Public Health, Welfare and Labor Committee- House and Senate

Chair sees a quarm so will call this meeting to order staff is passing out a hand out so really can take a look at that. You give her better few more minutes to get seated there's any in the back. First of all businesses adopt the minutes from the june twentieth meeting I need a motion to adopt the minutes. Second motion is second others if every they are any posed. Minister dot in first up on the agenda misporter are you here from or said children's hospital you can just counter the table and state your name for the record and here with and whoever you have with you there. Hello okay my name is don porter and the community program supervisor ends with me as samari hill she is the program coordinator you're recognized thank you chairman I would like to give a little background about the arkansas infant and child death review program. Um from this point forward I will refer to a cdr. The purpose of the arkansas infinite child every program is to improve the response to infinite and child fatalities provide accurate information on how and why are considered children are dying reduce the number of preventable infinite and child desk through local state and national recommendations the ice of your program is legislatively mandated by act eighteen eighteen of two thousand and five and it is grant funded by the arkansas department of health family health branch. We currently have elect eleven local teams that cover all seventy five counties in the state. And in reference to the act eighteen eighteenth of two thousand five it requires a death review of a four cases of unexpected death in children under eighteen years of age so the case is that we are allowed to review under this act are a child death where the child was not under the care of a license physician for a treatment of an illness that is the cause of death. Death was due to sun infent death centrum death was due to an unknown cars and the death was not under criminal investigation or being prosecuted so there are three main components of the structure of the icity our program. They program coordinator samaria hill myself the community program supervisor we provide the death data for case reviews for our local teams we train a support for our local teams and provide support for the program itself we generate an annual reports and we facilitate local team meetings and the recommendations that are may. The local isoty are teams are comprised of volunteers members are volunteers from acord disciplines such as lawn forcement corner medical examers office crimes against children division division of children and family services medical public health ems and prosecuting attorney teams make quarterly to review these cases that are assigned to them and then from there those keys those case reviews are to determine the circumstances that let up to the child staff and address identify any gaps or needs that may have contributed to those causes that may be needed in those communities or state wide. And then our icity are state panel is comprised of leadership from those accord disciplines and their state panel their responsibilities are to review and provide feedback of the earner report before we submit it to the legislative council and then support the local team such as helping with recruitment and also any any support for the recommendations. And so i'd like to highlight a few of the key findings from the annual report in reference to the accidental death the no seatbelt use the motor vehicle accidents was higher than seatbelt use in that with a rate of one point zero zero versus zero point five seven per one hundred thousand deaths. The undetermined das are related to sleeping or sleep environment had a higher rate than any other undetermined dess with a rate of four point five seven versus zero point two nine per one hundred thousand deaths. And in regards to the suicide das the rate of black children who died by suicide was higher than white children with the rate of four point sixty nine vs one point ninety five for one hundred thousand desk thank you. Members do we have any questions. Send yourself when you recognize your question. You tell me why we have such a higher rate death for black chore and the white children wise I honestly do not know why the higher rate of this among our black children versus our white children. Um but I can follow up and get some information for you on that. So we're we're standing and gathering data. But we don't know what the data tells us. I don't have that information in front of me. So I can gather if that information and follow up with you. Yeah really disappointed there if if we're going to report data and we don't know the reasons why the men are job as a legislature is to hear why this is happening and take steps necessary to to change that as a huge disparity and without knowing what the reasons are and we're just reporting data i'm very disappointed if that so I wouldn't so I assume you have that you can have that data within thirty minutes or an hour you could you you have their reasons yeah so it's something you can get to us pretty quickly mister charade effort they send that data you and you dispense that if you're not buying to the committee thank you we'll do that for you no problem representing pill continue recognized for a question yes thank you and I may miss this i'm sorry if I did on the excellent death with no seat belt to motor vehicle accidents due do you have that compared to a national average or we hire then the national average are lower yes we are arkansas is higher than the national average on seat then it was compared to the united the national average yes we are what is the dealt on that we are on our seatbelt use rate we are sixty nine percent on the seatbelt use rate. Okay. Okay. That's offering. Yeah. Ribs relative in your recognized thank you mischairman infant mortality we're like forty ninth or fiftieth and have been for a long time and with our homes we put in some programs but maybe there haven't been any long enough but i'm wondering and maybe you can't break this out for just information but are we doing better are we or you make and progresses at the same earning information about that well we do provide programs to address informate mortality some other things that that we do provide such as we do we conduct safety baby showers around the state we also provide training for our first responders and have them trained in safely budgetation and also provide products for them to provide the safety education and also provide the products in the homes where they are needed. We currently have sixty six satellite sites will be provide safely products too such as cribets and pack and plays say sleep sacks and board books for families in need. So we are we are working on addressing the infant mortality. Well that's an area we really need the emphasis. Really need to thank you. Your review rose you recognize for a question. Thank you mister chair in exhibit c two page six chart one i'm looking at the reviewed in fact and child death. Rates by racial distribution and I was just curious if you could speak to I think i'm looking at from twenty eighteen to twenty twenty there is a decrease. In white and black information child deaths. But then a increase. For all other races am I reading this correctly yes could you speak to while there is a decrease. In two of those categories and in an increase in the all other races category. Ah yeah so the increase in the rate from two thousand and nine to twenty twenty one the all other races that was are calculations are doing our death rate calculations and there I would have to do more follow up in our data and and looking back into our report as to more into why that is has increased. Follow mr chair you recognize and echo sender sullivans sentiment and and maybe this falls under somebody other than you but I would I would be very interested in the information for why we're seeing an increase in a certain category while we're seeing a decrease in another specifically with infant and child deaths being the the focal point of this example. I would I would like to have that information is experiencing as possibl. Would that be possible it's possible for must be appointment is it is it is it possible that I can provide I don't know but I can absolutely facilitate it certainly that center over your recognized for a question thank you thank you both for being here so I think the purpose of i've you'll be in here is just really to highlight this issue and how important it is and you know where are the areas where we can partner and you're the research the data folks and so where can we partner till really make a difference like how we need how do we change this right how do we move the needle to prevent this from happening so i'd love for if you you have to see too in front of you correct okay do you mind let's just talk through it and I want to hear you both of you ladies that are taking your time to be here today to really go through less than three this example and let's kind of talk through what you think i'd like to hear from both of you if you don't mind i'm and I do have other questions too but i'd like to hear from both the view where you think are the significant things that we should be really pointing our attention to so let's been some time to really thank through theirs and let's hear from you guys a ladies where you think are are the areas of emphasis okay and i'd love for it to hear from both of you please if I might make a point of clarification I think I heard you say this bit you're not including s UI d deaths in this data is that correct yes sue a deaths are including statements this is includes search and other unexpected to all of that's in this data okay. And we have the question for one it will hear your information they will get the other questions in the. She was pointing out. So I will start based on the report and the results of the report II would say that are our focus one of the areas of focus should be infinite mortality looking at a desire to safely or lack of save sleep majority of the das that have occurred or in an adult bad and so um or due to cost sleeping so I think I was sleeping in adult bed and adult beds yes or costly being on other surfaces that are not considered saved like a couch or reclining chair so um. In and so I think that targeting our education for ceasely practices are really important to help where the reduction of infinite mortality providing say sleep products for families that need those praducts. Um I think that's one area focus so that's what you were talking about like the pack and play yet and like the the portable cubs and things like that so we mean we need better education on safe sleeping not to cost leap with your baby not to put your baby in the bed next to you not to leave your baby with a lot of pillows couch things like that okay that's good and an age what's the age. Do we have an age specific on their do do we know how many are under the age of two or those under two do we know if they were breast feeding them or not do we have that level of detail on the age of the majority of these sleep related to some majority of their sleep related desks or occurring in our infants under the age of one okay okay. Tip to ask a question and i'll take some liberty as the tear i'm trying to understand where the suited deaths are in this day to are you have are you listening to that and and determine okay that's separate from this fix year so when you say and determine that's where you're placing this suited yes because that would just be a throughout me there's there's a new ones there I know between certain things i'm trying to understand. A little better when you say and determined to me as it as a person reading that that's like okay the most common cause of death is we don't know why but that if you what number of that thirty four is related to what we referred to commonly assets yeah so the reason why it's categorized and determined is because on the desertificate that is how it is listed as undetermined it may be listed and determined due to other causes they may be listed and determined due to some unexplained infinite death so that's why we listed it as an attempt based on the way it was listed in the death certificates. Um so looking at the the age range of sued on that we don't have it broke out specifically in this report but we can get that data to you okay yeah it feels like because I don't disagree with you like I think that we have a real octd with better sleep habits and embedded sleep education for infense in in how we can save lives but I think the way the date is being presented it's a little difficult for me even as a physician to flesh this out and understand that this undetermined that's what you're talking about everybody else in here may be getting that but i'm not getting that or just right now in and so when you say you know opportunities for making headway within for mortality is is with better sleep education I think I think diving into that date a little more is important I think another thing you said this important to point out is it much at this day it is dependent on how we report the death certificates right in in till who is responsible for putting death determination on the desertification and how how are you fleshing that out the corners or medical samers office and also physicians are can also be ones that put the manner of death on the desk certificates and so we get that information from the battle statistics from the health department has anyone put sids as a cause of death it's anything allowed says a rarely we rarely have a through saids case on a desk certificate than the cases that we review. And so I think you know less than ten but most of them are undetermined sued or a sixiation in app are promised committee i'll get the every based questions that I have one more question and then i'll get myself off do you have a sense of how many automaties were doing on these and determined death I don't okay we're getting few in the kicker there some people live in a way i'm gonna start with people that have an add questions i'll circle back to the people of orange had a chance to ask questions represent grandmother recognized for a question thank you very much. Some school teacher two days ago we were told that when I restaurants had committed to a side over the summer. And you know there was there was extremely hard on our school and another other school throughout the threat to stay in thread the nation experience that all the time I see you know some are recommendations in and isa teacher i'm seeing these you know we're we're getting more training onto this I prevention and schools for educators but I do I do think there's reality. This this