Public Health, Welfare and Labor Committee- House

Function I know from the fire US and world that I'm I do have one representative this has a quick bill to run that he has a obligations from let represent meanders come to the table and it are you rented house bill. Sixteen eighty one okay you're recognized to seven present your bill. Thank you Mr Committee just real quick bill six house bill sixteen eighty one the simple preemption bill to basically ban Love local entities from creating a universe makes basic income president will bill I'll take any questions. Member center you have any questions. Seeing no questions is in respect for against the bill. Sing NO one are you closing your bill I'm closed close your bill will of the committee The motion to pass any discussion on the motion C. nine All those of favour say aye aye aye opposed. Graduation you've passed your bill thank you members of a let representative Miller chair and I'm gonna come to the table and run a bill or if that's okay. This. Some. All right of. Represent Johnson you are recognized to run house bill seventeen sixty six thank you Mr chairman president you have several people in the audience that like to try to come to the table with me for this bill representing the fire community and also I think we have an amendment to this bill is that correct storyteller we mixed up here yeah we do we have an amendment yes Sir okay on. Make sure I'm not the one it's mixed up because this. Now it's always good to have a policy with you when you come to the table I gotta get crew today. Members this is amendment changing some agreed to language trying to clean up some stuff on this bill it's the the the amended language really truly is just some clean up on some dates and I'd be happy to answer any questions on the amendment. We have any questions from committee on the amendment. All right. I make a motion to adopt the amendment. The motion to adopt the amendment in discussion. Seeing none all in favor say aye. Impose a no. You have adopted the amendment. Members this bill is the product of a lot of hard work with a lot of people that I'm really proud of what we're doing with this bill senator Hammer not started this process several months ago with several people that are here at this table I do want to give everybody here just a chance introduce themselves for a committee to let you know what I have down here and then I'll proceed with presenting the bill. So I'm Brad hard nine the fire chief the city if a bill but I'm I'm here as a member of the fire protection services board on the fire Cheapside appointee At the consumer with the A. P. F. F. what they intend to be here they are in support they just weren't able to make it mad Stallings was on duty and and everybody else was this out of pocket. Umbo Higginbotham fire chief and crossed Arkansas I'm also the president of the Arkansas state firefighters association and the chairman of the fire protection service for. Marcus divine I am a general counsel for the Arkansas department of public service public safety division of emergency management my director it Gerry is not Hughes and what's in the city at this time and see deputy director is back in the back you know once and we of course worked on support for this bill and support fully. My name is Jeremy Cronin the fire chief for the city asylum springs here also representing the Arkansas association of fire chiefs I served as the president currently and we are fully in support of this as well thank you. I'm a captain does temporary in the North Little Rock farm Marshall's office assistant fire marshal and also the vice president of the Arkansas farmers association. Thank you gentlemen and I want to start by offering some some apologies to the farm marshals that are not inside the state office you know it's it's been an interesting learning process for me is I know my area of expertise is health care but I got very interested in fire protection and how we fund fire services and how far services organized during my campaign I worked in visited with a lot of uh volunteer fire departments and fire departments my area and in our efforts to try to circle the wagons get all the troops together we inadvertently what is it what is outgoing is we could have been or should have been with the fire marshals association I take full responsibility for that I thought we were talking to the farmers office of the state that that incorporated all the fire marshal's the way far Marshall protections it is S. as set out is is different than I anticipated but I think we've believe that our fee that they're still looking at this bill I don't think they're opposing this bill anyway but I I want to give them the opportunity to to consume and digest this a little more as it goes through the process but I I don't wanna miss representative present so I appreciate them being here today appreciate the time and after they've done in the last twenty four hours to help us get them up to speed on what we're doing in again my apologies for not having you all involved in that center so what this bill does it does quite a few things so right now far Marshall services are under state police so we do have a fire state fire marshal but that State Farm Marshall it's a person has many hats one of the hats that State Farm Marshall wears is being State Farm Marshall but they also by the duties within state police there to individuals or going to the State Farm Marshall in in those folks are doing some a lot of different duties you can see a lot of places in this bill where a fire marshal duties are referenced in statute we started looking at this pharmacy duties referenced a bunch of different places so this is an opportunity for us to coalesce what apart. Marshall does and then transfer those duties out of state police into the department of managed emergency management which is where all of our other fire services entities are so what we're doing is essentially consolidating our fire services under one place into the department of emergency management in doing that we're consolidating two boards right now there are two different boards that exist to address certain fire issues there's a fire safety board that operates under state police and the fire services protection board said that right to me property action service board that operates under the department of emergency management so we're do this bill we're gonna be able to combine those resources and do away with some redundancies increasing efficiencies and how we address things some of the things we're doing is we're providing a little more regulatory authority to that fire protection services board that they don't have now we're creating a fire registry which I think is really important so right now the state of Arkansas if you want to do something to incentivize people to be a volunteer fireman the say you want to waive driver of a car registration fee for those folks to say wanna give up for a free hunting license we can't really do that because we don't really have a registry of who the fire fighters in Arkansas are so this bill is gonna lead us create that registry in conjunction with the fire training academy it's also going to Create a grant funding process so far services are funded to some degree two ACT eight thirty three ACT eight thirty three is a act that was created in nineteen ninety one to try to provide funding to fire services it comes from a tax on fire insurance premiums so it's a point five percent tax on anyone that underwrites a fire insurance premium that was a new taxes created ninety one with the thought being that look you know if if we can improve our services in premiums overtime hopefully would would go down in that have a positive effect so it made sense at the time and I want to link those things the way that moneys access to it is it's department is designated portion that money they have to apply for that money through a grant process that's housed in the department of emergency management to get that money that they have certain qualifying certifications some departments don't apply for that grant money just because they don't whatever reason they don't want the money they don't need the money they don't wanna go through the certification process there's no Avenue to redistribute that grant money currently at a state level so there's money that's been seven ACT eight thirty three for seventy years that we can't really do anything with it it's kind of unclaimed and so what we're gonna do in this bill is any money that's been sitting there over two years it's going to grow roll into a new grant program to be housed under the fire protection services board to allow people to access that money it which could include even the fire training academy at some point because right now there's there's you know there's someone that's in need of funding to this will allow them as well as other entities to apply for grants to this process the far more social itself the funding. The funding that's in there for pharmacist services within state police I will track to the Department emergency management but we're also asking for some additional funding because we think there needs to be a more robust fire marshal US department within the state I think it needs to be a single full time job it is a full time job and so we'd like to create a state fire marshal that would be dedicated to this process we have the hopes of creating a grant writing position within this process is well we looked for variety ways to try to find that is you know there's a lot of pressure on general revenue it is hard to find funding so in working with the fire services we agreed to take a portion of the act eight thirty three money in in dedicate that to the farm or social of us fund within Adam so. Right now every year then the money that comes into ACT eight thirty three grows at a rate of three to five percent it has for about a decade so every year that many goes up what we're doing is we're taking fifty percent of the growth. And putting it towards the fire marshal in the other fifty percent is going into the ACT eight thirty three fund so we're going to continue to grow ACT eight thirty three money but for at least a temporary pretty time all this is going on we're going to take that money and put it over towards farmers I have hopes in the future the increasing funding ACT eight thirty three I've been very vocal on that front this session of talk to the association counties twice talk to the county judges I will tell this committee that we desperately need more funding for fire protection when we started this process in ninety one there was G. I. F. money that came along and when we were doing G. after many of going back and look at the money from BLR and a we were finding most obscenity push that money was coming straight from legislators to volunteer fire departments did you have money was propping up a lot of fire departments in the tune of about forty three four million dollars a year when Jeff money went away that far finding one way and we've never done anything to go