particular case, we're talking about 40, actually 41 visits, but I rounded it off to 40 today. This
one. So I understand that part of it, but then you said you'd save Medicaid $7,000 because of medicine. Is all the medicine you're talking about for the migraines or is part of that medication due to her injury that made her disabled?
Speaker 100
37:12
Okay, I'm going to let her answer it, then I will follow up because I've spoken with her family
Paula Williams
Unverified
37:24
or indirectly. Most all of the medicine is directly related to the migraines every day. Okay.
Thank you. Thank you, Madam Chair.
Chair
Unverified
37:36
Representative Wagner, you're recognized. Thank you, Madam Chair.
Representative Charolette Wagner
Unverified
37:43
Part of my questions were answered, but just for clarification, If we were to pass this bill, a patient would be able to go directly
to the chiropractor. Yes, ma'am. But still in place would be just the 12
Speaker 108
38:07
visits per year. I'm not sure. Our colleagues in DHS would
Speaker 100
38:12
probably be able to answer that.
But in place is the 12 visits a year. If you do away with the gatekeeper, then does that change the entire formula? I would think so. I mean, and if it didn't, we would definitely, you know, want that to be changed because of this example I've just given you in which we could present hundreds more. Thank you. I think I would
Representative Charolette Wagner
Unverified
38:38
need that clarification if we may have the lady from DHS to come back.
Certainly we can do that. Any other questions for the doctor
and Ms. Williams? Ms. Williams, it is a daunting task to come before this committee. I appreciate you being here. Thank
you. Ms. Edgen, would you mind taking your place at the end
Rosemary Edgen
Unverified
39:14
of the table again? Thank you. You're welcome. And answering that question. The chiropractic visits are 12 per state physical year.
They are separate from the PCP visit. So they have 12 per state physical year for the chiropractor. Does not get into the PCP. And the bill, as it's written, does not change the number of visits. The bill, as it's written, I believe just says they no longer would have to have a PCP in order to receive chiropractic services, but it does not address increasing the number of visits that they could have unless I have missed something.
Speaker 138
39:53
Thank you. Thank you, Madam Chair. Anyone in the audience who wishes to
speak against the bill? else in the audience wishing to speak for the bill? Representative,
I'm sorry did I see a hand? Sir, I need you to if you want to speak for or against the bill if you would take your place at the end of the table can you do that?
Sir, if you would, make sure that you identify yourself for the record and let us know if you're planning to speak
Ludwig Kozlowski
Unverified
40:48
want to make a comment. Please identify yourself first. My name is Dr. Ludwig Kozlowski. Thank you. I'm a retired physician. My specialty was physical medicine and rehabilitation. I dealt a lot with the chronic pain, not specifically with migraines. And what I would like to know is, first of all, I don't think that we can say that the
medical education of chiropractors and MD is the same. To be MD you have to go first to pre-med and then you have to go through four years of medical school and then you specialize and so on. I don't know how long the chiropractor school, how many years it takes. My problem is, did somebody look at the curriculum of both schools? And how can we say that chiropractor can function as primary physician? That's one question.
The other question is, when you have a chronic pain, especially, I'm not questioning the lady's pain. I empathize with her. But my problem is when you deal with a pain that lasts longer, let's say six weeks or three months, and here we're talking about years, was the patient or any patient who has a problem like that ever evaluated by a psychologist? You have to know that pain is a complaint.
It's a subjective. It's what the patient says. We cannot see if the patient has pain. But there are different ways to diagnose different chronic pains, and to me, I am not sure if the chiropractor, when the patient has been of such long duration, if he really approached all the, if in this case, were used all the things like, for instance, very often psychological
medical evaluation is necessary, especially when the pain lasts as long as in this case. Because sometimes it may be something to do with personality, and what bothers me in this case that this lady unfortunately has some other disability, and there's already sometimes what I've seen in patients with chronic pain, that they almost, once they have it, they claim they always have it. I mean they may have, you know, so there's a lot of questions
in my mind if a person with chronic pain should be treated by a chiropractor. I'm not questioning the professions, you know, whatever their abilities, but I just wonder, to me, as far Because I know, being a physician myself, the patient migraines, I would refer the patient to neurologist.
That's what I think is the proper referral. I don't know the curriculum of chiropractors, and before we come up with a bill like that, Somebody needs to look what is the curriculum, and if it compares, you know, if there's enough material in the chiropractic curriculum so they could treat migraines, I just question
that. Dr. Koslowski, thank you very much for being here. Representative Lampkin, I apologize to you. I overlooked your question a while ago. Did you have a question for someone that I
didn't? Yes, ma'am, I did, but I got it answered. You got it answered. Thank you very much. I just looked down and saw your name hadn't been scratched through. Thank you. Anyone else want to speak for the bill? Yes, sir, you're recognized. To come introduce yourself and the organization you represent.