student chose to take his life during a summer and i'm i'm curious to there's much investment on how we you know educate our community on teams with side or educate your families and our parents if there's been anything about that because they can fortunately you know during the school year teachers will could have may be able to help but when it happens in la july and we're not there just your thoughts or something I do it's it is a sad situation um we partner with state national part partners such as american foundation for suicide prevention to provide training and awareness and communities around the state if communities reach out to us and when ask us to come in and present or provide training filter fill that need in that gap we provide the assist training applied suicide intervention skills training to not only just to educators but to families as well or to community members. So we we are there for them when they need us. And and I appreciate that III think those things are good I worry it sounds like a lot of minus some of the assist training sounds like a lot of it is more reactive than proactive. And. And might be in the nature of the beast but you know we've my school specifically we've had a had a few kids do that have passed away from other means of the last it seems like since i've started teaching I think i've lost three or four kids at my school so some of those were from suicide some of those were firm other causes but. You know and I don't know if we could have prevented the other causes but the suicides we may have been elderly done do something so there isn't it's I got a passion for that especially at this moment so thank you what do you do and i'd love to work on some more proactive stuff as well. Others is anyone here from children's and is there someone else would like to come to the table may be provide a little more background information you're welcome to come in set we have a few more questions that maybe if you could come in introduce yourself and you can provide some more answers some of the questions we have in the q and after you introduce yourself we'll get back to the questions you're welcome to make any statements or comments you want based on the prior questions thank you I marriage at a carloam vice president of community engagement advocacy and help for arkansas children's and done and smerry or team members within one of my departments I wanted to just take a moment her address and earlier question about the financial death review data. I think there is a question from senator sole then around you know understanding the way behind some of the data that we're seeing and I just want to emphasize that really the purpose of the infinite child death reviews to take those cases of infinite child death that we don't understand they want how that child died and really to hick those teams are professional volunteers to take a look deeply and all the data available the information about the case available to us and then be able to say actually we believe that this is a result of superside or this is a result of and say sleep and for us to then be able to take that surveillance either and present it back so that community is organizations arkansas children's included but other organizations as well. Can then say sort of wet than it resolve in the same rate like why why is that wire children die in this way where when we're seeing these differences why is that that there are differences whether that's research younger fee or social economic status or some other reason. And then those organizations and individuals can dig and a deeper into the next sort of fees of either understanding the and or putting in together interventions for things that will hop address those things that we've seen as trends over time so so we've seen for a while sadly that we have high suicide rates among youth and there are lots of things that are happening nationally and locally that tell us some of the way that I may be happening and I am so very sorry to hear about the loss in your community it is tragic and it affects not just the individual on the family but schools communities it is her break in and as we see things like that happening and children that continue to die by suicide that is an opportunity not just for arkansas children's but also many other organizations telling and say we don't have enough rate we don't have enough resources maybe there's not enough training in there's not enough you know information out there about how children can reach out you know somewhere can be a time of isolation for kids and it can be a time on their separated from other social connections and so how do we help build that infrastructure now that the icr team is the one necessarily to do that it is there it is the responsibility of all verse in communities and organizations as we receive these data to then act on it so just wanted to share a little bit more about that. And thank you. Sinister and you recognized for a question. Thank you so based on what I just heard you say I had to be over a draft straight line between you if we have young children and are thirteen about who were taking out a gun and shooting themselves committing suicide and i'd really be interested in seeing how they determine whether that was a kid is playing with a garn and shot themselves or that whether that was suicide i'd like to have more information on there secondly based on what you said I would ought to be able to draw straight line between where that's happening because I see you have a geographically you know where it's happening you know what what you know the profile of the child who's doing there and are we doing track there are to be places where you're doing the training in those communities with children of that profile can I do that can you do it for me can you drive straight line to the weekend and additional information to the ganto what it is that you're asking about him yes yeah I understand you can pull it up. Um but if we're direct if we want to change this number then you need to know what counties has happened again with their child looks like and we're in that school can you do that that's what I want it's what i'd like to see if you can blink thank you thank you. Where's a pilgrim in your recognized. Thank you I want to go back to the unsafe sleeping habits has there been any. Look at using a model like the scotland baby box program I know that they start that in two thousand seventeen and see a lot of success with that and obviously you know I mean you're distributing pack and plays things like that which is it's great but I just has there been any sort of work on trying to create a program like that here in arkansas i'll speak on that so now there there has not in the reason why is because that the baby box program came out of new finland I believe and the that country has a great internal health program in the baby barcs is was designed where it was filled with safe prada diapers newborn care and that sort of seeing. But here in arka so there's no research that provides evidence that the baby box is effective and that it does reduce infant mortality then so we have not excuse me you said there's no research and are some we don't have the program arkansas so I don't imagine there would be any research on the programs of this and arkansas i'm sorry there hasn't been research that validates the not new arks out but there hasn't been research to validate that the baby box is effective but so here's my thing though so obviously though that boxes are safe place or children could sleep because obviously coastly being is not safe. But our so you know we're in those boxes they're providing information two new mothers about safe sleeping habits emergency contact information how to deal with show things like that that some others just don't get and so I mean I just. It's just that it's up that i'm surprised when I looked into since that program has been around for a while and and I mean I guess you're you're right I haven't seen a study i've just seen and don't evidence about people who said that this box is a good program to work but clearly most northern countries are doing this scout and has done it and i'm just curious why we're one of the worst instant in the nation while we're not looking at something similar like that when that's an easy free we give away that we can give to new mothers in in many ways were presenting information that I wouldn't get and then of course I guess I would get the safe place for that child asleep as opposed to being put in a bad with mom and dad and potentially which is our highest rate of informed death is is. You know the sixty eightieth which comes from coastly being so I just I just got a shock we're not looking. Yeah and we we provide say sleep education to family's mothers around the state we provide them a credit free of charges there's no no fee to that it's a free crebat where the crime she and also a safe sleep sag and so education and along with a safe sleep board work that provides even more education for families so we do provide their education the baby box is only good for it as long as the as the baby is growing in the baby will outgrow that baby box you know anywhere between three three miles six miles well with the pack and player they're crippled they can use that criminal all the way up to one year of age or even longer so this is a as is a safe space for them to place their baby. Represent rose you recognize for a question thank you mister chair. I was looking at. The methodology that was used for determining. Which cases were studied and of investigated study whatever terminology when used. But just looking at twenty twenty I noticed that only a hundred and ten cases were reviewed of the four hundred and seventy deaths that were reported. And I signed at the the rationale was it was impacted due to cover nineteen. The. I was curious. In twenty was at twenty seventeen twenty eighteen and twenty nineteen the deaths that were investigated. Respectfully were one hundred and forty nine one hundred and thirty one and then a hundred and twenty. With twenty twenty being a hundred and ten deaths. Do you have the total number for those years seventeen eighteen and nineteen of. Infit and child deaths on hand I do not have that on hand but we are not with me but I do have that do you have a rough estimate average is about four hundred and seventy in fifteen child das but the four hundred and seventy infinite child left that number you see there that's all in fit and child gas so when we get the infinite child death from the vital records department we go through there and we filter out the desk so we do not we filter out all the natural deaths because we do not review any natural deaths any decider coded natural and will be filter out all deaths where the child resided in another state so we do not review the cases where a child resided in another state so when all that data is filtered out then we're left with with about an average of anywhere between a huttering a hundred and eighty cases that are reviewable under the act eighteen eighteenth of two thousand five. So my question is and looking at the statistics untwenty seventeen twenty eighteen twenty nineteen and twenty twenty and we see this graph where it has gone up and down. Is that graph representative of the overall number of infant and child deaths in those years now. It's it's this graph represents the revealable cases so death may have gone up in a year reflected here as having gone down. But simply the statistics are based on what you review correct. So I do you have can you get rough estimates can you tell me off the top of your head with the total number of child and infant desk were in seventeen eighteen and nineteen for it on reviewable debts the total number that seventy number that we have for twenty twenty what was that number for the proceeding years it just I don't have an accurate number at averages anywhere between four hundred and twenty to four hundred and seventy total deaths of infit and child death. But we can pull that information you're saying an average is between four twenty and four seventy. Correct okay i'm i'm sorry mister chair a few more questions you're you're saying the average is between four twenty and four seventy so the average is less than the total number that took place. In twenty twenty. Because four seventy was a number in twenty twenty correct. And and then on this chart it shows twenty twenty as having been the lowest number so what i'm confused is like this graph is not a true representation. Of the number of child and into deaths showing this year as being the lowest reviewed but according to what you've said this would be the highest. Average year of deaths. So the graph represents the total number of desk that we were reviewed that we review that were reviewable not that total number of infant inch hilder so it's the the review viewable cases that we were allowed to review under the act eighteen eighteen of two thousand and five and so that's that that's what that chart to picks. The. I follow what you're saying i'm just i'm looking at the what is I cdrred one of those is providing accurate information on how and why are considered children or dying. And I would think it would be. Pertinent to know that actual number year over a year over a year regardless of. I heard you say the term natural causes etc and there's four hundred and seventy cases and we're only seen about twenty three percent of those reviewed and so I think that that may be there's a potential for under representation or over representation of a certain area or certain cause in my last question i'll be quiet was how is this representative across the state of those hundred and ten that we get to see the twenty three percent of those total debts what is that represented across those animal regional population centers you have the river valley of plasky county how is it determined the percentage of those like I don't think we can tell on that what percentage of those deaths from the whole state are being represented at any one of those population centers so like how are we supposed to know if there's an equal representation as. These in different areas about senator solve and mentioned hey we need to know where this happened and go to that school how are we making sure that each regional area is being studied respectfully. Yeah so we the cases are disseminated to the teams it is based on where the residency of the child not the location of their death so where the child lived those teams get those cases based on the counties that they cover and so the case reviews occurred there if I can add that it sounds like when i'm hearing as that for future reports have in information that shows total number of deaths then percentage reviewed by region like