back and replace that money for these firefighters we need to do something to increase funding ACT eight thirty three I'm committed to working on that process until we see some kind of traction but until then this is a fair way to take some of that growth and put it towards a good service with the fire marshal Services under Adam and I'd be happy to answer questions I'm sure these gentlemen be happy to answer any questions I just wanna make sure you'll see that this is a a well negotiated well supported bill and I'm thankful to all the German this table and I certainly Senator Hammer for all the work went into this. Okay. Student Russian Wardlaw you're recognized for a question. Thank you Richard and I and I realize I mean we are moving some Some growth money around but in the end I will take this discussion a little bit off topic but I think this is the place to have that conversation. You and I talked numerous times about the funding for fire departments and how short it is we spend a great deal minute set in downtown Fort Smith having this conversation but. Let's talk for a minute about how much that premium taxes actually used it in ACT eight thirty three and how the other part of it's just going to general revenue and how easy it would be to redirect a small percentage and I think we talked about a third of a percent at one time I have to present it was that means and how many millions of dollars that actually wouldn't give back to protection for our constituents title out the appreciate you bringing that up let to speak to that so right now it currently we collected two point five percent premium on every home insurance premium every fire insurance premium in the state of Arkansas in addition to that two point five percent this just flowing into general revenue there's this point five the goes into ACT eight thirty three so total were collected three percent point five of it is going to the firefighters everything else is going to general revenues what I would like to see is do is take point two five of the two point five in a move that over ACT eight thirty three that would leave two point two five going to general revenue in point seven five going and ACT eight thirty three that would increase the funding in ACT eight thirty three by about fourteen million dollars which is a significant increase in and in what they get in you know when you look at the overall budget taking forty million out of the tax that's already there this is an increase of tax this doesn't create a new tax this just diverts revenue out of it general tax to a special tax for the same reason that we would have done this in nineteen ninety one when you look at the costs of fighting fires and what what's happened over the years I mean we all know about the cost of doing business in any sector I mean the cost of turnouts the cost of equipment the cost of fire trucks this is all increased exponentially since we did this ninety one and it's time to look at increasing funding into something to give back to these guys I mean something like eighty percent of the state of Arkansas is protected. By a volunteer fire services they do this is there mmhm one of their main source of funding they desperately need this in the county well in president Johnson I think you would agree that you know with the washing of the turnouts the different things we've learned over the years and the cost of those machines I know Roger and I had talked previously about drugs background checks drug testing and different things that need to take place in these departments today and there's just no funding and there's no way to pay for that and that sounds simple background checks it costs fifty to a hundred Bucks they just don't have that and we need to work diligently to find that money to put over into to acting thirty three and not with that I mean you have my full support. Thank you. Do I have any other questions from committee. All right saying none don't see of worry one is signed up to speak for against the bill Rep jim Johnson you're recognized close I'm close for a bill I just wanna say thank you into the gentleman is been a long day I know you'll have a lot of discussions to the day so hopefully was productive in those a long wait to get to this point I know you all would all like to say staff at some point but I'd appreciate judges being here today for this committee and let them see your support Perrin and acknowledgement of this bill and with that I'll close and appreciate a good vote make a motion to pass. Of we have a motion do pass as amended. is there any discussion on the motion. Assaying none all in favor say aye. All opposed no. I believe you pass the bill thank you committee jim thank you thank you generally appreciate what you all do definitely thank you very much. Welcome to represent Beck you have a Senate bill your your run real quick all right what if the chair at my may jump in head or some for saying go ahead. Thank you Mr chair of Rick Beck district forty three. Okay go absolutely you are recognized in your run Senate bill fourteen fourteen all right. This guy this is a totally agreed upon bill basically tapping our state if you have a bowler you have to have inspected every year and everything it's got to be that comes out inspect your bill or and all that everything's got all this bill does is totally agreed upon all those factors and all this it's great pond is this it allows them like let's say that my bowlers specs it comes due in June hi for whatever reason I need to move that to two weeks later I can file an application to extend the extend that out when I when I file that that extend I pay for the inspection like I normally would have paid for the inspection when I come out and do the expected there's an additional fee because I went forward a couple weeks there. To me my schedule and then of. On that point on that new day what that two week date out that'll be my annual anniversary every year and that's all this does. Hi I represent Wardlaw you're recognized for a question he's makes me nervous how many times you said it was agreed upon so can you tell me what you guys changed in a bill to make it so agreed upon. It actually came from the inspectors group that they that they agree to that to allow this flex because it allows them some flexibility in their schedules also. Wardlaw can't see you thank you okay I. resembled Richey you're recognized for a question thank you Mister chair I don't have specific concerns with the bill I just want to make sure that for a safety potential safety concern of employees who would work in a facility with these bowlers soon before an extension would be granted think I saw up to six months that the previous inspection or something would have to be reviewed to ensure that there's no potential safety concerns you have to ask a question thanks at actually that they would have a history because I would have done the inspection the previous here on equipped so that they have a running history with this stuff I've had a lot of these when I worked in industry at that adult schedule of these industry just give some flexibility in the schedule. We have any other questions from committee. Okay what we don't have a way that have anybody signed up to speak for against The lightning thanks a motion do pass. Is there any discussion on the motion. All in favor say aye. Imposed a no. Our congratulations passed bill thank you Mr tech. All right. Yes this was members are there any just for us for the sake of doing this are there any any of our members are here right now I have any other bills or Senate bills you need to run our want to run. Of the person Gazaway you here you're ready to go. Gazaway. He's been as was six. What you are recognized to run. Seven seventeen thirty two. What. Mr sure the Arkansas pharmacists association which is. Avital witness on this bill was just here and now they appear to not be here so eight that's fine if you want to step aside if we can pass it and come back to it she's got ability right behind you thank you thank you Sir you bet. Representative Cavenaugh you're recognized to come and table present. Senate bill two ninety nine. Hopefully this won't take too long. Thank you committee thank you Mr chair so this bill is going to design a program that's going to be in nursing earn to learn program and it's going to authorize students to earn direct patient care clinical credit hours for working in the healthcare facility and it just sets up the guidelines for that it's just a way to try to help our nurse backlog to try to get more into the actual work force quicker. And that's really what it's designed for. And with that I'd take any questions. Where do we have any questions. We nine plus we have a motion I have a motion do pass and body all sorts of. Thank. You're recognized for a question a Mr how many clinical hours can they get with with this can I get can they use this for all of them or is it just portion of them it's just a portion of them if you're going to page two it actually sets out those guidelines and it talks about twenty hours a week for certified nursing assistants patient care technicians or a job similar to that and then direct patient credit hours under this section shall not exceed fifty percent of direct care clinical credit hours okay thank you so as a great artist thank you. Any other questions. Would. What we've got a motion of any discussion on the motion. Sam none all in no way is signed up to speak for against all those in favor say aye. And Bhosale Is haven't actually seen thank you Mr chair committee appreciate it. Okay now. Yeah I was going to represent Gazaway are you ready now. All right. You're just identify yourself for the record you're welcome go ahead thank you Mr chairman I'm state representative Jimmy Gazaway represent district thirty one. John Benson CEO of the Arkansas pharmacists association. You know you're recognized proceed. Thank you Mr chairman members the bill that you have before you is house bill seventeen thirty two. Which would require host cell distributors of controlled substances to educate communicate and provide a well defined procedural due process. For licensed professionals before limiting or terminating sales of controlled substances to certain licensed professionals. And what this bill primarily would do and and what it stands out of. Is the injunctive relief that's currently in place in the federal court that pertains to three specific pharmaceutical wholesalers McKesson cardinal AmerisourceBergen since the injunctive relief that was put in place in July of last year there have been some very serious concerns of Arkansas community pharmacists so I want to be very clear we're talking about our community pharmacist these are the pharmacist who live in your community who own businesses in your community there locally on we're not talking about retail pharmacies like CVS Walgreens nationwide corporations I'm talking about the people who live in work in your community who've had some real concerns about how they've been treated by the pharmaceutical wholesalers