Joint Budget Committee

Can go and take your seat seven thirty we're gonna have a pretty tight agenda this morning because we're going in session at eight thirty so if you're back make your way to the front got some conversations going take him out and then we're gonna go ahead and get started so with that chair sees a quorum first up the any comments no comments by the the co chair and so I really kick off things without a B. one. The thank you Mr chairman. On the agenda today are American rescue plan act of procreation requests that require approval by this committee this is to provide appropriation or spending authority for these rescue plan appropriations the first one is item be. And if you turn the cover page. You'll see attachment one at the top and I to be page one. This first request the Department of Health the program is for alternate care facilities. This is to increase hospital bed capacity at the Baptist health main campus in Little Rock Van Buren and enforce Smith the request is for thirty seven million six hundred and eighty thousand dollars Mister chairman. All right thank you I'm going to go ahead just opened things up to two questions and as we have some folks that make him testify will do that Senator. Hammer I'm Senate seats right you're recognized thank you Mr question on May is gonna be for DHS because are mentioned in this so could we get our department health I'm sorry Hillman if if we go ahead and has my from department health come up again is recognized for sale and then we'll just go straight in questions. Rename Mallory chief of staff Arkansas department failed. Thank you more miss Mallory over here too far left over here further left they're going to come on Page two said to help me. Help mitigate the. What a bot you reached out or there's arrangement made between permit health and Baptist health which have problem was I have no problems Baptist health I'm just wondered who else did you reach out to and we're other hospitals in the state that are not geographically served in this plan reached out to to ask if they want to participate in this also or why was it just Baptist health we did not at the beginning and senator Hammer because Baptist was the one that built out beds for us in the during the first way and so we reached out to Baptist to see about using those utilizing those bets. Okay and. Regarding how the funds are going to be used as this and I was trying to stand through this quickly is this just gonna be for staffing is that the intent of what the money would be used for it is my understanding the majority of this funding is for staffing yes now we have representatives from Baptist here that you know can go into the details of what say costed us out okay in this one and then of or drop off Mr and what a what I'm wondering is the money is going to be used for hiring out of state nurses that were going to pay more money to them then we are taking care the ones are gonna be here after this is over and I'm just curious about the dynamics of how this money is going to be used in if it's strictly gonna be out of state or how that's going to be utilized. Again I would refer to to the Baptist representatives is it's our understanding that they cannot get the nurses that are needed and I think they're looking at a hundred and seventy plus nurses for this proposal and that the nurses are not here not in this state to to be able to obtain so they are looking at out of state contracts to do this. And we just went through a bunch of health care which under the emergency proclamation we gave the governor a lot of latitude to change a lot of things in order to help move some people up the chain have those have those been implemented yet to where we know that what we have in state. It's going to be able to be adjusted in order and used the money to help do that instead of spending the money for out of state nurses I think there's a different proposal on the table to be able to do what you're talking about that I would refer to others to answer that question all right thank you Mister senator Hammer I think that's me later on in the proposal from DHS and members I just want to kind of make sure to keep things in order so if you have questions for map as you go ahead and just under your you're mocking I'm we'll come right back to that but right now it's just focus on Department of Health so if you're in the queue my assumption is that your one talked apartment health okay. So. All right Senator Ingram you're recognized. Well this is of a little bit broader than strictly the department of health of the center of it if the chair would give me permission I would maybe like to address some things from the Committee perspective that we passed out yesterday to come to this body. First. The American rescue plan of the Baptist proposal that we're looking at for thirty seven million dollars was brought before the American rescue plan committee on. Wednesday. The other two of a approximately three hundred or two hundred and fifty million were brought to the committee yesterday afternoon and we were given basically I was given an hour to look at this proposal all these proposals are in front of this body today. There are a lot of questions about these of that is far as own own on the part of the nursing homes it there's a lot of questions of is there are relate to the the rate of pay is widely varies for nurses from what bad this is is is talked about in in the committee to what unity is talked about in committee. And it the thing that bothers me more than anything was that the Department of Health reached out to Baptist. I am was. The to use the word let's just say ignorant of the fact the unity had bids that were ready to go. All they lacked was staffing. And I ask Dr Romero yesterday. Are you telling me that we've got so many hospitals in this state that we came whole every hospital in this state and know how many beds that are available for covid and how many bids that we have that of are just lacking staff and he said they had not done that they couldn't give you the only number they can give you is the number of COVID beds that are available not beds that could be available immediately if it just had staff. Now I think Joe Jett not get on the phone. in half a day in call every hospital in this state and find out how many bids there are that would be available. If we had staff this stuff is B. as haphazard. A small size I have a ask in these committee meetings Dr Romero. Gives great