breaking our these data differently for you going forward would be helpful and that's certainly within our control to create for our next round of reporting something that depends a little bit more of what it does that you're looking for rather than us having to pull it after the fact so we're happy to do that yes we're right. It mean to catch you off the representative of my bad i'm not good with this scream it's lots of bites it's very exactly driving who take over i'm certain that we could find those previous years if we did the research ourselves but I just and i'm not saying it's intentional but II believe that that chart could be. Quite a bit misleading if we look at these numbers declining thinking hey some of these things are working or and and maybe they are but if twenty twenty was significantly higher than twenty seventeen it doesn't look like that on that report at all. And I don't know that right now. Thank you center of a new recognized thank you just I think following them so I think also areas so two things you're following what the accels you to do I understand that but I think also the purpose of pulling data would be using the data to make a difference into change behavior right or to target and and help the data the data needs to drive our decision making process for policy that's why you're getting all these questions because these people are interested in changing the numbers and they're interested in policy changes and actual effective measures to prevent future deaths that's why you're getting all these questions because there's it's one thing just to present data which is what you've done and we appreciate that but it's a whole nother thing to understand the day to utilize the data as the vehicle for change to help drive our efforts in our decisions and where we need to place resources where we need to look at a policy differently perhaps it's in reporting perhaps it's in how we report on on the desk certificate so that we have a more clear understanding of an undetermined death we need to actually narrow that I think we need but those are policy areas that we can deal with so we're one of those organizations where we should be a huge part of that because we touch every one of those communities by other people we represent um and so when you I have a couple questions from myself and from mary bentley he was watching but when you look at natural deaths that you said that you are not that are not reviewable can you define that for me what is a natural death so it would be like pre termed a pre term death so miscarriages correct argue. Unique type of congenital anomalies okay so be considered a natural that post delivery can general so you have pre term and then you have because see this as this is information that I want to know too and cancer a child died from cancer or okay so illness or yes okay so an illness pre term okay but you could bucket that was probably illness could be any others kinds of natural death carses but but it would be interesting pre term is an area where we could actually prevent if we did more preventive and more health care while there expecting a baby so again if we were reviewing that pre term death. Right and had this as part of your data we would actually know where the majority of those preterm deaths are occurring where we could go in with with people and prevent that pre term that's what we're here to try to do prevent these staffs right so I think that needs to be something that we need to add we need to change this at okay so we need to expand what the data is and we need to be more directive in what we do with the data from a policy perspective that's why I have you guys here today so that we can actually use this as a at effective tool and then so you have posts congenital and you have and then you have the illness related desk right and then when you talk about the drowning death on page sixteen of your reports do you know what the ages are for those nine drowning deaths. The air the ages are range from one to seventeen. Okay so terminal death so we okay so okay. Well that could be very very different though right so it could be that right so needing to know how they they drowned rate so if it's a sixth of fifteen thirteen fourteen fifteen sixteen seventeen year old that may be at the lake. You know that something then we need a partner with arkansas game and fish great so we need a connect the data to the organizations that can actually help prevent those drownings if it's a toddler death and it's email at a backyard swimming poor those are completely different circumstances where you have different policy approaches on how to solve that problem to prevent that from happening does that make sense okay and so and then an as far as a what recommendations if any do you have for us to add to information that will be shared about school districts to parents due to act one oh one that we pass last session so act one oh one that was parcel session deals with the require public school districts and open enrollment to provide a information public school state students regarding water safety education courses and swimming license. Um so that may be something you might want to get back to us but if you could look at act on a wine in relation to your data and see how those two things could count account together to to be more directive so if you look at those drowning desk and where there are located we need a start in those schools does that make sense so that's from representative built and I may have some more a bit as far as. And determined I agree with representative johnson we need to make sure that we have those changes so my task might may my ask let's go back and let's look at the data and bring for a policy changes that you have its recommendations it could be what representative pilkington discussed could be something else but let's bring let's bring those forward and be more comprehensive in the programs that we have and where we can identify gaps where we don't have. Representative since you have a question yes or thinking mr chair thank you for being here today and in amare new new member soul most of the members may know this but when was this program developed in two thousand and five two thousand and five okay do we have any accumulative data over the course of the program that shows a decrease in empty death or what this prewid this research is actually trending in the correct direction yes we can get you data on your asking for mortality just everything that you're everything that you're reviewing in general okay to show that not only are we reporting the death and and the causes of death but what we're doing is translating a correlating to preventing deaths. Like there's been a decrease in number well what we do is we report the desk and like marisha had said is that we the the data is used for organizations and communities to take the data and help address the the causes of death and help initiate programs and training something resources to help reduce those that so we have the death data. But we don't report on how it's preventing the desk as far as like shifting the needle four next year you recognize I think what you would see over time there is and what areas have the number of deaths for your gone up and in what areas have they gone down like what specific cars are so we were talking about that by suicide earlier and we know the last few years you've seen an increase in that we talked about you know deaths with motor vehicle accidents we know of her time many of you know when you will see years and time or that has actually decreased and so so depending on cause of the death you would see a trend either up down or or flat so right at that the point to the point of my question is the relationship between now in the data and getting that information to the people who are trying to make an impact or a difference and II don't know what that relationship is that's why i'd like to see it the trend up and down are we getting the information out to those who can truly make a change or make a difference because if we have the data but we're not we don't have a next step to prevent or reduce then have in the data really isn't doing us any good in the matter I guess final question related with that is who who is in charge of what team can correlate to that information between your programs trying to find out who is that something that you proactively try to get out or all these other organizations responsible for trying to come to you we have the data they know what's here they can can get it if they want it. We are proactive about that and the teams are proactive as well so we mentioned earlier with the the volunteers that come together and each region the recommendations that are made then many of those organizations can carry forward and often do you wonderful and just out of curiosity i'm looking through through this all of your data is from twenty twenty is that correct what why are we three years behind on data so we are currently reviewing twenty twenty one cases now we're currently reviewing the twenty one it is the process of the timing of when we get the death data in by the time we get the death data from the vital statistics and in in given to us and then we decided out and disseminate out in our teams or two years behind in a review is that been consistent since two thousand and five okay so there's is there a hotel get that to a more. The. Maybe. Less of a gap than two years or is that just kind of but you think standard of practice it isn't sure practice thank you mister you're welcome representative ray you reckon ask for a question that you just a quick question on the the charity on page non cause of death categories so from time to time you hear these horrific stories especially around this time a year of children that are left in heart vehicles what what category would that type of death be put into it would be exposure to expert. Okay I don't see that one on the chart that would be due to we did not review any exposure desk that we are thank you. Membership any other questions. I'll just point out that i've been up you're reviewing this act. Eighteen eighteen and two thousand five demand knowledge staff tells me that x not been admitted since it was passed in two thousand five as in i'll have staff send that out everyone I think it's interesting I mean a couple of different things one thing you pointed out I think twice is that unless I misheard you the people doing all the work on reviewing these cases spending the hours it takes to read through the material and and sort through what the actual cause of death was in place into categories that's all voluntary so we're not paying anyone for this responsibility they're just of the guinness of the heart voluntary their time to do this reviews okay in the other port they are put out as when you do read this fact when I send it to you it is a little confusing I mean I appreciate you being here because it's permissive language in the act it says in the act that you may collect this data which so since you didn't have to represent you been with it it does say but that it does that you shall make recommendations based on the things you could work so there's some discrepancies probably some opportunity for us maybe the next session to look at the sacked and think about if this is data's important as think about ways we may want to modify that action a look at bringing the data better forward I do think moving forward if we can't have the data as you mentioned by region by county and then in the near over year so we can sort of see trans and they may be with that if we can dense mark that to national data that would be helpful so anyway represent yeah when we're comment just a comment on kind of like comments you're making at the end I mean II think we would really greatly appreciate if you had recommendations to improve that act things you find that are confusing just things you would like to to add to it but you feel like you haven't been given permission from the legislature to look at those things so please just think of some recommendations we would love to have those from you all who are actually doing the work you know it's better to get. Give boots on the ground feel than just us from a ten thousand point views of banks pretty ill being here thank you appreciate your town thank you so much for that opportunity to present yellow today we really appreciate it more incorporate this feedback and look forward to working with you thank you. Next that we have the little previously reached or center. If you just state your name for the committee expressed the bend to activate your mac there. Yeah press that they're now ready i'm new here hi i'm selling lewis i'm with the arkansas pregnancy resource center and we can address the center as the aprc from your and out. You reckon has to present testimony thank you well I sent some materials I had a time just to give you a little introduction to who we are but in summary we are a center of nonprofit center that serves any woman in their partner that is pregnant and not yet under ob care it's our goal to provide early pregnancy confirmation consultation resources and support temporary parents encourage healthy pregnancy and improve family outcomes. We do the store services which include medical grade you're in pregnancy testing limited obviously alter sound to determine just stationary age and in your placement. Sexually transmitter infection testing and treatment. Pregnancy consultation resource coordination mental health consultation family parent education and material resources a few points of interest expand on some of our services we contract with a social worker a social work professional from a local clinic to work on site is individual provides resource connection to resources like arkansas children's hospital today and thank you for their service to this community cause they help our parents alive. And that helps our clients fill in power to meet their parenting financial mental health and crew goals. We also contract with a mental health counselor to provide on site support were clients or in need. Both of these services are offered all of our clients. Thank you members with any questions. Center of any recognized thank you thank you so much for being here one of the reasons why I wanted to have all of you come in president because we haven't heard from ya and it's important that we hear from yall and the important steps that you are providing for maternal health care because you have to be part of the discussion and it's important for you to be part of the discussion one of the acts that we changed was the right to know and see act so that if anybody refers a expecting mother for an abortion that then they would have to have an ultra sound and that would be placed