Public Health, Welfare and Labor Committee- House

License to be referred to registering to be a role for and it has some guidelines in here as to you know that you still have to meet certain criteria one of the other elements that is really good about this is that We run ended we hear a lot of times especially if there's a storm chasing kind of situation where roofing companies come through fly by night companies come through that go to somebody's house I can do your roof but you know I need some money down they get the money down and then they never come back so This registration and of course you know it's going to take some consumer education as well let them know that before you give any money over or commit did you find out whether they have a current registration or not but part of that registration also would be a requirement that they would have a performance bond equal to fifteen thousand dollars my understanding looking into this and talking to people the insurance department that that is actually it's up a lower cost to have a bond as opposed to caring insurance you still have to have workman's comp and you still have to stipulate that there are other guidelines that you are following and we can go into those more in depth but I just want to go ahead and kick this off and then I'm going to turn it over to Mister crow took to let him talk about from the agency standpoint why they like the direction of this bill. Mr thank you yes you're recognized thank you I'll close all the same this is industry driven bill this was not a bill that the we at the board came up with it is from the industry into does a lot of good things it removes a residential refers from the licensing aspect Committee turns in mass one to register but at the replaces that with a bond as as was just mentioned What we can do a someone richer office we can take away your licence and that's important tool to have no give the wrong and I'm a big proponent of having that tool we can also take away your registration in this case in the same situation with this loss written what we haven't been able to do and this is get your money back to you when I look at the pressure on people to do it and they do a lot of times we put pressure on that out of fear of losing their their license but this bond will be a wonderful thing for consumers it's so to me it's like it's a great combination of less government and more consumer protection at the same time. So it doesn't decrease the requirements of a row for from what is currently currently you have to have a license and so there's a few things that depends on what level license you have but you might be having to take a test you might be having to give us a financial statement and those things will be gone so does reduce those but on the other hand the in the bond this is better frankly than that so it gives you similar or better protection yes Sir. And there is levied just going to say also abit referenced is the registration process requires a statement under oath that the application applicant requesting the roofing violate the contractor registration that several things that they're at least eighteen years of age the statement we have say their name the physical address or telephone number name of the applicant's business the address of the applicant's business name of all of the person's authorized to act for the applicant's business the statement also would be that the applicant complies with all federal state and local laws and rules is or is not registered certified or licensed as a roofing contractor in another state has or has not been the subject of a disciplinary action in this state or another state as a roofing contractor so there's a lot of protections here and this is all information that would be available to consumers if they have a question about whether somebody that is pro approach them about repairing the rule for giving them a new. Providing a new rough the consumer could contact other contractors the licensing board and find out if that company is currently registered. Representative Gonzalez you're recognized for a question. They Mr can you show me exactly where in this bill that instructs the licensing requirements. Yes. Sorry one second C. All Saints all new language very first learning the very first section section one is the exemption section from the licensing law which is and seventy twenty five five thirteen has a new exemption has a personal interest of one work is a written contract or as defined under seventeen twenty five one oh six so they with the roofing contractors are now it will be exempted under that new think that's exemption section subsection six exam okay okay thank you. Any other any other questions from committee. Yes representative per you're recognized. Thank you Mr chair. I'm looking at the fifteen thousand dollar performance bond. Will that be a blanket bond or will that be a fifteen thousand bond that's required per contract that's a blanket that's that the once. It's not perfect obviously contributed but it's once that fifteen thousand has been spent so if there's three claims on it five thousand each then that will the model will be exhausted is not per contract yeah have you followed Mister chair yes if are you aware if there's any companies offered a blanket performance bond a blanket one I'm not aware no Sir I know wants to do bonds like this that's a total limit of ugh there's a lot of contract but not the per contract That's. If I made a that's usually more of a performance bond bill that enters a cost for that if the government doesn't all the time government projects you have to be bonded and that's that's a complete bond for the project if I've seen a few residential people who want a moment on that's not normal not normally seen in the industry you can get them from but I don't know exactly how that works it's outside my area so the general speaking made the comment in the commercial industry especially in the government building for government buildings and other private sectors they're not very common in the residential industry. Any other questions from committee. Seeing none. A. We have two people signed up Mr Crowe is that right that's I was made okay that's to a one other person signed up to speak for the bill Scott Wallace if you would come to the table. And introduce yourself and who you represent. This just so he wouldn't feel alone. Your twins in the good introduce yourself please. Scott Wallace I'm up president of alliantgroup pros here and in a moment I'll you're recognized thank you. I just I am definitely for this legislation the I got in this business over ten years ago and came from a very different. Business background very professional business background and this is. Quite a bit of a different business to say the least and any protection that we can give to the consumer and help eliminate the issues that a lot of these out of state refers that come in because and and protect our Kansans is definitely something we need this is not a any legitimate roofing company and I've spoken to numerous owners and everyone of them would be absolutely a hundred percent for this because we're legitimate businesspeople there are a lot of people in this that are not and you know we want to stop it from hurting archaisms and this is something that. I can name you ten different people run off the bat of people who have been taken by the state refers to collect money and then they never see him again and so this is a way to at least have some sort of a remedy to get some of their money back. Any questions from committee. Seeing none thank you for your comments and. Sir anyone here in the audience who would like to speak against the bill. For the bill. Representive you ready close for your bill. Yes I am as as I mentioned other several members here they're on the insurance and commerce we have a another bill that has already made it through the house I think it's in the Senate insurance commerce committee that deals with deductibles and making sure that the consumer knows that they have that responsibility well this is just another part of that puzzle to give extra protection to consumers of the fifteen thousand bond may not be very much to cover losses but there are other other provisions here that would protect consumers one being I believe it's on page two that a roofing contractor a person shall not act as a roofing contractor after July one of this year less a person is granted a roofing contractor registration certificate by the residential contractors committee or they're exempt from certification in a person that fails to procure roofing contractor registration certificate is required under the service under this superb subchapter is upon conviction guilty of a Class C. misdemeanor with each day in violation of the requirements to constitute a separate offense so this gives additional criminal penalties for someone being in violation of this and I think this would mostly apply to some of these fly by night companies that come in the chase of storm they come in and they try to take advantage of people we're we're going to be able to help consumers and protect them during probably what is most homeowners most vulnerable time so I'd appreciate to your support and and would appreciate a do pass. It was will the committee. Representative Johnson's may the motion of do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries congratulations your bill is passed thank you Committee. Okay committee we're going to move on to. S. B. three thirty two. Representative Johnson are you prepared to. Yes. You're recognized thank you Mr chair members with chairs permission I do have some witnesses are some folks coming to testify on this. And and I think they're the coming in of from the okay on their way. Okay that's not them. If they could come to the table Yes if you all would come to the table how many do we. Yeah. For. I think there's there's for. People. Okay. President. representantes NO I have a question so we have four people signed up to speak for the bill. Are these the for people you have at the table per perhaps I I don't know who also did everybody sign up here okay I think so okay now we're in the presentation stage yeah they will be doing the presentation Okay but. And we may have to limit the presentation if it goes way too long with this many people okay we'll. I will Basically turn it over to them to present so my presentation is gonna be very short and then go down I think each of them to each have something to say. I was gonna say. If you could have someone be the lead presenter and you all feel free to add to that but we don't have a lot of time for everyone to present the whole. Right. Yes that's fine okay if you would I need each one of you to introduce yourself and who you represent. You can turn that second Michael on their own. Okay. Jerry Harrison I represent Harrison energy partners. Kamarg side director clinical engineering at Conway regional and also a board member for the Arkansas association healthcare engineering. Terence Axio the into the biomedical solutions I represent their party healthcare consultants. But Cummins I'm an attorney I represent Harrison energy partners and who is also a member of the association of health care engineer so indirectly there my client as well. Right you're recognized to present all right in the interest of time I'm just going to turn it over to them let them discuss the president Bill. Originally. Thank you Mr chairman put put simply in the history of. Commerce the United States with someone purchases an item. They don't have to ask permission of the manufacture about where to services. How to repair it or whether they can sell. Because of modern technology manufactures of staff started manipulating their products to insert code and certain certain trap doors and tricks so only they can fix it so they've created for themselves a repairman Oboli. And in the medical industry this is putting lives at risk because it it threatens the capacity of a hospital that is waiting to repair ventilator for instance and. S. the weight on it on one single manufactures rep who may or may not be able to get there in a reasonable amount of time when there are ample qualified trained and credentialed technicians available to repair that item what we have here I want to these two gentleman working the hospital industry this gentleman here is a is a it works in engineering part of a clinical engineering part of the hospital and he knows what hospitals due to that. Repair and get keep keep systems operating and keep them in good repair this gentleman here is actually in the independent repair business for this highly technical equipment and he knows the vetting that goes on in the credit the the qualifications he has to meet to do those repairs the Bill. Will only requires that manufactures. Share these tools the codes and the spare parts. At a reasonable commercial price so the owner of the property can decide who is going to do the repair that's the intent of the bill and the purpose of the bill. so with that I think I want to check I would so the opponents of this bill at. manufactures really only one reason to to vote against this bill if you want manufactures have this protected repair revenue that's unprecedented in the history of American commerce. They they throw around vague allegations that this puts patients safety in danger. And they also throw around it at a. Allegations about elect Lexell property infringement they're hoping that you don't know what how op hospitals operate and they're hoping that you don't know much about intellectual property and that the confusion of to vote against this these gentlemen here can tell you how hospitals operate and that's and I'm going to shut up and let them do that this gentleman that here's an engineering deals with intellectual property issues daily and he can tell you why they are not triggered by this bill so with that I think I'll enter it let's start with drew drew Harrison Andrew if you again tell your credentials and and and and take it from there absolutely a degreed engineer for renters Arkansas about twenty years experience I don't think anyone ever grows up saying I want to be in the intellectual property expert but I found myself here today doing exactly just that so Go it you you want to just kind of walking through real quick that sure some of the highest high points I've got in every copy of any negative selling or scare tactics or fear tactics that have been associated with this bill and I read all of them and and I think that are absurd and I'll give you just one quick example I'm trying to keep my time sort of at two hours I'd feel a lot more comfortable but I'm not going to do that today if any shall have a prime sleeping tonight you can call me and I'll put your right to sleep but that being said one example is I heard about patent infringement now anybody who is understand Pat Frenchman fact I think they teacher in an elementary school if I'm not mistaken the first thing that you do to get patent protection as you take your design a hundred percent of your design what you want protected and you turn that into the panned barman up in Washington DC who turned around attorney and and produces that for public viewing so anyone that says that this infringes on patents Richmond does understand that that's already been turned over a repair man working on a piece of equipment and these can in this guy's hospital is not going to show anymore design features that have already been submitted we going for the Pat this is so true what copyright two you only need copyright protection for items are produced in public. You don't need him if they're not produced in public trade secrets if you have a trade secret in your company you should not share with your employees we are not asking for trade secrets to be shared with this bill what we're asking is for you to share the information needed to repair equipment that's in this guy's facility with that I'll turn over there and we did come prepared but we're not able to distribute some of you have letters that this letter here's is written by political interference recognizes that is as the guy in the country that is most influential guy the drafting of of the accreditation rules for hospitals across the country he walks through every allegation has been made against this bill in the box this letters signed by twelve Law School professors whose expertise is intellectual property they walk through every allegations been made against this bill and the focus be happy to make these available to your razor and the chairman allowed up anti right now but we. No we can't we can't hand those out there is it's an opinion so you can summarize on if you want to hold it at so let's turn it over to the gentleman who can't summarize. Thank you chairman again Karl Marx director clinical engineering for Conway regional also certified health care technology manager and certified by a medical equipment technician. It boils down to the biggest thing that the that the proposed or that the detectors miss bill are trying to give you is patient safety. The FDA came out two years ago and did a study on this whole thing about patient safety and found that there is absolutely no difference between having a third party come in and third party in house or we there's there's no there's no correlation between any higher risk of having an OEM versus a third party or a in house program do this the. It's insulting because. We have we have the ability and it's my job to make sure that the patients are always safe that the equipment is always safe in the hospital that's what we do every single day there are hundreds and hundreds and hundreds of checks and balances that go on with with regards to the different regulations that are put on hospitals the the inspections that we have to go through a joint commission with the Arkansas department of health with the centers for Medicare and Medicaid services in order to get paid for federal funds all these things that it's preposterous to have a a a somebody say that having a third party or having somebody else repair their equipment is unsafe it's it's absolutely not true I mean I'm I'm happy to answer anybody that has questions on on either patient safety or anything if you guys have anything that you'd like to ask me I'm I'm open to questions I would suggest the before we close the queue you respond to the notion that because of this bill whatever one does anything in this bill change the federal requirements or state requirements so you work under number two it. Is there anything about this bill that would allow you or or persuade you to hire anybody that was not qualified to work on a on a device you're recognized appointment at a hospital. No so so basically what this bill does is it gives it gives hospitals more options for repair there there's not a single hospital out there that would be willing to hire anybody that's not qualified in order to in order for me to get my job. It is just like any other job you have there's there's a set set a set standard qualifications that you have to that you have to possess in order to get a position within the facility in order for me to go hire a third party company I need like Terrence with with tips if I wanted to hire his company to come in and and perform service on our on our hospital medical equipment. I've got to make sure that his company is vetted in order to get a purchase order over to him in order for me to get a purchase order for his company he's got to have a legitimate business I mean he's in order to set up a business in Arkansas and parents can can speak to how how it is to set up a business repair business in Arkansas it's not it's not anybody can do it you can't in NO hospital whatever hire an unqualified person to come in and perform repairs on our medical equipment it just doesn't happen it does not happen so. So The purpose of the bill the purpose of the bill is to. Is to Ensure that a hospital does not have that maintains full capacity keeps its equipment in in operation the Max amount of time it does nothing to under cut any rules or regulations that the hospitals operate under and and it it and it doesn't impose any burdens on a hospital phosphoryl don't want to change the way they repair equipment they don't have to fifty or seventy percent of the equipment in hospitals the manufacturers already voluntarily giving this information and and if there was going to be any safety issues or intellectual property litigation flowed out of that we just seen it it's not out there that's a smokescreen hospitals need this we're in a pandemic it's not over I read the paper this morning that the variant is is eight double cases in Brazil we're gonna have future public health crisis there's no reason to leave medical facilities in Arkansas with less capacity because of a manufactures artificial monopoly repair and that's that's what this bill tries secure. All right let me. Just just as a kind of a wrap up to the the opening here before everybody has questions that the main purposes bill in this the the reason why I think this is a good bill for everybody to support and in this this became a much more of a at a. Issue during the past pandemic I think it's something that is probably ongoing issue for a longer period of time but when you have software you have a high dollar piece of equipment. That you have local folks that can repair but a manufacturer during the pandemic stopped their repair folks from coming sometimes even into the State of Arkansas to repair these things and so if they stopped corporate travel get a high dollar piece of equipment that was not able to be used. And repair to get patients. Care that they need and so this became much more of an issue if if a local repair technician either employed by the the medical facility the hospital or outside contractor has the expertise to come in and. You know repair that but they don't have the software key to turn it on turn it off or whatever that happens to be Then they're shut down and they either can't take care of patients or there there may be long delays and in some instances there's not the option of buying an additional piece of hardware to go ahead and take care of the customers while they wait. Weeks months. Okay so pandemic year maybe before those those manufactures can will open up their their stuff to come send people and so that's why this has become much more of a key critical issue in this time is to make sure that our Arkansas. Facilities have the equipment that they need in order to take care of Arkansas patients in a timely fashion and continue to hold hold down healthcare costs as much as possible I think that is kind of the nut shell for this multiple page bill that you have you find before you and I think we've got the experts here to answer any questions I'll shut up now. Representative Payton you're recognized for a question. Thank you Mr chair and seventy five percent my questions got ended up being answered as you close their appreciate it I was