Speaker 143
44:54
I'm Maurice Traylor. I'm a chiropractor in West Memphis, and I represent myself. This is an example of why patients need direct access. I've been a chiropractor for 30 years. My father was a chiropractor before me. Medical physicians are just not open to chiropractic utilization. It is much better now than it was when I first went into practice 35 years ago when I had patients ordered out of their medical doctor's office for coming to see me.
Chiropractic education is on par with medical education in this country based on the type of patients we see. We don't see crisis care patients. We don't prescribe medicine and we don't do surgery. The extended education that medical physicians get beyond classroom training is primarily in surgery. Our curriculum is nearly exactly the same. We use the same textbooks, and it takes four years, doctor, post-college to become a chiropractor,
just like a medical doctor, just like an optometrist, and just like a dentist. So this is why the people of Arkansas need this type of legislation. We would like to work with DHS. DHS isn't interested in working with us because of the past prejudices that we continue to experience and our patients continue to experience, and it's costing you all money, costing you a lot of money.
You have a vehicle that you're running jet fuel in that will run better on regular gas. And we have a piece of the pie, a piece of the answer. We don't have the whole answer, and we're not here to tell you we have the whole answer. We would like a chance to participate, and we would like a chance to help. And we're willing to play our part, and we're willing to be open about it. Give us a chance. Thank you very much. Thank you, sir,
for being here. else wishing to speak against the bill?
Representative Perry, you're recognized. Motion for immediate consideration. That's a proper motion, not available. All in favor of immediate consideration, indicate by saying aye. Aye. All opposed, no. So the question then before the committee is House Bill 1831. All in favor of House Bill 1831, indicate by saying aye. Aye. All opposed, no?
No. Representative McLean, you failed your bill. Committee, without objection, Representative McLean has a
second bill. We're going to go ahead, while he's at the end of the table, allow him to run that bill. That's House Bill
1475. Is that correct, Representative McLean? Yes, it is. So if you will have your guest introduce himself again for the record. We have a handout, I believe, for this bill as well. And Representative McLean, if you'll proceed once he introduced himself.
Speaker 59
48:20
Thank you, Madam Chair and committee. House Bill 1475 deals with
Representative James McLean
Unverified
48:24
amending the Consumer Patient Radiation Health and Safety Act to include chiropractic aids and chiropractic assistance with the expanded duty of radiography. Madam Chair, I have with me Dr. Tom Taylor, who is with the Arkansas Chiropractic Coalition. And with the indulgence of the chair and the committee, I would like him to further explain the bill.
Tom Taylor
Unverified
48:51
Dr. Taylor, you're recognized. Thank you, Madam Chair. My name is Dr. Tom Taylor, and I'm president of the Arkansas State Board of Chiropractic Examiners. And representing on this bill the Arkansas Chiropractic Coalition, which is a conglomerate of the three state organizations. Present law, but the Arkansas Department of Health permits chiropractic assistance to be trained in radiology by doctors in-house, which does not adequately prepare the CAE
in this uncontrolled, nonregulated environment. Also it allows these two six-month permits to be issued by the Department of Health, which during that time the CAE has to obtain six hours of continuing education, which can also be done in an in-house, uncontrolled, non-regulated method. During this two six-month period, the CA has issued a temporary license initially for the first six months, and then if they do not pass the radiology exam, they can reapply
and receive an additional six-month period. Then if they don't pass the exam, then it's two and they're through. Public offices, as a result, has ended with a high turnover and hire new CAs. The law just allows them to hire new CAs, and this process starts over again. So this has resulted in a revolving door of untrained staff with two six-month permits. Present law permits the Arkansas Dental Board to regulate their dental assistance and radiology,
And there are other states that also allow state boards like the Arkansas Chiropractic Board to regulate their CAs and radiology as well. The Arkansas State Board is a state agency which will assure that rules and regulations are implemented in CA radiology to protect public health and safety. Your voting for HB 1475 is a safer chiropractic assistant radiology law for chiropractic patients in Arkansas.