since this injunctive relief came down I want to be clear this bill plus all pharmaceutical wholesalers those are the big three and those are the ones who if there been problems that I think the problems have been well but they're all other pharmaceutical wholesalers are also concerned here and we just want to make sure that they're it they are communicating that they are educating and that they are keeping informed the Committee pharmacist that they serve you know particularly there have been instances since this injunctive relief came down and this is the real concern of these wholesale distributors sending letters. Giving five days the pharmacy five days notice that they're going to cut off their supply of controlled substances and you know that just has tremendous negative impacts number one that's going to shut down a locally owned business in your community if that pharmacy can't get controlled substances to provide its patients who are prescribed those controlled substances by doctors in your community by the way. If they can't get those controlled substances to service their patients those patients are going to go elsewhere and it's going to shut that pharmacy down and they've been given as little as five days notice that the wholesaler was going to shut off their supply and if that happens these pharmacies are gonna go out of business this happen to a pharmacy in my district in particular this happen to a pharmacy in Van Buren that almost went out of business that and my understanding is this is bound to. A kind of a suitable replacement for a brief temporary period of time but it's it's definitely hurt his business and there are other pharmacies that this is happening to and unless we do something to correct the business practices of these pharmaceutical wholesale distributors I'm I'm afraid it's only gonna get worse and so I have John Benson here with me president of the Arkansas pharmacists association he's very familiar with what has been going on since July of last year and I think you can give you a good rundown so with Mister chair with your permission I'd ask that he be allowed to present as well you're recognized missions and. Thank you very much a John Benson. I just want to say we do have a pharmacist here today that will testify after means that we'll get into some more details about his experience so I'm not gonna go through every detail with it but I just wanna say with with the wholesalers the example he gave a minute ago the of the we decided to permanently shut off controlled substances not temporary like a permanent controlled substance shut off this is not just opioids these are all controlled substances including medicines to treat ADHD medicines to treat anxiety medications to treat opioid use disorder or addiction and so it is it is all of them I just want to clarify that in addition. There's only been one wholesaler that has been very aggressive on permanent shutting off controlled substances the others have not sent out similar letters but they have had some issues with suspicious orders I know there's a hospital in Northwest Arkansas children's had a recent issue there's a hospital and grab it the AG's office is been involved in investigating those cases and they've interfered with patient care on on specific drugs for what's called and it's a little bit of a nebulous term but suspicious orders without clear communication and collaboration with the providers hospitals and pharmacists and impacted so the language in the bill the idea is yes it does apply to all wholesalers but in drafting the bill the idea was communication education collaboration and working together to solve issues would be good for all wholesaler's as was the thought behind the the bill process is the way I understand it with that. Be happy to answer questions well and and Mister by could I mean I I have a few more comments just like to make so as Mr Vincent alluded to there been several stakeholders involved in this process the attorney general's office who is here who is in support of this bill I think you will be testifying in support of this bill they helped draft this bill. to really try to increase transparency and again communication with the community pharmacist before these wholesaler's shut him off and I think the common respect refrain among community pharmacist is if we knew what you wanted us to do we would comply with it but see it's a it's a game of hide the ball with these to wholesalers and I understand according to the injunctive relief they can't reveal their algorithms they can't reveal certain metrics that they use and then applying suspicious orders or identifying particular pharmacies who they have concerns about but there are ways that they could communicate better that they could educate better but they could work we had as a partner the community pharmacist who they serve because at the end at the end of this change is the consumer and the the people who are going to be hurt are the patients who go to the pharmacy who are going to be able to get their prescription filled by the pharmacist because the host seller is threatening to cut that pharmacist off at any moment if they're concerned about the prescriptions that they're feeling. And beyond that it will have I think a chilling effect among the whole whole pharmaceutical community pharmacy industry if one pharmacy for instance doesn't bill your prescription because they're concerned about being cut off then that patients going to go somewhere else to try to fill that prescription and then that that pharmacy is going to be concerned about filling it because they don't want to violate the metrics and the algorithms the standards because they're afraid about being cut off and ultimately gonna have patients who were prescribed these prescriptions by doctors who are not gonna be able to be serviced it has a real chilling effect across the entire market so the attorney general's office has been involved they helped draft this legislation because they think it's a good step forward that will help consumers it will help protect our community pharmacist. and you know once again that we have some pharmacists here who I think can testify about how this is impacted other businesses these are people who are just trying to make a living her filling prescriptions that are written by doctors who live in their community who are trying to comply with the law and if the host sellers actually acted in good faith. And actually we're trying to be good partners they would cooperate with them fully but the whole sellers haven't done that quite honestly and that's what we had to bring this legislation that's why I'm sitting down here at the end of this table so that's what the bill is about that's what the bill does increase education communication transparency. And I'm certainly happy to answer any questions. You have any questions from committee I recall represent Alan you yes Sir you're recognized I thank thank you Mr chairman I'm not the best thing you mentioned earlier A. L. testimony that that was wine wholesale wholesale in particular that was trying to. That you notice trying to cut him off are you at liberty to tell us who the wholesaler yells or you just want to do it if you don't want to do it all record we can talk about of off record no I I would there there is a New York times article about it and a couple weeks ago it's. If many of you haven't seen that be happy to share that but and there's a there's actually a court case out of enduring over that case and wholesalers AmerisourceBergen okay okay. So. Follow. So this bill is designed to prevent things like this from happening. Or to make it harder for them to do it. This bill is designed the language is written in the bill. And and let me say there's another version on the Senate end where there were many concerns brought forward including from the AG's office and be fair to say and we went back to meet with them and other stakeholders business believe Arkansas association of Arkansas counties and others state board of pharmacy and this second version came out in the second version was the attempt and what I think did a good job of is to write language that Didn't conflict with federal law or that was the goal didn't conflict with the injunctive relief but it added some additional things that would be good under the state law to provide education resources collaboration accept or to make sure pharmacy knew well in advance if there was a concern what that concern was to work on it to not end up getting that letter and be surprised and be permanently shut off. Follows cometh I thank I like this bill along with you I was trying to do this is a good consumer bill especially when you have patients out there the the payment all the medication and they can't get it and I know how difficult it is because I I have to go through that every month so I'm I'm going to support this bill. Thank you. Okay members we have any other questions from committee. All right of represent recognized for a question. Okay. Thank you Mr I want to jump ahead you guys gonna have somebody share from super save out of enduring today he could not be here today the but do have some information the other story be similar I would say the loss of the controlled substances he's lost about twenty percent of his business and talked to him yesterday and they have about sixty patients who have legitimate prescriptions for legitimate docs who can't get those prescriptions filled in the local community because the other pharmacies are scared to death their next they're gonna get that letter next now I'm not saying they haven't I don't know if they I know everyone in the New York times article it to travel seventy five miles to receive the prescription for cancer pain but it's a real patient care issue from being. Mr internal auditors to still too much thunder of anyone else's future testimony but how would you feel comfortable allow breeding just briefly on. Kind of when this was a brought to the pharmacy Hey we have these concerns there's the stuff we think that you haven't done right DO a through F. they did a two year after they're like okay too bad it could you elaborate just kind on the unrealistic expectations are placed on them right so five five I know of for pharmacies not five four pharmacies that got the letter from amerisource said we've made a decision to permanently cut off your supply and in all four cases they felt like they hadn't had clear communication a clear understanding there was a problem before they got the letter I'm not saying there is no communication but the communication received didn't seem severe I also know that the state board of pharmacy I know I don't know if he's here or not but not currently that the state board pharmacy at least in our conversations with with doctor currently. I didn't get any notification or call are concerned that it was so serious that a permanent revocation controlled substances was was going to occur but Mr minuses case and well documented the New York times article he he received a call on a busy Monday afternoon