facts and figures about what's going on what's happening day I have asked for three times for him to provide me that information this is over a three week period I've yet to get that information it would be extremely helpful for the public to know that for all of us to publicize what he's got a but he can't get that information. I am very uncomfortable with all of these proposals I would like to ask you all to think if you are not comfortable with the. To run this back through here in A. L. C. we need more eyes on this then what is occurred yesterday and what's going to occur in here this morning I understand like all of the all the desperate need for beds for people in Arkansas because of this crisis but I also understand we've got one point six billion dollars and we're going to spend over in here today over three hundred and fifty million of that thank the the same manner as the administration broadest three three hundred million dollars in broadband we had addressed a hundred fourteen million which needed tweaking which obviously we had gotten that so as you ask these questions you here today I just want you to be cognizant of the fact that we can put this back through of peer in a LCD got a lot of eyes on it because as far as I'm concerned I'm not comfortable at all with the level of scrutiny that went on yesterday and I'm worried about today thank you for the latitude Mr I think Senator representative voting you're recognized for a question for department health. Thank you Mr chairman I will I will. A little concerned or curious about that the year in these two requests from the hospitals I understand the long term care situation in a course is applies to but there's two hundred and thirteen new nurses. That are going to be required in unity has had numerous nurses quit and they had one day I think I believe they had nine test positive for covid so how were they going to get these two hundred thirteen positions and well over the certain do we have all of these beds available when we what I haven't they come forward about the hospital bids before now I think I can answer that question represent including unity is talked about it for a while they prepared for about a year and a half when they thought the regional surge is coming they set up these code I see you business of the code other couple bids on the other campus in town and so they've been setting in ready waiting for the day that they would be needed and as far as an outlet to speak the staffing you know directly themselves but the the goal in the commitment they have is that these nurses will come from out of state and I don't know how much dialogue use hand with unity but I know this at any given time there are thirty patients COVID patients in the hospital and there are seven to fifteen that are emergency room waiting for beds you know as well as I do that were you know generally a regional hospital and we full from a lot of north central rule areas where there is a lot of need and so that's why the proposal exists today I've been talking unity for a long time about the surge that they're actually having in the hospital right now with COVID patients and the need for beds because again we have the conversation we're shipping code patients out of the state and not able to give them care here because we don't have the facilities are the best take care of them. And so again we'll bring up the hospitals when the time comes but as far as you know that need their goal is to not drain or hurt the other hospitals to make sure that we're taking care of these patients with new bodies that do not currently exist in state of Arkansas for the nurses. Well I understand that Mister chairman but my my question is. Relative to. We we have been told and in the past week that is a staffing problem and not a bad problem I'm not opposed to what we're attempting to do I'm just curious about we're going to find two hundred thirteen nurses house of the state of Arkansas and like Senator Hammer said or we will pay them more than we're paying or nurses is a bit on the front lines for the past few years and I think that'll be addressed it is far as the the compact Paris that's going to be addressed at a later portion but again these nurses are only going to be working with COVID patients in COVID room so there's a there's a little bit of a difference I believe and we do have the need I think they'll testify that we have the need and we have the bets again I'm I'm pretty proud of what unity's done in regards to having that bed space available and you know the the to really be looking ahead and and be prepared they've been prepared since day one their innovative and it is something I'm proud of we just do not have the bodies to your point earlier. Did you have a question for eighty eight your. Thank you Mr thank you. The representative Springer you're recognized for a question eighty age. Thank you Mr good morning good morning thank you for this proposal I think is needed and necessary so thank you very much for sending this to us today I just have one specific question do you are you aware of how many of the patients of the two hundred and twelve hundred and twenty all Kansans are currently hospitalized do you know how many between the ages of eighteen and forty all hospitalized that something you go with this time I do not but we can get you that information thank. Senator Chesterfield you're recognized for a question yes thank you Mr chairman thank you this morning I am concerned it may be for DHS A. U. D. H. S. ID no your help yes ma'am man would be for them was inappropriate and to ask them something is it related to these two goals or in that let me explain Mr press they can get back to me one of my major concern is I'm hearing from so many in House nurses at DHS that they're not being considered as are being paid what other nurses are being paid and I need to know whether that's true or not because if it is we're gonna have to step it up so that we can maintain the nurses we already have as well as bring on other nurses okay my concern and I think that can be addressed pretty well in the the coming proposal Senator Rapert. Yes thank you Mr chairman and of course I personally if have been on the phone with some folks regarding bids obviously and I think it's important that we have beds available for people to remain in the state and so my question is in my discussions with some of the hospitals regarding this the past couple of weeks it's been. Again not