Thank you. Thank you, Dr. Taylor. Committee, any questions? Representative Lee, you're
Speaker 151
51:10
recognized. Thank you, Madam Chair. I have a motion
at the proper time. Thank you, ma'am. We'll get back to that in a moment. Any other
Representative Andy Mayberry
Unverified
51:21
questions? Representative Mayberry, you're recognized. Representative McLean, are you aware of anybody opposed to this
Representative James McLean
Unverified
51:27
particular bill? I have not been informed of any opposition, nor has anyone spoken to me personally, or
any of the representatives of the chiropractic community. Representative Mayberry, we
do have a notice from the Department of Health. They're going to be speaking against the bill, so we'll be able to hear from them soon. Anyone else have
a question? Representative Lee, you're recognized for a motion. Move due
pass. We have a motion due pass on House Bill 1475. Anyone in the audience wishing to speak against the bill? Representative McLean,
if you'll move over to the side for a few minutes, that'd be great.
Sir, if you will introduce yourself for the record, please, and then
Robert Breck
Unverified
52:15
you may proceed. Thank you, Madam Chairman. My name is Robert Breck with the Arkansas Department of Health. There has been an amendment put on this bill. We did object to it earlier. would have exempted chiropractic aids from the law altogether. And I hate that I haven't had a chance to speak with Representative McLean about this particular amendment. To take you back, in 1999, there was a Radiation Consumer Protection Act passed. Before that
time, when you went into a doctor's office or a chiropractor's office, the person who gave you that x-ray may have been the receptionist, but there was no training required whatsoever. That's a very dangerous situation. So in 1999, the radiologists got together with the various groups and passed that law to protect people from radiation. The reason that there's a high turnover rate in these individuals that Dr. Taylor mentioned is because they're not
passing the test. The test is a standard test that's given nationally. It's not difficult if you study the materials. I know that personally because I passed it, and I've never taken an x-ray in my life. And I can assure you that none of you want an x-ray to be administered to you or your loved ones with a person who cannot pass that test. That's the only reasonable explanation why chiropractic aids or the chiropractors would want to remove them from the general
law that applies to every person who gives x-rays in Arkansas, with some limited exceptions. Exceptions have to do with dental hygienists who receive significant training to get their degrees in radiation safety, and also people who do podiatry. Because of the low doses of radiation and the minimal risk that's attributed to those types of X-rays. In the chiropractic's
office, they give X-rays of the complete spine. That subjects all of your organs, including reproductive organs, to radiation. We strongly oppose this bill. I take any questions you MS. Committee, any questions? Representative Lee. MS. Thank
you, Madam Chair. I guess I'm lost.
Speaker 151
54:50
They're still following. They will still follow under regulations.
Speaker 162
54:53
So I don't understand what your concern was. MR. Well, my
Robert Breck
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54:58
concern is they fall under regulations at this time. There's been concern and there have been efforts in the past to exempt chiropractic aids from the general law. I can only assume that they want to lesser those standards by putting their licensure under the chiropractors so that they can continue to take x-rays.
The reason that people have a problem with this, that doctors and chiropractors have a problem with the current x-ray laws, It's because these individuals are not passing the test. And after one year, they have basically a one-year on-the-job training. During that year, they have an opportunity to train. The Department of Health is required to give them a study guide, which is a very good study guide. And they have opportunities throughout that year to pass the test. Okay. I understand that.
Speaker 164
55:51
So you're speaking against this bill on the assumption of what they're going to do in their regulations if we pass
Robert Breck
Unverified
55:59
this? That's correct. What other explanation would there be? They want to be exempted out of the law. There's no doubt about that. This is an attempt to make it more palatable that, yes, they are going to fall under some regulations, but we have no idea what those regulations are going to be. We know what the regulations are now. There is a national test that's given.
There just doesn't seem to be any reasonable explanation for them to want to be exempted from the general law that would apply to
everyone. Thank you. Thank you, Madam Chair.
Representative Andy Mayberry
Unverified
56:43
Committee, any other questions? Representative Mayberry. I do have one. Can you elaborate just
a little bit on what the potential hazards are of having someone who is not qualified administer these services?
Robert Breck
Unverified
56:56
Yes, you can do major damage to organs. Unfortunately, you won't know that when it occurs. If you're giving too much radiation, just we all know what's going on in Japan right now and what people are concerned about, the effects of radiation. If you're given too much radiation, you can damage organs significantly. Unfortunately, you're not going to know it immediately. It may
be two years, five years, ten years down the line, but you can do significant damage.
Thank you, sir. I believe that's all the questions. Anyone else in the audience wishing to speak for
the bill? Anyone in the audience wishing to speak against the bill?
Representative James McLean
Unverified
57:47
Representative McClain, would you like to close for your bill? Thank you, Madam Chair. I would just like to note that in the present law, dental assistants are exempt.
So we just want the same consideration for chiropractic aids, which are probably on the same level as dental assistants who have already been exempted under this law. And with the permission of the Chair, if Dr. Taylor has any closing statements, I'd appreciate him have the opportunity. Dr.