he was by himself there was another pharmacist there so he's both the owner and the operator in the clinician on the same day small low volume pharmacy in a rural area and. at least that part of town to have a high need area and then he at try to answer the questions of the phone call he got didn't have all the answers he asked to reschedule the call for a couple days later and they said they would but that call never happened and never got a chance to really go through the concerns and resolve them and then receive the letter was permanently shut off and has appeal denied to just give you some perspective. Thank you gentlemen page well it and that I will would like to say to someone in response that one of the things that I expect you'll hear. the host sellers say when they come here if they come up here to to speak is that there under federal injunctive relief to basically enforce certain terms Under under the opioid settlement essentially and. I think it's important to note that I mean I've read the entire injunctive relief and the injunctive relief specifically anticipates and their specific sections of the injunctive relief work specifically anticipates that states will regulate in this space that state it specifically regular as mentions that states will paste will pass statutes or regulations or rules maybe pertaining to the injunctive relief and so the Attorney General's office who is here and I'd like to say Mister chair I meant to have them come up to help with the presentation they're here and I meant to have them join me at the table when I sat down but I forgot with the chairs permission I'd ask that they be allowed to join. That's fine. So I do want to be clear that number one if when those sellers get up here they're gonna talk about the injunctive relief in that they're just they're bound by the terms of the injunctive relief and while that is true the injunctive relief anticipates that states can regulate in this space if they would do so by statute regulation and rule. That's what this is and the attorney the attorney that the attorney general's office in the public protection division of the attorney general's office have been very careful to write this legislation in such a way that it does not conflict with the injunctive relief in and instead complements the injunctive relief to try to help the pharmaceutical wholesalers. Do more education do more communication provide more transparency so that pharmacies can comply. And I suspect they're going to come up here and tell you that they've done that but the stories around the state and the stories from around the country suggests that they have not Mr Bentsen is repped by reference The New York Times article which I have right here which talks about in the state of Michigan for instance The You'll bear with me. Just one moment. The Texas I'm sorry the Texas attorney general's office since the injunctive relief came and had received five thousand report since June Michigan had received more than ten thousand reports So that you know there have been issues that have all of this has arisen kind of since the injunctive relief happen. And it in particular you know there been instances in Arkansas Mr Bentsen represent references the instance in Van Buren where he almost lost his business entirely in there been other situations around the state where that's occurred and again it's just had a chilling effect on the entire community pharmacists community so I'm not going to belabor the point but I would ask that the attorney general's office be allowed to comment on this is what. You're recognized man this state your name for the record please Alex spent in the attorney general's office and first I would like to commend representative Gazaway senator Patty John at this is we've been very intentional and we've spent a lot of times and coming through the injunctive relief and high level I want to stay on the record that this bill does not violate the injunctive relief and wanna make that very clear on the front and the terms of the settlement provide a process for distributors and to monitor inconsistencies or skews me for process for distributors for minor minor inconsistencies between state laws and regulations and the injunctive terms of the settlement and we are already getting notice of suspicious orders and quarterly reports and there are things that are being sent to our office that could easily be sure to others to increase transparency and I believe right now the I think it's fair to say that the feeling is that the goal posts are not just moving but they're also camouflaged for these small business owners and what we've endeavor to do with this bill and is to. Creates more transparency to create due process if there is a question about any and dispensing practices and to allow time to for the small business owners to pretty much clear their name and to show that they are legitimately dispensing these controlled substances and and we are very supportive of this bill. The questions committee members. We do have some incentive speak against the bill. We were in we were in danger. At the center right Lindahl. Yeah you just come to the table state your name here within the. You're recognized to present your testimony. Apologies for the poor penmanship Leland all senior sorry vice president of the state of affairs for the healthcare distribution alliance it's DA is the national trade association representing healthcare wholesale distributors we are in opposition of the bill but we have firmly committed to working with the pharmacy association board of pharmacy the AG's office and the sponsors of the bill to try to figure out some of the issues that we have in the concerns we have I think it's important to note that is your represents thirty five wholesale distributors three of those members are involved in the injunctive relief that was referenced earlier and the other members about nine have operations in the state of Arkansas so this legislation does not just impact the companies that are under injunctive relief and impacts the whole kind of scope of whole sellers that are operating in this state and trying to provide medications to all the pharmacies hospitals nursing homes et cetera some of the issues at play is yes there is the terms of the injunctive relief and we do through our analysis we've had this bill since Tuesday evening so we have not had a century of the throw time to kind of go through it to be quite honest but there is some concern from our members that they're it are some discrepancies and some issues with injunctive relief for the three that are bound to that agreement on a national scope but again it was signed off with the Arkansas attorney general's office last year and it is a new program so I think those three are kind of working through it the one number that was addressed earlier AmerisourceBergen has committed with the pharmacy association and others to try to improve communication practices and and do some of their work in good faith to make sure that the pharmacy community on the grounds here kind of understand the protocol understands what the situation is and how their control process controlled substance process works on the other and we have an issue. Where are companies are heavily regulated I think you can look up wholesaler's an opioid issue and and you can see that we are bound to DNA and federal regulations and complying with that and what they are required to deal so there are issues at the federal scope on what they need to be required to do in order to flag suspicious orders and hopefully provide any other bad actors from operating in the market and that's really what their goal is is to ensure that there are two pharmacies or or white white or others that it kind of have a diversion aspect to their business so they're they're in a in an odd place where they're trying to make sure that there's patient care and the pharmacies are able to access product but then they also need to ensure that they are conform with the federal law and the regulations and protecting against diversion of controlled substances as well so I want to state that we are very committed to working with the sponsors with the AG's office with the pharmacy association board of pharmacy and anybody else to ensure that the committee on the ground understand kind of what our companies are working towards to make sure that this issue is resolved and again I just want to state the one company that did have those four letters has Been on the phone today just to go through some of the issues they've sent a memorandum or I'm sorry letter of commitment to Arkansas pharmacies to say here's the steps that we are going to take here's the changes we're going to make up to make sure that the pharmacies in the on the ground in Arkansas I understand the process and we can do this better going forward so I want to make sure that that's very clear that we are here to be at the table we do just have concerns the legislation and how it conflicts we believe with injunctive relief and with Federal D. A. Clark regulations. Thank you. Thank you for your testimony we do a someone signed up to speak for the bill Jamie Hancock or you here helps us a question. Representative rose yesterday started out at notify. miss is it Lindahl the document okay thank you two quick questions one in in these situations where these pharmacies are flagged Would be correct to assume that they are treated as if they're guilty until proven innocent. So each is so cringe at the age of wholesalers have to kind of figure out their own program for identifying suspicious orders or or finding things I don't know when it gets that level it I mean I think it's very individualized so it might be very company specific to be quite honest and if you'll share or how you will come to those conclusions or how you set threshold or words some of those pieces if you get to informative on it then you open the door for bad actors to take advantage of the system so I know that our companies when they do flag suspicious orders there are there can be suspicious I I've used this before suspicious is kind of a misnomer to be quite honest it could be like a of flag that the pharmacy accidentally ordered one extra zero on their order pattern and that's kind of cancel from our our distributors and they can kind of re order again and kind of correct that issues there is opportunity to correct the issue I think when they put in some of the injunctive relief issues perhaps there is not enough education that went on so there might have been some of that feeling but hopefully with that the commitment that we have from our one member and and the others to just kind of work on that process and make it better hopefully that's not really the case of the feeling at the pharmacy will follow Mr recognized for fallen. Do you think that it would be fair in a situation where a pharmacy was flagged for that pharmacist and pharmacy the business to be treated guilty until they prove themselves innocent. No I think it their business partner I mean I think our company