necessarily many places was in actual rooms in a bed it was the staff saw it is that is that I want to reiterate that because it really is the staff issue it's not so when they say we don't have a bad it's really that we don't have a bed with staff yes Sir is that correct so so in the end a lot of the of the surgeon lied of need and and I was looking and I didn't get to it yet I was looking for that number of how many total beds that are in facilities that may not be even used just like what Senator Dismang was talking about a what county do we happen to know how many how many beds are available at some of these facilities that may just need extra staffing that sort of thing so that we can increase even more capacity we do not we is the health department Senator Rapert don't know that I think that's what Senator Ingram spoke to we know that the number of licensed bands that we license as far as health facilities but we also know that they flex up and down on those licensed bad simply because they don't want to come and ask us can we add a bed you know once a week when they get the staff what we have focused on and what we are looking at now and are concerned our staff bids because that's where we can put patients we haven't really focused on how many beds are in hospitals simply because even in a in a normal Time that flex those beds up and down so. We'll it may be the House Jody and or someone hospital association I think that would be important for people to know because it It allows us to have an idea truly of the fact that yes there is space. And there's the bill and have those beds but is that really the staff that is the issue because it does change the dynamic we can get staffer we hope we can get staff we provide funding but the idea that there's no room whatsoever left that's that's that's another level of of concern so I would appreciate some feedback at some point on that yes Sir we can work with a hospital association and and get those numbers incinerator we actually started that discussion yesterday and in the end I think the thought is that there's bed space that can be dedicated for COVID use that's ready to go so essentially include light on in your where you need to be these hospitals can also you know put forward a some type of proposal and will do this quickly as we can to to address those ending up with the one thing to keep in mind I think is we don't need to be cannibalizing nurses from one hospital the next in the commitment here for both of these institution at least my understanding is that these nurses will come out of state which will then be a benefit to these other hospitals in nineteen. Well I reader what I stated which is the the the whole point is is that we have staff available to handle them and not it would be nice to know what that university is as we deal with new variants we're have obviously we now know that many people do have the vaccine are getting sick and so those are issues that I think would be important for us to know just for capacity purchase thank you yes Sir thank you. Represent Johnson recognized for a question. At some point I'll get this figured out. So so I personally have been in the hospital in the emergency room working. Throughout the summer I personally been in the are working the last week and I can tell you firsthand the situation you know it is a site it is a staffing issue I think I think probably every bit every hospital in Arkansas has empty beds you know if you think about the role hospitals and again I'm I'm gonna get to a question but I appreciate the opportunity to dialogue that you know if you think about the rule hospitals in Arkansas and what they can manage a committee of the rural hospitals or entity all the time right we have hospitals that were built to manage twenty thirty patients because of the way medicine is moving towards a specialized urban urban shift these beds are sitting empty because we don't have specialists in these facilities to care for those kind of patients so every hospital in Arkansas there's a delta between the average daily census which is something that I think we contract correct. So the average daily census for every hospital is available that's the total number of hospitalized patients every hospital also I would I would think with the Department felt as a registrant licensed beds yes Sir so so to get to the number there base looking for simply a simply delta the difference between the total number of licensed beds in the daily census reach hospital that should be easy to report but it's not as clear and simple as we're trying to make it because for a lot of these hospitals especially the urban hospitals they have licensed beds that are functional so you know that some of the hospitals maybe license for four five hundred dads because and you know they're older hospitals and we've gotten to where we hospitalized less and less people overtime and so even if you hear a hospital maybe license for five hundred beds in the mail we have two hundred fifty patients in the hospital that doesn't mean there's two and fifty functional beds and so even with that math that's a hard number to get at and then Furthermore when you talk about covid. The the candidates we can treat covered patients in a pretty specific these need to be negative pressure rooms they need to be set up a certain way and so again if we want to try to oversimplify this problem we want we want to simply answer to say okay tell us how many beds we we have term tell us how many beds are empty but but is there is no real simple answer in this problem because when you're talking about COVID patients you know that that's different at the staffing is read it you know and everybody I think it's coming round of this understanding I hope at this point to the staffing is the critical issue and I'll you know as to get to a question I think the timing of this is important would you agree that we are currently in a dire situation where time is of the essence and we're competing against multiple state for a single resource yes Sir I I know that that Baptist can speak to this but you know that the companies that I've reached out to I mean date they have told us that state you know submitted this proposal is that change in every day you know it's kinda like the PP issue and the issues that we had at the beginning of the pandemic people are buying out stuff out from under us so so it is a critical you know the time it's time critical yes Sir thank you I