in their chart but the reason for me why that's so very important not just to save the life of it and born baby but also for the health of that expecting mother and the health of the expecting baby so there's folds right in to the whole discussion we had previously about pre term mortality and preterm bursts and I want to really make sure that we have a full understanding of what all of you do in your space and how you contribute to maternal health care in arkansas and that's very important for me but we need to expand their we need to make sure every expecting mother has a network of support available for them and that may look differently in different parts the states not everybody has a resource center not ever they may feel comfortable coming to a resource center I get that but I think it's important for me to to really highlight what you do and and how you're doing it and so my question though is. Do you do you make referrals for when you have an ultra sound are you able to make referrals do you make suggestions as to where they can get further maternal health care thank you for inviting us to decent drove in and thank you for your kind words and involving us in the discussion it is our desire to to cheaper goals and are yes so we do make medical referrals within our community we when we are doing a limited obey ultra sound if we do not see a pregnancy any address where it should be and there are other factors that are involved that could lead us to believe it said a topic pregnancy we do refer that to a albeit in the area if they are a medicaid or do you not have insurance coverage you mess women's clinic is a very helpful and receiving those clients for error as well would you get strict precautions i'm not a nurse I don't wanna tell you what those precautions are another **** director that's here today can give you that information but we do refer I give strict precautions for symptoms and causes and what they're feeling when they should go the doctor that yes we do make medical referrals within the community okay thank you I think that's really important. I'm sorry one of the thing I want to clarify that I speak on behalf of the APR c only we do have a lot of pregnancy centers without the state two others are here to speak today so what we what I talk about today only applies to us just just for confirmation I think I understand this you're a non profit organization yesterday okay see what else have any questions. The. Thank you so much for being here today presenting thanks for taking it easy on me. Next we have misses from a carrying hearts pregnancy center. The. I think we have a hand out from them as well that should be in front of you looks like like this. Yeah. The. Future state your name for the committee to. The. There I am out there again I heard my name is daniel e i'm a registered nurse in the executive director of carrying hard to pregnancy center you recognize. So to tell you a little bit about carrying hearts we have two location one in north or that span established for nearly forty years and in the little rock where we just moved and on auto's gate and one year's one year ago and we have eleven staff and two full time and night and nine that are part time and approximately thirty volunteers as an executive director I happened to have it will be experienced in a registered nurse I worked at you I mean for almost thirty years happened that being in labor and delivery in the other half being was previously known as the angels program or and the hybris gob program in worked in their call center managed that and also and worth in telemedicine so just to give you a little bit of my background that cannot lying me at nicely turn to help with this position that i'm in now we have a medical staff that is and we have a nurse manager that has about thirty five years experience we have a part time rn that covers are north of rock center so we always have a registered nurse at the centers we have approximately eight volunteer areas all of those are trained in limited i'll be ultrasound I am as well we have a licensed professional counselor that is volunteers first surface is one day a week we have medical service oversight from our medical directors which one is emergency medical physician and that there's a local obstitution that resort all your sound and also direct says funded for court cases as shelly was discussing in a few minutes ago we also have a clinical advisory committee that makes up of two physicians and who are ends that i'm overseas medical and policies and procedures and we have many non medical staff which include our client services directors we have three of those that includes a license shut social worker. I've retired school teacher and a formal law enforcement officer so i've a very bried previous experience that now work in this line of work but actually help us with a you know the the clients that we see so we have also a register dietitian that actually works as administrative assistant and we have development coordinators and three perceptioners so I just can't want to give you that the brad view i've water staff incorporates because many of us are in our second careers and are now and working our dream jobs so in a non profit we are able to take time with the clients and assess their needs give them claim community resources to meet their needs or i'm i'm going to tell you some of the things that we do to help me those deficits that we are so. We provide as you see in their car that we get add that I gave out we provided all the same services that shelley and mentioned so I won't list those again for you but one thing that because of my experience my nursing experience and in high risk obey I would like to kind of make some parent levels to how those typical services also meet some medical needs so one of the things that we're aware of is like the us department of health and human services they have some goals and objectives just to prevent pregnancy complications so these in I apologize for my lack of professional am's here but just been a little bit nervous but so as far as are nursing an assessment gets when we see clients at and she has a nurse visit we have a nursing assessment and we incourage an assist in early prenatal care so in some of those times that me that means actually making the call with the clients and we assess their ability to do this on their own we have some clients just because of their their previous experiences with the health care industry or lack of confidence or you know just lack of ability it may take them to long to reach that goal their self so we actually step in and assist them in making that car offer to make their car we also can identify possible indicators of a high risk pregnancy and also make that approp you know appropriate recommendation of you know you ims is really the place you need to go or you know seek a maternal feedle medicine doctor for this type of thing and not that all of my nurses are experts in this but so there are certain things that are just very obvious in theory and of the previous specially of previous pregnancies that we can make those recommendations for. Also simple things are we educate unhealthy pregnancy on things that they can do just a hard better outcomes in their pregnancy we are so instructed them and starting in their prenatal bottom and or when we had the luxury of having those because some time local physicians will give us prenatal evidence as samples that we could actually give our clients and but we teach them at the importance of police accident early taking that for deprivinative of a birthday facts. And then we offer online pregnancy in parenting classes and many of our clients do as sign up for these m and d do you take these because we incentivised them we have a store at our north autoxenter that they when they take these classes they earn what we call marmie backs and then they spend those in our store to get the things that they need for baby so we we do this obviously we want them to have these material things but we are so want to encourage them to continue their classes and learn these things to be the best parent that they can be also those same pregnancy classes that are online do you address a lot of the things that have been talked about today as far as just in think care saved sleep all of those things are addressed in these aren't line courses. Also am we promote infant safety by we get car seats so when they complete these one of our classes then we not just one classes but a system of classes their offered eight car seat or a pack and playing their choice choice we were gifted actually by one of our donors with several of these this year we were planning to use some of our dfa green funding to keep that bank of car seats impact and place going because this is not something that we did on a regular basis before this year and but we see now just how many of our clients need these things and of course if anyone comes to us in die your need just had a baby doesn't have this we're not going to require that she do the classes or going to get her this encourage her to do the classes we're going to meet that need and we also we see a lot of wow and I had the numbers with me today in case you asked but we see several clients that come in there are using elicit drugs or alcohol and with those especially those that are motivated they have to be motivated to to receive that care and treatment but we have those recommendations and those community resources to plug them into so that they can start to em receiving that care. So you know early treatment is important in all of these things and we we may not have the resources in house ourselves but we have a bank of a community resources that we can refer them to. Thank you so we just heard from children's their effort for half an hour they reached out to you for training. The could you repeat that i'm sorry to children to testify it about the challenge they're three in for death rate and all the different issues they are are you just talked about the training that you offer to half and have they reached out to you with training. Um so we have not seen the year and have i've been at caring arts we have not had training from children's now maybe they have in the pack thank you center of any recognize yet I think center to sell and actually ask one of my questions was how many referrals do you get from children's hospital other hospitals do you get any referrals from county health units do you get any referrals to you and maybe that's the question I should have asked the previous one as well but and you can take notes of this and get that back to me that would be helpful but do you do you call getting any referrals from county health units or from any hospitals from now and i'm glad you brought up the county health units because just in my prior work what I would like to refer actually for early per natal care two county health units that offer me maternity care but plasky counting in a longer offers that because I guess lack of access there's there's not one that i'm aware I didn't plastic account either offers maternity care they're outside in the rule areas they do but this would be help because that that is one of the other things that we see with our client tell is we're encouraging early per natal care were assisting those that will allow us to but there still is that group that we follow up with that has not yet I mean they're on second time trying to have night gutten into prenatal carrier that we're seeing what all we can do to help them without a lot of time it's because they're still waiting on their medicate approval cause many of our clients are received pregnancy medicaid or they're in that gap zone where they don't meet qualifications for pregnancy medicaid but yet there are still low income and they know that there will be significant out of pocket when they are going for a prenatal care so that often deters them at the math I have one more question. And school referrals so yes so i'm working on that so just recently because i'm still fairly new in this position at the end of last school year make some really good connections with a plastic account in school system there there's lead social worker when she's connected me with their leaders and we're about to connect again that school is begun and but with the funding last last go around what the first go round and I used some of that sanding in for publication are well similar to what you received today and the other thing stating in our services that we will have some for everything up for the major schools and plastic and they're going to allow you to just sound like they are really good means nothing in law that I understand that that wouldn't prevent that right there's no there is nothing not that i'm aware of either and they so it's a very receptive to that and we are doing actually some advertising digital advertising on some dfa name for that too but digital advertising actually to the schools yes for that thank you yes so apologies to mislears cause we keep taking questions now you you're welcome to come back if you want to answer the people so sad just a couple of questions and some of this is information or you may not be able to answer some of this but the specific to you do you have a sense of it sounds like a new practice testing so some women come in and found out they're not pregnant right what do you have a sense of health and that's happening is that happening with some regularity is that a rare thing so yes we do have there's kind of some even flow with that you know we may have some months where we have more negative pregnancy tests than others bad and. So in there I would say an average of fifty pregnancy test demand I would are most months it's like. Five ish you know that would be negative we do so we happen to be located directly next door to plan parenthood were in the same parking light erm so we do m c more at that location that are coming over just for sti testing and we do treatment now as well that actually is not on that car that you receive but we started just two months ago trading the two and we have limited testing and forgotten a real committee as because they are the matters for you know common ones and we are treating for those now that because all our services are no cost that we do you get walk overs and that so we're we're seeing a higher level to answer your question because you're doing for any suggesting on the women that are coming not specifically representatives and becoming for straight for those that are just wanting sti treatment we ask if they have any concern about being pragmate so we don't test them unless of course they opt in for that so some of those are getting treatment without being tested having them protected sex and concerned about sdricing the possibly