wondering about the need for the bill. But the. I would assume that the manufacturer is offering service at a reasonable price and in a reasonable time frame the as a hospital administrator they probably beef topping our list for repairing the equipment with the. Well I guess it depends on what your definition of reasonable cost a reasonable time frame is when you have a piece of a critical medical equipment that's down possibly with a patient on the table so to speak I mean is it is it one day is it two days to get there or is it they call the guy that's in the hospital to come out and and fix it there's been several instances where I've I've actually witnessed the manufacturers repair person on site. On the phone with the main thing with the with the OEM tech support doing the same thing that I could have one of my technicians do if the exact same way but we're having to wait three four five hours the next day two days from now it depends so. So if I get a follow up yes you can so you have technicians than that are there full time on staff yes Sir I do okay thank you thank you Mr. Representa Miller you're recognized for a question. Thank you Mr chair I have a. I have several questions but with your indulgence I'll ask one or maybe a follow up and get back thank you. Shall not be in a hospital administrator if. At the end of the day. This is a business there's negotiations that go on in the business right now do you have What a hospital or or any type institution goes out to purchase equipment and I know a lot of times I have a cousin who is in the medical equipment sales business what a lot of times if you go maybe with with you might get one manufacturer to sell you maybe multiple types of equipment for for whatever you know reason if it worked out good for you but your term up trade secrets. So right now do you have the ability army you have the ability to negotiate. Warranties. When a warranty is voided. Of these top trade secrets and all that kind of stuff right now do you. I'm I don't understand what a trade secret has to do with the warranty. This section here okay can I get opting in yeah what. Okay well I mean what I was what I was referred to a few if you're if if I'm in your position and I'm by and from Payton medical supply company he's probably going to business in this area yeah if I'm buying from Payton medical supplies come in I want to buy a bunch of layoffs some lights from operating room ventilators and fade into machines. All the folks would say are pretty Bob. And US and paid like that we've got a warranty you can buy the five year warranty by the ten year warranty a lifetime warranty there's all this stuff and I'm like okay now one of something happens I have to wait on your repairman. Longer than I deem necessary. M. as well warranty gonna be voided if I have Clint Penzo repair company. Come in and fix it. And. You know in some situations that's why some sense to go she ation party so well you can't but he's not going to have the Clint Penzo is not going to have the the knowledge of our our software are whatever to to fix it so yeah you want to be boarded at that point I would come back to Payton and say. Well in these instances would you be willing to give that is at all something that can happen right now in the go she Asians. And. Well I wanted to quickly say that the bill is very specific that it does not injured or impair whatever warranty contracts makes as I understand I understand that I'm here in front. So I think there's some confusion about this bill because really why this bill is here is because the digital millennium Copyright Act of nineteen ninety eight allow for some loopholes to be created that allowed people to put competitive or anti competitive I should say triggers and their equipment and I'll give you perfect example anybody in this room on the LG refrigerator. Yeah LG refrigerators if they trip off they require somebody with L. G. software to come and reset them even if it's a simple trip now how many of you I don't know about you but if I lose refrigerator my house only have one refrigerator if I lose refrigerate I lose all the food in the refrigerator as well that is anti competitive in fact before nineteen ninety eight that would be a violation of the Sherman antitrust class truck antitrust acts but now with the digital millennium Copyright Act there's some loopholes in there that that allow manufacturers I'm going to full disclosure here I represent Williams I represented only as my entire career that's right the evil OEMs which this bill is based I currently represent about twenty OEMs and about seventy percent of them are plane fare Senate representative then put their trust in this guy right here to choose the best people to do the repairs at his hospital possible the other thirty have entire marketing departments that are currently working to take advantage of these loopholes so here's another example we built a hospital right state of Arkansas and we go to the consulting engineer we go to the architect we say Hey our systems are open we are the easiest company need for you to fire you can put your trust in us because if we don't live up to your expectations you can fire us and then we go into we sell that equipment for very little margins you less than four percent margins on that date because we're just trying to get our foot in the door and then we set by the way was open but you have to have our software to be able to do it sorry you have to hire us that's what this bill fixes fixes that stuff that is wrong it doesn't fit with the good people doing it fixes what the the people who are taking advantage of the digital millennium Copyright Act people who wrote a letter to a lot of you guys last night you can speak about them if you want. What to to to answer your question first I'm not I'm not an administrator at the hospital I'm just a director for clinical engineering but yes I do get involved in some of the and some of them to go she Asians with that now if you have enough if you have enough clout and if you're if you're hospital system is big enough let's say for like a common spirit health you know they they have another I have a hundred and twenty some odd hospitals they have a lot of pull with the manufacture and they do get a a bunch of different breaks if your. Pick a hospital out in the middle of somewhere in Arkansas you don't get that you don't get that up you don't get that ability to negotiate with manufacturers like like bigger systems to and so you're you're stuck with whatever they give you you the take it or leave it. But there are other. Companies out there doing the same thing there are options in my correct are you all the only one who I'm talking to you I guess you said you were talking about. Are there other companies that do what we want I would we are trying to do the right thing if this bill does not pass I will go to the other manufacturers that we represent so we have no choice and I'm sorry to say this in front of you we have no choice but to start taking advantage of the digital millennium Copyright Act. Because. Other companies and other competitors minor starting to create softwares and not and not selling them to other people which creates servicemen I please because that's what they're trying to do to the hospitals in the state of Arkansas I've heard stories from DO we what I'm we work in twenty three of the twenty five largest hospitals in the state of Arkansas because we are the company that tries to do things right. And. Not being able to service you have give other people the capabilities Services quip and walk people and and that's what this bill is trying to avoid. We will get back thank you Mr okay we've got other people signed up. Representative Boyd you're recognized for a question. Thank you Mr chair so. I help me understand just a little bit so I'm I'm trying to it sounds like you're talking about a federal law that we're here changing a state law so it is whatever this law you're referring to the where the loopholes is that a federal law. And if so how are we going to fix it with the state law. Because the the the additional money Copyright Act allows you to put an ace what's called a service stop or a with the better term for it's like the felts machine you're talking about the service service service key so what happens is there is a piece machine that weapon she was at the it's a machine that can take blood pressure so you will this are more vital of vital signs it is the machine that you're we'll from you know the nurse will from room to room and the that machine has a battery in it rechargeable battery because you know they have to will from room to room. Do you want to tell the story sure yeah so so we we run into issues where the Like like you said we have a a blood pressure of a vital size machine that we can but the nurse control from room to room well it it's battery operated obviously well when we're looking to replace the battery when it dies or during the normal course of it's a preventive maintenance We we've been able to source that battery from other sources other than the OEM for significantly cheaper significantly less expensive price in the in the magnitude of maybe a hundred two hundred dollars a battery cheaper so what the manufacturer did was come out with a software update to the machine and the they figured out that they can put a chip on the battery and that if you don't use their battery it's going to every single time you turn that machine on it's going to it's going to display a warning that that you would need service in it you know and so the nurses every time I turn on they think the machine is broken. It's not broken it's the same exact battery that the OEM was using we just found it for a cheaper price but they just put technology on it to lock us out of it and charges more for it. That's the kind of stuff that that is unacceptable in this field. Yeah you're recognized for follow. Okay so let me go back to my question. I under the way I understand this is I think we're talking about federal law that creates these loopholes now help me understand how passing a state law it will will it will rectify that situation it will kind of count staff is well trained staff the software that he needs to be able to service that piece of equipment it doesn't change in federal laws it doesn't change any laws whatsoever despite what people are saying what it does is it makes a soft makes the manufacturer that device shall have the software to see concerts at himself. And change batteries that's what we're talking about that situation a federal law that. Obviously you're not going to change federal law here you're not going to change any of the any the standards that they have to meet any of the inspections they have to have any the credit ations you're or you're simply requiring the manufacturer to make unfair commercial terms the tools necessary to repair equipment the most expeditious and and cost effective way in the medical field during pope public health crisis that's the purpose of this bill. The representative nine dollars you're recognized for a question. Thank you Mr Kind of going back and forth on or rather I like this or not I like working on my own stuff and also like free markets and you saying seventy percent of of the players are are good players in this field why can't the market take care of this issue itself however that thirty percent getting enough market share that they're making the difference because of this problem we have to do this and as or any other industry that that we do this and you mention the LG refrigerators will but now that I know that all the reviled year for greater I wish I wish I would've known that before I bought my was referred to. Your second question first if you grab for pick up. It's out of warranty you can take it to get here they can work on the reason why is because the auto industry fought this for years and years they told everybody would cause driving safety issues and cyber security problems and electoral property crimes but finally they saw the writing on the wall and they entered into a national memorandum understanding so they didn't have to fight it in every legislature and get a password which obviously is that that would be great if if this and if these industries would also do that. the reason you can take your truck the good years because all auto manufacturers make the same exact tools available to repair on a fair commercial basis so they can plug your car and diagnose it they can order the four day in parts and they can fix your truck that this is the exact same situation. The so in answer to your first question about the thirty percent so hospitals need the the cutting edge technology in order to stay competitive right so they're looking to the purchase the the those fancy machines and all the other stuff like that the same repair techs they they get their pool of repair techs from the same pool that I that I swim and it's not like there's some sort of a special breed of of engineer that can on that no that's got some super power that can work on these things the the. Ninety nine percent of the time we can get the same tech support if we if we could get the same tech support that their engineers that they send in get over the phone we we can repair a lot of these problems the at the same time. Without having to wait. I guess it still didn't answer my question this to how they get enough market share that they're that they're causing that big of a problem seventy percent of the players are or plan right you know what why can't the hospitals figure that out and say okay we're not going to deal with these guys over here because there's plenty of other. There's plenty others play with so. So if you went bid to you when the the facility. And so what we do is it what you can do is you you have companies that go out big equipment low cost just to get their foot in the door and then once you get your foot in the door then you use tactics like this to drive a cost after the sale to be able to to are you telling me that have to take the lowest bids I'm in. But it depends on what part of the hospital you're in but as part of the hospital we deal and I deal in facilities he doing clinic sometimes you do have to take the lowest bid so not not always the lowest bid but it's who's who's got the the latest and greatest technology out there you know that that that kind of stuff because that sells you know that that sells the problem is is that yes they will they will they will under bid or they will you know knock off of a civic significant part of the purchase price that make it looks very very attractive the hospital administration when they're making a decision and they go okay well yeah we can we can do that. Not fully understanding some and sometimes about the the backend server side and sometimes they do understand the back in server side on the on the surely the dollar side of it is this going to cost us a hundred thousand dollars to take care of this piece of equipment per year you know after we after we purchase it but the problem is is that yes it might cost him a hundred thousand dollars take care that a commitment but if if that piece of specialty equipment that company usually does not have a repair technician even in this state that they may have one or two people for an entire region like maybe a southeast region or something and so if that piece of equipment breaks you're having that you're at the mercy of however other many hospitals that's broken out for them to come to get to you first we're all we're wanting is being able to pick up the phone and say Hey we'd like to get access to this so we can you know walk us through what's going on and we can't get that. At the follow up missed. Sure I mean I guess I understand completely what you want I think I what I can't understand is why the administration would make a choice to go with that company who who they know that small provide that versus the other it's it's a good. I'm I'm just really struggle with what you would do that western the LG I wouldn't I'm not gonna buy LG refrigerator so at that because originally it looks like it will put them out of business and others catch up with the technology and you have a topic technology on the other seventy percent of the vote if the meat is a good question and then the other let yes. So so when you're dealing with the government as a third party vendor I work with the government some and they they only accept the lower speed oftentimes and what's the except that Lois be it you're kind of forced or they're forced to by that piece of equipment so a lot of times people by quipping that they don't even want they just have to buy because of their budgets that allow it to them in a given year period. The the other item is that this can these tricks are these trap doors to use stops can be installed hidden without the owner's permission in the form of a firmware upgrade so a commercial piece of recognition equipment last twenty five last twenty five years so it's not like a hospital can come and say Hey two years afterwards I'm not up I'm not cool with you doing these all these tricks to try to monopolize the service on this piece of equipment I'm gonna throw the score mentalities machinery out the parking lot and get another one they're stuck there merry to that piece of equipment and the situation with Phillips that's not that far that's not that battery thing in and through a firmware and if you have ninety eight percent Phillips bottle machines final such vital machines my services are vital some machines or teach me thank you then you're not gonna go throw a hundred two hundred these machines out because you're already trained on those machines you're married to him and so it's the life cycle it's not like a refrigerator of the House every seven years ago I never gonna by Neil G. again you're married to this equipment for a long time once it's in your front door. It's a got a couple questions. and just so you know I'm an engineer to a wonderful for thirty years I bought a lot of equipment I bought some lemons to okay. And I don't know where to start on this but are you asking us to require a company to sell you a product. Art tool whatever are you asking us to require that. I'm. Yes by law. We on the equipment yes we should be able to serve okay yes the company that you're asking us to do that for are they the only company that manufactures that specific product. Yes. So they're the lone supplier of these are you Sheens six o'clock let's take a computed tomography machine CT machine the other state that places a CT a cat scan CT cat scan okay so let. There's not just one manufacture the manufacture those right there's just twenty four go ahead well for mortars more than four but for that I will go ahead. Either way. I can't I can't take let's see manufacture a we have manufacture eighties machine in our hospital and manufacture be as willing to sell us service tools for for manufactures bees city machine I can't take manufacturer bees service tools and use monster manufacture As machine because manufacture a has there. They're locked down you service passwords all the other stuff that that's specific to their machine so I'm I'm reliant on getting the tools from for machine a from manufacture a. So these are high tech machines what's the what's the cost of one of these machines. A city anywhere from million and a half two million Bucks do you think these corporations spent a lot of money to design and develop these million and a half dollar machines yes I do think this from a should recover that cost. Bear the cost that they put in to develop this product yes I I I believe they should okay so and the my machine you have a choice. You said there were others that I heard while ago that seventy percent of the company's. Don't do this thirty percent do so evidently on some equipment you have a choice in these machines these companies have business plans and I agree with what you're saying there are companies they put a million dollars in the R. and the they develop these machines and their business plan is to sell it to you it cost and they're going to recover all their money on maintenance that's just their business plan you should find that out before you buy the machine instead of later on and maybe have to go to another company and I mean that's a decision sure you have to make chairman I can I can assure you that that they don't sell them to us at cost and that they do plan on making a lot of their money on the service side but on the on the flip side of that I know that bigger corporations that are able to in that have more negotiating power than smaller hospitals are able to get that same that same service from them at a much much forty fifty sixty percent less than what a smaller hospital could. But but again that's the free market I'm not saying it's right or wrong what those free marketing what I'm saying is is the bill will give hospitals choices on how they can service their equipment that they purchase they don't the hospital is not required to serve and to to sign any sort of a an agreement at the time of purchase to service their machine. They're not required to motion do because really slick salespeople can can make it sound like if they don't then you know you know it's just terrible. So one more question I let the other committee members but you mention tools or somebody mentioned tools. okay so this company develops a tool to work on a specific machine it's only used for that purpose and they don't want to sell it to anybody. Correct so why don't you go make your own tool similar to what they had to have that made you you can't the it's it's a I'm not sure what the the intellectual property part of that is we give ME I would assume that if you try to make that too would you be reverse engineering something in order to make that tool we're not looking to will reverse engineering's allowable if it's not and. Am I correct Mr it's definitely allowed for inter operability As if it's not if there's not a patent in effect you can reverse engineering that tool. Am I correct on that. A that yesterday was okay I don't I don't have an answer that at this time I think that's true if it's if it's not covered in the past. Some I mean I'm having trouble because it seems to me like we're not allowing the market I understand your situation and it's a bad situation. But a free market should be a free market ideology other folks Mr chairman if if if I might real quick though and I understand how you're looking at it because I've been thinking about this a lot longer than you have the opportunity to. But. You go back to the to the black letter law in the United States blackletter just rules of commerce in the United States a request you know since the industrial revolution. When your grandpa bought a tractor is his. You wouldn't anyone infringing on the rights Pat if you went resold anyone in the John do you know you wouldn't printing on John Deere's patentee he could fix it he got hired by the defense or are anybody want to fix. That's