Taylor, you're recognized. I would ask you to try to be brief with
Tom Taylor
Unverified
58:29
those. We have a very long agenda today. Yes, ma'am. If you'll notice on the provision in Section 2, Arkansas Code 17106-111, where it's added language to this bill,
it says the Arkansas State Board of Chiropractic Examiners shall adopt rules in accordance with standards recommended by the American Registry of Radiological Technologists for education, testing, and certification of chiropractic aids or assistance. It also says it doesn't prohibit chiropractic aids or assistance from obtaining radiological certification through the Department of Health. Now, the ACRRT certification is already a part of the bill that was passed with the blessing of the Arkansas Department of Health.
What the Board of Examiners wishes to do is adopt the same rules and regulations in other states. There are 20 other states that have these same type rules and regulations in place so that we can keep this revolving door from coming about that is happening with the CAs now getting trained properly. And these CAs, on the average through the ACRT program, gets didactic classroom training of 48 hours a year, and this training is by a diplomat at the American Board of Chiropractic Radiology.
There's a lot of safety features built in here. The present law now allows a loophole where the CAs are coming into chiropractic offices and they don't get that training. We wish to provide that for them and implement rules through public hearings so that we can address this and help the public safety and welfare of the citizens of the state with regard to radiology by the CA. Thank you. Thank you, Dr. Taylor. Representative McClain, are you closed?
Madam Chair, we're closed. All right. Committee, the question before the committee is the passage of House Bill 1475. All in favor indicate by saying aye. Aye. All opposed, no. No. Representative McLean, you failed your bill. Thank you, Madam Chair. Thank you, committee. All right, committee, Representative Hall, I don't know if you were here for the announcement, but we are going to recess at about 1115, and we're going to come back then at 1145. I know you have some wonderful guests.
All right, sir. Thank you. I just wanted to make sure you were informed. Next on our agenda is Representative Rice. Are you in
the room? Representative Wilkins, you're recognized to present House Bill 1855. Can we once ask the first question?
Thank you, Madam Chair. Actually I picked up the wrong bill back there. I'm running one in the judiciary at the same time. Let me get
Speaker 180
1:01:37
my copy of my bill. All right. We've all done it, sir.
I know that. I was on my way out. Haven't we will? I thought we were about to adjourn, and I was headed to the judiciary. But anyway, this 1855 is a regulatory bill. It's not an anti-abortion bill. It's not a pro-abortion bill. It is a regulatory bill. Several hundred non-surgical abortions are happening in our state every year.
We are, all we ask of this bill that any clinic that is doing, any facility that's doing more than 10 a month report to the Department of Health. And that the Department of Health license them. actually it's not a it's a regulatory it is a regulatory bill is what it is I'm not going to go much further in explaining it because I know we have people
signed up on both sides who speak for it and against it so
at this time we can call those let's see if
the committee has any questions first Representative Gaskell you're recognized Thank you, Madam Chair. You
knew this was coming, didn't you? I know it was coming, Doc. You pick out the number 10. What about the guy that does 9? I cannot answer that. I did not pick the number.
Oh, I'm just here arguing right now. You know, this is the way I feel about it. If you do one a month, you need to have to register. This is the number 10. I don't know. It seemed like a fantasy world like the one
I lived in last night, but this is my
personal feeling. Thank you, Madam Chair. Thank
Representative Charolette Wagner
Unverified
1:03:52
you. A little too much information. Representative Wagner. Thank you, Madam Chair. Representative Wilkins, since you have put the stipulation in concerning licensing, before,
If they have only done less than 10, they don't have to be licensed. So what is the
procedure to be licensed if they do more? You know, I've talked to the Department of Health about this, and they are going to be the ones in charge of writing these regulations. That's the reason the actual regulations on the facilities. That's the reason we set the effective date to begin January 1, 2012 to give
everybody concern, time to get together and work out for regulations.
Representative Charolette Wagner
Unverified
1:04:38
Did I answer your question? So they do not have those regulations
in place right now? This law will require a license. Right now, no. As far as I know, they have no way of reporting, no way of licensing. But my question is, what
Representative Charolette Wagner
Unverified
1:04:56
will they have to do to be licensed? What is that procedure? What are those things that
they have to comply with? I cannot answer that right now. Maybe Robert Breck can with the Department of Health.