so specific question do you offer any for for the women that are uninsured do you offer information connect them in any way even if they're not pregnant with resources to if they qualify for medicaid or either under expansion or traditional medicaid or you connecting those women who are not pregnant with those resource so we are connecting them with resources for care and for for example that arkansas department of health has the burst care program that that is not only just me my grand screening that they also do perhaps mirrors and screening for a certifical cancer so we had a girl come in just the other day for needing this I guess the reason i'm bringing this up is because one of the issues we have with pregnant women is a lot of them qualify for medicated medicare expansion and it's it's to celebrate. Cost more cost effective to have them in roll before they we found out they're pregnant than after we find out the pregnant south we're looking for ways to connect dhs directly to women who are trying to get pregnant who conducting behaviors the month result in their pregnancy and if they're eligible trying to connect them dean as opposed to finding out their premium and trying to enroll them in medicaid because they're different programs so i'll follow up with dh so maybe dhs can reach out to the pregnancy centers to try to maybe help connect you with resources that could put those dots together that would be great now that interesting in your question and a little bit better so with the price those that are pregnant we are definitely giving them all the instructions of how to apply for medicate those that are not pregnant now we are not doing much better II definitely wanted something that's an opportunity and i'll follow up with the hs try to help with that the other thing that least the sort of another question this is not specifically for you but maybe there's someone out there they can answer that all of authorities people present here's labeller's pregnancy centers do we do we listen to principle centers do we know how many pregnancy centers are in the. In the state is this something that just your colors of british center to the sweater by calls yeah it's it's it's a specific designation so we are affiliated so we are a we're free clinics we don't charge for anything we don't under maria king talked to this to she will be next but we don't paul under a lot of the same regulations because of how we're designated but I wouldn't. We are goal is we want to volunteerly meet those standards like we we don't really fall under hipper because I have with that's a health we don't charge for some bit we voluntarily you know that's the right thing to do so i'm not looking to regulate you I just I think interesting to if we have a catalogue of how many pregnancy centers are there in the state of arkansas if we don't have that having that's important and if this is an opportunity to connect the hs two women who are planning to get pregnant but not yet pregnant I think that's I think we need to be utilizing that so just was curious if there is sort of a here's the list of yes there is that less emery is going to talk a little bit more to that because we we do have a network okay any other questions. Thank you for your time and testing you welcome. Maria spare so referenced if you could come to the table and introduce yourself and tell us here with. And animal recognize i'm seeing former representative hawks in the back I understand he's a part of this appreciate you have a new heaven here today and. As always you're always welcome come in you make a car me. Okay thank you. Yes my name is maria spear I have had the pleasure of being the executive director of life choices pregnancy center in conway for the past eighteen years. But I also now currently serve as the cef ceo of the arkansas pregnancy network which they were referencing as our association of pregnancy centers here in arkansas and I sent you some slides earlier we don't have to go through these in detail but I just thought it was some good reference points from maybe questions I might have which one of those is already come up how many pregnancy centers exist in arguments are so you're looking at anywhere between forty and forty five and pregnancy centers and most of them are in our association we do have standards of care that are required to be a member of the association there also national pregnancy center alliances that require standards of care or being a pregnancy center that most of our centers are aligned with one of those national agencies as well so while while there is not licensing and regulations standards for pregnancy centers. In arkansas i'm going to clarify that point in a moment there are some standards of care that are being upheld both nationwide and at the state level I will say I appreciate the. Attitude of arkansas towards pregnancy centers and there are other states that are becoming very hostile to their pregnancy centers and issuing guidelines and regulations that are forcing pregnancy centers to close. This is happening in some of the more and. Liberal states who are still passing abortion laws where abortion is still legal and I just wanted to hit those points really quick and since the overturned a rovy wade I wanted to just briefly mention the state of abortion in arkansas. Obviously. Are legislation that may be some of you had a hand in passing and made abortion illegal in arkansas after the overturned arobie way this resulted in. The fact that while abortion is not legal and arkansas women are now traveling across state lines to obtain abortions or they are ordering chemical abortion mailing pills to their home and this is happening a white m again because all of this is recent we don't have a great data yet but you have to realize that. When people are not seeking medical care so they're not seeing a medical professional and all they're just going online and ordering pills sometimes internationally and taking those in their home. Um. And then delivering a baby alone. We know that this obviously has risk associated with it and I realize that there may be limits to whites this body can do regarding the regulation of those mailing pills. Um but I do want to bring it up and I do want it to remain something on your head and in your heart because. That that is a crisis for women in arkansas. And also organizations have cropped up that are willing to pay for these women to be able to travel to obtain these abortions to buy these pills and some of the girls that we've talked to they called them scholarships and. These organizations and so again I say all that to say that while abortion is illegal in arkansas still women in arkansas are having abortions and so I don't want us to forget that or forget the health risk associated with that for the women and the baby we've already talked about all the great services that pregnancy centers offer again I do want to clarify though you heard for some of the cream of a crot what donna and shell you're doing at their centers here in literally are top of the line like they are doing amazing things and so i'm so glad that you were able to hear from them and and again pregnancy centers around the state offer similar services and some of those different depending on the size of the center in their staff and what they're capability is and but in general very similar service says especially the main services of pregnancy testing ultra sound referring to community resources that is huge for us education material assistance those things are pretty consistent across the board we talked about how many pregnancy centers there are and really there's a pregnancy center and i'm forgetting to move my slides but you'll have it in front of you so it's okay. There's a pregnancy center in every good size town in america uhm. National numbers these are from a report that was done in twenty twenty and this is am twenty seven hundred pregnancy centers were surveyed and it kind of gives the value estimated value of the service is provided because I think that's an interesting point to mention when we're here at the capital and I know this isn't the budget committee but again a lot of you also serve over there and just seeing the value that's provided by the pregnancy centers free to the state and free to these women due to the generosity of our donor base and sometimes grants and other things that play into that but the arkansas members that thought would be the ones you're most interested in that's the next slide there this is am twenty centers responded to the survey and and so you're getting a partial work and been in twenty twenty two over fifteen thousand women were served in these twenty pregnancy centers across the state and sixty percent reported an increase in demand of services sense the dobs ruling and add those fifteen that was over a million dollars and material items and I think that was a conservative estimate on their response on the surveys honestly and over four thousand ultrasounds provided in those twenty centers in twenty twenty two and over a million dollar value of those ultrasounds if we and it that was a conservative number two I think and the number nationally that you kind of use for that is two hundred and seventy dollars now I don't know anywhere you can get an ultrasound for two hundred and seventy dollars at an ob clinic and they want more money than that if you don't have insurance but anyway I wanted to share those numbers with you as well as the next line just let you know of the twenty centers that responding kind of the budgets that you're looking at there and you know the centers talked about additional funding would be used for staffing facilities. And material assistance for clients like the girls mentioned trying to get them car seats and basenet bass and ads pack and please dippers formula all the things. Medical services expansion to do more. For these women. And marketing to let them know that we're there for them and that they can access these services at no cost and then the one of the main things that I want to mention today is we as a network and have been working on launching a statewide teller health initiative. Which will be a heartline chat line hybrid combination that will be made by nurses are in or above and coupled with a statewide marketing program again trying to let women know that they can talk to a medical professional before they make any decisions about ordering a pill are crossing a state line and also while on that phone and i've been looking over the script and things we're going to be connecting them to resources we're going to be asking what are the pressure points in your life what are the things that are stressing you how can we help you with that and then connecting them to resources local to them and through that hotline so I wanted job to be aware that we're in the middle of that. And probably launching before the end of the year. On that. And conclusion just some rap up statements that we've already heard about the good work that pregnancy centers are doing in the state. Open for questions. Ribing further some recommendations thank you mr chairman I know we put her side quite a bit of money for pregnancy centers how much date furning are the pregnancy centers accessing from that phone. The great are you talking about the dfa grant yes ma'am I think there were sixteen organizations that applied for that many and then we're able to go back and get more so and I know like don't mentioned they are using that many to buy materials and I think some did some staffing things and marketing was a big thing that a lot of them use it for so they are accessing that money I guess my question is to know how much of the funds have been excessed at this point I was not in charge of that and but I do know. That they have gone back a couple of times and done other distributions so I think there using it up so someone else might could might know that answer better than I was just kind of wondering whether typical center how much they would excess I think. Yeah. How much. Okay that them got fifty one thousand appears from that money should be able to get that information from the face I can I can have that information looked at and I was just curious if it's really because it's a good question thank you. Setter over the record so on your conclusion statements the reason why I wanted to connect and have you on the agenda today with the am infinite and child death review program and all reports and then we also have the maternal death yes that we know is high so we arkansas has been in the news we know that this is high we know we're forty ninth that at fifty it is a suggestion testic that I don't want to live with and I don't under unknown that nanos appear to see this we we want to change that number and so for me it's really awesome about connecting make sure we have the right kind of data that were tracking the right kind of things but utilized that data to connect to. That that we are actually yeah move in the need or so promoting women's insurance health and the wellbeing a families well will precould lead to a lot of preventions of the death that we heard about in item number c and then also the suicide and the mental health here because we don't know how many of these are young women that may have committed since I because they became pregnant and they didn't have anywhere at a time I mean you just don't we don't know the details of those suicides and then pre time deaths err we need to know those and the how we prevent them and I think there is such a big place here of connecting all of you together so I really just appreciate things a representative first and had great questions I want to really analyze you know how you're using the money and how we can be more effective and partnering because it's going to take everybody really to change this number and we all are passion about really trying to give women better health care prepreterm and pre natal health care and and then vitamins I want to ask you quickly about the vitamins. Um and this is a question for the health department but i'm I would love to see if we have any type of a statewide program and I don't think we do at the health department not sure if we do a night but i'm prenative items I think those little talking about this did the genetic disorders that could occur particularly with women that may be of low economic status and have different types of genetic issues. II know we see a lot of that unfortunately and in the rule parts of our states where we've got to have a little bit of a better understanding of what's happening there to prevent so that they know the risks associated worth having a child given their own genetic histories we don't even talk about that but but those concrete some very serious you know issues and