been the law of the land four hundred twenty five years that when you buy something it's yours and and repair issues do not infringe on any copyrights you have the right to repair something you all. But only the advent of modern technologies allow manufacturers to create a monopoly that never existed before in the history of Commerce the right to force purchase of your product to ask your permission on it and how they. Manage that there that property for the life of the ownership you have to come back to them and asked repaired if they don't if they don't like I your repairing it by the uses talk technology you no longer get to use that piece of rickets down and it stays down but you thought you owned it when is that ever been the rule but what is stopping you from repairing that machine today pardon me what is stopping you from repairing that machine today they are they own the key date they've designed it in a way that only they can fix it and I have to go to them they've now created a monopoly that never existed in the art rules Arkansas and here's another thing I'm having to go probably to a national or international company to fix it as set of this gentleman here who's got a small business. In central Arkansas with the equally qualified technicians to do the work you've created a monopoly this that's put small and medium business you're protected monopolies but down I'm not accusing you but by voting yes this bill your continued to protect an artificial monopoly it never existed before in the history of commerce and putting your local small and medium sized qualified businesses that could come into that hospital and do that that repair out of business because they're not in the in the monopoly. But you can't repair that machine because you don't have that part correct if they will not solve release the person you can't make that part of yourself for you can't find anywhere else well I share a lot of those parts are going to be part of the past Mr chairman I think it's a software key so it's completely the manufacture software key at I mean it it's not like if it's if it's your if it's the state your car or something like that and the you know twenty years ago you could go out there and repair just about anything on your own car yourself if you went down to the auto parts store in and and you bought the but the thing And took two screws out. Replace the the part and your car worked now you have to have the software key in order to make that repair that simple repair and and even take it to even a local someone to get that diagnostic tool or reset those codes or anything like that and in this instance and courses is much bigger than than just your your car but I mean for on a personal level cars. Pretty important critical piece of of equipment for us to to do our jobs in in working life today but. Without that software key that enables that that thing to turn back on you're dead in the water and that the it yet that million million half dollar piece of equipment is I understand what you're saying there were times but somebody brought the car issue up earlier well I go to AutoZone by parts I still work on my car because I like to do that and and there's a lot of things I can't do because of the the software but if I go to AutoZone or some other parts store there at they cannot check everything on an automobile they'll tell you for certain thank you still have to go to the Ford or Chevy or whatever dealer his or any or any other and any other shop that is been able to buy that a quick or by the same equipment from those manufacturers. But they say you have to go to a dealer in certain cases in certain cases okay okay anyway I'll let somebody else representative Miller you're recognized for a question. Thank you Mr We talked a lot about the market. And you know free market I think a lot of this and they're generally believe in that. And I think the. Well there's a few others that believe. I think what I keep what I keep struggle with on on this aspect I've got other questions about a lot of other aspects of this book but we can get to that later is. And I didn't get a clear answer earlier so I ask again. When you when anybody hospital any institution goes to negotiate. A deal. You can always negotiate. The warranty I mean now they may not be willing to negotiate. But there's. Plenty of other companies. That that that are out there not maybe none of them were will maybe they all have a agreement that they're not going to go she eighteen top warranty work or or whatever but I highly doubt that. So. Right now. In an institution not. Negotiate to get the I use the word trade secrets earlier to get the the. Whatever information software codes whatever that would be necessary in the event that the company could not service set themselves in a timely fashion and then the two parties could agree on what timely fashion was can that not happen today. Yes that possibly could happen today but now you're looking at some infrastructure issues with with your facility so a lot of it a lot of the equipment is Interoperable so you have one brand of patient monitor and everything so now you're going to buy more patient monitors. You know that if you buy that same brand your your backwards compatible with with what you currently have so you're you're you're not having to show a whole bunch of money all up front. So what if you want to let's say you you ask them Hey you know ask your question they say now we're not willing to do that will you you don't have to buy their equipment right but now you're having to shell out a whole bunch more money have a completely different system put in your hospital OR have two different kinds of monitors which creates a you know possible patient safety issue on but knowledge of different things like that and so. You know you just. I mean I I mean I'm. I don't know how really to answer better answer your question then I mean most of them will not negotiate with you on that so. Follow up Mr yes you're recognized what. So most of them will. I mean I have no clue I'm not in that business so I have a close. But I know that. By saying most there's a few that might would. Yes and. Why. Are you looking at this bill as a quicker fix. To just get around there. Stipulations on who works on their equipment. While the hospital or institution or whoever of maintains the ultimate liability. No so so the pandemic kinda highlighted the need for for us to have access to for the hospital to have access to to that kind of to the parts to the service keys to the things like that because we had issues getting engineers and and a timely basis and we we saw kind of some writing on the wall we have qualified people in house that were we're would have been able to repair certain things quicker but. You know we we don't want to get into another situation where. Our we've kicked this can down the road and we're still not able to get the you know the the server software and now we have another crisis that hits and nobody I mean they they banned travel inside. And now and now we can't get anybody in. Not now what we do what we have qualified people that don't have access to the things that we need that are they're fully qualified to do it. Thank you thank you Mr. Representative clown you're recognized for a question. Thank you Mr chairman. Okay so one of Canice switch gears on you just a little bit to get some assurance so we've we talked about cars and tractors and blood pressure machines and then we went to CT scans so. If your facility has the software key. This this CT scan or the M. R. or whatever it is it's clock in and it's not working and you've got the software key to get in there. How can we be assured if we vote for this that your technician. That is is not at the home base of where this machine is being manufactured how can we be assured that it's going to be repaired the words that's up that's I can imagine the intricacies it that be like asking me to go work on the space shuttle it's it's just not going to be turned out good so it's one thing to replace a battery but what about that so I'm I'm just interested in the safety issue thank you. So in regards to the safety issue. As I alluded to earlier there's. There's been many instances where I've I've witnessed the the manufacturers service technician during the same exact thing that I can do you know when when they're on site when they're talking to their their. Resident expert at the home office so to speak you know getting that technical advice. I have I have technicians on staff myself included that have that have specialized training that can do the same exact thing calling the manufactures and getting we're not asking the manufacturer's suggested by hand that over to us we're for for and for free and what we're asking for the ability to just pay for it we're asking for the ability to for us to be able to access the same things that their their technicians are able to access. We'll talk about the the the departments that that these people. To make sure that qualifies how do you make sure outside people like there are qualified. So in order for and in order for us to like I say hire a third party company They they've got to provide their credentials on on the annual training what they're what their specialties are what they're what they're Yeah accreditations qualifications are you know and then we look at those and we we choose a you know if we were looking for a third party company we choose you know which one we think is best to to service that piece of equipment and then we we go with that with that company but it's not we don't just go down the street and find a warm body and say Hey you know how to fix a CT machine yeah yeah we'll go fix mine you know we we won we can't and into it did that mean that never happens anyway so. Yeah can I add to that the there's nothing in this bill that changes any medical facilities liability the live in a world to liability under methodology latest loss that I but I I know how it works The hospitals as you know doctors hospitals and clinics everybody in a they know that about legal liability there's nothing in this bill that changes their responsibility to make sure that. Their systems and and equipment are or were you safe and they know that it's the the the facility that's recall responsible not the manufacture not you know anybody else it's going to be responsible if a patient or is injured so nothing changes there there's no there's no motivation for them to go lower their standards for who they're allowing to fix their equipment because that liability stays exactly the same. And the and the the server Katie that I'm not they have to speak to this but they're audited the state has requirements there's a joint commission was like all the recognition. Medicaid Medicare services I mean we we have to meet a whole let me of of of Rules regulations in order to you know prove that were maintaining hospital equipment either to manufacturers specifications or to an alternate equipment management plan I'm all that's documented. Follow and audited. Hello. One more follow up. So I understand what you're saying I appreciate that and the liability I totally understand that so let's just take the CT scanner out of it and just to look at the C. B. C. machine it the medically down the road it is it under under the same rules and regulations for patient safety or date or do they go in and they get through four or five twenty Spurrier's results and say I think there's something wrong with this at that guy didn't didn't do a very good job. I I can't speak to to. Like them the. What we are called doc in a box I can't speak to what they're regulations are I'm sure if they're providing medical care in the state of Arkansas there is there's at least Arkansas department of health oversight of that most labs have a national laboratory certification you know in a lot of it's tied to the reimbursement so there's a there's an incentive to do that but I but I can't speak specifically for those those facilities. Okay so I've worked in the clinics and doctors offices before else are. summer the clinics and doctors offices will be closed. I've worked in clinics and doctors offices before so every every piece of equipment that you service has like its own risk assessment this associated with it according to the OEM as a third party vendor we a abide by those regulations I don't know that answers your question but regardless of setting yes. Okay representative when you're recognized for a question. Thank you Mister chair I think a lot of a service of prophetic to the problem that's being presented what I'm struggling with and maybe a few others as well as is this the correct remedy for that because often times it's easy to say let's have government mandate as was mentioned before the company has to sell a product but I think a lot of us prefer market solutions we talked about you know just in the example here if everybody's not running on selling the LG stock based on what's what's been said here but you know they're than we've learned things we tell each other things not we like to think that hospitals are full of very smart people so that if you get conned by a business who comes in with an aftermarket commitment that you weren't aware of word would get out very quickly to all the other hospitals in the state in the nation say don't do business with this group and that the the natural market forces would shrink that thirty percent of the bad actors down eventually to zero because they wouldn't find any other customers have has this come up in other states and what other states are are how are they dealing with this situation. Okay our system of that speech I know with automobiles in two thousand twelve a the vote went out to meet in Massachusetts actually went up for public vote I'm not a lawyer so you feel free to correct me in a language here but it went out for public vote and Senate president of the citizens and and Massachusetts voted FOR this is acting for the for automobiles instantly they gave independent repair shops I don't know about you guys I don't know how many of you guys take your trucks or cars to UPS only to the dealership but I take mine to where ever I want continual what part needs to be worked on if I get a transmission I take it to this guy if I if I just get an old change I don't take it to the dealership of if I'm if something's acting weird and and I think it does need to give the division I'll take I'm not has into the date dealership I. Get to make the decision. I trust this guy right here I just got out of my life I get a car recognition and I'm close to his hospital I'm going to because I know things to keep him up at night our patient safety. That's what if this guy up at night this is what gives him nightmares is about him failing to do his job in in the cost and somebody if the pain or even something worse. I do not trust the marketing department of a large but we am I do not like a Williams taking power away from him to make decisions that help make at that health patient safety. So I am. For for answering your questions I'm I'm a proponent of of free market as well but it's there's also the the allure of marketing and when when you have a a fancy a new fancy thing and your and you can benefit from that like from a surgery that can be done with the robot for say then you want to go to the hospital is going to provide you with the the surgery that's going to be the latest and greatest cutting and stuff correct. So yeah so so hospital administration is is kind of stuck between a rock and a hard place on on you know balancing being competitive in the market with the the newest latest and greatest off with with our servicing side as well to sometimes we we recognize that there that it's not the best service to added to the you know what we're looking at it but they they make a decision they being administration makes the decision to to purchase that anyway What. What it boils down to is it's it's not it's not an issue Antill it's an issue where where you have one hour an hour and a pandemic and and let's say that piece of equipment goes down and we need to get it back up really quickly and now we don't have access to the the tools we need in order to take it back up because let's say the manufacturer cannot get in there to repair it in a timely and amount of time or can't get in there at all. And so what we're asking for in this bill is the ability to purchase the same tools that they have and be able to repair it ourselves. I mean I guess if I can follow up yeah I guess what I'm asking is is it can't that be done on the front end representative Miller was talking about that earlier can't that be done on the front end because we can forecast these things for granted COVID because all off guard but now we've got that knowledge I'm just curious can we do that and then also the other question that was part of this is what other states are doing this in the medical field and how has that gone. I apologize because I probably could have got brought you an exact survey this legislation I know it's been introducing California I don't know what status or outcomes I know it's been a decent Oklahoma I don't know and I think it's been a reason other states specific to medical devices there's the broader. Legislation that's been introduced probably twenty states the only one I know that it's passes is Massachusetts is passed legislation and have some kind of a referendum on these issues in a broader sense that was the car the automobile I think that was focused on cars but I think they've also dealt may maybe with some broader issues there When the broader bill that just to. Attempts to. I don't like it over everything at you you know the the the John Deere caterpillar have been really active fighting those and when you guys are ready the farmers will come in here and if you think I get a little righteously indignant when I talk talk to a former about this and what it's like when you have two weeks dry season you can get the John you're going to come fix your million dollar combine and you got five other guys that can fix it they they're they're go crazy about this but we do want to fight that off here we this is a pandemic there's a health crisis these guys are or have an acute problems and your solutions right over a long time I guess this could be negotiated other business but they have two million our piece of equipment that they don't change out every day and they they they are where they are today and also I think. Khalq into a E. had that other example they can change the rules tomorrow they can do it software update and you've got a new purple you didn't even know about it in your in the what you thought was your equipment that you all I guess that would seem to come under previous agreements that should be able to be of litigated but but to be clear no other state has done this yet I'm not aware stages pass this matter this is I don't I don't believe so but but also due to your point on the first part of your question with I have negotiated out and everything a lot of times more when the hospitals recruiting physicians and and everything they they use these tools in order to fix that to to entice physicians tend to our you into our system and and I mean sometimes it's it's a you know the physician goes well if you would if you have this piece of equipment that I'll come there you know and so that that is a huge driver of of some of the decisions that administration makes as well to but. There's also certain piece of equipment that that are very other very unique and and are the only ones on the market the the one of the surgical robots that are out there right now it it's currently the only one on the market I think there's some competitors coming out soon which hopefully will will allow more competition and and the way because they're they're very very very protective of other stuff even though the machine itself is very very simple you know an example with that was that robot that we haven't and secretary it has an arm on it that's a mechanically controlled arm it started making some weird noises and everything like that when we were calling the manufacturer to say Hey we need you guys to come and take a look at it and I like what we got were tied up we can come and take a look at it right now but guarantee you it you're going to have to replace the on because we've done it a hundred times and like okay well how much is your most a hundred thousand dollars for the arm. Okay I'm willing to go up and take a look at it right now I go up there and take a look at it. Never never dealt with this robot before but it's a very very simple device even though it sounds like you use your robot anything special and everything I go up there and take a look at those two su Senate backed out just a little bit. Double Loctite tighten back up seven hundred thousand dollars. I mean these are the things that I mean we we're we're competent enough to fix specs these things. You know what we're asking for the tools to do it you know and I get it that it's you know that there's a huge market on the service side and that they they they love it you know and and what we're trying to do is is saying Hey we we love the service side to we want to keep it and and you know as useful as possible in the hospital that you know because I mean it benefits everybody in the end. Representative Gonzalez you're recognized. Thank you Mr we've been on this for a very long time now and it seems like same questions keep getting asked and answered almost the same and I know I can make a motion to end debate apparently because the the debate hasn't started we're still in an initial testimony so I think what I want to ask the sponsor to do is if he would pull this down let's move over to the special order of business that we have had on the agenda for several times and as been passed over a month and move the stay long little bit. representative Dotson I I agree with what representative Gonzalez is saying because we do have a special or business at four o'clock and we're forty minutes past that and there's a lot of discussion we still have a long list of questions. So there's a lot of unanswered questions that maybe you can address with the members. And bring it back. All right if if we can maybe put this on a special order for Tuesday. I'm here we go again okay we'll we'll pull it down and let the other special order. Thank you thank you for that thank you. Thank you for your presentations. Okay committee We have on a special order of business. H. B. sixteen eighty five and H. B. sixteen eighty six representative gray you're recognized to present HB sixteen eighty five. Thank you Mr chair and if I may in the holding room is doctor Garner I'd like to have her come to the table with me yes okay thank you. There she is. So given amendment for this bill yes at a okay committee the members come around. Sixteen. A man would you identify yourself and who you represent. Picture top. Dr Kimberley garner I'm representing myself as a board certified geriatrician family