Public Health, Welfare and Labor Committee - Senate

Twelve fifty eight. And the. Is the representative Johnson here. All right if you come forward it and introduce yourself for the record can start presenting your bill. Representative Lee Johnson. You are recognized thank you committee members first on the server recognize Senator Hammer is a co sponsor on this bill and that without his hard work and diligence we wouldn't be sitting here today with what I think is a good piece of compromise legislation there are a lot of people that worked really hard to get this bill to the point where it is both nurse practitioners and physician so the intent of this bill is straightforward the intent of the bill is to create a legitimate pathway in the state of Arkansas for full lock for Tommy for nurse practitioners to practice without a collaborative practice agreement with physicians current state Arkansas to practice as a nurse practitioner you have to have a collaborative agreement with the position what this bill does is it creates a new board. within the Department of Health in this portal consistent for physicians to be appointed by the governor three of those physicians would be born from each medical school so everyone from the you M. S. one from the medical school towards math and one from the medical school in Jonesborough four physician would be from rap appointed at large it would also point for nurse practitioners to the board three one from each of the two each from a teaching facility operate three forty from teaching facilities in the state of Arkansas the fourth would be appointed at large this new board it's responsibility would be to do two things number one would be to that all applications for full practice authority for their legitimacy the second thing would be to build any complaints or concerns that might come up in the process of full practice authority nurse practitioners practicing in the state of Arkansas those complaints and concerns could then be re educated there under this board's authority or related to the medical board in the for and the nursing board at for their input it also requires and before prices thirty nurse practitioners to post their full practice authority nurse practitioners practicing without a collaborative agreement in their place of work again this is something that is was was sort of hard we negotiated the two most I would say contentious points of negotiation one that ours of hours required to be allowed to apply so under my bill the hours or six thousand ten forty that's equivalent to three years that is mean you're automatically give in full practice authority but that's the first step to apply the other thing was the composition of the board this is a fair and balanced board was agreed upon by both that nurses and physicians and so it's a good bill would compromise piece of legislation I think images for an issue that would really struggle with the state for quite some time. and I'd be happy to answer any questions. All right thank you so much ladies and gentleman do you have any questions. All right to Senator Sullivan you're recognized thank you deserve fifty eight Madison does this affect our current medical board anyway no fifty seventh I know that this creates a new for the I guess I'm using the word border calling it the full practice authority active credential committee but yes it's it's its own independent entity but the medical board of the nursing board will have an ex officio member that will sit in on the board to get to you to provide input but this does not affect the medical director if you know once one applies what's the timeline for. For working through that process so we would give us some latitude for that to be promulgated in the rules making process for the committee would like them to be able to look at you know how long it takes and also one of the things I didn't mentions it does provide that if you if for some reason our spectators did not full practice authority the committee has to give feedback as to why so they specifically understand what the short phones were in the application we are asking for feedback to the public health committee on a regular basis to try to provide you know some documentation as to how many applications if you had how many were accepted and provide some accountability that waste but we haven't specifically statute written a timeline. All right okay thank you any other questions from the committee. All right seeing none does anyone in the audience want to speak for or against all right I think we have someone. All right. All right to. This is for and the Julie wiry if you want to come up. All right yes yes Sir senator. Did you say there's nobody to speak against the bill no I haven't said that you hit okay just wanna make sure thank you. All right this is to the wiring here. Okay if you come forward. Is it okay to take my mom please thank you. Good afternoon everyone I'm Julie Wiley I'm the president of the Arkansas nurse practitioner Association first I want to thank representative Johnson and Senator Hammer thank you for all of your hard work and dedication on this bill for nurse practitioners patients and the overall health care our Kansans as many of you know. Nurse practitioners have worked toward full practice authority for years to help meet the needs of our patients especially in rural and underserved areas of the state during the covered pandemic many nurse practitioners were furloughed and unable to provide medication refills for the patients due to the restrictive collaborative practice agreement. Currently a nurse practitioner requires a different collaborative agreement for each worksite this bill provides opportunities for us to fully practice within our scope including prompt response during a crisis or disaster assistance local health clinics and limit with limited budgets provide care for rural and underserved areas of the state assisted health