is hopefully approached it like we are there are their customer and they work together to ensure that patient care is available so I would hope that's not the case from our members final question Mr you're recognized. You said that you had expressed willingness interest to work with representative AG's office pharmacy association does that seem to resolve the issue and and like why are we still doing this legislation if if you feel like you're resolving it I hope so I mean for wide fingers crossed tools as well but that I think that there are again we just got this language on Tuesday we had a Senate bill that we had kind of addressed concerns with us while we have reached out to the representative and senator that are running the probe this legislation we reached out to prior to the AG's office and with the pharmacy association the board of pharmacy and hopefully getting to that resolution obviously this language is a bit news that kind of coming through some of the pieces but I think we're moving in the right direction I'm hopeful that we do come to some type of kind of agreement that our members can continue to operate in line with federal standards and ensuring that the state pharmacies are in a good place as well I'm sorry Mister one last question you're recognized thank you are you aware of any non independent pharmacies that have been flagged. I think there's been Arkansas yes I don't believe so I'm I'm usually not thank you Mr how that process works they don't inform us. President Allen did you have a question you're recognized thank you Mister and miss Linda Linda yes on the okay we appreciate you being here today And I know use say the all willing to work things out. If it wasn't for this legislation. But you are the Senate that a woman. Thank you for the question I mean I think If HCA was involved in the in the conversation or we are brought stable a hands down unequivocally yes we would be at the table we would help kind of Colette's our members to work with the front all of the groups involved and kind of try to find some type of agreement that. Follows I guess my second question is if that was the case why did you all come before today. Thank you for the question we were involved in the previous Senate version of the bill so that was about a month ago and since that time frame we have offered to kind of try to work together With the other with the sponsors and all the other members I had brought up but. To be quite Frank we hadn't heard back okay everyone follow. Would you agree that prior to coming to table today that there was no resolution in sight. No possible resolution. I I disagree I think there are probably some some pretty good resolutions that we could come to especially I think this legislation comes after of an issue with one wholesaler specifically so if we can figure out. Legislation I guess why it why are we looking at trying to solve one concert with one company with the other companies seem to be doing a better job at trying to in place and implement this injunctive relief or the other members that are not involved in injunctive relief have I've done a decent job I mean then D. A. regulations have been around since nineteen seventies and there hasn't been this issue so this is new and I would say that that's kind of. Where we are and if there are issues that we can kind of work together with this we are committed to do that okay one thousand man. Of all the things is happening today the person this will be her is the patient. Patients can get that to the best of twelve possibility that it would be more difficult the difficult for them to to be here. So so talented and went when a patient is struggling we cancel any of the cities this should not be a start before he issue to get the tools. But you're going. I would wholeheartedly agree with that okay thank. President Wardlaw you're recognized for a question. Mr you're not just talk but I want to ask this question first of pharmacy association animal come back to missile and off I guess I'm saying that right John. Can you Mr president can you talk about representative roses question about percent guilty until as I heard presenter represent Gazaway talk about a pharmacy invasion beer and. I just I don't think that question was answered. And I think there was a legal answer was given and I'd like to hear the fax line House Bill and before you guys came to the stay one before this negotiations started. So we reached out I did the association did to amerisource last fall when I saw the first one of these letters turned out there was another one that have been a few months before I'm sure there are other pharmacies that have gotten these letters but they don't want to talk about it once once it's resolved they don't want anybody to know they might have been in trouble or in violation of the a law or even though they weren't it it presumes that you are creates that showing affected representative Gazaway talked about earlier I talked to the governmental affairs team in AmerisourceBergen the chief controlled substances. I don't remember his exact title but David may with amerisource about the issue what's different Arkansas house some other metrics and some of their concerns don't apply in our state and don't make sense in a rural state and and basically he said Hey if this ever happens again we think we're doing a good job there's always a possibility this just a one off let me know and so the next time I heard about it was in Van Buren with Mr Mani's and as soon as I heard about the situation I gave even David Mays cell phone number and said Hey I know the top guy that's over this program in AmerisourceBergen calling up see what you could work out called it by understands he called him he listened he was going to look into it and get back to Ames. Never happened so David took the call heard the concerns and then the next thing I know the pharmacy has been permanently cut off and have their appeal denied and since then we try to have you call them in for or try to bring him in and December to have a discussion with all three wholesalers and they all declined because it was too close to. Yes Jett into J. P. R. Christmas and they had other responsibilities and weren't able to come in and I don't know exactly when HTA was notified and out of the season yeah it so they were notified that the that there was an issue I don't speak for her but that's way I understand it. And I didn't have a good working relationship yet with HDA I mean historically wholesalers have been we have had theirs when you look at the state board of pharmacy there's very little regulation that's part of the issue is the state board of pharmacy is communicated to me that they don't have a lot in there like how to do something with this information if they think they're acting in a way that's dangerous to the public they just didn't have anything on the books that really gave them I want to speak for the board of pharmacy but by oppression is that's they didn't feel like they know what they could do and and I know I'm going on represent Wardlaw but bottom line is is that even after all that and we got into session and the bill was introduced. Another pharmacy and shared and that was the national independent pharmacy of the year for that company for the best service in the entire country got this letter and they got the letter as a result of selling part of the company to the to the son of the owner or a higher percentage and then they did a you know a review of the controlled substances didn't show any concerns to about it and then they got this letter that said you've permanently been cut off from controlled substances so that's why it's moving forward because even after all those phone calls all those conversations all those efforts to resolve it they didn't show any effort to resolve it and representative Allen hit it dead on the money the only person against heard here is the patience because patience a chair and now don't have access to that controlled substance and some probably needed so. I think it's wrong to not answer questions representative rock road asking awhile ago because you are presumed guilty when those letters come in you're cut off and. I mean I I I just it just bothers me a lot when witness acidente one does not answer directly to a question I'm I'm just a little country boy and I like stuff to be direct and we just kind of beat around the bush there thank you for that Mr Benson. The other questions from the committee representative voted to recognize thank you Mr chair you talk about metrics and I apologize I was in another room you talked about metrics how broad of a scope for these metrics in terms of geographic you talk about Arkansas specifically is this a multiple states across the United States. I'm sorry could you clarify and like on the mat the metrics that you use to make decisions like this how do what geographical areas is just metrics that are specific for the state of Arkansas for a community in Arkansas for the United States so according to DA so we're trade association representing thirty five members so I cannot speak to each thirty five members and how they. To their operations that's just not information to share with us from what the DA says it's orders of unusual size frequency in ordering patterns is what flags in order to be looked into so that is kind of communities they look into the community to see the pharmacy orders of that community or the state or or different kind of patterns but they're specific way of analyzing it is very company specific and proprietary okay so it so would you think that it does or does not take into like the unique dynamics of Arkansas market for rural communities like impoverished and a rural communities. represent I will I would hope so but I can't I really can't speak that I'm not sure I know that one are in a call earlier that props of some education that are members could B. important have to understand kind of how different communities operate but. And I was not trying to be evasive earlier I just some of the things from being a trade association there are limited information that we receive I know what the D. is requiring when drug relief and and hard members operate but. By no means to have all the information and company specific information. Members of the other questions. C. nine represent Gazaway did you have a comment. Well I think. Thank you Mr yeah just in response I mean as I appreciate seller industry coming of the end of the table today and and announcing a commitment to do the right thing but I do want to point out that this is been going on since at least this fall Mr Bentsen reference the fact that we've been in communication with these wholesalers I had called a J. P. R. meeting and put everyone on notice that this was a big issue you know did you see them coming forward with solutions coming forward to the legislature with solutions on how to solve this issue no we filed another by this there was another bill filed that passed out of the Senate committee much earlier in the session once again they have the