physician and costs of healthcare physician thank you. Give the committee a few more minutes let the amendment that. I think that may have all taking a bathroom break the. Okay representative ray you're recognized to present your amendment thank you Mr chair so this bill I know there's been a lot of controversy that's been on the agenda or on the counter for quite some time and I grossed an amendment in the bill not too long ago there was a word that was incorrect so trying to fix that we came up with this amendment What I'd like to do is to the explaining amendment in the bill it's hard to explain the amendment not with the bill itself okay we'll. motion. I have a motion to adopt the amendment indiscretion on the motion. Seeing none all in favor signify by saying aye. All opposed nay moshing carries your members adopted you're recognized to present your bill as amended as amended thank you Mr chair and so what this I'm a taken what this bill does as amended and I can I can go back there and walk you through section by section and what was change but there are two main things that that this bill does have and I think through a lot of language and amendments convoluted the process and I think possibly confused everyone but two main things that this bill does right now I'm. Me go to page five. So right now a surrogate that can make healthcare decisions for a patient essentially can make decisions for the patient that that the principal or the patient could make on their own behalf with the exception of artificial nutrition and hydration. In order to make that decision currently the S. the supervising that the supervising healthcare provider has to agree with the circuit making the decision as well as a second independent physician so what this amendment does because of the amendment is pretty much the bill at this point so what this amendment does is it says not only do you have to have the supervising healthcare provider agree with the circuit you also have to have either an independent for a physician who is not the supervising healthcare provider or treating healthcare provider or healthcare institutions ethics officer or ethics committee so the crux of this is we're adding an ethics committee as S. the second piece to the supervising healthcare provider having to agree with the circuit so the issue that we've run into is it's very hard to find an independent physician who wants to come into this due to liability purposes they're not involved in the case they don't know the patient and it's almost impossible to find somebody to do it so we're leaving that it's still an Avenue but then we're also adding an ethics committee to the process that they could replace that second independent position if if needed the other big the other thing is and it's at the very end of the bill and and honestly amended it to the point of watered it down it doesn't do a whole lot the very last piece to the bill. As far as a concerning court jurisdiction under this act. A proceeding under this act the current wording says shall be expedited on the courts civil dockets. All I'm saying is in it shall be addressed by the court within three business days after service of process on all necessary parties is complete so I'm trying to find the time frame and bring it down because right now it could be a week two weeks the whole while you've got a decision that needs to be made about end of life care for a patient who's very sick and. If the court doesn't hear the case within three business days there's no repercussions in this bill as I say I've watered this down to try to make it more palatable for those that had been opposed to it so more than anything at this point that's just a suggestion so Dr garner do you have more comments you like to add and turned right back on. Well I just like to say that you know we always try to follow the advance directive that the individual has written but there are some circumstances where the situation has changed dramatically and the family who generate this request of know that the situation has changed so much that the advance directive doesn't really meet our address what is the concern I'll give you an example because I like examples but better than you know just somebody saying something we I had I took care of the lady about seventy years old who was our family described her as the energizer bunny she took care of her husband who is very sick and us but she'd started having chest pain so she went through all the process of evaluating that and was recommended to have bypass surgery. She did do that but unfortunately and and right before going to the by pass surgeries the physicians had or fill out an advance directive and she said basically do everything. Unfortunately during the surgery she had a massive stroke devastating stroke such that she was unable to move unable to speak and the neurologist who are caring for and looking at the have said that most likely she could even understand speech. This was devastating to her family but they said based on the east this is something she would never want to go to stay in a nursing home to being transferred to a nursing home or live where she couldn't speak and couldn't understand speech as best we could understand because we can't even tell us that she can understand at this point and so they wanted to change the advance directive to meet the current circumstances so that she could go to hospice. and so that's sometimes things happen nobody can really predict everything that you can that can happen to you I'm anticipating some of you might of had experiences where something happened that was totally an unexpected and nobody could predict. And so this allows that person that they trust either the healthcare agent or the circuit to look at the specific circumstances of what has happened and this is somebody they have identified or the if they haven't named a healthcare agent with the what happens is a provider identify someone who's showing care and concern for this patient. They're able to say What they wrote before when they couldn't expect this would happen. Is something that. A two physicians or an ethics committee can weigh in on and say this makes sense this makes sense of what the family wants to do is the right thing to do it just prolongs their death or increases their suffering. The this request would come from the family or the healthcare agent or the circuit has been identified by the provider so it's not something generated by the hospital or a or physician or healthcare supervising healthcare provider at all this comes from the family saying that they instructed that they'd written I could expect this was happened and they. They know what the person or can express what that person would want to if the under the circumstances. So unless you have some questions that's really what I wanted to say it's it's making sure that we really trust that the person who is there circuit or the healthcare agent that they have named instead that they trust that we allow them to help us god and have shared decision making in these complicated and very stressful and distressing situations and this is not uncommon I could sit here all day and tell you that case after case where people could expect to be diagnosed with end stage lung cancer in stage colon cancer almost the last or pancreatic cancer and what they originally written maybe years before doesn't really make sense now based on what the family knows about them or their trusted trusted agent. And one more thing to you in the amendment failed to mention this but if you look on page one of the bill as I went through this like with a fine tooth comb. On page one I did delete lines thirty three and thirty four so they just deleted section two in its entirety there was not totally sure how why this was in the bill but it said Sir get includes without limitation a supervising healthcare provider is designated under another section when you reference the other section and you look at it that sections as a supervising healthcare provider cannot be a circuit so I conflicting language I have no idea what this language was even added so I district that whole section outside they will there be any confusion and I do not want to supervising health care for about provider to be a circuit so that was the other things are really bill does two things as an ethics officer or committee into the decision making process in place of a second position and I added guidance for three days to the court for putting this on the docket so I'll be happy to her we'd be happy to take any questions probably her more than. And this bill just deals with advanced directives is that right. It's not poles juster advance directives. Will this bill really is only dealing with the surrogate and the decision any decisions outside what the principal would make so like anything to prolong the life or death the life of the patient a natural death of the patient so I don't know that it really does necessarily deals with advance directives are poles it's just about that end of life decision and who can make it in how many people have to be involved to make that decision. Thank you I guess I'm trying to figure out how this ties in advance directives and DNR's and and I have all of this fits together a it it looks like the bill just addresses advance directives but it does it involved in ours as well or just advance directives. It doesn't specifically addressed in our state in our system position order that only a physician or has supervising healthcare provider like a nurse practitioner or physician assistant could ride so this is saying about those does that share decision and and that we follow the advance directive and allowing and I guess I could send exception if the families generated a request that said this is the advanced record that they filled out before doesn't make sense right now with the circumstances that were currently facing. But at the family could also make a decision to keep them alive and and they don't have to make a decision to disconnect them or whatever they also can make decisions to keep him on life support and absolutely and in advance directive can say a want you to do everything in fact in this case that I was talking about her that that's what Irvin instructor said she wanted to do everything and we get a individuals all the time to say I want CPR I want life sustaining treatments an advance directive allows them the individual to have a voice about the care even if they're so sick they can't tell us directly and it allows us to have a trusted person that they have said I trust this person to make decisions for me just like in a pub a power of attorney for finances or state or anything like that it allows whatever they want to communicate to be communicated and I as a physician hope and pray that they have won because it lets me know to specifically what they want but yes the family or the healthcare agent can say do everything and say keep them on the ventilator we're there's no determination is just respecting what they want. Yeah and a representative Ferguson to I was looking at the the statute that this touches so the the main crux of this is in authority of a surrogate and it deals with the sensually in the absence of individual instructions or other information so I simply an absence of an advance directive the surrogate shall make the decision in accordance with and that's where we're kind of making a few tweaks. any questions committee a wrecker dark clad you're recognized. Thank you madam chair. Does this bill in any way shape or form. Preclude the ultimate right of the patient's power of attorney or the patient's designate a to make these decisions. Do you want me to go ahead So if the supervising physicians said that it did not make sense to not follow the advance directive we would follow the advance directive that the individual had written. This is only if the family request something. Outside of what's in the advanced directive then eight two physicians or a physician and an ethics committee would review that and say this makes sense or not. Yeah this isn't changing any current statute the only thing it truly is doing is adding the ethics officer or committee as that second wind has this is the second conferred with the circuit. The sale of please. It's certainly go ahead so if I understand and that's what I'm trying to do. So if the advanced directive in in the medical opinion is. Is out of line. And the patient's family agree. For these two entities whichever one is involved they agreed then then you go against the advance directive. So the just to clarify that a little bit the family or the healthcare agent because it a healthcare agent can be anybody besides family member have to request this they would have to say that the instructive doesn't make sense and then it is reviewed by this other just look at the medical record look at the situation look at what the advanced practice says and say yes it makes sense to changes in the under the circumstances or no it does not and then we would follow the original advance directive they said it was not. So it's just for them to review but the the ethics committee does not generate this a physician or a nurse practitioner none of them generate this is has to be generated by the family saying at the with the circumstances what they wrote before and they've looked at the situation I know what their family member would want or the person is designated them would want because they're supposed to talk about this that's the only one who can generate this. Thank you and all in all three would have to be an agreement so the family or the circuit requesting it the supervising healthcare provider plus other as second position and I didn't even say supervising healthcare provider this amendment says position so the second position or ethics of council has to agree to all three have to be an agreement. In the. We're with the ethics council they would be in the hospital. I mean so cumbersome would that be I guess my question every hospital has an ethics committee. Of some of them contract with other or agree with other agencies to be either ethics committee if if that's burdensome for the smaller facility so they have one but every Jaco requires every hospital to have an ethics committee so there would you know of any hospital in Arkansas would have that kind of committee to be able to review this. President of Gonzalez you're recognized. Thank you madam chair Like representive cloud I'm I'm just trying to understand this too and even though he's gone the doctor in the past I'm not once I've had a little trouble with it today it is what are the what are the exceptions of the advance directive how does how does that work and what exactly are we changing from that so to and if I'm if I'm thinking right today there you can create an exception but it requires to physicians and now we're just adding the ethics. Committee your or ethics and with them all right in that yes yes and there was terminology before that and they did stricken this is except that artificial nutrition and hydration may be withheld or withdrawn upon a decision of the circuit only if and that's where it goes into the supervising healthcare provider but the physician in so the amendment is actually a little more vague and it says unless a determination is made and certified in the clinical record that the principal is highly unlikely to regain capacity which that's normal language in the bill already to make healthcare decisions and that the particular healthcare decisions in the principal's best interest. Or is otherwise appropriate to avoid care that serves only to prolong the patient's natural death is agreed to by supervising so it doesn't even spell out artificial nutrition and hydration as we had in the past it actually is more broad so this I could see this being used more often than just for artificial you know hydration where I think before like it's the so you want to take somebody off of the ant that's not excluded here that can be done without these extra layers the way I'm looking at this is because it's more broad they're actually they're going to be more cases where you will have to have that conferring physician or ethics counsel involved is if that makes sense of your auto the language understood understood okay the okay thank and this is this is a very I've read this bill and I've read the statute so many times and I confuse myself reading on. All right thank you yeah I mean I guess my concern was that we the third possibly wasn't and the exception now that we're creating an exception to override president instructed but that is not the case right there's already that exception now okay all right thank you. Any other questions from committee. Seeing none. we do have. We have people six people signed up to speak against the bill. Sheila Purcell if you would come to the table and introduce yourself and who you represent. Thank you. My first time to give testimony here so I just I thank you for the opportunity to do this I'm the director for northwest Arkansas respect life and I've had been the director there for about six years and have been involved very involved in doing all that I can to promote to uphold the essence of the sacredness of human life and left Bellavista this morning and that the three and a half hours down a back that it's Eminem for me it's worth every minute and every mile because I think this is so important I think this is a very dangerous bill I'm old enough to remember as I'm sure some of you all are to that slippery slope that we saw it happen with abortion and that when it first started out you know just these really exceptional cases about that the under privileged person on welfare who is twelve years old rate buyers step father and that it should be allowed here and you know a guy running around Arkansas St and. safe but rare you know or legal that rare and that we've seen since then that rare increase to sixty million dead babies later and I think that these House bills both sixteen eighty five and eighty six that is just one more step on the slippery slope for assisted suicide and euthanasia and I think as the other people like this will speak on in more detail but for me the scariest part is that it just seems like the sixteen eighty five is it changing the law to go beyond the physician and it allows physician assistants or the nurse practitioners to help in making these end of life decisions and I mean I can if I was a. Nursing home owners something I can understand the advantage to that because it makes things a little more. Efficient and expedient and cost effective to to be able to spread out the decision making for end of life decisions but. I thank. Cost effectiveness and efficiency expediency might be good for hospital equipment or manufacturing widgets but these are life and death decisions and if you make the wrong one someone's someone's dead you know and I guess to just personally one of the things that Northwest Arkansas respect life does is that we reach out to nursing homes and particularly Medicaid funded homes they're poor of committee have dementia they can't speak for themselves they are so totally vulnerable to the health care area and we need it to that to the staff there sometimes we can't even go in and see people they don't have visitors they don't have family they don't have the money and they're so dependent on having a legal system support their rights it's it's mandatory we we have to do in fact I wish that we were spending our time in many right now on a polling what we have as opposed to loosening things here a little bit so I just I just want to say that I I think it's a bad bill I firmly stand against it and I hope that you will vote against sixteen eighty five thank you I'm not take questions thank you for your comments that I have it is a question representative Gonzalez you have a question I'm sorry I'm not questions thank you okay thank you. Road ma'am if you would come to the table and is your self and who you represent. Hi I'm rose Mimms executive director of Arkansas right to life thank you Mr chairman and committee members on behalf of Arkansas right to life in the national right to life committee and the network of members across Arkansas and the United States we urge you to vote against house bill sixteen eighty five an act to amend the Arkansas diss health care decisions act. As you know if you read my correspondence with you on both house bill sixteen eighty five and house bill sixteen eighty six that is it is our strong belief that this legislation could lead to euthanasia even though that may not be the intent. Because of that and our opposition the votes on this legislation will be included in our pro life report of the ninety third Arkansas General Assembly. Both of these bills on appearance are complex but in reality both are fairly simple and asked the question. Who decides when you can't. Who will make treatment decisions for us when we become disabled sick injured age are terminally ill and can't speak for ourselves. Under house bill sixteen eighty five a circuit. Our supervising healthcare provider can end up circumventing the clear written advance directive or clear wishes of a patient in regards to nutrition and hydration our other life saving care if they deem it is not in the patient's best interest our service only to prolong the patient's natural death. Arkansas law already does not require provision of medically futile treatment. There are many patients who will die without treatment but could live for many months or years with the provision of treatment. I had first hand experience of this with my eighty four year old mother when she was hospitalized with pneumonia and later developed sepsis in CDS it was on event not once but three different times in the ended up having a tracheotomy. She were covered in left without a feeding tube for another three years because we were there to make sure her wishes for food water and air we're provided when she couldn't speak for herself. House Bill sixteen eighty five weekends Arkansas's provisions on the administration of foods and fluids under current law strong protections are afforded to someone who indicated a preference to nutrition and hydration orally or in writing through an advance directive. No one wants to prolong dominating. But a patient's decision to continue treatment should not be over ridden in order to hasten death. Patient's own preferences for treatment should be honored and respected not dismissed by ethics boards that could have an inherent bias based on perception of low quality of life. According to a twenty nineteen National Council on disability report and I'm going to quote this under recognized however is that a physician subjective judgments about whether a patient's life would be worth living should they receive treatment and survive also play a role in decision making. This consideration is a frightening concept for many people with disabilities because that some healthcare providers most unknowingly harbor biases and misperceptions