Robert, you willing to answer that? Mr. Breck, if you will, introduce yourself for the
Robert Breck
Unverified
1:05:19
record and answer Representative Wagner's question. Thank you, Madam Chairman. Robert Breck with the Department of Health. There are current abortion regulations that are in place. They were last revised, I think, in 2000 and 2001. They're pretty comprehensive. The thing is, they were written in mind for the surgical type abortions, and there's one
clinic now in Arkansas that is a licensed abortion facility and follows those rules. The way this current bill is written, it would include non-surgical abortions, and in other words, the RU486 prescribed medicines that have the same effect. By extending it out to January 1st, those regulations could be amended to make them more compatible with the non-surgical abortions.
And therefore, they could be licensed, is that what you're saying? Any facility or any person that did 10
Representative Charolette Wagner
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1:06:21
or more would have to be licensed. That's correct. But my question is, if they did change those regulations to include those who do not do surgery, they could be licensed if
Robert Breck
Unverified
1:06:31
those changes are made. Well, they would have to, if this were to pass, they would have to be licensed. They would have to follow the current rules unless those rules are amended in this interim
Representative Charolette Wagner
Unverified
1:06:41
period. And still, I've not heard any of, what are some examples of the rules?
Robert Breck
Unverified
1:06:46
What are those rules? Well, I wish I
knew them well, but I don't. Well, what they do, they deal with staffing. They deal with emergency procedures. It deals with contracts with outside facilities if there were to be an emergency, if there was a complication during a procedure. There
are 21 pages of rules, but it mainly deals with the facility itself. All
Representative Charolette Wagner
Unverified
1:07:10
right. And do you anticipate that there would be a lot of them who
Robert Breck
Unverified
1:07:17
would not be licensed? Are you saying how many more will be licensed if this were to pass?
I can tell you that at least two facilities would be required to be licensed if this were to pass. I do know that. And those two facilities are the Planned Parent facilities here in Arkansas that do provide the nonsurgical abortions. Beyond that, I'm not certain. Thank you.
Thank you, Madam Chair. Thank you. But remind the members of the audience, while it's tempting to make sure that our members have all the information they need, please don't pass information to the members at the table.
I'd appreciate it. Any other questions for
Mr. Freck or Representative Wilkins? Representative Word, you're recognized. Thank you, Madam
Chair. If this piece of legislation passed, will it be difficult to police those agencies that are currently now doing those type of abortions? We don't think it will be that
Robert Breck
Unverified
1:08:18
difficult because of the low numbers that we're dealing with. We're only certain that
two other facilities will have to be licensed should this come
about, and then it may be dependent on the rules that may be amended to be more compatible with the non-surgical, but we don't expect it to be that difficult. But now there's an inspection that's required once
a year. It's unannounced, but an unannounced inspection once a year is what's performed now to look at those facilities. So there's only about two
facilities out there that you are more or less concerned about at this time?
Robert Breck
Unverified
1:08:58
Well, I wouldn't say that we're concerned about it, but I think that there are two facilities that this bill will impact. There's one currently facility that's
licensed in Arkansas is an abortion facility. With the wording of this act, we know that
Speaker 42
1:09:16
there will be at least three. And those two facilities that are not licensed, is there any particular
Robert Breck
Unverified
1:09:22
reason why they are not licensed? Because the current wording of the statute says that that particular facility, their
primary purpose has to be abortions. And so the Planned Parenthood facilities right now, their principal mission or their primary concern isn't necessarily abortions. I assume that it is family planning. So they don't fall under the current definition. This changes the definition of what an abortion facility would be to any facility that does 10 or more a month. Thanks, Madam Chair. Thank you. Committee, seeing no
further questions, what's the pleasure of the committee?
We have a motion due passed from Representative Mayberry. I know we have people signed up to speak for and against the bill. I had made an announcement that we were going to take a recess at 1115, so I'm going to leave it up to the pleasure of the committee as to whether we recess now or we go on for the next few minutes and finish this bill. Finish the bill. All right, that's what we'll do. Anyone in the audience wishing to speak against the
Speaker 14
1:10:33
bill? Let's see. Let's go down the list.