opportunity to engage and bring their own solutions their own legislation the table they've not done that now here we are at the end of session I've got another bill filed and now all of a sudden it's we you know we have this commitment to do the right thing and I want to believe that's true but I've got two weeks to pass the bill and with this committees help I'm going to pass the bill you know we we talk about the wholesalers you know once again. The I don't think that they're properly to a representative will just point taken in market considerations in the State of Arkansas is a rule state there are rule community pharmacies that may be the only could only pharmacy within driving distance for a lot of a lot of rule folks who live in these rural communities. And you're not understanding once again this goes back to an issue that I don't think that they've adequately address not understanding the unique needs of each community of a rule community never rule state like Arkansas and trying to hold them to the same standard as you would holds a Connecticut Rhode Island it with different populations with different socio economic conditions I would populations who had to work hard over the years do do physical labor whether that's on the farmer in a factory you're gonna see a lot of that in Arkansas probably not gonna see a lot of that in Connecticut maybe maybe not see a lot of that Rhode Island I don't know how they're treating people because they don't reveal their metrics and and to be fair of the injunctive relief doesn't allow them to reveal their metrics so I understand that once again better communication. More transparency that's what this bill is about we want to do the right thing I will say and I I just wanna make the point if they would have acted in good faith if they would have act if they would have acted with fair dealing during this entire process I doubt seriously we would be here I don't want to file this bill I want to go through all of this. Right once again here we are. We do a someone assigned to speak for the bill thank you for your testimony Jeremy Hancock could you hear. If you just state your name for committee you're welcome procedure testimony after statement. That on. my name is Jeremy Hancock I'm a pharmacist and pharmacy owner Paragould Arkansas I'm one of the one of the four that received this letter much to my surprise and. So it just a little background I want to keep you all know it's been a long day but I'll be glad to answer any questions but it just so quick background may of twenty twenty right the middle covid is when we got our very first request for review of our data they use the third party vendors called the this one's called pro compliance the polls are data compiled and the identifies it sends it to amerisource in a in a version that they they view and and that was first time may twenty twenty and of course you know what was going on a may twenty twenty we're right milk Covin and it was a wild time in pharmacy. I'm not lobby was closed we were just trying to stay healthy. that in and to help other people am by a wholesaler contacted me wanting me to do an action plan based on the data they saw some concerns on the red flags when we submit action plan I submitted that a call first of all I called some colleagues SO Hey have you had to do this no no no I had heard of this okay kind on my own here did I'm all day it is it was it was I'll admit it was brief it was generalized nobody gave me any guidance or what they wanted in there and so it was pretty is one page submitted they rejected it told me what they kind of wanted a little bit more into it sold the final one and it'll be three pages long estimate it is approved. fast forward to may of twenty twenty one get another request for data pulled from compliance review and sign off on it Senate in the parliament that a not another word was sent. So I thought I was good things we're proceeding with the action plan producer numbers everything's good fest forty again to may twenty twenty two I get a get a third review poll data I think nothing of this literally is just a phone call Hey we need for data okay you have my permission they pull it I didn't think another thing about it because there again no concerns no fears and we know we're doing everything correctly. August eleventh I believe it was Friday August eleventh. At I come into work some days I'm in and out and I'd come back after lunch and there was a letter on the desk the open up really not thinking anything of it it was one page and this is a photocopy. This was it it was one page there's a little bit on the back but anyway and basically how to star read in the US and by about the third paragraph about Philip the floor and because it says that there will restrict the sales of all controlled substances listed chemicals but will continue service for non control products this restriction will take place this this restriction will take effect five business days from the delivery day the letter remind you this is Friday afternoon. So you can't get anything done on Friday afternoon I'm burning the phone up trying to get some help realize and I he was the. John Benson was gracious enough to take my call he was off work that day be moving assigned into college it took my call an in kind of gave me a little background I had not heard about the injunctive relief inform me about it at that point and tell me we talk Monday and that's what we did let the we can go by anxiously waited Monday we got some we got on the phone felt like would make any headway talk to doctor currently state board pharmacy course representative Gazaway and and some other colleagues and finally finally seem to get a little bit of help and crafted a reconsideration request to the wholesaler submitted it and on August twenty fifth we had a phone call with them. On the phone calls about thirty minutes long we reviewed their concerns and you gotta remember we're going and I'm going into this blind there's very little information it's very vague and broad they can't tell you this because injunctive relief you don't know what you're supposed to be doing what you're not supposed to be doing what you're doing wrong and they start giving me examples of of problem areas and a list of these problems they they pull one patient and they say this is a problem and they start listen off well you know one patient in my pharmacy the service about three thousand people in Paragould you know it I'm I'm not going to make that connection right away with who it is I start reading it off in they finally they get down to the day supply in the prescriber in the light bulb went off in a total on the phone call said. This is a hospice patient you're talking about at it hit me who they were talking about. Civically and it was at that moment in the phone call when the tone and tenor changed and they kind of started stumbling and fumbling around on the phone a was the senior division division control investigator and pharmacists I started kind of stumbling a little bit and it was almost as if they would never had never considered the fact that this might be hospice patient and and so that was the moment that it all changed and by the end of the phone call they said well tell you what Mr Hancock we will go ahead we're going to approve your your request reconsideration and will will review at a later date now we go ahead and we make a lot of changes drastic I mean drastic changes this permanently impacts may has impacted our business I say personally I hope it's not permanent but it feels permanent it feels like it'll never be the same again. and we are turning away legitimate prescriptions I can tell you right now day day we turn away legitimate prescriptions Bacall's we fear our numbers are going to worsen. And that that's not even something that should come into our calculus as as a pharmacist when we're working that shouldn't that's a distraction in in something we do not need to be there I don't need to ever have a prescription brought to me and very first thing off the tap is all that's controlled substance my with my number's gonna look worse and we're going to shut down so now sorry your own way I turned I turned away a person who just saw psychiatrist for the first time he is the anxiety and it was a psychiatrist said nope thank you I'm sorry can't get right now in the end and I had to have some conversation houses people up I flirted with the idea of not doing hospice at all to improve my numbers and morally I just couldn't do it. It it was just the it was wrong so so I decided against that and had some very of had some awful conversations with patients some not sometimes they start crying sometimes they get mad it just various but it's a distraction it had it as representative Gazaway said it's had a chilling effect on the community US independent pharmacists were really even the chain pharmacist in our small community or close were friends and so they're like well we know there isn't anything wrong so we're not gonna take it either we're not we're scared to death to so people just have been in a tight spot if if there start on any kind of new therapy or anything currently in Paragould and and I want to say the a relationship with wholesaler's critical and vital to provide patient care obviously I can't dispense drugs that I don't have you know in pharmacies and wholesalers are critical vital to physicians physicians can tell you what's wrong with you but if they can't treat you with medication what good does it the right so we have to work together this has to be a relationship that works I think this is just an example of a time when legalities kind of got in the way of the everyday way of doing things and and I appreciate the bill I'd be glad to answer any questions I have much more information looks that I could talk for a long time but I don't want to keep you saw. Thank you so much yet represent road have a question yes thank you for testimony this real quick after you had a couple of data pulls from program clients you have the the one that was in August that you think was the ultimate inspiration of the letter that you got gave you the Hey you're not member to purchase these drugs anymore from how many ever days for it was you had had any individual communication with. So may was the Deadpool tweet tweet to the letter came in August okay that's what it was okay sorry and then there was a phone call August twenty fifth about thirty minute phone call and since then nothing. But the phone call was after you received the letter this yes so you were told you were no longer be able to purchase these drugs and the once your patience needed do you feel like you were treated guilty and had to prove yourself innocent all absolutely I don't think it's a question they they they go through you know pharmacists have a corresponding responsibility to to ensure that each prescription is legitimate and appropriate and we do that we've been doing that and I have instances in my career where we have caught illegitimate prescriptions and we followed you know what what