about the quality of life in capacities of people with disabilities. These assumptions can have. Can and have impacted physicians willingness to provide or continue lifesaving care to a patient that has or will have if they survive a disability classified as medically severe. State laws which vary greatly in their content and approach defined the protections are lack there of the patient's wishes to receive life status life sustaining treatment. Hospitals have turned to process based approaches utilizing internal ethics committees to arbitrate medically futilely futility disputes. Despite the increased attention however disability bias still finds its way into futility decision making in court. None of us knows when an accident medical emergency illness or disease may render us incapable of speaking for ourselves when it comes to life saving medical treatment that we want or don't want. Again the question is who decides when you can't. Please protect patients rights and vote no on house bill sixteen eighty five thank you. Thank you for your comments. Jerry **** if you would come to the table induce yourself and who you represent. Thank you Mr chair members of the committee I appreciate you Taking the time to listen to it to us and I know this this bill and the the companion bill sixteen eighty six of generated quite a bit of discussion and I want to say to each of you that I apologize if we came on a little bit strong on the front end of our opposition to these bills and you may have gotten some calls and so forth so we're just trying to do the best we can but we do oppose this bill I think you can't really understand sixteen eighty five very thoroughly unless you also understand sixteen eighty six the other bill that will be heard in just a little bit because the two bills really kind of work in tandem with one another as as I was originally told and I think that was the word that was out at least that these were bills that were supposed to address the shortage of doctors that they couldn't get enough doctors to come over to the nursing home elsewhere in sign post forms and end of life documents and so forth and. I really don't have much of a dog in that fight me is far as the whole end of life and who signs the forms so want to make that real clear on the front end I'm not getting into the scope of practice part of this don't really get into that but when I do look at this bill I think well it's it's more than that. And and what kept troubling me is I kept seeing things in there that did not seem to connect with who signed a form and that sort of thing And so I'd like you have a real by me I had a long time of sitting there trying to figure this out but let me see if I can be specific by calling you of two line in chapter and verse in this bill if you look at page five. Sturch on line six in going down to line eighteen. The E. notice that line eleven through eighteen strikes a considerable amount of language there that has to do with what you do with people that are getting food and water at the end of life and and it just strikes that and what we're left with this what's up there in lines six through ten. Which it says there it says a surrogate. May make all healthcare decisions for the principle that the principal could make on the principles on behalf. And that's that's that's where that stops. No the way the I read the current law is that yes they can make decisions except if it's going to involve food hydration then you have to it go to the living will you have to do some other things here about supervising healthcare provider second independent physician in that it has to be that continuation of artificial food hydration is merely to promote prolong the lack of the active dying and not or any and the principal is highly unlikely to gain capacity to make decisions and so what we what we have here and I've I've looked at the the amendment and I'm still trying to digest that I think is you are and I'm I'm not convinced that that amendment addresses this because the amendment addresses the spending the advance directives and so forth so my question is for the for the person out here who does not have an advance directive they don't have a piece of paper that says anything and there's all the sudden you've got a circuit here. And then the worst scenario is some people that don't have family M. and unfortunately are people who don't have family that are in these places and I know it puts everybody in a bind when they don't have anything on record but I'm just looking at how that affects those people the ones that don't have anybody. I think a person has a good strong family they're probably going to going to make it through pretty good unless we get a COVID situation where they say well there's no family you know readily available so we're gonna have to pick it up make decisions. That's a problem that section right there is a problem it is way more than just who signs forms. Now the next part of it and that's the last thing. We go over to the end. Again I come back to if I go to the very last three lines of the of the bill. Where it talks about the courts. I realize that right now an institution can get a court order. And they can put pressure on a family or anybody to pull life support nobody wants to do that nobody wants to be in that situation. The fact that this puts a three business day limit on the court. That means that judges got to figure out what's right. Anyway only given him three days to do it. I have somebody's life is hanging in the balance. I would rather the judge have whatever time he or she needs to figure out what's right and make the right decision and not put under a. Stop what you're time table about how quickly have to decide that that's not right. And so with that ladies and gentleman I conclude by testimony on this I'll be glad to take any questions if I can answer them. There is always give a question I do the. Thank you Mr After what you. Breeding lines six on page five that you'd mentioned. Yes I see what you're saying they're in and that is concerning if you read that by itself a circuit. May make all health care decisions for the principle that the principal could not make on the principles on behalf Then you're striking out who has not been designated by the principal and I get it I mean the what what I've read that when you for so that that's very concerning but all of that is under the authority of the circuit if you go back up to page four. Lines thirty two through thirty six and on line thirty six in particular is says in the absence of individual instructions or other information so who still. The form takes precedence over the decision of the of the circuit or if the individual is obviously conscious and can make their own decisions they can give their own individual instructions so that is that really what. When is that how you read that or will what I'm reading and again I think we'll our discussion represent Gonzales underscore just how hard these bills are to understand and I've I've read them and read them like others have. I I the way I read this and and I you know I would defer to attorneys and others that may come up here in just a little bit. But it seems to me that if you don't have anything written down then you're pretty much at the mercy of this of the surrogate whoever's been appointed and they get to do with the whatever they want to and I I don't know we're all that leads represent Gonzales I don't know we're told we're that we're put says but we're talking we're not talk about. Something this trivial here we talk about life and death you know if somebody if somebody you know their life a life and death decisions and I think it did it requires us to be really delivered if about this. And that's what concerns me so much. Resented Payton you're recognized for a question. Thank you Mr thank you Mr **** So that was half of my question you just answered and and got asked. There's some very similar to it at the bottom close to the bottom of page five line twenty nine hours is an agent or circuit shall not make a healthcare decision is contrary to the express terms of the principles written advance directive and then it goes into this amendment. And you said you'd study the amendment so does the amendment. Help a leave any of your concerns there or is can you point out in the amendment the language it would. That would be contrary to you to your beliefs I'm I'm frankly I'm having a hard time with it DO understand it because I just got it when you all did in a minute over here trying to look at it and try to put it all together and so my my basically the amendment saying that we can the agent or circuit could make a decision outside that's contrary correct to the advance directive if any of these things happen right yeah above you I believe you are correct I believe yours or something in this language that you can point out that would trouble you're. And not not not right now no not really not at this time but I I just need to look at it more thank you not at not at this time okay but others may have better better insight than I do understand yeah thank you for L. in trying to put you on that I don't know I and I will I'm trying to avoid the question either thank you Mr president of Johnson you're right you're recognized. Thank you Mr Mr ****. You pointed out something that I I mean I read this bill. But I hadn't seen this before and I really start paying attention that line six on page five that you're talking about. The land reading it a circuit. An existing law says who has not been designated by the principal may make all health care decisions. A striking out that who has not been designated by the principal that's a good point hi I. I think I kinda like that better that a circuit. Would have to have kind of been designated by the principal before they can. Do some of these things I've been trying to but if I may what I'm reading it but I I yeah if I'm if I may I know we're just back and forth with this but it doesn't say what kind of surrogate anymore it just says the circuit whether they've been designated or not designated or certified or not certified or whatever word you wanted to use it just it that's is gone will it goes back that's where it goes back up to the top of that authority of the circuit on page four the end of page forward says the circuit shall make a healthcare decision accordance with principles individual instructions if any and if any yeah and and other wishes to the extent known to the surgeon right if the adults of individual instructions is the new language circuit shall make the decision accordance with circuits to termination or principals best interest. I mean I. I'm. I guess I'm I'm struggling to and and sorry I I've been doing some other things other room didn't get to hear the presentation or or some of testimony up to this point but At. Help help me understand why. Striking that language is is not good well here's the you have to read it for what it says here. Hey what we're left with the start with that it says a surrogate may make all healthcare decisions for the principal that's the patient that the principal could make on the principles on behalf that is as broad as you could get I believe if if I were if I'm able to make somebody's healthcare decisions the same as if they would that's there's nothing more broad than that. And so Where does that lead us in in the in in what we're writing into the law and what we're empowering surrogate's who may or may not be appointed by the patient who may or may not have a written directive to go by who may or may not know the patient you know they I mean we don't know what all the circumstances are out in that we just can't and that's that's kind of where it goes down to that next session at the bottom of the page five where it says an agent or circuit shall not make a healthcare decision that is contrary to the express terms of the principles written advance directive correct S. and right goes into the part that you said that if you see that where I said we were via with that we're talking about written advance directives so if I if I have a piece of paper that's on in my file that says what I want then that's that's what that's talking about but this appear above it is not talking about if you've got a written directive it just says they can make decisions It I I would assume that this would be applying more to people who don't have a written directive. Up there et weird where they get to make all the decisions. But see again I'm just going to say the that's how complicated this is and it really and it just makes me real and settle that we are that we're it we're so in indefinite about what all this does. Thank you representative Miller you're recognized. Thank you Mr. Mr ****. Tell me the. Because I'm sitting here wrestling with this both ways a see both angles yes Sir I don't think. Hello hello get in that tell me what it is about the way that we're handling the situation right now. That makes. You and. Everybody that's against this bill a lot more comfortable. How this is being handled now as opposed to how it will be handled. After this bill passes right about right now it's going on is so much better than than what could be. Here's what I would have but I know it is that right now I think the the sponsors of the of the measure and others have not made it extremely compelling case that something is terribly broken and needs to be fixed. Now that said I have visited with palliative care experts at Baptist health and elsewhere you tell me that they really do believe the healthcare decisions act doesn't need to be worked on. But this healthcare decisions acted that the is being changed here was worked on by a whole bunch of people people that understand the end of life issues palliative care experts doctors people coming at it from different religious points of view it took a lot of work to build what's here and so it's really dangerous I think to just to drop in here and just so we're going to change this and we we hope it'll work out okay. And so I think if this committee feels like something is broken it may be the met then I think there ought to be a lot of really smart people sit around a great big table and figure out what's right and what are to be done here and not not do it without that kind of input that's really important because that's how this got here in the first place I think okay and and again I'm you know I think a lot of you so I must say with all due respect. Which now gives me the go ahead to say whatever I want about your. But. You I still didn't hear an answer on I heard. You thought that the bill's sponsors those who are for it did some things got together had some talks. Whatever but what specifically about right now. Again just ask the same questions Gimme something specific to what I say Hey you know what you're right and make me believe okay so. This bill taken with sixteen eighty six and I know we're not debating both bills but they are somewhat joined at the hip. Shifts the balance of what gets done at the end of life more away from the patient and what the patients' desires are in more in the direction of the people that are providing the care like the the institution that's what that's how I would take this in its totality. Is it it's a shift of power. Are you re finished the. Okay let's go ahead no yeah well is there but most people like you to well no just Carlton wing. And now John Payton. Somebody else well in Gonzalez. And madam chair if I may I don't want to burn up everybody else's time because there are other people here that that have something worth saying too so I want to be cognizant of their time I'm glad to answer questions if you all want to ask me but. Gonzales Payton yeah I want to wait as well organization would be specific okay okay fine thank you madam chair and and I appreciate your congeniality let other people speak but I I'd like to ask you this on the. Page two. Okay and a line six is as the designation may be oral or written and then it says a circuit may make healthcare decisions for principal who is an adult or mainstay minor only if not counted focus on that only if okay the principal has been determined by a licensed physician to lack capacity. An agent or guardian with the authority to make healthcare decisions decisions about their principal has not been appointed. Right so I'm in this area that we're talking about is only coming into play in the absence of a directive in the absence of the patient giving some indication who they wanted to be a circuit I believe the writing which in here says that he would upon arriving at hospital the patient can say this is my circuit basically. It's remand of how we're going preference who we appoint as a circuit if the patient is unable to our hasn't appointed a circuit you know we start with the wife or the husband was and we go with a mother or father or adult child goes to quite a list before it gets down to kind unassociated people that list is Page three line eighteen nineteen twenty. So my question is. Is it possible we're debating what decision can be made or is it just wholly about who makes the decision. Here. I understand you may mistrust to use making the decision but I could assign paranoid to anybody what I mean I could see where somebody could have ulterior motives B. in the spouse or the child with the parent or or or whoever but it seems to me that this bill only addresses who's making the decision not changing what decisions are legal or not legal. Is that how you interpret it if you look at page three line three it says they shall consider. But it doesn't mean I read that not as a mandate about who they go to first and so I don't know how all that well I do I do believe I I know how that reads in the in the law you consider it well okay we considered it but we went down to the letter D. or a a for whatever and we picked that one because that was a lot easier to do. and so I still have some some thanks to I do have a next about that represent Payton and if I could follow pretty quickly I I would agree with you if what you pointed out applied. To the list but it doesn't what you pointed out is under subsection three the listed under subsection for. So that doesn't apply let me look on the shelf if you'll bear with me just a minute let me read. May consider the proposed surrogate that Senator be there may consider on line ten yes we have online routine that started the whole movement ability to to visit the principal during his or land availability. When did find the person is closer than May proceed in order okay so look at the line sixteen. They may not shall. May proceed. So you'll be more comfortable that said shall absolutely okay yeah thank you Sir yes Sir thank you Mr thanks thank you Mr thank you thank you represent paid for your questions because that's what we need to do is we need to look at this here and I appreciate that I ain't seeing no more questions. Thank you for your comments thank you Mr chair and I I'm sorry this took as long as it did but I appreciated thank you. Tony road. You would come to the table. Introduce yourself and who you represent. My name is Tony rose I represent American speaks. But mostly today I represent a daughter who took care of her parents who had bearing forms of dementia and disabilities for ten solid years into hospitals nursing homes assisted living breaks. Things like that so I really appreciate the amendments that you made I really do and I thank you for that because I know you were trying to accommodate a lot there so. But but here's the thing that I just want to caution you about as you consider this based on my experience over those ten years. Is one the qualification of the people that can appoint themselves circuit's because you can have two folks there and everyone can appoint the other a circuit so it can be two nurses on the floor taking care of that patient and one of them says you're going to be the circuit for that person. If you read the Piece that rose sent out from doctor Smith. There there needs to be some standard of of qualification and expertise in dealing with allocated care for end of life decisions because. There is definitely ageism within our health care community there's ageism and our communities period. And let me tell you once you had eighty five. There's a lot of I don't I just don't want to fix this I don't you don't need to a knee cap anymore I'm just going to so this up or you know why he sent you the physical therapy you're not capable of recovering anyway you know my parents or recommended to go to hospice multiple times. And because they did have me as a surrogate I insisted they go to physical therapy I worked and made sure that they were taken off of psychotropic drugs at that were keeping them from recovering physically so there needs to be some standard of qualification for these circuits to be able to make these kinds of decisions whether it's in this particular bill or trying to substitute a poles of one page three checks off the box or an advance directive the other thing to consider is that I had to carry around an advance directive a medical power of attorney general power returnee all the time both on my phone and in a folder in my purse because nobody could ever find it I gave hospitals nursing homes assisted livings of multiple copies but it wasn't just hospital to hospital it was shift to shift it was nurse to nurse you know one person knew about it four hours later nobody knew about it you know the hospital say well we change software and we lost it and things change but nobody ever had a copy of the advanced directive even though I went there remove paper making copies of those so take that it can into consideration the other thing is we just came off of a pandemic or I would not have been allowed to to do those things and I really hope that not that wonderful bill the all past you know allowing the circuit the family member the loved on whatever to be in there by their their side. It fixes that but while what if. What if things change you know what if we have another emergency and we make an exception for that and I'm not allowed to be in there with my advance directive and my knowledge of the fact that they can do more or that I have a vested interest in them living instead of being shuffled off to hospice I heard that my dad needed to go to hospice so many times. That by the time he really did need to go to hospice I didn't believe them. And he lived a week longer in pain and suffering that he needed to all about that forever that's my bad. But that's those are the some of the things that can happen. When I'm qualified people. Get to make these kinds of decisions so I would love to see one I'd like to see the the doctors fixed because they seem to be the problem if they if they won't show up to make these decisions but. In any of any of that I looked at all of the states that have similar tight bills to this for the circuits to make these kinds of decisions most of them require a little more training so for example. let's see. Have have a list of not gonna