Ms. Brownstein, I believe, is first on the list. If you will, take your place
at the end of the table. Introduce yourself for the record. And what I'm going to ask you to do, we have, I think, four people signed up to speak. So if you will, as we go on, try not to repeat what others have said. Let's make sure that we're
Bettina Brownstein
Unverified
1:11:04
talking about new testimony. Ms. Brownstein, if you will. Thank you. My name is Bettina Brownstein. I
Speaker 211
1:11:09
previously spoke before this committee. I'm an Arkansas licensed attorney who does reproductive, women's reproductive rights cases and have litigated in Arkansas before,
sometimes successfully. I just want to speak to the fact that I think this, if passed, this law will be unconstitutional. It's the same reason that I've spoken about before. It's a government regulation that has no purpose, that will not increase the health or safety of the women seeking abortion. It's a government regulation intending to impose a substantial obstacle. That's Planned Parenthood v. Casey. That's language strictly from that case. We'll increase
the cost to the facility, which will have to be passed on to women. There's two things that are troubling about the bill specifically. One is this number that's an arbitrary number, doesn't seem to have any rational basis. Also what does it mean, 10 per month, each month, 9 one month, 11 the next? It's unclear to me what the numbers mean, and I think that's a real problem, the vagueness about it. The reason I think this government regulation purposes to put an obstacle is that the facilities
that do abortions are very widely regulated, and I know others will speak to that. Have you heard already that they're inspected once a year? They have regulations from Arkansas Medical Board, Nursing Board, and other governmental entities. A lot will depend. Another big problem with the bill is what rules and regulations are going to be passed by the Department of Health. If the facility that does medication abortions is required to comply with the facility regulations
where they do surgical abortions, that would clearly be a substantial obstacle with no basis in health or safety. So that's another problem with this bill. You really don't know what kind of regulation is being contemplated. Thank you. Ms. Bronson, would you take
questions? Representative Ward, you're recognized. Oh, Representative Ward, what is your motion? Motion
Representative Ward
Unverified
1:13:26
to limit debate to both sides.
The ten minutes, please. Motion to limit debate, ten minutes on each side. That's a proper motion, non-debatable. All in favor indicate by saying aye. All opposed, no. So we'll be limiting debate, and Mr. Price will be keeping time for us. Representative Mayberry, did I see your hand up? Do you have a question? You're recognized. Thank
Representative Andy Mayberry
Unverified
1:13:55
you, Madam Chair. Let me make sure that I'm clear on something that you said, that one of the reasons that you believed that this would be unconstitutional is because of that licensing through the Department of Health
would not promote better health. Is that correct what you
said or am I misstating that? Well, not exactly because there is
Speaker 211
1:14:18
adequate regulation in place now, so there is no necessity for more regulation. One of the problems is we don't know exactly what regulations we're talking about. The bill is silent on what the Department of Health is going to be doing.
So, yes, in principle, I believe that there's no need for another regulation. Secondly, I really don't know what regulation is talking about. I think
Representative Andy Mayberry
Unverified
1:14:46
that's a real problem if you're voting on this. As I read the bill, ma'am, it says that they shall be licensed by the Department of Health, and that's essentially all the bill that, much like all the other facilities
that deal with health issues. I'm sorry. Is that a question? Yes, would you agree?
Thank you, ma'am. You may be doing my job for me. No, I would not
agree. Thank you. All right, Ms. Brownstein, thank you very much. Next on the list to speak for the bill is Mr. Danny Gunderman. Mr. Gunderman, if
you will, take your place at the end of the table and introduce yourself for the record, please, and you
Danny Gunderman
Unverified
1:15:31
may proceed. Thank you, Madam Chair and members of the committee. My name is Danny Gunderman. I'm a local representative for Americans United for Life. And I apologize for bringing the information to Representative Wagner at the table.
I was unaware of that rule. I'm sorry about that. Apology accepted, sir. Thank you. Representative Wilkins, I very much appreciate you bringing this bill before this committee. I think it's a very important bill. I was unaware all of these years. I think everybody now knows from testimony already given that we have at least three abortion facilities here in the state that provide abortion on demand, and I was surprised to find out that only one of those abortion clinics is regulated and inspected and licensed by the Department
of Health in our state. I very much appreciate this bill because it's going to add the accountability and oversight that I think every abortion needs to have in this state. So I'm going to be very brief, and I just would like to see a yes vote on this bill, and I think it's a good bill. Thank you very
much, Madam Chair. Thank you, sir. I appreciate you coming. Now, next on the list
Speaker 14
1:16:38
to speak against the bill is Marie Newburn.
We're going to have some handwriting lessons. That's what we're going to do. I apologize. During
Speaker 206
1:16:52
the interim. Maybe we should put please print. If you would, introduce yourself for the record. Thank you,
Speaker 217
1:16:59
Madam Chair and members of the committee for allowing me to speak today. My name is Murray Newbern, and I'm the Director of Community Affairs for Planned Parenthood of Arkansas and Eastern Oklahoma. And here in Arkansas, as you've heard, we have two health centers, one in Little Rock and one in Fayetteville. Over 90% of what we do in our health centers is preventive.