then how you deal with that after you know it is is serious so you can't you can address that question. I know we are giving out pre native to our girls who test positive but I know not every single has the luxury of having that in their budget so if there was a statement and to get those dispensed out and if help departments were giving us out and pregnancy centers I think that would be great. I mean thank you for like me to back up and so yet they are quite expensive and to purchase for clients and that is not within our budget and like I said before we are being gifted sand there there are some grants for rural areas and angel button I do believe and we we've applied for it several times a gap deny because one of it political area bet we would like to have yep from the health department because that is set we emphasize it with our clients and they're not really expensive to buy at one more bed yet sometime we don't want that delay you want to put it in their hands that they start taking right thank you. You're send yourself in your account thank you I think I heard you a minute ago say that we are abortion pills are coming into the state women are taking those and they're giving birth at home to a dead baby and yeah and so however do you know if the department of health I didn't see that on their tracking she. The bad department of health i'm sorry children's hospital are they how do they track there do you know there would welcome sir if they're having the meld into their house there is no way to track it. Ok so they're not tracking ok thank you can I make a statement to that. Are our abortion members are going to be bearing off so there are ready you know not accurate so where it looks like our abortion members have greatly declined in arkansas and where they were not gonna be able to count those happening at home and a lot of girls are afraid even if they have to seek emergency care that they're not their stating that they're having a miscard they're not stating I took the abortion pill at home we're having girls come in now that already had the abortion plot home waiting for them they were ordered have it at home and then come to cs to find out how far along they are some of them are and were glad that they're doing that interesting as enough to tell us that. So I think that's another point of education if we could educate about the risk of ordering medicine online that you don't know what you're getting I don't know if that falls under this committee's per view but I do think it's something that we need to look at because if we can't stop them from coming in which i've talked to some legislature and this difficult I realize for your figure out how to do that but then maybe we could educate. Reversing perk didn't you recommend thank you coming question one is I i'm glad to see that you guys are no longer using the work crisis in your name you know obviously I think a lot of people get pregnant it's not a crisis for them so they don't utilize this the centers but a reality there's a lot of good resources you have these should you such as one of the pretty bad the question I have though is for insurance carriers like blue crossfully shields and teen all these other ones you know what which you can also don't take insurance as my understanding but they also do have initiatives and of the blue new foundation currently is had a round of grand funding aimed at maternal health and so i'm just cheers is you know obviously an out of prevention is another phrase goes but you know I mean is is there is there any sort of relations with some of their foundations to do anything like that to just just work on this area or they've just been complete silent often yell on talk to carriers and they don't talk to you. Yeah I mean I feel give me their name i'll definitely call them and see if they'll work with pregnancy centers but I would say no because we don't deal with insurance we really haven't ever looked at programs like that we saw having so that's an interesting proposal okay just curious thank you appreciate what you do thank you. I did want to make one other comment regarding the question you had earlier and send your solemn you ask about children's coming in connecting with us we actually have had children's into present to our clients they came in and earlier this it was like late spring and for our parent and group parenting class and they did bring. There cribs are their pack and plays back and we were able to disperse over twenty of those over the summer so I will say that we haven't made a connection with them and they did come in and talk about safe sleep and some other things with our mom so I just wanted to mention that since it had happened at my center and I am made a note to send out we have a great email network among the centers and so i'm going to email them and incourage all of us to consider connecting our negative test clients to am asking them to go ahead and apply for a medicaid so i'm going to do at least that part yeah what will follow with the address to yeah that would be great a repsy rose you recognize requestion yes thank you mister chair. A. There's all discussion earlier about the prc grants that I know that all three of the centers I had spoke and received funds my senator did not bet the other should ok so a center i'm involved with invort smith received funds I know there is fifteen or sixteen and total and I know we've got well over sixty in the state some centers I as I understood chose not to receive those funds others for various reasons may not have qualified could you speak to maybe how this could be more easily utilized what we can do concerning that type of a program how that could be more beneficial to those other centers that either chose not to work informed or simply didn't qualify this last go around. I think everyone was informed we definitely sent out the information and that I think everyone knew about the opportunity some you have to realize each pregnancy center is and it's own nonprofit and so it's rained by its own board of directors and so each board gets to decide how they're going to manage the center and the fundraisers they'll do and the grant still apply for and so several boards and including my own chosen not to apply for the grant one at the beginning there was some haziness about what the audit process would look like what any of that that was a little scary for some boards and just to jump off and not know what they would be required to give back especially when you're talking about him organizations or faith based and so that's where the other rabbis in that the grant many did have a clause in there about could not be used for religious purposes and so there were some centers that were hesitant because of that factor so I think definitely we could talk about ways that york at help us maybe that would ease some of those tensions I know there's other proposals being floated around about a tax credit and maybe something with the emma funding I mean there so there are some things I think we can do to maybe work around some of that. Just in conclusion resource centers around this day could utilize these could benefit from these funds correct and and finding pathways to make that. Easy to use is probably a little bit too simple but finding ways and to make these funds accessible and ways it would not damage the missions of these centers continuing to improve upon that would be useful correct yes I think we can definitely keep having those conversations and I appreciate the willingness of this party and the body and at the capital to pursue those ideas thank you reversing bill continue recognized yes a woman think on the you said about four hundred women travel across state lines go get abortions yet clarify on that that was a again we don't have numbers from twenty three yet obviously and so twenty two numbers showed that four hundred arkansas women traveled to kansas to get an abortion but remember rofel win. You know in june so that only half a year really at that now in twenty one when row was still in place only seventy arkansas women got an abortion in kansas so you can see just in half a year how many more women and then once again. We are not in control of how kansas and illinois report their number so hopefully they will tell us how many arkansas women got abortions there but again those are numbers that we're going to have to wait and see like what it is for a full year but yes it is happening in a week talk to these women and we know what's happening then where I better. Friend is a state senator and illinois and tells me how terrible and she sees the ads that they playing kentucky in mississippi of hop on the train and you know be back in time for dinner kind of deal but what i'm curious about is do you know how many of those trips are sponsored by their employers. Who do not offer maturity leave II do not and I don't know how we would. You know how much those numbers but you're right to point that out it is something that's happening with frequency and maybe that's something you could look into one i'm curious to because we've also seen a decrease in the amount of material that's offered by employers as well which a lot of people don't talk about but even large corporations like disney things like that cut back their attorney leave yet they're still paying for abortions and so i'm just curious are you seeing cuts and attorney leave here in arkansas as well just curious and has that reflected what you think is people find themselves in the situation to which they need to utilize these services or go at a state to terminate their pregnancy. I wouldn't say i've ever talked to a woman at our center that said that was her reason for animal but you'd not to say it's not out there. Um i've not heard that about maternity leave I have had several clients just have concerned about keeping their job because of becoming pregnant and we educate them of what we know as far as you know not being legal for someone to fire them because their pregnant and should make accommodations and for whatever changes that they need so we try to educate as far as that goes yeah and I need to recently there are some federal legislation pass as well about making the workplace more inviting the to to mothers and I don't have that in front of me but I mean is that. Get our are you informed women about those you know the change in law where they're able to you know as for reasonable accommodations and things like that I can care there's like a whole list of things that came out recently but i'm just curious about where when I read an educated on that so that they can't feel they can be pregnant and you know protected on the work force. I do know that we tell them they can't refire for that that's pretty but I am i'd be curious to get that law from you and I could disseminate that to the center so they would be informed that inform their staff so they could talk to the ladies about that yeah having it membership in the other questions that are open you recognize just just one I would love on your surveys if you had the ability to know how many referrals you did for high risk pregnancies after your ultra sounds and I know are not the field track that information that I think that would be really helpful for us to come and know so that we can kind of just owe a sealer's partners and helping to solve this the there is a crisis but we know with maternal and infant mortality so that would be a great thing and if we can have that information and then lastly and we were talking about the chemical abortions and the pills I know of someone who's. Married their married daughter had a miscarriage but had a a chemical dnc which occurred at our home it was incredibly dramatic and sound I mean that I just can't even imagine. If that happened to my daughter he thought and I wasn't there or somebody went there to explain and I just I think that's a porant that we're training young women. Who may have miscarried in this fashion by the using a chemical dnc or chemical abortion if they've miscarried a baby and there you know able to have it in the comfort of their home no that's incredibly dramatic and so are you I mean that might just be another thing they I mean if you're a pregnancy resource center I would just encourage you also to reach out to women who are trying to have babies. And who are miscarrying because this is happening and that's incredibly traumatic and you have the skills at really to be able to help that young woman so I would just I don't like that that's happening I wish we could change our health care situation to wear you know if you're going to have if you've gone in and we know you've miscarried you've gone you've had an ultrasound and your obin says you're baby is no heartbeats your baby has died you're gonna have to have a miscarriage we're going to have then that needs to be done in my opinion for the mental wellbeing of that young woman in a medical setting. And i'm not sure why it's not being done that way but that that's an area that as alarming to me so can I make a statement yet and i've now been finished with that everything you said is is very true and there is a and kind of a new trend that is coming around that would make this even more traumatic so at the abortion more right now as two medications add the first medication if press down it it blocks the processed around and that causes the baby to die there's the second drug is or just call it sat attack that's an it causes the contractions and causes expulsion they are now in it I think new mexico I do believe it's the ones that see in a lot of this now the wanting to do away with the first drug because it's the one that that is getting the most attention and the one that that they're thinking about making it difficult to access meaning that they will start and they have already started doing this just I haven't heard about it here yet only using the second drug saturday and so although we already know chemical abortion is traumatic it is causing so much charmer on these women that will now be delivering live babies because they don't have the first medication it's all traumatic and difficult to speak of but there are gonna be delivering very premature live babies and that is going to be horrific so a new problem is it what is dawning honest. So I am terrible with this of your representative first and you recognize it yes senator urbans call me it at I just wanted to you to understand why it's in advantage to be able to hear the tpl's and have after a miscarrier my daughter just had a miscarriage last weekend she lives in texas she couldn't get the two peels to clear the blighted over him that was still in the uterest. Which have been a very inexpensive procedure instead she had gone hospital and have generally in a station with a eight thousand