what you the normal what you're supposed to do on that sort of thing report to the State Board in and medical board in the department of health and and I've been through all these processes before and so absolutely they treated us like we were guilty of doing things in and filling and like I said. Treat us like we're doing something wrong on these on these things that were hundred percent. Correct them legitimate. Thank you for your diligent work and sorry video through this president will do you're recognized thank you Mr chairman thank you for coming down here thanks for your testimony I've got two questions I'll ask you this one first were there any on site visits done prior to this letter how I mean seeing you know as a bad actor or. No and I and I will say this and I had I've been this is not only me talking but this is other people have told me we purchased a bank building that was built in two thousand six and Paragould the bank had pulled out a pair of old and left the bank only one of the most secure pharmacies if not the most secure pharmacy in the State of Arkansas or maybe the nation vault is one foot thick concrete and steel rebar and we have a vault door we have alarm system we have multiple cameras very secure is a bank would be and I feel like if they'd come in saying that in person they might have a totally different opinions absolutely follow up. as you know I represent a large rural district the city apparels not in mind parts of Greene County so for these I have thirty three thousand constituents in the largest town is thirty six hundred folks so for rule Arkansas this practice that you were subjected to how detrimental is this to patients in these rural communities I mean help with travel with with fear that that a pharmacist is going to be treated this way they're not able get the medicine and how detrimental is this to rule Arkansas very and and there's one bullet point in my letter that's very concerning and for anybody in the state of Arkansas should be concerning one of the reasons why they this is one of the four reasons why they were no longer going to so controlled substances to me okay the reason is dispensing for patients of general practice family a multi level practitioners conducting chronic pain and comorbid mental health therapy well as I told him on the phone call I have some severe been ruled Arkansas and of course no the caller ID said Long Beach California and they said no and also let me tell you something we don't have a bunch of pain management and psychiatrist in rural Arkansas are general practice practitioners are basically all we have and so that to be that for that to be listed as one the four reasons why you're going to basically shut me down put me out of business is is absurd and out and I told them it even in my action letter there is nothing I can do to address this bullet point. Thank you for testimony thank you representative Gazaway I have a motion at the proper time. Any other questions from members. Senate thank you so much for testimony represent Gazaway you recognized to close your bill thank you Mr chairman. I think the minute I want to belabor the point I think there's been a lot said that hopefully gives the committee a clear understanding of what's going on here. I will say you see the impact this is having on Community pharmacist the impact that it would have on rule Arkansas community pharmacies that service rule Arkansas that would give you an example representative Allen mentioned you know cancer patients for instance this is an example it cited Arkansas in the New York times article charity benefit all forty two was in the middle of radiation treatments for cancer in Northwest Arkansas he was facing a series of surgeries when AmerisourceBergen blocked her pharmacy from buying controlled substances in November miss benefit all tried to find another local pharmacy to fill her prescriptions for pain and anxiety at least four refused she said on days when she did not have enough pills she would vomit from the pain ultimately here on colleges called Oklahoma City chain pharmacy that agreed to fill her percent prescriptions at a location ninety minutes from her home AmerisourceBergen had cut off her usual pharmacy super save drug over series of what they deem or red flags. And so you see. What the practical effect of this is it it's already happened it to one Arkansas pharmacies been threatened to multiple others. And at the end of the day this is going to affect consumers this is going to affect people who need these drugs have been prescribed these drugs by doctors under legitimate prescriptions. And so if they want if if the whole sellers want to come to the table that's fine I'm happy to have discussions with them but my intention is to pass the bill and so that's what I present to you today. Members any other questions. President rose recognized for a question motion at the proper time actually represent Wardlaw B. doggos the punch represent Wardlaw you're recognized. The motion to pass the discussion on the motion I don't often discuss from the chair I want to say thank you representative Gazaway is an issue that's personal to me I work at a hospital and being your and very close to the pharmacy that was mentioned in reference and is a very important issue to raise attention to and so grateful for the work done on the bill and if there's no other discussion representative Alan. I want to thank you for what you're doing and I want to help you pass this bill. Okay. Members any other discussion see none all those in favor say aye aye opposed congratulations your bill is passed thank you Mr chairman thank you Committee. President Kevin are you in here still I saw you at one point. Waker at Niger. I was not. Baghdad. I well I don't know what she was enters this is taking in the scenery I didn't notice are back to. Reporter representive park. You're recognized understand you have an amendment to house bill thirteen oh five yes Sir thank you and I think they'll be handing out out. We've changed it from sixteen years old to fifteen years old. And again this is for well I'll just wait to see if you get to see that amendment this is also a hand out of the other exceptions if anyone was interested in. You have a minute before you members Give me a chance to look at it. Do you have another hand If anyone wanted to see the other exceptions if that was something they were interested sounds like people the answers that they do. You're recognized presenter amendment thank you so much so the change that you've seen in the amendment is changing at number seven from age sixteen to age fifteen as you all noted earlier I thought this might help to see the full text of the other parts of this law description that gives those consents it's really shows who can consent to medical treatments and we're what we have done is on number seven here our current Arkansas law has any on emancipated minor and we're just Replacing of sufficient intelligence to understand and appreciate the consequences to and on emancipated minor who is fifteen years of age or older for these purposes. There's any questions on the amendment. I have a motion on the amendment. Thank motion documented dollars favor say aye. Posed you guys. Your your minute has failed. Is there other opportunity or other questions that the committee might consider that was the amendment that I was asked to make or looking at this after this morning you can read the bill but not not with the amendment okay could read the bill and the amendment did not pass in okay a voice vote thank you for clarifying that for me well I would like to bring before you today the to solve issues for parents in particular for children ages twelve to sixteen that currently are faced with a state Dilemma in trying to get records of their children's notes with their doctors and having the authority from the State of Arkansas to. be in charge of any child over the age of twelve and this became apparent when mercy's health systems which is one of our largest health systems with many parents. insured we're having trouble getting this information and having been notified that because of federal requirements not because of federal requirements but because of our Arkansas law that had that. Skews the phrase in it they would be some subjected to changing the age from sixteen to twelve. If I would just remind you that all the things that you're required to be sixteen years of age and older to get a tattoo to get a driver's license to get married. A if it's even older for alcohol and smoking and things like that so what we're saying is we believe a child ages twelve to sixteen I was willing to go to fifteen I thought that was what the committee was requesting. That a child would still need parental consent and this parents would still have. The authority from the State of Arkansas to oversee their child's medical treatment and procedures with that child's doctor and physicians so it would be a partnership between the parents of the child and their position and with that I will take any questions do you have a question or comment. Mr chairman I just is this the same bill that we heard earlier today at the present time I would say this is same billion amendment failed on a voice vote okay hi and reshape that I mean I appreciate her support of the bill I would moved for immediate consideration. So we we can have immediate consideration to after. Main motion which would be a motion to pass. So the members you've heard the bill. what select committee. Your bill spell for like a motion. Thank you. President Clinton Oakland and she here there you are you have a couple of bills to present. Recognized president. Senate bill four fifty two Senate bill four sixty three. Thank you. A committee Michael and then represented house district ten. The consent really low okay I'm a star if you don't mind with a House resolution ten sixty seven. Is there any objection German now you can start with that thank you you're recognized so good afternoon today bring you how ya House resolution ten sixty seven it's a resolution that urges Arkansas institutes of higher education can you hold for just certain. Which which which bill are you presenting I'm sorry you know at four to present today let me do that one for public health instead. That's okay education about that it's a long day for all about set again let's presents about Senate bill four fifty two that is absolutely under in the following days thank you okay Senate bill four fifty two it it modifies what used to be called the preamble of this legislation does not change the law and anyway but it does have some reflection on state policy and basically it strikes out a couple lines is a continuing population growth either causes or aggravates many social economic and environmental problems both in the state in the nation and it also strikes out a contraceptive procedures supplies information as to and procedures for involuntary sterilization are not sufficiently available as a practical matter to many persons in the state again it doesn't change our