Cancer screenings, cervical and breast cancer screenings, annual gynecological exams, sexually transmitted disease detection and treatment, and family planning birth control provision. I'm here today to speak against 1855. It does nothing to protect the health and safety of patients. Facilities ought to be regulated in a manner that applies to the services they provide. This would require the Arkansas Department of Health to license facilities
that perform abortion even if we don't do that many. Abortion providers are already regulated. All health care facilities, including abortion providers, including us, are required to comply with a variety of federal and state regulations. These include the Federal Clinical Library Improvement Amendments, CLIA, Health Insurance Portability and Accountability Act, HIPAA, OSHA standards, as well as state and local regulations, including building and fire codes.
codes. All medical professionals, including physicians and clinicians who work in abortion care, are required to maintain professional standards and licenses and complete continuing medical education courses. This bill creates no new data. All abortions are currently reported to the state, so this bill provides the government with no new information on abortion incidents. It does potentially could create more burden, however, on the Arkansas Department of Health.
From my understanding, if this bill passes, we at Planned Parenthood would be required to be licensed under the current regulations. There are 21 pages of regulations, and as the Department of Health representatives said, they were originally intended for surgical abortion providers. We do not provide surgical abortions, and it would require facilities adjustments for us that are simply not necessary.
I'm happy to answer any questions. Thank you, ma'am. Representative
Gaskell, you're recognized. Thank you, Madam Chair. So you work for
an abortion clinic? No. You work for a
clinic that performs abortions? Yes, sir. Well, somehow we're playing semantics here, so naturally you'd feel that way. Thank you, Madam
Chair. Any other questions from the committee? Thank you, ma'am. I'm sorry, I see some questions.
Chair
Unverified
1:19:56
Representative Malone, you're recognized. Thank you, Madam Chair. You said that this licensing would cause you facility adjustments. Can you explain that? For example,
Speaker 217
1:20:07
medication abortion is not a surgical procedure. It is administration of a medication, a pill. The facilities as they currently stand, the requirements under the Arkansas Department of Health require a recovery room, adjustments to, you know, many, many things that our offices
is like a regular doctor's office. We have examination rooms. We have the actual administration of the medication doesn't require a recovery room. So it's not applicable to what we do. And that's our argument is that this would be a burden for us to refit, rebuild, to do something that provides something that we don't provide, which is surgical abortion. And I might add that medication abortion is extremely safe.
Representative Andy Mayberry
Unverified
1:21:02
Representative Mayberry, you're recognized with a question. Representative Malone has already asked
Representative Jon Woods
Unverified
1:21:16
my question. Thank you. Thank you, Representative Mayberry. Are there any other questions from the committee? Okay, well, thank you for your testimony. Thank you. MR. So we have – is there anyone in the audience that wanted to speak – let's see here.
Carol Rotting. Speak against. MS. It's right. MR. Carol, you're recognized. And if you can just present or, you know, state new information and something we haven't heard yet, that would
Carol Roddy
Unverified
1:21:54
be recommended. Thank you. MS. Thank you. My name is Carol Roddy. I am an attorney. I am a woman, and I am a mother. And I am here to just caution the committee that passage of this legislation, which does
nothing, adds nothing to current law as far as regulating clinics that provide abortions, will be challenged. It will cost the state money, and it will add additional state employees on the payroll. So if we're about saving money, I would urge you to vote against this bill. Thank you. Thank you, Ms. Roddy, for that
testimony. Seeing no one else on the list, is there anyone else wishing to speak for the bill?
Yes, ma'am, if you would, take your place at the end of the table. Use yourself for the record. And I'm going to ask you to please make sure that if we've heard the testimony before, let's don't repeat it, and let's make sure
Juliette Cassell
Unverified
1:23:06
we stay focused on the bill. My name is Juliette Cassell. I'm with 40 Days for Life. I'm the local coordinator in Fayetteville, Arkansas. And I support this bill because it's good for women.
Currently the level of regulation of abortion clinics in Arkansas is in stark contrast to that of services that provide seemingly less risky procedures like tattoo parlors, cosmetics, things like that. They have much stricter regulations than the Planned Parenthoods do currently that provide abortions, which there's a question whether the procedure is safe that we just heard. Section 2 of the code that regulates the rules pertaining to permanent cosmetic and tattoo
establishment says that there are regulations because it's important to protect the health of Arkansas citizens, and that's what this law would do. There was a clinic in Fayetteville where it was reported in the paper that over 20,000 abortions had been performed, and as far as we know, that clinic wasn't ever regulated because of the loopholes in the law. And so there's nothing to prevent Planned Parenthood from ever doing surgical abortions. They could decide tomorrow that they wanted to start doing surgical abortions. And then the chemical abortion procedure in Canada, the trial for the approval of the
drug was discontinued because a woman died during that trial. So there are serious considerations whether that is a safe thing to be administering to women or not. Sorry, I'm nervous this is my first time testifying. There have been recent news stories just showing what can happen when regulation of abortion clinics get overlooked. Many of you may have heard about Dr. Kermit Gosnell in Philadelphia, Pennsylvania. He also had clinics in Delaware and Louisiana.