go through items in give you a couple examples They have requires collaborative practice agreement with a supervising physician requires collaborative agreement with the physician unless and P. has special permission from the board require supervision of a physician or service surgeon requires a protocol agreement with a supervising physician so it just it goes on and on and on everybody has different language but most of the states requires some sort of additional training and if you'll read that letter from doctor Smith he makes that very very clear he has some great folks that can make good end of life decisions for people but they required training and mentorship so those are my concerns about this I think you're going to hear from or have heard from much greater experts I'm just a I'm just an expert tiger daughter and happy Thursday thank you any questions. Representative Miller you're recognized for a question thank you and thing Mr central record. I'm making represent Payton must surrogate until the end of the day today world record everybody started. That's been done. What kind of training does he need after I say eight. Keep me alive. Okay that and I'm I'm I'm not making light of it but I mean honestly like what what are we talking about the type of training me somebody says for reach a certain point pull the plug if somebody else at like maybe I don't want to pull the plug let me keep kicking of and so I mean what type of training are we talking about a single class are or what I mean give me some idea about that place sure so first of all if you did make representative Payton your circuit then there would be a presumption that you had made some communication with them about your end of life choices also there might be some assumption that we know what how you're operating before you enter that hospital twenty four hours ago or five hours ago or two hours ago and that the person that is looking at you now doesn't know that so that may make a difference and or at least admitted to me that you may be in a situation where you could recover to be able to go into some of all that so type of training the top type of training that doctor Smith talks about which is much more specific in his letter but it does address things like ageism you know that when you're forty five or forty or whatever you know you have certain attitudes and perceptions of what quality of life is and you need to have some training about whether or not this person should go to hospice because of they'll probably die within the next forty eight hours or whatever and they will have never have a quality of life but there's so many things that older people with. Dementia can't communicate and it's. Let's face it of. AP ends up a period ends and physician's assistants and pretty much all health care are very overworked very stressed out especially after this pandemic and they're making decisions faster making them and in a hurry so they may have a level of care but they. They also need to get to the next room occur a good example I think it's a minor example but it might help. My mother went to physical therapy several times either she you know brokered knee cap or something. And the people that were in physical therapy the nurses they would do things for her to get on to the next room they treated her like a patient not like a physical therapy patient but is somebody that they needed to get out get on the pot and get taken care of so they can go to the next room okay that's not what they were supposed to do what they were supposed to do is say that. Get up. Put on your clothes. Kitchener Walker get to the potty well that's going to take ten minutes whereas they could lift her up out of bed will around center down the pot get her up and get her back into the bed and. Two minutes you know. So those are some of the things that you have to be trained and cautioned against when you're put in the place of making these decisions for people. I wish Dr Smith was here could tell you a lot better than me okay thank you that's an example representative when did you have a question. I think I'll I'll say that okay all up for the first. All right that's all the questions we have thank you for your call right now thank you. Paul Byrd to speak against the bill. Please enter this yourself and who you represent. Thank you chairman is the Mike on. Good deal hi my name is Paul Byrd an attorney here in Little Rock Arkansas I'm here for myself. You know the. This is a subject is very hard to cheer. What you have to ask yourself is. The law that we have now in the protections it gives us and what problem is this. Bill trying to solve. And. I can't find it hi read the Act as it is now and all the laws and and the protections are there so let me. Save a couple of things that have me concerned. under the current law. As in the this amended law. If the supervising healthcare provider cannot find. One of these family members. And finally comes down to a conclusion on page three line twenty five. If none of the individuals to act as a surrogate under this subsection or reasonably available. An informed consent would typically be fought from the soften the principal the supervising healthcare provider may make the decisions. After they consult with. The ethics officers or the ethics committee or and here's the big change. They can obtain a concurrence from a second physician is what the current law says. Watch now changed is they can go to physician or they can go to an advanced practice nurse or they can go to a physician assistant. So the protections that we've always had is if if we can't find the circuit if we can't find the family then we're going to have at least two doctors who have their licenses on the line make the decision that is a societal. Protection. What we've done here now is made it where it doesn't take a doctor or a second doctor to make that decision. Ironically. On page five we've now amended it. To where if the surrogate. Has it has to follow an advanced directive they can go around it. If they get with the at the supervisor healthcare provider gets with the ethics officer ethics committee or a physician we've now put it back in it there has to be a physician but that's only if there's an advance directive we've taken it out of if it's just a surrogate. But what may even be the most dangerous at all. If we look at what we've done. To the surrogate. The surrogate can now. This is you know this is after they've gone through that whole S. and they can't find anybody for the final of the family members. A surrogate may make all health care decisions for the principle that the principal could make on their own behalf the prior law laws exist right now says wait a minute that's a lot of power. So we're not gonna let you make all those decisions Mr Mr get. When it comes to hydration or nutrition. If you're going to withdraw hydration and nutrition. Mr Mr get our supervising healthcare provider. You can only do it. If it's authorized by an advance directive or if the supervising healthcare provider. Goes through all the steps they have to make before. So now the circuit has full power to withhold hydration and nutrition and that has been something that we have fought for and fought against the ever have anybody have that ability without the societal protections that we have regularly been asking for which is to have a medical doctor put his license on the line to make that decision the only. The other thing I would say to you if you look at current law as it defines a supervising healthcare provider it means a licensed physician. Or. Other authorized independent health care providers undertaken primary responsibility. Well we we in this your body has now amended what an authorized independent healthcare provider means it can be a physician's assistant are authorized practice are in. So these no doubt these are major. Major decisions especially what comes to the hydration and the nutrition and ironically. The supervising healthcare provider has more power if they can't find a circuit and if they do have the circuit they've got more protection against the circuit I don't see those two provisions out they both need to read the same. and that's all I have and I'll be glad to answer any questions representa Eubanks you have questions. Thank you Mr chair. You're saying that the physician would be put in their license on the line by making this decision correct I believe a physician or a lawyer puts their locations online anytime there working for not agent or client would the would not the nurse practitioner or the physician's assistants be putting their license on the line as well well I would I mean we've given authority to treat people so I've got to make tempted with old hydration nutrition to make decide I mean where I'm not ready to talk about sixteen eighty six yet I assume that's coming up but you allowed to an advance practice Registered nurse or physician assistant to be able to define what when it's a terminal illness. I don't know do we ever decide we didn't want doctors making decision once a terminal illness I don't want my loved one or myself as I get more gray headed to do not have a doctor deciding when my own this is terminal but that sixteen eighty six I'll talk about that. In a minute. Any other questions. Seeing none thank you for your comments thank you persist okay that's everyone who's signed up to speak so representive are you ready close for you bill. Yes thank you Mr chair. Stop taking four pages of notes and I will try to be as fast as I can and I think I may go backwards order since it's the freshest on my minds but to Mr birds he says is about the circuit having full power to withhold food and hydration this is not correct that's not what this bill does this bill is still leave that in place anything that will pro long the natural that has to have the same exact protections that were in the bill originally I'm just saying that in place of the second position you could have ethics council I'm not giving circuit any more power than what was already in statute such will be very clear with that May not make decisions. He said what problem are we solving he still can't figure out what problem we're solving again the only problem I'm trying to solve with this bill is adding an ethics counsel prior to the three days just for guidance there is no you're right I tell you there's nothing in it that essentially there's no repercussions if the court doesn't do it within three days so since I add an ethics council trying to see what it feels Mr **** he talked about and representative paid you had him your to asking him questions about the list of circuits and it says may that's what's already in statute that's what they approved years ago when this was written. I would actually be glad to change that to shale I probably should say shall it's not what I did in this bill that so we could talk about doing as one of the lead out there that I'm actually should go in that order and I'm not opposed to being shall I just want to point out that that's kind of what everybody agreed to do was make beginning has nothing to do with my bill You know he said this shift away from the patients again I'm not shifting anything from the patient I'm not changing what the circuit can and can't do I'm just adding that ethics counsel. at miss rose she wanted standards for circuits again not someone else to file a bill that just that sets up standards for circuits are training for circuits are all that that's not what I'm addressing this bill tries just trying to add the ethics counsel. You know and I. Right on right to life and I appreciate everyone says to Marlena passion everyone's been about this and I've tried to amend it the best I can to still accomplish what I was trying to accomplish but address concerns as well and I do understand Rowe said this is going to be on her report card but I guess I will fail because I introduced the bill I don't know what to tell you I've had they know a family council sent out mailers to a lot of people's districts on the vote against this bill I've heard that I'm promoting euthanasia so. I want to say I'm not a I'm not promoting euthanasia I'm just trying to help someone in the life if they have an issue. And they need to make a decision that we have an Avenue that actually works because this bill right now doesn't work so well we in its current state and and finally the I guess the last thing I really want to address is. The first Speaker Misperception of actually had a couple text not sure of. What nursing home she actually goes into or what she does because of it tends people texting me saying you know if never heard hires number in our nursing don't know where she came from but the one thing I do want to address she talked about cost efficiency and that it will be cost efficient for me to write this language to kill people first of all that's just insulting and I do take offense to that that is not at all what I'm trying to do is let's look at it from a practical standpoint if I'm hospital do I want to do something that would cause the death of my patients sooner or at all no I'm looking at it from a purely financial perspective my reimbursement gets I get money gets taken back from me based on my brutality right so member tell the rate goes up I make less money on all patients not just that patient so it's detrimental to me for that patient to pass away matter fact a lot of hospitals we tried ship a patient it's end of life to the nursing home so that that patient doesn't die in their facility right so it's bad for business and if I'm a nursing home and I have a deceased patient or deceased resident the no longer make money so to say that it's cost efficient for for this for us to try and expedite death is just incorrect and it's insulting and so again just to summarize just trying to add an ethics council I'll be glad to add the shall miss Indian if I need exactly think that's a good idea and with that I'd appreciate a good vote. What you have motion yes a motion to do pass do pass as amended do pass as amended. The discussion on the motion representative Penzo you're recognized. Thank you Mr chairman. I think this bill does a lot more than create an ethics council and I pretty much agree with everything Mr bird said when he came to the table I think this waters down lot of inner life protections I think it's a extremely bad bill I've had it a tremendous amount of out reach on this people reaching out to me to have respect for a lot of people that came to the table I'm not I'm not concerned about vote no because I'm worried about my score from Arkansas right to life for the family council I think this is the for one piece of legislation no offense but you know. but I just I just would ask everybody to vote no on this I think it does kind of open up some doors that we don't want to open up and I appreciate a no vote on this from everybody thank you. Representative when you're recognized. Thank you Mr you know this these two bills and this will talk about this one in particular it's been yes but not following a tennis match sometimes he does far as what's what's being said and then there's like this mythical to tennis match going on as well as far as what people are saying about what's actually being said and as I've gone through and I've I've listen to the testimony as I've I've I've read the bill and I read the changes. What it seems like when I look at the bill and the amendment itself when I look at page two line eleven through thirteen Page four line thirty six Page five line six in the strike it actually seems to strengthen. The end of life decisions as far as who is being involved with this. And so with that. I'm trying to figure out why we're getting the help of that we're getting on this bill I guess that's that's really I do like the idea of the shall I would appreciate that on the Senate side would and would support that thank you Mr. Representative Bentley you're recognized. Thank you chairman representative. Great I just wanna thank you for the time you take into this bill you listen to my concerns and I appreciate that and I agree with representative wing it strengthens what we have in place I'm really in favor of this bill it thank you again for listen to my concerns I appreciate it and I think we all care about patients end of life I think it doesn't increase of what we do in that in that show on there I think there's a lot amazing that they were have been there all along and it made it better I appreciate. All right any further discussion. Represent Payton you're recognized thank you Mr and since I mentioned the shall I wanna thank you for offering to amend that I guess I would agree with representative **** I when I read this. I believe it it does clarify. How we appoint the circuit. On Page two line fifteen it says a supervising healthcare provider shall while work on the amazing shells shall appoint a circuit. We've got to spell out how they go about prioritizing who gets appointed as a circuit if you get down to the bottom line is that the the gentleman was talking about their and they can't get a circuit that have to go to a to a second physician or advanced practice registered nurse it spells out that that person shall we cannot be directly involved in the care of the patient to the county get in an unrelated second opinion right there. I'm I'm comfortable with it and I'm sorry that it has fostered a lot of confusion I hope I'm not wrong by voting for thank you. Any other discussion. Seeing none motion on the floor is do pass as amended all in favor signify by saying aye All opposed nay. Hi seven the motion passed. Raise your hand. I only see one. Resolution bills passed thank you Mr chair committee. Thank you you're recognized to run. H. B. sixteen sixty six yes sixteen eighty six or sixteen eighty six I think I may be too tired is going to run this. I do have and I do have an amendment on this one as well. Yes there's an amendment to the amendment over there. Senate committee. Okay is amendment come around. And hopefully we can make this one faster You want to go ahead and tell about the animals Senate will send this to you and Mr Bernard when he was up here he kind of alluded he went into sixteen eighty six for just a moment and then he just you know kind of said I wait till we get there but one of his concerns in sixteen eighty six and I did listen this was something that might even represented Bentley brought to me was the definition of terminal illness to be honest with you I'm not entirely sure why that was drafted into the bill terminal illness has been in it's been codified in the bill in statute for years without a definition I didn't see a need to add the definition so what this amendment does is essentially deletes those. Four lines that have the terminal illness definition and. I have a motion to pass to approve the amendment. Any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay moshing carries your members been adopted you're recognized by your bill as amended thank you Mr chair so this is what I'm doing here is this is an act to amend the Arkansas physician order for life sustaining treatment act or what we shortened to poles so a post form. So currently the polls form and it's again in order for life sustaining treatment. can only be signed by a physician and so what I am proposing with this legislation is that a nurse practitioner or a physician's assistant could also sign the form We have a printed out twitch I look at it I mean I can if anybody wants to see it it's here it's like thirteen pages they're at thirty to believe thirty two other states that allow PA's in thirty seven other states that currently allow a PR ends to sign the form and that's out of it there's roughly I think forty. Roughly forty states that use the polls form so a majority of the states do allow mid levels to sign this form that's the the first thing that it does this this bill does the second thing that it does is that it allows the day the last document signed to take precedence so your prom sure you'll hear you we have an advance directive and we have a pollster two completely different forms the advance directive is completed by the patient themselves as to what they want do not resuscitate you know all life saving measures whatever it is that they want the pol Sgt is a physician order for life sustaining treatment and actually I've got a I brought a copy of it here with me and it's a voluntary form and I will say that it's a voluntary form not something that a physician or nurse practitioner anyone could force anyone to do the It's voluntary it has to be done by the the patient or the patient's agent a and has to be signed by the patient the patient's agent along with the this the healthcare provider. More than anything a poles form is used as a communication tool so if you are in a nursing home when you're headed to the hospital that form the nursing home should send that form with you on the way to the hospital so they know if you want full treatment prolonging life by all means selected treatment or come for treatment so it's more than anything it's a it's a communication tool. Everything that in the form itself and a mid level can do in order already so it's not like either they are working within their scope they're not working outside their scope and more the thing is a communication tool so I go back to that said the second thing the second thing says if you have an advance directive and you have opposed no matter which way they were done the one that was executed last is the one that takes precedence and what we will find as well have a someone with an advance directive that's ten years old was under different they didn't you know under different circumstances and they'll have a poles form that's done near the end of life that says something different than what was in the advance directive this changes it from always being the advanced directive as the document of record to being the last one that was authorized. That's the two main things that the bill does we did define advance directive of not hurting you would miss it had an issue with the day that with defining advance directive or advanced practice nurse and I'll leave it at that And see if anyone has any questions and also have Dr garner I think she still here yes if she wants to if she could come up Mr chair. If you would please introduce yourself again and who you represent I'm Dr Kimberley garner and I'm representing myself as a board certified family physician and geriatrician in hospice and palliative medicine physician thank you represent Wardlaw you're recognized for a question. Thank you Mr. President Graeme when we went there to session representative Johnson had a bill I've had a bill we advance the nurse practitioners in a way this session so that they could both move towards independence from the physician we're saying I got to serve so many hours under physician and and we've made on PC peas. Why why would we not do what your bill does And would that not fall in line with the previous bills that have been passed