don't have any other questions. Russian Fortner recognized for a question. Thank you a I'm over here for clarification is the total forty eight million of the first of number one and number two is that for staff only I'm hearing that the beds. Are probably available is this all for staffing and if it is what time to discover a month a year again representative Fortner I would I would. Is it an you know Baptist has the details and unity has the details but it's our understanding the majority of this funding use force these nurses and others medical staff that they want to bring it yes are in for a period of sixty days both proposals or for a period of sixty days forty eight million dollars is for sixty days that's a lot of salary yes Sir it's four thousand dollars per bed per day. Earners. We're we're paying per bed per day now what do you know what they're details are and they are they here could they answer that call yes are they all like to know we have representatives for both proposals even if that invited by three shifts that still might expenses we have them here okay could I have that answer. It would that's that's what we said we're we're going to you know go through questions with the department of health and then we're going to circle back and then the hospitals that you know have representatives here they're gonna answer questions so that that's thank you Mr Jones were read the process right now Representative paid you're recognized for a question thank you Mr and I have a specific question for the Department help with this question is also going to be extended to the. Recipients of the money so we know there's a staffing problem shortage there's labor costs are going through the roof and we're looking evidently out of state to try to bring in staffing and that's gonna be expensive we need it we're in a we're in a crisis and we need it. has the department of health. Developed any concerns over the fact that some of these entities are demanding and mandating that their staff be vaccinated and we have a lot of the staff that is refusing that. And how that plays into the equation here. If we're going to use taxpayer money to prop up their labor force and yet they're doing things that are contrary. To the end goal which is scaring off part of their labor force has the department of health. taking a position or or developed any concerns or done any math Dunning's figures on how much this is affecting their the crisis no Sir we have not so so far the Department health is ignoring that I wouldn't say we're ignoring that but that's a business practice for the hospital any entity and we we don't. We don't have to tell them how to conduct their business every day well I have several businesses and I appreciate that the government does tell me how to conduct my business and a lot of areas and and tells me how much I will pay somebody for overtime and and I have restrictions on what I can demand a vine ploys that are issued by the government but in this case the taxpayer's. Are you pay in the labor force. So if the taxpayers are going. Hey the labor force I think get compass gives us a seat on the board. And I think it's time the department health. does some research and figures out some numbers on how much staff they're going to lose with these demands and then I'll be asking questions of Baptist immunity about whether or not they're going to be making those demands of their labor force thank you Mr. Senator Hendren recognized for a question. Thank you Mr chair and I I want to thank representative Johnson for his comments because I think it is hard for us to understand the complexity of assessing the status of hospitals in the status of staffing shortages. But I think all of us know having talked healthcare workers there's a crisis in their exhausted and they need some relief so I heard from the previous question that we're talking about forty million dollars is gonna lie sixty days correct yes Sir so as well and I guess the hope is that in sixty days are numbers begin to come down and we can begin to taper that off I guess what I'm asking is will there be a time in thirty days or so that you will make a decision that we're going to have to add another thirty days to this in order to not be in a crisis and all these people who come into the state to fill these needs not known about be employed next week is our time line on when you would bring additional request we will we would be monitoring this closely that's what we've talked about is thirty or forty five days the with the trendy is and Revisit what we need today but you think that would be within like thirty days of the termination of of the sixties so again that we don't end up in a in a crisis with trying to make a decision with a week's notice or days notices Senator Ingram yes Sir we will do our best okay thank you. You have representative love you're recognized for a question. Thank you Mr It just framing first of all let me say I've been listening to the conversation before I got here and I do share the concerns of sentiment Ingram has This is a this is a lot of money other proposals were put together rather quickly not to say that the need is not there because I do understand that the need is there but I want to ask Department of Health this because I don't want us to be so short sighted then we're missing the bigger picture we're talking about labor force. And we're talking about nurses and we have a number of schools around here they have nursing programs. Is the department of health working with other higher ed or any other institution. To to kind of bills to try to bolster our schools now so that we can produce more nurses instead of looking outside of the state to get the nurses. Yes we we work with the schools to do everything we can to to get more nurses into nursing programs whatever we can do along that line we do you know I'm and I'm a nurse by license and you know it we need more nurses that you know that's just how it is yes so the answer to the question representative love would be yes okay so I'm I have a follow in because I heard that you all saw Baptist health out to work with them to to put together a proposal or or something to that effect. Okay I assume that the department of health is going to do the same with the nursing programs around the state so that they can bring a proposal together so that we can bolster our nursing programs. Because if we're talking about a nursing shortage and we're talking about going out