dollar real I mean that's the difference in these states that have outlined these drugs they're making it increasingly difficult for obese to provide every health care of when someone his truly had a miscarriage I mean and i'm not getting i'm not going to expand too much on the point but these are drugs that get used in the merge department's well in a practice emergency medicine they're used appropriately in their appropriate times to use these direction they're inappropriate times and what we need to do is trust our positions in holiday physicians accountable to appropriate behavior through the medical board so rather than outline these medications making sure that the physicians are exhibiting appropriate behavior at it to me is a better way to approach this and that's just just mark two cents worth on the topic somebody else have any questions. Seen it thank you so much for your time is very good information we appreciate you if there's anything else you want to have the committee to have feel free to get with cable and she can email it out to the commit. Seem I think a department of health. Mister gilmore you hear. And whoever else you want to bring. The. This is out of number g I think you've got this small sparrow bonder. To peruse on tobacco certain. Report. Yeah. We've allowed it. Seven minutes. Now you can take as long as you want interest in hearing about this for free to tell us you are in section of the committee and you present matt gill more department health. The. Good morning kenya eding to argue some minority health commission. You recognize thank you thank you for your time today I know you're a busy median and i'll track this as brief as possible and I have miss items with me with the minority health commission and on the past that we had been helpful I think to have some of the programs here to speak some of the different things that the tobacco some commission funds go towards so. In a minute to my turn it over heard and let her speak to some the different things that she is involved in across the populations she serves but you have before you the twenty twenty two and a report for the tobacco commission this is an annual report we do this and every other year we do that by any of them between that. But it's similar to which often in the past if you go to page leave seven or eight you've got a graph that you seen before for other reports with some information there and then you also have some tabs on the side for each specific program um i'll just make this as brief as possible and give a few highlights or comments from the report and then i'm going to turn over to miss adding to speak to some of the things that she does with the minority health commission so couple of things let us in this report of a lot of things we tracker numbers around different populations and groups that we serve for this year for twenty twenty two we had some some good increases across a couple of different things one of those is around there health education that's provided a lot of that's done with uh youth and healthcare professionals and other things but arm significant increases there the number of health professionals educated that cease that's provided to some of the programs that's also clinicals that are provided by different programs that have health care clinics. And then also through the college but will help the uams and then some of those education accounts as well or through the program there round working with youth in them with healthcare professions but also with tobacco prevention program so we had a good increases there across those health education type outcomes as far as the screenings that are provided in this addings will speak to that little while but some of the problems do that provide that local communities across the state a different events or have a mobile health union that goes there so so i'll increase there for this year also sauce and increases around our be well and it's partner filth this is the line that provides education in assistance to those that need help with a particularly with to back a session but also focuses on some crime as these issues solve it increases in that. And then also the amount of leverage funds brought forward about the programs in the money that they bring in that's through donations through volunteer hours but significantly through outside grains that they bring in in a partner up with. We did see some decreases in the amounts of individuals a served through their medical expansion program I think in the year before and twenty twenty one there were some things that were relaxed as far as like with the hospitalizations that that funding goes towards across the four populations there was some cashier and it was a waived and so that population group for that year but that's gone back to normal now so that number is going back to it more a standard number that should see from your year and then also the number of patient encounters in the clinics those numbers went down a little bit I think you're in covered we had a lot more folks utilizing some of the clinics for different services that needed those like with vaccinations or just a health care around kovia and that sort of thing so that number went down as well. So if I may at that kind of a quick summary of the report and and I want to save some time from his eddies to speak to some of the things that she is involved in with the minority health commission that's okay. That sounds great good morning and thank you for the opportunity to share a bit about the arkansas minority health commission and the impact they were making around the state you can see from the comprehensive at c report our efforts inactivity that have been going on this past fiscal year but I was just like to highlight a few things number one our continued efforts at performing important health screenings around the state as a result of our efforts we were able to increase the total number of screenings we conducted this past fiscal year by over two hundred percent. Some of them more than twenty one thousand health screenings that we were able to perform include blood sugar screenings blood pressure screenings as well as cholesterol screenings all of which are key indicators for heart disease our mobile health unit continues to be a very popular and highly request it we are honored to have been able to assist with tornado relief a few months ago by taking the unit to win for nearly one week we provide a health screenings as well as technical and partner with the local health unit to be posted in one of the hardest hit areas of the city should not only print bar certificates shot records which certifications and much more our unit was able to visit all seventy five counties at least once this past fiscal year and we are indeed excited about there. Those interested in requesting our unit like I said it is very popular in highly request it those who are interested in having the unit in their community can reach out and make a request on our web page or about colon error office at five zero one six eight six two seven two zero we've restarted our community health forums that we were doing around the state where we host a healthy band in the community bring our community partners like the arkansas price state cancer foundation as well as arkansas breast care and others as well as invite a local position to come and speak with a tendence about the health conditions that are affecting their particular communities and counties we offer that position that position to answer health related questions and concerns both during an after the community health forum last fall we hosted a community health forum in phillips county and hell in a west helena and we are currently making plans to host in which of counties specifically and augusta later on this year. We are also proud to have hosted two summer day camps for kids ages 9-12 there I can't I can't program and falcon account and also in ashley county and we are equally excited to establish a new partnership with recycle bikes who generously provide it gently use and refurbished bikes along with nobody new helmet as well as bicycle safety classes to all the kids who participate in both camps and speaking of partnerships we have established a new partnership with the chronic disease department at the arkansas department of health to distribute life pressure cus to those we encounter in the community who have a history of hypertension but do not have a way to self monitor at home were finalizing those plans and the variables that we need to collect in anticipate beginning distribution later on this month and then finally on behalf of the arkansas minority health commission team and its board of commissioners we want to thank you for your support in helping us to reach an advance our emission thank you. Yeah. I'm happy to take any questions or however whatever whatever you receive later in your recognized for a question thank you mister chairman thank you for being here for talking about your program but I had a question we talked earlier about mortality rate and children as we've stated a couple of times where at the bottom of the list on that and we we really look you know what can we do how can we improve that and we've tried to do a lot of things but it sounds like you're in a very good position because as stated earlier the mortality rate in minority. Babies or young people is four times higher than in the white community so you have that connection is there anything that can be known I mean to expand your program to work with. Infants or young children. Thank you for that question and there are a couple of things that we do we have sponsored a state wide authority a traditional african american story to fight betas already incorporated and day partner with a national march of times to do the storksness program and that kind of helps to address some infinite mortality with young african american women in addition to their we partner with the arkansas breast feeding coalition to to stress the importance of breast feeding as a relates to maternal health and infinite health and we're also looking at ways to partner with other state why organizations to address specifically maternal health and infinite mortality in minority communities we're having actually conversations about that as we speak nothing has been finalized to announce a meeting new but we are having those discussions thank you for that as others have said we really want to work on the ad and improve there because that's one area not just because we're the worst but you know we we want to help the young people as much as we can thank you look for more look for announcement soon thank you. Represent pilgrims in your recognized effect thank you. I really know if you're not answer this question but I i'm i'm curious obviously and all of these. My heavier minority areas and arkansas there's a lack of access to care do you know how many minority majority schools districts have school based clinics within them. I do not know the answer to that at the top of my here but I can find that out and report it back okay and then I may I didn't hear this but i'm i'm curious to you know obviously I think. You know with within that community there's. You know even even though the what way commute as well I mean men often times are very hard to get to go to see the doctor and obviously I think with the amount of a beasity we have in the state is a big issuing can you talk about that in in in your work with the minority of the commission what you're kind of doing to address and and and even to some of the men's health issues that are going on because I know getting them to complies they're probably the hardest group did to get to go and so I just those little two areas if you can touch on brief i'd be curious to know what you all are seeing out in the field sure and thank you for it for that question men are tough but we do have some men who if you know they get a splinter they're going to be doctor and we're we're glad about that because they are paying attention to their health but we do encounter men in the community who are resistant to to access in the healthcare system and that is why it is so important for us with the arkansas minority health commission and the things that we do to be there to meet folks where they are literally going into communities with our mobile health unit with the things that we do to screen for cardiovascular disease as you know it is the number one cause of death for all americans in particularly it is an issue for minority communities but as a relate to to to lbc and overweight we have our seventy five sundays cut work and twenty one day program that is really very popular in the community and around the state it is a twenty one day program aimed at using food as the medicine model to help to address cardiovascular disease through healthy eating a lot of times when people think about healthy eating and they don't think it takes a girl particularly in the south we love our our southern comfort classics but with our twenty one day program utilizing our a seven eight bright sundays cook but we are able to address things like heart disease. Doing it one meal at a time and so that's one of the things that we use to address not only men's health but health in general and not with just minorities but all people can take part in our programming and so that's what we have for to address obesity and overweight in in minority communities but in addition to that there are seven i'm sorry there I can't I can't program it also focuses on healthy eating visible activity i'm incurred starting at an early age and again like I mentioned we are really proud to have partnered with recycle bikes to provide that form of physical activity that a lot of kids just are not utilizing these days riding by exchange rather beat inside on video games but through providing bikes to care they can get out with their helmet engaging some physical activity and hopefully we want to see them when they're thirty and forty years old with hypertension and diabetes I hope that answered your question. And you recognize thank you mister chairman I guess i'm gonna as some question i've asked for ten years. In medicaid is my main concern I mean i'm i'm glad all the health initiatives that you're doing but because we pay for that health care as a state. Every really seeing any reduction in smoking and medicaid populations. I think it's going down as it's slow and we are able to get slow that's you know lowering home there's other factors that come into that role that as far as in the state wide number it is coming down gradually in medicate yeah I know we like to say smoking so stations are reduced when we look at the total population but when we isolate it to medicated there was numbers have hardly moved