law it just gets rid of the statement that the legislator was making at the time to make a different statement. There's of any questions. Seeing none of the no one signed up to speak for against the bill are you closing your bill yes Sir. Because my bill. There's oppose the bill so the committee. The motion to pass all as favor say aye opposed. Your bill is passed congratulations thank you. C. two hands. Representive Waldridge. Representive Waldridge. No. Representive Richardson. Representative Richardson. Representative Graham like. Representative Graham like. Representive road yes. Representive road both yes representative more. Representative more votes yes representative Schultz. Representative Schultz votes No representative Terry. Representative Perry votes No representative Pilkington. Representative Pilkington. Representative Alan. For president of Allen votes now representive Kenneth Ferguson. Representive Kenneth Ferguson votes No representative consolidates. Representative Gonzales both yes. Representive Bentley representive Bentley votes yes representive Ladyman. Representive Ladyman. Representative Deborah Ferguson. Deborah Ferguson. President of Womack. Representive Womack representive McGee. Representative Mickey votes now representive Eubanks representive Eubanks. Representa Wardlaw. Representive Wardlaw. Representive Wardlaw votes yes representative Miller. Yeah representative Miller votes yes. Sorry bills failed thank you you're recognized president House or Senate bill four sixty three if you like thank you ma'am maybe all right so this is Senate bill of four sixty three this simply adds a aligned to the legislation here it directs the medical board that if the doctor fails to comply with the subchapters in this section on the boards and using drugs at the board shall remove the medical license from the doctor. Members any questions. Sing ninety was sent to speak for against the bill. Seeing none are you closing your bill I am close from a bill. With the committee. The motion to pass L. as per se I. Opposed. AS haven't. Representive Waldridge. Representive Waldridge votes yes representative Richardson. Representive Richardson. Representative was extremely. Representative Graham like. Representative rose. Representative rose yes. Representative more. Representative more votes yes representative Schultz. Representative Schultz. Representative Perry. Representative Perry votes now representative Pilkington. President of Pilkington representative Alan. Representive Allen votes No representative Kenneth Ferguson. Representative Kenneth Ferguson votes now representative Gonzales. Representative Gonzales for the S. representative Bentley. Representive Bentley votes yes representive Ladyman. Representive Ladyman. Representative Deborah Ferguson. Representative Deborah Ferguson representative Womack. Representative Womack. Representative Mickey. The representative may give votes now represent of Eubanks. Representative Eubanks. Representative Wardlaw. Representative Wardlaw. Representive Wardlaw votes yes. Representative Miller representative Miller votes yes. Yes we on here. Sir representing your bill is fail thank chairman thank you Committee yes. Members I have several bills president I'm trying to see if there's anyone here that wants to present a bill. Yes. I move forward to take charge year and I'm gonna get senator. Twenty four she's got with. All right. Representative Johnson you are recognized to run House Bill twelve sixty one first thank you cadd Mr chairman committee this is that treat triage transport bill the ambulance bill that we passed a committee and out of the house for a few weeks ago went down to the Senate we did an amendment on the Senate in to help with some language that some of the insurance provider's word about this just come back down here for us to concur with that amendment be happy to answer questions. Say no questions we do have a motion. to concur I represent Wardlaw any discussion on the motion. I just hope they don't roll call the. Me to represent. All right. All those in favor say aye. Any opposing of. You have passed the concurrent the concur we've concurrent. Don't you do it. You put your hand. All right congratulations you've concurred with something. I know you're recognized to present as B. seven nine members the emission amendment to this bill if we could pass out that amendment that be great. This is senator Hammer small. I'm blaming him because he's not here this is a bill that passed out of this committee went to the floor get re referred to committee because there were some language issues that need to be cleared up with the Department of Health the nurse practitioners this is all agreed to language that now I think we have a very clean bill this is a bill that again was just a cleanup language on that independent practice nurse practitioner bill that passed last session and I think we finally got to negotiate an agreed upon bill and have to try to answer any questions are there any questions from committee on the amendment. Say no questions we have a motion to adopt. In discussion saying none all those in favor say aye. The post a note in congratulations you've adopted the amendment you're recognized president Bill the bill is as discussing amendment be happy to answer questions and questions from committee saying none of so no one signed up to speak for against we have a motion and discussion on the motion. As amended of course yes make a motion to pass as amended of a discussion in all those in favor say aye. You oppose. All right congratulations that's built. you're now recognized president House Bill. Seventeen thirty four. Members this is a bill that amends this statue called the patient right to know act this is a law that was passed that some time ago to insure that discounted care when a physician or healthcare provider leaves a particular I practice self whatever reason news and other we're doing a couple of things in this bill this is again this is a negotiated bill between providers and hospital association who are some of the main employers of the Haas of the physicians and health care providers to get called into keeping up with the regulations outlined in this bill in said that what what this bill does is is that it requires that a practitioner is relocating the practice to notify the hospital certified mail really it's been sometimes where there's been something as simple as just a sticking out I put out to this requires the provider to provide appropriate dedicate vacation through through certified piece of mail Brosseau in. Changing some of the ways the damages are collected so the way it's written right now it's open ended and it's it's a thousand dollars a day per violation the way that's written there is there there is no limit to what that can go up to an actual damages this is just providing a limit to that and I'll be happy to try to answer questions on this bill. Do you have any questions from committee. Seeing none does anybody signed up to speak for or against the bill. represent Johnson you're free close to bill I'm closer bill percent did not make a motion to pass well a motion to passing discussion on the motion. Seeing all those in favor say aye opposed say no graduation fashion bill thank you I do have a I guess is the next bill seventeen seventy eight okay yes house bill seventy seventy eight that we we created a graduate medical expansion residencies mansion Board at twenty nineteen in doing that we use some language that has since been deemed question with constitutional change in that language to to meet that requirement they were also change the composition board so that we can make a concession for the new medical school that's being built up in Northwest Arkansas so that they can also have a position on the board at this this is also negotiate a bill with you and that's the ultimate schools in the state hospital association medical society everybody agrees these changes we're making to the composition of that graduate medical education expenses. All right to any questions from committee. Seeing none of them seem by signed up to speak for against you're recognized closed building closer bill make a commission to pass I have a motion a discussion on the motion. Hey none all in favor say aye. Impose a no. Regulation page bill I do want to run the streets with the permission of the committee The chair house bill seventy five president Pilkington he had to leave he texted me and asked if I would run that bill for him I've read that bill I think I understand what it does to be happy to present the bill. You're recognized go ahead so as I read this bill members this is requiring informed consent before a healthcare provider of surgical masks and a patient I think what he's getting at here there's been some complications in the past with the surgical masks he's just asking that healthcare providers provide appropriate informed consent about they're gonna have meshed pretty and that they're going to it did there are risks associated with the surgical masks and if it's an emergency situation where they have to put it in certainly they're allowed to do that but they need to inform the patient within forty eight hours the patient and consciousness this is what we needed to do and I'd be happy to try to answer any questions on this. We have any questions from committee. Seeing none I don't see why I signed up to speak for against three close I'll close we have a motion do pass on tabling discussion on the motion. Seeing none all in favor say aye. The post say No graduations you pass the bill thank you Mr chairman. All right. It members you don't mind let me take a minute just to look through the agenda I don't think there's anything remiss and I know it's late evening but I'm trying to be thoughtful to members because that I'm concerned if we don't get things out to not that we may not be able to get get anything out. In recess for two minutes I've got you on the clock. Members were gonna called called back into session represent will understand you're prepared to present a representative pelicans bill seventeen eighty six is that correct yes you're recognized I'm a committee that we help from representive road absolutely Members of you follow me there bill it's pretty simple it adds one sentence in the statute that if abortion is going to be performed for the life of the mother that it's performed inside an emergency room or hospital I think we can all agree that's probably the right place for that to happen is probably where the mother is going to be anyway in that situation so it just makes it a lot safer and not with that I won't belabor the point but I appreciate a good vote and let represent road at anything if if need to be. The representative said perfectly appreciate a good vote. I see no one signed up to speak for against the bill I make a motion to pass a motion to pass so as favor say aye hi oppose ayes have it graduates you pass bill. The members I don't see any other bills on the agenda right now and we're gonna go ahead and turn it back on thank you.