through this committee and the legislature no I I completely agree with you I think it does fall in line and also one of the other things that we're seeing and it was very evident during the pandemic but one of the other things is. Sometimes it's hard to get physician in a building especially when you're talking long term care whether it's more likely to be nursing home. Nurse practitioners tend to be in the buildings daily weekly there there more often and because the model of care has shifted in the last I'd say eight the I set up a model to do that I guess about eight years ago so that's about the time it shifted so what you're starting to see now as you'll have one physician who's like the medical director over a lot of facilities and that medical director will oversee nurse practitioners at each facility and so that that physician or medical director may not go to that facility but once a month once every two months and once every two months it's mandated by federal law they have to be seen by a physician every sixty days so it's about the that's the maximum time they can go so what we're finding is we need you know the patient needs this poles form signed but can't get it signed in a timely manner so this would help expedite the wishes to go into that poles forming a more timely manner so as follows this is sort Committee knows but Right now those nurse practitioners are basically seeing these patients work in these forms and in these doctors are signed into law as agreement to that situation and doctor Gardner C. shaking your head so you you you completely agree where I'm going with this so this just basically puts the practice and puts the ink down to that person that's there with that patient at that time instead of having to go to that medical director that only seen on every sixty days probably not talk to the family it but maybe once every six months with this nurse practitioners there all the time see in that family having those discussions so you bring in that closer down to the family it would you would you agree to that I would agree to that yes Sir Many times well let me just say this the nurses nurse practitioners and physicians' assistants can write every order in the long term care facility or nursing facility that's on this poles so that that is in their scope of practice and it has been that's not something that's new I know you'll have expanded some of the things for them in this legislation but that has been in the practice and in their scope thank you they've generally talk to the family and fill out these forms but the only thing they can't do is sign them and so a lot of times they are waiting for a provider position to come around to sign the form for for it to be active and that can cause some challenges if something comes up in the interim and. That has not been signed. Thank you thank you Mr president Ferguson you're recognized the I have rivers questions for doctor Garner do you do these polls forms yourself do you have these end of life discussions in my act in the biggest concern I hear from people in a knot that was pretty involved in the polls discussion for the last four years. Do you really feel like a PR ends are competent to do these discussions I mean you you don't you don't want someone to be coercive you know you want them if if patients want a lot of medical services you want that made available you don't want someone to encourage them to not get medical care of so I guess that's my question are are you not having those discussions now you're just signing a form that the A. P. R. eight students that already is what happening. I have the discussions and sign the form I have nurse practitioners to maybe go to home based primary care you know out in the in the. Patient's home and they have the discussions and some and they write it up and then I review it and call the patient to make sure this is still consistent with what they want but then assign it but the nurse practitioners that I work with they know these patients so well they are not trying to coerce anybody they look clearly can say they want everything they want all active treatments or they want something in between or they want comfort measures. I believe a nurse practitioner or physician assistants are capable of having that kind of discussion of my my nurse practitioners and physicians' assistants that I work with do that I have to bring it to me to sign and I guess my question is are you doing any sort of a voluntary training with them before they still are doing that are ready I mean what you know is a loosely again our nurse practitioners have long term care of training which includes end of life discussions asking people what they understand about their illness what are they hoping or expecting to happen what are they worried about we specifically do that training to make sure they're prepared to have these discussions. Mascolo I guess I'm just trying to feel comfortable that that would happen everywhere and it's not just specific to your situation with the appearance. Well once again that's in their scope of practice so to have that in their scope of practice they have to receive that training you can't get people scope of practice that doesn't include that does include the training to be able to to provide that scope. And that's been for a long a long time I mean it signing the in our forms has is part of the national scope of practice for nurse practitioners it's it's been an established a process is just an Arkansas can't sign these forms even though they have that in their scope of practice nationally yes no I mean I see the need from I've had discussions with represented Graham just trying to feel comfortable with that I guess yes to put to be in the scope of practice they they have the required to have that training okay we'll we have other questions. Represented more. Thank you Mr chair representative very Page four I just Family council head raised a question and I want to make sure that I understand it because I think it's a valid point so Page four lines twenty five through thirty six it seems to say that the post forms will replace advance directives if the post is more recent so would the physician the the post actually replace with the patient had said and if so could you give me some context and help me understand why that would be the the case. The one after that are you going in office okay and so that's and that was the second piece of this that I said. It does oppose form replace an advanced directive the way that we are changing this the last document created would do that it's not the same type of there could be things in the advance directive that are outside with these polls does that would still be active but if there's contradictory language between the two we would look at the polls form instead. In all the time positions such as myself but also nurse practitioners and physician assistants have discussions with patients about now they've got a serious thank credit cancer diagnosis but may have filled out there to instructable on time ago and so we have what or call goals of Kerr discussions with them so that we can make sure they understand what the illness is and the eight what they were asking what they're hoping for what they want and we write these things based on what the patient tells us. As in the other of bill you know if they can't tell us and we have to look to the circuit. If there are unable to communicate let's say a person with advanced dementia of my mom had I had to make decisions for her not as a position but as her daughter because she could make the decisions for herself. Quick follow Mr quick a so just help me understand if you're having engaging the patient in a conversation why would you then not work with the patient to do a new advance directive the end of this gets complicated and and so hello my so in the case of dementia which we we have an aging population and we have a tsunami of aging patients and the tsunami of patients with dementia if they have dementia they can't compete revise their advance directive because they don't have decision making capacity and that happens very frequently especially in a long term care settings a large percentage of those patients don't have decision making capacity so if we determine that they can't analyze and. Of look at the decisions I make and make her communicated decision to us we are mandated to identify the circuit as that other law bill designates the other spouse adult children and there's a hierarchy for that that we go through. then we have to look to their to a circuit to help us and that's why circuit is allowed and has been allowed on the previous polls. Law Tuesday of sinuses will. I think I would say that I mean if if they have capacity than obviously they could do they could sign this and they can change their advance directive no they they don't have to do this if they don't if they still have capacity and that's fine in on here does say there is a section be where it talks about discussed with patient who has capacity or legal representative and it goes through that there's an advance directive on file dated such and such date so the primary goal of this form is to try and shore up with the advance directive is and what the patient legal representative once and then there's also a place for advanced directive not available or no advance directive it also I mean in a perfect world you trying shore the two up but there are instances where you're not able to do that and that's what I'm trying to address. And I will just say that this also protects the patient for what to get what they want because if they were and it is a communication tool but I had a specific situation where I had a patient that was going to hospice it was only two miles away but because his vital signs were out of parameters the paramedics had to divert him to the emergency department he ended up getting coated which he did not want and died just because we didn't have any way to or the pulse was not available at that time it was just two miles but you know when you get outside whether you have the DNR order in the nursing facility or you have that the in order in the hospital there is a gap there where you could get things the paramedics have to follow protocols I guess I should say the so this allows them to have a what's called a portable order which means an order that protects the parapet paramedic and allows them to get saying get what the patient wants in that transmission time and that transfer time. Representative Johnson you're recognized for a question. Thank you Mr chair Trying to figure out of my question was answered they're not. I'm. I'm. I'm in section two and. Kind of struggling back and forth with some this language and and you're talking about your pants directive. So the you struck line one there page that is not everyone wants line twenty five on page four yes. On twenty five and twenty six. Where it says licensing treatment form is not intended to replace in a man's directive. And So now it will be if this is passed. That if you will supersede advance directive if this goes into law if the polls for was executed after the advance directive and is in conflict with the advance directive that is correct. Okay. But the advance directive is what the patient wanted yes and a lot of times the polls form is what the patient wanted as well the legal representative may also complete the polls for legal representative also is a guardian durable power of attorney which was again appointed by the principal by the patient so all of those things are I mean there are things that the patients and that power of attorney should have discussed these issues ahead of time they should know they trust that person to make decisions on their behalf again or the circuit which is he goes down that list of things Majority of the time the legal representative whether it be the power of attorney the guardian the surrogate does know what the patient's wishes where. Okay. And can also that since the last paragraph there it says if conflict sense yes exists. The recent Dawson document takes precedence. I'm not sure if I've got a question I think a I understand. Can. I'd like to say only about thirty percent statistically across the country on that thirty percent of people have an offense directed so this allows a of legal representative that there's no advance directive to to make this these designations so that the patient can get the same care they were getting in the hospital or in a. Yes would you mind. Nationally only about thirty percent of people have an advance directive so this post allow. People to make these designations even if they don't have the or their legal representative to make these designations and it's a communication tool the hospital does not have to follow the polls they have to write their own orders there's other orders that are in the nursing home this is just making sure that the as they transfer the those previously designated recommendations are honored but it also gives whoever's receiving them at that facility an understanding of what is previously been. Assigned an unwritten. So it does protect the patient to make sure that what they want is even in those. Kind of transfer times yes the same care. Okay thank you for your comments we we have five people signed up to speak against the oh I'm sorry representative Bentley you're recognized Dr garner thank you for coming here today and I'm a real advocate for these polls I think they're great forms and do not think that these changes in this bill might post more available to Arkansas students across the state make it a. We were more more patients can have that we have more people available to get them totally filled at yes ma'am. And it thank you. Okay thank you. Of the first person to speak against it the bill is Sheila Purcell. Presented by yourself and who you're here to represent. Mr. I appreciate by this here today but we're all retired six twenty five six only limit three minutes per Speaker please three minutes per Speaker including questions thank including questions. Okay the motion is limit three minutes per Speaker including questions all in favor signify by saying aye. All opposed nay. Motion carries were limited to three minutes three minutes starts now my name is Sheila Purcell and the director for northwest Arkansas respect life and that's the organization that I'm representing just to answer your previous question that read but nursing home that we see is is called the waters in right in Rogers but they've recently changed ownership again either now called the blossom I believe that and that's that's why I find these House bills so scary because of the people that need their protection the most these are folks that don't have advance directives they don't they're mostly Medicaid people their dementia folks and quite frankly I'm glad that a doctor has to sign off on this poles it's one more level of protection that they need because they can't they can't defend themselves and the fact that one thing that would have to be changes is the title of the the document is no longer a physician order for life sustaining is there a nurse or practitioner or something because we don't have that qualification and I just an example like the waters with the changeover the ownership to change the high turnover the employees you know you wonder how much training people are getting and yes it is cost effective it is it more expedient it is more convenient just to be able to have a series of people sign off these forms and that's not the best protection for the for the residents so I added I'm not saying that this bill is going to directly kill a resident but it's what I said before it's one more step one more step on the slippery slope I think polls forms in and of themselves are. Are a little bit dangerous it's like deciding today which are gonna wear in February. You have a kind of a good idea but you don't know the specifics of the situation in February what you the code that you say you need to you might not need that but you maybe forgot about whatever you're making medical decisions today on a poles form for a medical situation the future when you don't know the details and now we don't even need a physician to sign off on it and that's one more layer of protection that we're losing for these very vulnerable people she paints a rosy picture for people that have made advance directives that the people of communicated with the physicians but these vulnerable folks in these Medicaid phones homes don't have that and they need to be protected by law our laws must protect those that are the weakest the most defenseless in the most vulnerable in our culture. Vote against this house bill sixteen eighty there couple questions would you take questions and take questions and all right thank you for your comments. K. next road men's you would come to the table and Easter seventy represent. Thank you Mr chairman Ambrose mims executive director of Arkansas right to life everything that said before on sixteen eighty five stands again except I'm going to just add that you know back in twenty fifteen I spoke against the polls to. And then twenty seventeen we were back with it and I worked with many people we sat at a big table and many people were involved in a in a poll said I feel good about it was a ten page document and it's been whittled down to five pages barely five pages and a lot of the good stuff that we put in it has is now gone I just want to read to you. Because the Legislative findings were one of the most important things I thought in the polls because an advance directive is not just in writing you know my mother before she got sick we were having a discussion could you should have the discussion about these issues she said I want water and I what food. And she paused and then she said and a year I want a to okay so it wasn't difficult for me when she need to be on a ventilator three times that she got that bill later in she lives in Austin model would you want that again she said yes Is save my life I would want that again. Okay so the Legislative findings in the original holes that was passed in twenty seventeen says it is important for individuals to make healthcare decisions before a medical crisis or emergency occurs healthcare planning is a process rather than a single decision that helps individuals think about the type of care that they would want if they become seriously ill or incapacitated. Encourages individuals to talk with their loved ones and physicians regarding their health care decisions in advance directive gives individuals the ability to put their wishes and riding it to identify another individual who would speak for them if they become unable to speak or make decisions for themselves the physician order for life sustaining treatment for compliments an advance directive if existing by taking an individual's intentions regarding life estate sustaining treatment such as the intention set forth in an advance directive and converting the individual's intentions into a medical border. So I'll just read the. Testimony under well we have three minutes I'll try to go fast. This bill would make dramatic negative changes to laws surrounding advance directives it it strikes is Mister Dotson said the line in the in the polls to fifteen seconds. Vote no on sixteen eighty six please thank you thank you for your comments. Jerry **** please come the table inducer seventy represent. A Mister chair before my time stars may have have somebody passed out a copy of the polls to form that we're talking about with that is just the form just a form yes like for I'll bring it up. Okay. Thank you Mr chair of members of the committee the the form being passed out is the what is the what we're talking about so thought it might be good for you at least have that on your desk so you can look at it. The I'd like to call your attention to page two line twenty four through twenty eight. Where it talks about what a patient is sincere patient is an individual who has a life threatening critical medical condition or terminal illness for whom a. Supervising healthcare provider or physician extenders has determined that a physician order for life sustaining treatment is consistent with the individual goals of care I read over that a dozen times probably never never saw this deal it was called to my attention. I don't think the sponsor intends it to be this way but the way that reads is that the only people under this under this that could do a pulse form would be a supervising healthcare provider or physician extender since you have stricken physician out of there so that means if your palate of Kerr expert over Baptist health like doctor Smith. It reads as the where he would not be able to fill out a pollster form and I know that's not the intent but I believe that's what actually how it read what it does. And so that's that that's a problem with this the other thing is I want to call your attention to the polls form if you look in the upper left corner of it it says in bold print there up there toward the top it says polled compliments compliments an advance directive and is not intended to replace that document now the reason that's important is because the polls form was developed by a whole bunch of people that got together a few years ago it said this is how we ought to do the directive for people that are about to die not expected to live more it wouldn't be surprised if they lived more than a year they would be surprised if they live beyond a year and so they made this form for that purpose this bill changes that form into an advance directive I can't tell you all the ramifications of that but that's not what this form was made to do is to be an advance directive and it's clearly stated on here you go to the health department website and it says this does not it is not intended to to be in place of an advance directive and so the with that the only other thing I would say is in a row five times chair but I'll try to get one more point very briefly it's on page four line thirty one third through thirty three were striking the words when appropriate and desired by the patient and we're saying to the extent that it is in the best interest of the patient who gets to decide that. Rather than saying when appropriate and desired by the patient that's that shift I was trying to tell you about earlier it's shifting away from the patient and what they or what their desires are and I believe more in the direction of the institution and empowering them thank you Mr chair I'm sure my time is up. we do. We do have a question you get thirty seconds representative board. Thank you Mr chairs of Mr **** I just wanna clarify on page two when you when it says supervising healthcare provider or do you not read that is a physician would give is in the back yes yes absolutely I'm glad you asked that it could be that physician that is right there L. like if I'm the city physician I'm supervising health care person I can do the form but if you're a palette of Kerr expert the smartest guy in