of state to get nurses and I like I said I understand the need. But I want to see a long term comprehensive plan on how we get our nurse and. Our nurse these are nurses from in state so number one that the funding that we have is not going out of state it's staying here but number two we have a a long term strategy for how we solve this nursing problem because in six months just say for instance of the not the numbers going down in a month and then it three months to nurture the numbers go back up we'll be doing another proposal like this and be so much money. We have to have a long term comprehensive plan to address this and I can part of that representative love that's an item for okay that's to address or in state nurse issues and then also I think part of what we've done in this session will or not prior to the session within the emerging decoration what's the sum of the requirements that may be in place now to to ensure that we can staff up as quickly as possible with the folks that were churning out of schools you know today and so I think you know that that's part of I don't speak for you but that's my understanding that's the big reason that we approve the emergency declaration was to be able to to do what we could to staff up with our in state folks and but but the the the pay issues and kind of an issues use that'll be an item for one okay yes I think this one's going to present them or then I'll say then thank you Mr thank. All right representative Ballinger recognized for a question. Thank you Mr I'm a follow up to represent Payton questions without piling on the silly but. Currently you what is a roughly about thirty percent of healthcare workers are not vaccinated that the numbers that still pretty close is to physically right yes there is so if that's the case then I think that would make sense for the the Department health to start looking at this is a really a potential coming problem because we do have a lot healthcare facade to facility required the vaccination at and then we'll and it's at least at this point made promises of terminating people someone who worked away through pandemic if they do not give vaccinated so we we really could be facing right now we're at crisis as far as bed space because lack of personnel if we terminate a lot more people that we could be even more so at crisis so I I would just say that the Department health really should be looking into this try to assess the best you can what that is and and that way we can have some idea of what we're facing three months from now okay representative Ballinger will work with a hospital association to see what we can do along along that line thank you. All right. Representative Scott you're recognized for a question. Thank you Mr chair I have a question I know it I'm over here sorry it might not be just a simple answer because this issue is so complex but do we know I know representative Fortner you told him the average cost that in the proposal or Pam four thousand per bed is there some kind of data or information that would maybe educate us on how much its cost in this state or the patient for us to treat just the average state of a co the patient. I know this state might very depending on how long they're in the hospital but there is there some number that you can tell us that we're paying kind of per patient just at their stand this many days this is how much it's costing us to treat a co that patient we do not have that information now at their agencies and organizations may have that we do not now and we do not that at the during the first way we worked with the VA and and the permit cost for the VA was Sixty four hundred ninety five dollars for a for an I. see you bet per bed per day per day per bed per day yes ma'am so this this is this is less than that so that that's all I have to go one okay with thank you. I thank you to our Senator Hammer I think we started with you will. You may not hospitals you got a question radiates. Okay. Okay. Well I am a thumbs right there thank you I have a question of the chair we've got for proposals before us we're not getting answers to questions about this one because we're waiting for the other three come up behind are we going to vote on each of these one at a time or you gonna let it cycle through and then we vote on him as a package or what's the chair's approach well my my approach was taken one at a time so you know and after we finish with eighty agents covering questions on both the first two items Baptist will have represented come that can answer questions I December that point a good vote and then I move on to the next but I mean I'll if there's a you know will the committee to wait then that's also something we can do okay but by my approach when I sit down here today was you wanted time okay because. All I Want to maybe DHS was mentioned while ago about about the emergency their proclamation that we passed they're supposed to be getting these things in place and I think that's a critical component to making a decision about this law now that points taken in so we can an imminent date with we're going to do that what I would like to do then is let's limit some of the debate that we're doing answer the questions I understand that there's some points that need to be made in some concerns that need to be vetted heard but if we can just kind of expedite the process is good the questions then we can get to that a discussion on the overall package if we can do that as a kind of a compromise we can come back at a principios addition each one and then vote of each one in the end okay so okay all right how many how many thank you how many patients have been transferred out of state right now that are COVID patients that have not been able to have a bit found in Arkansas I don't know the answer that senator Hammer who would know that we want our our patients we would just have to survey the hospitals for that information. But that's one of the arguments to be made here today is this is the reason we need to do this because patients are being sent out of state but we don't know the answer the question right here now as far as how many we just know that patients are holding in hospitals in the ETC's and not being able to be transferred okay and do you know if they're going to require all two hundred seventeen workers that are coming in from out of state to be vaccinated as a condition of higher and are the specialized to COVID unit requirements so that all two hundred