And this is just a snippet of the grand jury testimony talking about the horrific conditions of that clinic. He was charged with murder of one woman and seven infants. The report describes that the clinic reeked of animal urine, courtesy of the cats, that were allowed to roam and defecate freely. Furniture and blankets were stained with blood. Instruments were not properly sterilized. Disposable medical supplies were not disposed of. They were reused over and over again. Medical equipment, such as the defibrillator, the EKG, the pulse oximeter,
the blood pressure cuff, was generally broken. Even when it worked, it wasn't used. The emergency exit was padlocked shut and scattered throughout in cabinets, in the basement, in a freezer, in jars, and bags and plastic jugs were fetal remains. This is a clinic that hadn't been regulated since 1993. So if we're not regulating abortion clinics, who knows what horrific things could go on. It doesn't matter whether the procedure takes place in the clinic or at home. abortion has serious risks. It has serious side effects, serious complications. It is
a dangerous procedure, and it needs to be something that the state is on top of and looks into to
protect the safety of women. Thank you. Thank you, ma'am,
for coming before our committee. Anyone else wishing to speak against the bill? Anyone wishing to speak
for the bill? Certainly. Take your place at the end of the table. Introduce Use yourself for the record and try to not repeat testimony, if you would, please. My name is Rose Mims.
Rose Mims
Unverified
1:26:33
I'm the Executive Director of Arkansas Right to Lie. One of the reasons that this bill is needed so desperately is because of the statistics that we are getting about the number of these chemical abortions that are being done in Arkansas. For example, in 2006, there were five for the whole year in the state. In 2009, there were over 500. This number is only going to grow as the popularity of this type of abortion, you know, the word is spread on it, and it's going to grow.
So next year, it could be 1,000. So these clinics that are primarily doing them, this is their business. They are in the abortion business. Planned Parenthood is the largest abortion provider in our country. They do over close to $400,000 a year. So this bill is needed, and I appreciate the vote in support of it. Thank you. Thank you, Ms. Mims.
Anyone else in the audience wishing to speak against the bill? Anyone in the audience wishing to speak for the bill?
Speaker 177
1:27:52
Representative Wilkins, would you like to
close for your bill? Thank you, Madam Chair. Just briefly, there was concern about equipment and all that kind of stuff. I want to read from the rules of the health department. The department may adopt appropriate rules and regulations regarding the facilities, equipment, procedures, techniques, and conditions. I think that's something important to keep in mind as we go forward, and I appreciate a good vote.
Thank you, Mr. Wilkins. All right, now
the question before the committee then is the passage of House Bill 1855. All in favor indicate by saying aye. Aye. All opposed, no. Representative Wilkins, you have passed your bill. Ladies and gentlemen, we are going to take a 30-minute recess for lunch. We'll be back here at about 12 o'clock.
Agenda
Call to Order
HB1985
HB1831
HB1475
HB1855
Documents
No documents posted.
Speakers
Representative Linda S. Tyler Chair
Unverified
Representative Donna Hutchinson
Unverified
Speaker 18
Representative Mark Biviano
Unverified
Phil Tobin
Unverified
Representative Billy W. Gaskill Chair
Unverified
Representative Andy Mayberry
Unverified
Representative Ward
Unverified
Speaker 50
Representative James McLean
Unverified
Speaker 62
Tom Taylor
Unverified
Speaker 67
Speaker 59
Representative Charolette Wagner
Unverified
Speaker 79
Speaker 83
Speaker 88
Rosemary Edgen
Unverified
Representative Stephanie Malone
Unverified
Speaker 90
Speaker 100
Paula Williams
Unverified
Speaker 99
Speaker 114
Speaker 115
Representative Buddy Lovell Chair
Unverified
Speaker 128
Chair
Unverified
Speaker 108
Speaker 138
Speaker 48
Ludwig Kozlowski
Unverified
Speaker 143
Speaker 151
Robert Breck
Unverified
Speaker 162
Speaker 164
Representative Butch Wilkins Chair
Unverified
Speaker 180
Speaker 42
Speaker 14
Bettina Brownstein
Unverified
Speaker 211
Danny Gunderman
Unverified
Speaker 206
Speaker 217
Representative Jon Woods
Unverified
Carol Roddy
Unverified
Juliette Cassell
Unverified
Rose Mims
Unverified
Speaker 177