at all according to the data senior I think it slip it is slow but I think overall the state is coming down. I do think you know with our session activities and that we work with DHS and some those activities and making sure that we're connected there and then with our be well quite line I think that's connected and making sure that they are aware of those services and connect them back to the program that DHS or medicate would offer. Is it as fast as i'd like it to know about i'm really also but and then we got the vaping prices that's gonna you know make more smokers going forward or have some bad outcomes in between that but. As far as medicaid in general I mean it is coming down but it's it's been slow. Can ask a valid am one thing I found in my community and probably a lot of low income communities is that you have to back a retailer sort of targeting these populations if we is there anything we can do is a state to regulate they had a more address. Really it's targeting it with with low low price to back a product so some of the funding that is designed for the tobacco prevention side of this goes to tobacco control they get the face through abc and that that group and they do go out they actually use monitors and they they get consent and all that and they go in there and you don't make sure that they're not selling the matters but also they look at the signage and then there's also a part of the program there invital to report whether seeing at the at the local stores like you're talking about there is a lot of alls around that with the advertising that we have you know just because of. Free speech and that sort of thing but I think tobacco control does a pretty good job trying to make sure that they don't you know violate the laws but yes it does you do so doesn't and if we'll overring him you know areas and individuals or areas to have a higher principle and I guess my has another question i'm sorry maybe this is the dhs question but how many because you know what sixty percent of our delayers in the state are medicaid how many of those pregnant women that percent as smokers actually smoking during their pregnancy we have any data on there. I normal. Yet we're not what you would do I just get that we can we could try to okay thank you. Represent item and you recognize thank you mister represented pilkington brought up something that was a really good question I think about me and not wanting to go with the doctor and not really take care of their health and when we we looked at data earlier about you know children under eighteen and I noticed that this was broken down by regions and I don't remember which region but I noticed in one region that the suicides were a hundred percent mail the auto accidents were like eighty five percent mail and and so it it seemed to be a lot that the mails were affected a lot more as for these activities and health issues. And in a we we see a lot about women's health there's a lot of published about that and that's not bad on the place who put me in the paper saying that that is not bad but you know I believe we need more emphasis on men's how how do you get to me and how do you get me in the gold of the doctor and and I was better anybody I mean I didn't take care of my health when I was younger. But how do you how do you have a message that they react to and get them in because it seems like at least in the younger age groups. The men have more issues or it I think they have more issues maybe because they don't come forward then then the women. And I guess the question is do you agree. Or not so I think that there are several ways that you can approach that and thank you for bringing it mental health last year for our by inning your son if we focus completely on metal health in communities of color in your absolutely right the the numbers are astonishing with me with black men in particular i'm so throughout the year we have tried to support organizations non profits who were doing that work we know that we as the arkansas minority health commission cannot do it all alone but through partnerships we can help to make a dent in that how do we address man in and and meet them where they are we literally have to get out there and meet them where they are there are for example there are a couple of cities around the state who offer midnight basketball and that's a place where men can go in have some physical activity it's all man that's just that's what they do but one of the things that we're looking at is to to being there remember meeting people where they are being present and then talking about you know if there's a break a water break in weekend come in and talk about hypertension we can talk about prostate cancer we can talk about colin cancer because we know that those particular cancers are one arrives in men so literally meeting people where they are there may be small groups but if we can just affect one or two people then that's one of two people whose lives we may have a positive positively affected and maybe those are lies that we have changed in or saved in the process so doing small things like that I think will help and sell again we are looking into ways where we can in be present and meet people where they are particularly with men represented lighting and can you may well touch on this with her screenings that she goes out and does I think that gives you know people that in the community and opportunity to go in to get their numbers checked and I think sometimes when they see those numbers are surprised and she does a number of screenings are. A large majority of across the state from the tobacco settlement phones and then also one of our programs are under your missed are some of that and I think again once if they show up and they get just one of the numbers check I think that does give them a pretty good idea that I am likely to go in and take a little deeper here and I think just have a lot of warranties offering that sometimes sparks are conversation and they can then point them back to a local healthcare provider or someone the community that can work with them and and help track that moving forward. You're absolutely right and thank you for mentioning that a lot of times with me and you know we they don't like to approach the health care system but when we screen someone and they have you know a struggle level hypertension they haven't been to the doctor in years we can educate them on what these numbers mean we can also educate them on places they can go in their communities at a local health unit or you know to go and see their own physician to get those numbers check because there are some things that they can do a lot of times people say well what I don't know won't hurt me while the truth is what you don't melt can indeed hurt you and so if we can shelve them what these numbers mean what they are then we can help them to be proactive about their health and again is meeting people where they are whether it's at a health there where there's on the basketball court or wherever. The. Send yourself a new recognized thank you I know we will call them and already help if we don't deny services to anybody be each time the mutable characteristics do everybody that shows up gets treated that is absolutely has access to the services where they do that or not however when I look at your website and it talks about the introduction and you track the gender and the race of professions. And then when you talk about the when you talk about what. Applying there there seems to be a big focus on diversity and the workforce. And which is a higher prior equality merit in the work force our diversity and the work force. So I think so those reports she's referencing are required by some statutes I think that's why she did those and she continues to do them but I think two part of what they're trying to do is try to get more minorities in those health care professions because sometimes some individuals you don't want to see someone from there raised when it looks like them in that profession so I think that's kind of where they're coming from and while they were doing those types of reports and have the type of work in mode yeah now I think this for allergiment to have one of more diverse work force is a good thing we want that we want to achieve that however at some point there is a decision to we hired this person based on their merit or do we hire and based on our diversity numbers I just want to make sure you know the supreme court decision just came down recently for higher ed saying we're going to base things on mirror and if we're going to hire based on our need for diversity or based on our need for merit we just heard you know how poorly we do and health care as a state I and we need to be recruiting and employing based on on their merit not necessarily on diversity so I guess we have that commitment from there department health as far as we hire yes based on mirror yes sir okay thank you thank you mister chair members with any other questions. If not earning without objection in this report stands review. Thank you you're welcome thank you and appreciate your time next that bag in department of health. Doctor tell you here with laura she hey. Just come to the table introduced yourself through the committee and then you're free to present. Thank you mr chair members of the committee i'm laura shoe on general council for the department of health and we have three rules to present to you today in an interest of time and we will do a brief summary of the procedural history and what this rule is going to be dealing and dr petel is here with regard to the rules pertaining to reportable diseases. This rule is modifying some of the the list and adding some nationally notifiable conditions also some conditions that are newly proposed to be added at the state level including alpha gal and animal by it also make some adjustments to the blood lead recommendations according to the CC we have clarified some other conditions and also made some changes with regard to reporting we are encouraging the preferred electronic reporting using an hl seven feed or continue to utilize a phone calls or faxes we had a public hearing held on this rule back in november of twenty twenty two we received no public comments we have the authority to add these conditions according to twenty dash seven does one of nine and went in. And we are happy to take any questions on the rules pertaining to report all diseases members are there any questions for going through. Seeing known this real stands review. Thank you thank you. Moving on to the next rule we have the rules pertaining to the list of controlled substances in arkansas and I have with me a mr shame david he is a the branch chief and also the director of our pharmacy services he assists in coordinating our list of controlled substances. We are adding several substances as recommended by the arkansas state crime lab and also mirroring any changes are pursuing to dea federal changes we have complied with an act from twenty twenty three and implementing act six twenty nine we are aware that there is currently a federal challenge with regard to that act we are a monitoring at the status of that litigation in the attorney general's office is representing the state of arkansas in that case it's my understanding that the attorney generals offers filed its response to the challenge on august eighth and the plaintiff's responses do on august fifteenth so we are monitoring that a federal case are with regard to any changes with regard to that act we had a public hearing on this rule in june of this year we received no public comments we have the legal authority to promulgate the list of control substances pursue it to title five in addition to the fact that sixty four dash two one six mandates that we update this rule on a yearly basis and we are happy to take any questions members with any questions. Ah sorry I mean i'm going to get better this give you know the chance that a representative talking to near recognize that just to be clear nothing came off the list correct that it never chanced the full review this nothing's coming off the citizens list no sir we don't have any deletions from the list on any other questions for committee. Without objection this rules things review thank you for your town. Thank you mister chair members of the committee moving on to the our last rule the rules for hospitals and related institutions in arkansas. Um carney melton is the director for the center for health protection and she is here with me to help answer any substantive questions procedurally you may remember am approving this and alc under the emergency rule as status this was approved back in may this is the permanent promulgation of that rule that was previously approved that emergency royally lasts for one hundred and twenty days so it will expire in september so that's why we're already moving forward with our permanent promulgation of this rule this is to implement at fifty nine of twenty twenty three to provide forward this new license or type for rural emergency hospitals. And the governor's office has approved this rule the board health approved this rule and a we have had no public car minutes I pursue it to the or excuse me we did have one public comment that's listed in the summary after we had the public hearing we provided the response we had one question from the bureau and we provided the response and were happy to take any questions members do you have any questions we are in this rule. Seeing known this rule stands reviewed with that objection. Ah this comes the end of our agenda members a couple of housekeeping items I think I said it takes that to the house members about the moving forward the second thursday the month is actually going to be the first thursday of the month so moving forward we're going to try to hold this meeting on the first thursday at the moth so our next meeting would be september seventh. And then october december seventh just you can plan moving forward this this will be the time for this meeting and put that on your calendar we may have the meeting at different locations where we can maybe have in some of these meetings different places around the state will make sure to provide that information to everyone as quick as we get that information available to us center urban had to lead to get a lunch and she didn't want to mention that she has a community service project she's working on during the weekend. Alc week I think she said it were if she has a community service project she's in a red if you're interested in it reach out there it has to do with this basically recycling program if anyone wants to work with her on that and having them for the business for the committee. But with the add any other objections that this meetings object.