seventeen are there to conduct a specialized unit that's coming in. I would let Baptist in unity answer that question okay I'm sure there's there's specialized vaccination I don't I don't know the answer to that okay and if you look at the hospital association proposal. As have you been involved in the hospital association proposal on the list no Sir okay so you don't know or do you know this is based on four thousand per bed I'm just wondering how that would compare to the hospital association proposal that's on here and why one would not be sufficient and we need both but you haven't been involved in those discussions no Sir okay and then as far as the Sturch. I lost it thank you Mr thank you. All right resin Payton you have another question for eighty eight sure you ready for Baptist or what's that. Okay. Thank you Mr this is pretty short amend a minute ago you mentioned we were paying little over sixty four hundred dollars per bed per day for VA patients that's what we pay during the first wave we're not we're not in contract with them anymore okay well I was going to ask if that bill is going to be reduced and the with this four thousand dollars with their own and so we're not thank you try to make them thank you Mr all right. All right members again now to get Questor Baptist would put yourself in the queue let's try to run throughs of those quickly can we got about twenty minutes I think some pretty important items to cover if we can we're not able to come back in here one reasons we're here today doing it this way so we could have a discussion about it is opposed just signing some of these things out between the pier in the AS the chair so I represent Ballinger in if there's a question started gonna ask let's not circle back through and do it again in this kind of keeper points to the end Senator Ballinger you're recognized. Thank you Mr at my questions for was for Baptist at this point you guys do not have a of mandate for backs nations on your staff is that correct and then then my follow up question would would be whether or not you intend to put backs nation any man is and recognize yourself and we may just expedite things of all three including unity assist public proposals are similar we'll just let you all take questions to try to expedite things that if all three of you could recognize yourselves and then we'll just get to the questions quickly some regardless of the president of the central region from Baptist health. I'm branch believe the chief financial officer for about the self. Stephen weapon presidency of unity of. And so to the question for Baptist of vaccinations and of staff we believe in the collaborative relationship and collaborative team building sort of jam something down somebody's throat doesn't make for collaborative team this body disagrees on a lot of different things yes I'm sorry. Start over apologize second time this room I'd rather be at the hospital so I apologize the truth is we don't believe in jamming something down somebody's throat we will try to have a collaborative team building model I work a lot of professionals and so just like this room you have disagreements to try to work across the aisle to find common ground and so that's what we got it Baptist health and we start at the very low vaccination rate among our staff or up to seventy percent of our staff members we believe that's the way you build a team that lasts you work with each other so that is our philosophy that model we've grown more more more team members vaccinated overtime and that's kind of how we're handling the vaccination. It in the honestly of unity just want to answer that question I was going to ask them as well as a resident yeah. Yes Sir very similar to what about this is the we feel like we have professionals working organization capable of making their own health decisions. And one follow up real quick we are you guys that would you have any problem with hiring somebody who is terminated from a hospital because they didn't want to get vaccinated. Mr would be glad to hire them thank you very much. Okay all right Senator Hammer you're recognized for a question. Thank you Mr the the two hundred seventeen I noticed in your proposal that you guys if you get clearance for this today are going to be able to have this stood up ready to go by this weekend if I saw that run my interpreting that correctly. Of the original discussions had an approval date earlier of based on our understanding of the timing we did have some stuff lined up we've past that date and I've been clear in those that we will do our best to to get a staff here is fast as possible to get those beds open but that data is fluctuating so we have passed the date that we put in our proposal that said it would be open this weekend we do think we can get beds open quickly and Mister crane can speak Tuesday closer to the details but we have passed the proposal all right so you have the you have the up mechanical things in place but you don't have or the bodies in place and of the two hundred seventeen that you're planning on bringing in you'd be ready to put in place how many do you know how many patients have been sent out of state because they could not get a code room in state that comment was made well go do either of you all of that I don't have the specific day for the state I can tell you what I see in my system is that people can't get in to get taken care of that have governor don't have co but I was here earlier this week talking about the Monday fifty two people spend the night across Baptist health of yours in the emergency room because we couldn't find an inpatient bed it had to wait for the next day so that's a concern I don't know how many or transferred out of state Sir I'm sorry I don't have that information okay and then with regards to the issue of we're gonna be paying these nurses are coming in on a contractual basis you're gonna have to lock in and I guess for sixty days just to get in here so the funding is up to this amount do you anticipate that the whole amount would be used or is it possible that if we turn down the code right next two three weeks being optimistic up are you gonna be obligated for the full contractual price you're gonna have to make with the two hundred fourteen employees so we could count on all of this my. Ani being gone regardless so it's contracts for services so you go out and you make a contract with an individual to move here and to take that so we would be out committing