the world the way this reads you couldn't do it for you see and nor could doctor Gonzalez or doctor cloud or doctor Miller they would be in time is a thank you thank you thank you Mr chair. Tony road. We say okay. Palmer's. Please enter seventy represent. Yes three minutes. Okay Paul Byrd I'm turning here in Little Rock up here for myself You know we have a. Hale is a system of government. It's built on checks and balances we have three branches of government it's all done because we don't we want to be sure that power is checked. And here we have all the current law that at least a medical director working at a nursing home. Has to get off his tail in income or to the nursing home and decide what's in the best interest of the patient. You're taking that away. You're taking away the advance directive that a person got to go and do and think about before they ever get in a crisis situation but now it's gone. In your other bill you make sure that the surrogate is not somebody that works for the healthcare provider you're trying to get that independence but what you have now is you have a nursing home employee this going to be talking this person into signing a form. It does completely away with their advanced directive and whatever's in conflict that advance directive is gone why may come. And so I'm just amazed that were taking our doctors completely out the impact would call it a physician order is not a physician anymore order anymore it's it could be and are in order it could be a physician assistant order what we're looking for is that person that's independent a medical doctor that has to come over and put his license on the line to look at this patient and talk to him and decide what you gonna have now is the ability for a person to just disappear and go away and again it doesn't talk about it you can take away hydration and nutrition this can take it away. This can trump everything that happened over there in the other bill you just passed they can still do away with hydration and nutrition which was not something we ever had in our law in Arkansas before so I think it's dangerous I think that you're going to be able to have employees be influenced by people who don't want this situation of a patient or resident this guided to Q. but is also the size of a fist it's been sitting there growing and you'll never see him because they'll just silently yet die away at a nursing home I will never hear about it will go to a hospital they won't go to to a of individual doctor who's gonna see and say wait a minute this shouldn't have happened they'll just disappear I still have sex thank you for you. we don't have time to questions or thank you for your comments thank. All right that's everyone that signed up to speak on the bill representative great clothes for your bill. Yes Mister chair thank you I'm getting so tired I'm not sure I can even close properly Additionally I guess I'll go back in order again but to miss Purcell talking my COSTEFFECTIVENESS is absolutely not true and having a nurse practitioner sign the form over a physician has absolutely nothing to do with costs you don't physician doesn't charge you to sign the form a nurse practitioner doesn't charge you to sign the form and what has to do with this top affected miss of time so it's sufficiency but not COSTEFFECTIVENESS I mean she did not post in general but that post is already here it's here to stay in the somebody strikes the entire language and I know of road talked about a ten page document we will that down to five I will do anything down we just don't put all pages of statute in a bill we just put the part in that were changing so I have no idea of what the actual statute how many pages it actually is I also like talking about it being a nursing home employee and it not being independent and all that. You know I'm sure there are a few nursing home state employee directly a nurse practitioner but. You can't bill it you can't bill Medicare you can't bill insurance for an employee that use that you for an employee of a nursing home that would be included in your daily rate right so in order for a nurse practitioner to get paid for what she does she here she does they've got to work with the physician may have to be a billable provider and they have to bill insurance themselves so these providers are independent they are not employees of the nursing home they're independent providers and so they're not carrying out the wishes of a nursing home there essentially I mean they they have a license to protect their doing what's in the best interests of their patients not what's in the best interests of a nursing home at it I just don't understand that piece of it but anyways how we're tired ready go home and I guess I just I'm through I'm tired at this point. A motion Second I can give a motion or a motion to do pass as amended thank you motion on the floor do pass as amended in discussion on the motion Dr representive cloud you're recognized thank you Mr chairman sorry that I was not able to Aston attorney this questions but I'm wondering if our discussion here is even legal or germane center talking about the polls and it means position and on both. sides of of the polls for repeatedly it's physician physician physician physician and or or if we pass this we're going to change all that so. Do we need another form before we have an a new law or bill would be my question I'm not an attorney Dr Gonzalez maybe you can answer it. But. I'm sorry I couldn't get to it as that thank you representative Miller you're recognized for a question for discussion I'm sorry. Well thank you Mr chair of. I'm I'm I think a chance to ask this I've heard this time around a lot so maybe somebody can bring it up in discussion and and sheds light on it I've heard a lot of talk about protection protection of life which I'm all for. But. Who. Who. Are we protecting. These people from. I mean I like it is that makes sense the road those who try to get a version that can speak to that been discussion that would help me out so thank you. Representative Ferguson recognized. Actually doctor cloud sort of address what I was thinking at I'm sorry I didn't suggest this to you before but most states to the extended this to nurse practitioners other people they actually changed the name to miles to medical orders for life sustaining treatment I don't know if it passes you might consider amending it to change that language the you know so it reads more appropriately I think. Representative Bentley you're recognized. Thank you chairman again I want to tell you a representative great thank you for making the changes that I had asked for in this for me listen I appreciate that greatly and I'm trying not to get offended by people thinking that nurse practitioners that have received geriatric traer training specifically in their scope of practice are unable to fill these forms are more than capable and I think we'll have patients get better care or have more patients get their directives that they want done and I really appreciate you bringing this forward and I'm definitely for the bill thank you. Senate Penzo you're recognized. Thank you Mr chair I like this one less than the last one. And I'll be voting no and I just need somebody to do this for me. Representative paid you're recognized. Thank you Mr chairman committee I'm sorry I was out and missed opportunity to ask a couple questions dot. Of default to every bill is a knowing somebody's can turn me yes I mean I had to significant concerns on this bill that I could not get answered because I wouldn't hear and that's my fault but the fact that this strike in the languages says a post. Form is not intended to replace an advance directive. And then at the bottom. The way that it's worded. To to say the the. The most recent document takes precedence it's it's worded wrong for the to accomplish that because. I've read it two three times and it says if a conflict exists between the most recently executed document and the advanced directive. So he can't put the advance directive in. In the first place because it spells it out in second place but anyway I will be voting no and and I unless somebody in the discussion can can tell me does the polls kicks fire at some point. How to House that wording not wrong in that in the last few lines. All right. Seeing over the discussion you can discuss because you're on the Committee you're recognized thank you Mr chair and I was going to address representative clouds questions about the the poll stand and representative for reasons I'll be glad to look there other states that have left it as physical as pole Steven though they've allowed me levels to sign it but I'll be glad I mean to me the name of the form is not important that but I'd be glad to amended on the Senate side to change the name and then what would that change the actual form itself I'm not opposed to that at all and then representative Payton. The Committee too tired to even answer your question on that one If it passes let's talk about it because my intent I want my intent right so if you're not reading my T. ride I'll be glad to give a parent then we'll fix it for the name more than likely I'll be glad to to work with you at least look at that but. There's discussion there's no response to okay so this is discussion I can see where your intent as stated for that last part could be corrected with amendment I have no problem with that can you speak to. Your and would somebody or I'd like to I'd like to know what the intent is on scratch in line twenty five and twenty six home page for. You're recognized representative ray thank you Mr chair. The intent on scratch in those lines was to allow because it says it was to allow the most recently executed document to take effect. What here's what I would like today I would like to talk to the attorneys again and see if I couldn't leave that in there and have that last paragraph still be if still be affected if that makes sense I don't want this the editor to separate tools they're used in different ways most of the time but they overlap in certain settings So I will let me work with an attorney you know work with you on that I know you price still going to vote no but at if I can leave that in there and still have the intent of that last paragraph I'll be glad to do that. All right see no further discussion motion on the floor is do pass as amended all in favor signify by saying aye. All opposed nay so as I have a motion your bill is passed thank you committee chair. All right representative Johnson you're recognized to continue your bill. Quickly. Okay committee what we're gonna do is we have three people this is a S. B. three thirty two that we heard earlier. We've got three people signed up to speak against this bill those three people are going to come to the table all at once and then we're gonna have a closing with representative Dotson and one person. So right now represent Dobbs I'm gonna recognized. Three people to speak against the bill thank you Mr. You might need to give them your chair if you don't mind. Thank you. So what we have is fielding graves William Atkins and James Benson they get those correct if you would please introduce yourself and who you are here to represent. Thank you Mr thank you for continuing hearing on this matter we really appreciated I will be short. I feel aggrieved to the advanced medical technology association patient safety is of paramount concern for our members the market and regulatory environment in this area is largely dictated by the needs of the OEMs to comply and meet their requirements with the food and drug administration so this is not some other kind of scheme this is about meeting our quality system regulation requirements and making sure the needs of our customers and patients are met OEMs are regulated by the food and drug administration of the quality system regulation system it's a complete lifecycle management process includes regulations for repairs not authorized repair technicians are not regulated by anybody in the space not by the FDA not by the state of Arkansas the licensure requirement there maybe third party certifications but they're not regulated we hear that auto mechanic analogy come up over and over again our mechanics are regulated comprehensively by the state of Arkansas there are mechanics liens there are a whole a whole series of processes for complaints complaint management etcetera I just wanna make brief comment on the COVID connection we saw no appreciable uptick in delays and return of repairs at all because of covid our technicians did not experience difficulty crossing state lines because they were designated as essential workers who work in the department of homeland security health and Human Services and all the states to make sure that that was true across state lines finally the market is healthy we say we heard the concept of ownership will understand it's very important other foreign concept here to consider is freedom of contract. the market is working very very well and the FDA's actually to do that in the report there are wide variety of business models in the medical device servicing and repair market and they fit the needs of the customers quite well and there's a lot of choice law diversity and that area finally want to speak to the trade issue trade secret issue that came up in the bill the language actually says this subchapter shall not require an original Quinn manufacture to disclose a trade secret to an owner or independent repair provider as except as necessary provide documentation parts and service tools on fair and reasonable terms. What is that mean that means going to court eventually that's that's what it basically means there's no way to figure that out outside of a court setting we can be sued under the deceptive trade practices act how is that help patients has at all possible a hospital's it's not good for healthcare system so respectfully opposed to the bill the gentleman with mere from that the great team at GE healthcare and they can answer a few questions as well said said bill would introduce yourselves and and who you represent sure my name is James Penson I'm with G. health care of in which the foster home for seventeen years I put together asset manager programs for hospitals and clinics across Arkansas Missouri Kentucky and parts of Illinois Arkansas recimo life I can assure you that I've worked with all the way from the ballot measure injuring engineering group all the way to CEOs CFO's all throughout the hospitals and everyone negotiates all types of things with their service agreements or warranties and such as that and we explain matter a lot more but the market dictates a lot of that thank you for. Well you mad constructors Service for GE healthcare myself as well as my forty service technicians all live here in the state of Arkansas so we've never had an issue getting out to those sites the service equipment. All right any other comments any. From you all. Just respectfully ask for your novo today and and thank you for the time appreciate having questions representative Payton you're recognized thank you Mr can any of the three of you confirm or deny that equipment that had been purchased and in service for a year to three years has been altered in a way to change the serviceability or take possession of the serviceability. I can answer that what for our equipment that has never happened we never change to where they could be serviced and then couldn't be serviced after the fact. Okay thank you thank you Mr. Any other questions. Representative Ferguson you're recognized of course this is you know part of this whole right to repair issue for a lot of things for my phone you know that nobody but apple can fix it I mean full disclosure being of my husband's radiologist so we have a big outpatient radiology center and it to me it seems like an anti competitive bill because I continued the maintenance contracts in the repair prices are outrageous and not competitive so it seems like all you're trying to do is eliminate the competition in the repair world to Meeks having and to your point and we've had we've had machine stay on for a couple weeks where you had to cancel all the patients because we're not a big hospital and you can't get people out to repair but so I guess maybe address those my. What I've seen in our own office but. Okay to the extent that prices are ever high or perceived as high for repair the cost drivers there are high quality regulations with the FDA so we're not cutting corners were never using substitute or aftermarket parts three D. printing parts using sub standard methods so there are cost drivers there to be considered but beyond that I could speak to the Pacific circumstances you've mention but. Sleeve there. Okay representative Coleman you're recognized for a question. Thank you Mr chairman when you sell this equipment do you reveal to these purchasers the of those keys in there that they have to know how to do or just a against the will for willful failure to disclose this information to they buy this equipment no one that you have some keys in there that they can't operate they just come along two years later and find out hello I can't work on this. Thank you for the question no like any contract you have to disclose all the terms of the contract or you could be sued for breach of contract or again be subject to the state's unfair or deceptive business practices act and be sued. So yes we have to disclose all the terms of contract before it's. Executed. Any other questions. C. nine thank you for your comments thank you thank you. President Dotson ready close. Thank you Mr chairman members the committee I'm gonna let. Mr Harris Wrapup Persson's aria Give ups give some comments and then and then I'll finish it up. My name is bill Harrison my company is in the commercial air conditioning business we work in a the majority of the hospitals in Arkansas I've been involved with health care for all my business career and I understand the all of the the challenges that are faced by our process. I know that this last year has been a really terrible year for because not only did they have the expense of dealing with COVID they had the reduced income that came when they had to delay a lot of the procedures that are that were. Considered to be elective procedures. I also know the the passion in which my fellow Arkansas Association of healthcare engineers the passion in which they protect the safety of their patients and I do not believe that our bill will produce will produce any reduced safety for the patients and hospitals in Arkansas it while it's true that a lot of the major health care facilities in the major cities of the of the state have adequate Relationships with major manufacturers when you go to Clinton or Mountain Home or get out in the Harrison there's a lot that there are delays General Electric is an excellent company obviously they've got a large service staff here and and based in Arkansas and I'm sure they get very good service that's not always true of all of the healthcare manufacturers in all of its facilities in Arkansas. What I'm asking you to do is vote yes for this bill so that our hospitals have another option of getting the equipment that is that they have purchased and they're using two Sir to to heal patients back on line and when it's when it's offline and they simply can't get someone to come to their location and repair it with the proper software service tool so that's that's the real heart of this the use of software service tools to but not alive service on existing equipment is the key to this whole thing and as for you know it was an excellent point may that that the hospitals need to negotiate better contracts so that they avoid this this problem however the our hospitals in Arkansas or full of equipment that is been purchase and it is being use that some I would have to quit my life as long as twenty five years and at this point in time there is no way that are hospitals can afford to purchase a lot of new equipment with the new negotiated terms and and continue to serve patients again I ask you to vote for this bill so that our hospitals in Arkansas the large ones and the small of can better serve their patients thank you appreciate your time. And let me just conclude by saying I know it's been a long day I'll I'll be extremely brief here We would if you if you'll think back several hours ago we heard a bill on the floor a little while ago talking about your right to repair your own property. that was representative Womack ran that if you recall I happen to print that vote count out in eighty three of us voted for that overwhelmingly we all kind of think that if you own something you should have the right to repair your own equipment or your own property in that particular case What we're talking about here is a is a little bit longer term equipment that you you bye you pay for its fairly expensive and you. If there's the possibility that a software key can change after the fact with a security update or a firmware update and completely lock you out of the ability to use your own property that you've purchased and paid for and that's that's a that's not good and with that This bill supported by the Arkansas hospital association Arkansas Association healthcare engineers I just ask for a good vote and make a motion to pass. Okay motion floors do pass the discussion on the motion. Intimately recognized I know we're tired I make a quick but as a business owner with some very expensive equipment if I had not had the opportunity to get my Quitman fix I've been in the business a long time ago just get the people out of Ohio that made those machines I've had about a couple times about five thousand dollars just to get them there to work on the machine thankfully the good on the phone and I didn't get the technical things we need to get it repaired by local electricians here in Arkansas I wouldn't I would been out of business so long time ago so I'm definitely do pass on this and I would encourage my colleagues to do the same. It is a motion. Seeing none. most on the floors do pass all in favor signify by saying aye. Those opposed nay. Sedans have been. Thank you. The same place I get women a roll call. Colorado. Representative Wardlaw. The representative Wardlaw. Representive Eubanks. Representive McGee. Representative make a. Representative Johnson hi. Representative Miller. With that no. Representative Payton Representative Bentley yes. Representive great. Representive great. Representive Gonzales. Representative consolidates. Representative Boyd yes. Representative Alan. Representative Allen. Representive Coleman. Representative Pilkington. Representative Pilkington. Representative wing. Representive weighing. Representative Penzo this. President repairing. Representative Davis. Representative Davis. Representive cloud yes. Vice chair Ferguson. Yes yes. Sure Ladyman no. Well represented your bills fails. Thank you all from same with this we are adjourned. Who. That's second hand was kinda weak they're not committed.