and just for the record is not just nurses that are needed in the state it's respiratory therapists it's other personnel other clinical team members that are needed the preponderance is nurses and that's where the biggest Amanda so I'm not overshadowing that by any means but and it is an eight week to thirteen week contract that you make with these individuals in these companies to bring folks Senate so that's why the numbers are going to how they laid out in the hospital I'm sorry in the hospital association has a pole so it seems like you are going to get this place should benefit from the hospital proposal if we releases side here we're talking about two hospital networks and please don't take this personally but I've got to hospitals in my district I'm just curious did you reach out to them who reached out to all the other hospitals to include them in this so that if they had rooms that could be stood up so that people would have to be transported we're talking about ambulance transfer as well and I don't see that covered in this in anything and I just don't want to be I don't want the silo within the look and find out when I walk out of here that other hospitals in other parts of the state Senate we could have done this to if we would been asked I'm just trying to figure out who got asked who got invited to the meeting and all the other hospitals going to be okay with this if we do this. so just a couple thoughts on that question one we do have current nurse you mentioned earlier of issues and pressures and AJ a proposal for based on what I've seen is there to help hospitals throughout the state solidified the existing nurses you mentioned the folks standing next American Lawson we're very sensitive to that fact we spent many hours working on a plan to address is that uh with or without funding we're we're gonna have to do something there this specific proposal of which is separate and is Mr current pointed out is focused on bringing in a hundred seventy plus RN's to create additional capacity so this is above and beyond what we've done we saw the need in the state and we responded and said Hey here's something we can do when the idea was there of other facilities I thought Hey they may see this and take this is a model to be able to use and and and I would encourage we didn't really have time due to the emergence and the status of it to reach out the consensus on the so bad to sell so here's the part that we can do there's a huge amount of risk involved with securing four hundred plus care givers so hundred seventy those nurses although we've got support staff restore therapy physician coverage that's key we talked earlier about beds being available in the specialised of the bed the nurses as part of it you need to position health care for those patients as well and so the emergency rooms that are going to be accepting additional patients need additional support cleaning EDS or environmental services hugely important we're struggling there right now so to commit to this level of increase which we saw as the State need that's that's what this proposal is based off of and we did believe that others may follow that of the. Sixty day of when we look at this and it's in our proposal is and and it's towards the end of our proposal reset that we're committing to this for sixty day or view of the US was really getting some assistance with the risk associated with it well acquiring this committee individuals and bringing them in state but then we did believe that once if if the patients were to come because you know last time COVID was really surgeon it kind of trickled off their so that there's a lot of unknown here that if we lock in for two months to three months that we get protection against that but if it did continue to search other some of that that we could bill for that would help us to stand out longer period and we did put that on or proposal that we I couldn't guarantee because I can't predict the future but we did believe that if patients that come in if the needs of the search continued if the need was to continue those beds that we'd be able to use Billings to help support the future and you can't find two hundred seventeen nurses in the State of Arkansas that come out of retirement that are capable of stepping into these units Shorty done because we're about to bring a lot of people in from out of state paying higher wages than what we're paying the people they're gonna be here after this is over I guess that's part what I'm wrestling with there's is there opportunity to provide this to in state people that would meet if you put out the call verses out of state thank you so the the man and healthcare for twenty six years the nursing shortage has always ebbed and flowed it is been there for the twenty six years that I've been there it has never been more cuter exacerbated by the increased demand and caring complexities the volume that we're seeing today so you know we were talking about the nursing schools earlier you know four years ago Troy wells asked us as a strategic vision to double the number of nurses we graduated at the Baptist nursing school four years later we've done that we still have a huge. Vacancy rate regardless of what was going on with code before before COVID we had a significant vacancy rate and nurses this is just continue to outstrip that supply. So I'm. Yeah and in addition to to that internally to your comment about retired we've done to say well we've done two things about this and then also in department health in the last surge they did send out a request for nurses to volunteer to step up it was a call to action I remember being on the phone referred to it is war time and saying no one's gonna come save you for the US and so what we gonna do there were some names that came from that those been better those are being put on us as potential resources here locally about this too we do have another thing we've done is we do have some nurses that were at the bedside and have since moved on to board ministry to functions we're not asking them because from a professional perspective it's risky for them to go back in after some years of not practicing of what we are asking them to step back and help in certain ways to help support our existing nurses so that we can lighten our load we're doing that of nonclinical I'm I'm a medium scrub of figured out what size group aware because it will be volunteering to deliver patient meals and so we're. Do we gain. I thank you I representative Johnson you're recognized for a question. Thank you. Strong maximum mark was on so at there's a lot of issue being made about the that the contracting of nurses you know in what what I to call refer to miss travel nurses I mean it to help help me understand I think I do but also I think just for the committee as a whole this process of contracting to get these nurses here first of all is that something that's already being done by hospitals all throughout the state right now and it's something that's of this been done throughout the pandemic is that fairly common practice for shoring up your nurse shortages solid Stephen definitive but absolutely I means over to twenty six years we have ebbed and flowed my and my career we have used different levels of contract nurses depending on the service that you're short of but absolutely I'm gonna call every week with either the hospital CEOs or the regional CEOs here and and I'm the metropolitan area of Little Rock and we talk about the fact that you couldn't get contract nurses and we were all trying to to get contract nurses we have a strategic opportunity my opinion right now or other parts of the nation have don't have the cover demand that we do and so we have a strategic opportunity to garner those for the you know the age of thirteen week contract that opportunity I fear is going less so I'm sorry did answer questions we have used contract nurses and everyone is out trying to get those contract nurses if I can follow up I have a couple quality that one would be so to understand that process better the hospital's not contracting individually with these nurses correct they're contracting with an agency in the agency actually recruits spends money to recruit spends money to bring these nurses here in travel spends money to pay bonus incentives just a sign on bonuses so when we see a number like two hundred fifty dollars an hour for nurse is that straight pay for nurse on an hour. Early rate or is that sort of the total cost average for the whole package getting them here recruiting them traveling the whole thing help us understand that that is absolutely correct that I think that that number two hundred fifty kind of got taken out of context I mean not that was the an average when you bring it we have physician's rest with their prisoner says I think specifically to nurses and nursing contracts you hit the nail on the head of exactly how it works there's a rate of pay whether it's a hundred dollar hundred ten dollars and a lot of that money goes to the company and then what goes to that individual nurses significantly less right it's so one another question for for care out and I know it's going to be this is this. I understand are sent Arkansas nurses. Are absolutely able to sign on with travel companies and working this contracted environment and and these agencies are going to be looking under every nook and cranny for nurses that these agencies don't have a hundred nurses setting in weight correct ready to swoop into Arkansas and take these jobs even if we start this process today there will be a time lag before these agencies are able to bring these nurses in is that correct that's correct and again you know we start this conversation awhile back so we were out just filling out some of these outside companies for the supply that they had and so back to my common around Arkansas has a high demand other parts of the nation don't or aren't get aren't there and so that creates some opportunity for us to bring in outside help to Arkansas right now thank you so back to the point about not hiring any nurses in the state of Arkansas that's contractually what we've said to these companies and we've that those to make sure. Thank you I appreciate that. I thank you representative will you're recognized for a question. Thank you Mr chairman I certainly don't want to leave this meeting with the impression Mr would have that I didn't know your circumstances and I'm sympathetic to all three of you and I will thank you for what you have done and what you're stepping people have been faced with what you've done there my question is just you know what what per cent and and I realized that we have people in the waiting room twenty thirty fifteen hours it the the of servers. totally aware of that. What what what percent of the problem is staffing verses rooms. For us I would say that it's it's all staffing issue we have that we have the facilities to take care patients we just don't have the nurse's arrest or therapist lab technicians so you would say is a greater percentage of staffing verses room. One more follow up One more follow up I have the and you may not know this Department of Health but. How many out of state patients do we have filling Arkansas bids to that is not in our hospital. And the reason I ask that I hear early home when the search started to that Harrison was getting a lot of patients from brands. We don't we don't. Tomorrow we don't have those numbers representative waiting we do know that at especially probably two or three weeks ago there were patient several patients in Northwest Arkansas that were coming from Missouri. In the northwest or the state yes Sir with the possible to get the numbers you're getting the other numbers for. I think that would be an interesting number understand Memphis I understand West Memphis Fort Smith with their proximity to other states you know but just to find out the number of in that are coming in sure would would be interesting thank you Mr chairman thank you representative of Senator Teague you're recognized for a question. At. The only. Is this chairman would you accept a motion for me yes Sir I move that we adopt this items one and two. Okay and I think there's a planned into come back Monday with emergency ALC meeting to deal with three and four okay so my motion is to adopt items one and two so we can get on with our work okay. Amiata motion rations to. Immediate consideration okay so we've got a motion for a a motion to approve items one and two with a motion for immediate Senate consideration all those in favor signify by saying aye those opposed and that was the immediate consideration now we've got a motion to approve items one into. Motion got a second all those in favor signify by saying aye those opposed motion carries and then my understanding is in this will be center Senate or the the chairs of ale C. will call an emergency meeting will take up items three and four on Monday.