fairs or free health clinics as needed in our local communities and innumerable others areas collaborative practice agreements raise the cost of nurse practitioner provided services and can impede collaborative care rather than foster it there's practitioners across Arkansas collaborate every day with very professed various professionals beyond the collaborative. In practice agreement. With the passing of this bill we will continue to collaborate like many other health care providers this bill does not expand the scope of practice for certified nurse practitioners scope of practice as determined by education or national certification and our state licensure. Many of us work in real communities. Medicare advisory committee meeting in December two thousand eight stated we're seeing we're seen for years that beneficiaries and roll health areas are much more likely to see it in P. R. PA for all or most of their primary care that's a trend or that's a pattern we've seen for a long time. I myself working rule Arkansas and practice in elder radio in Union County we have over forty nurses practitioner serving a primary care excuse me yes you need to be seen and speak on why you are for this bill rather than. Continuing on about what nurse practitioners to do speak on this bill okay thank you for practice authority without allow us to continue to get high quality evidence based care to our patients should something unfortunate happen to our collaborative providers I work in an effort to setting with chronically ill patients the more majority of these patients are Medicare or Medicaid it's extremely difficult for my patients to find a primary care provider full practice authority would allow nurse practitioners in my area to be able to give more access to our Medicare and Medicaid patients of all ages. Are you not a goal and health care to take care of each patient as we've been highly trained to do this will give access to care for the patients of Arkansas and we hope that you'll consider this bill in favor all right any questions from the committee. Right seeing none thank you very much and there is no one to speak against so If you want to close for your bill. A representative Johnson. Thank you madam chair committee members you know this is a good compromise piece of legislation I'm sure you can find us practitioners and physicians who wouldn't necessarily agree with every aspect of this bill that's the way it goes with all compromises but again I think this is a piece of legislation that moves in the right direction I appreciate a good vote thank you all right before we take that vote I just want to thank both the nurse practitioners and you representative Johnson and those that you worked with the other physicians for coming to a compromise that helps so much and and it certainly levy Eads a lot of wasted time. Thank you and with that I'm going to call for do you wanna you wanna say something please the what he. All right call for the motion I have a do pass do I have a second all right all those in favor say aye all those opposed congratulations your bill has passed. Alright ladies and gentleman come break from the agenda right now and I need to have a motion to put a Senate resolution of before you today and we do have the resolution if you would pass that out placement Senate resolution seven and may I have a motion to suspend the rules so that we can put this resolution I have a motion and a second all those in favor say aye all those opposed and senator Clark if you would go forward and introduce yourself for the record then you would be recognized to explain The motion. Thank you madam chair members of the committee if I may. Like to S. of Siri's dean and Aaron Hogan to join me to help present this resolution right. And thank you committee we there was some miscommunication we had asked for this to be on the agenda and as determined I know. Things get lost on a regular basis so thank you for allowing us to. To proceed. Of the resolution of this fairly simple it's about keeping the. The bottom of the table total by keeping this promise to protect the welfare of children by keeping this promised Arkansans children. And as a former youth pastor. N. as a state senator of who has. One of the bill the last two years or at least introduced a bill on parents rights in fact have it sitting on my desk right now haven't signed at this time. Of our children are under attack. And the first line of defense is the family is our parents and without will turn this over to misting in miss Hogan Page well if you would introduce yourselves for the record please. Madam chairman over movement if. Thank you. Thank you madam chair members of the committee on fisheries dean and I'm with the Arkansas family council. The committee and chair my name is Erin Hogan and I'm also with Arkansas family council thank you you're recognized thank you madam chair thank you members of the committee for the opportunity to come before you and present this resolution we appreciate senator Clark for sponsoring this important resolution of this is a really straightforward resolution and it is to protect the children of Arkansas it contains no mandates and it doesn't require anyone to do anything but what it does is it outlines how our children should be protected and lays down the foundation and framework of how that can be built upon over time everyone and especially adults should be working every day to do our individual parts to protect children and we believe it's important to get the philosophy of protecting children in print and on paper and that's why we have this resolution miss Hogan elaborate more on the resolution right. Thank you siris thank you committee again for allowing us to be here Office kind of reiterate what Sri said I think we can all agree that there are many harmful forces out there that are vying for our children's minds and their hearts and so as adults I think one of our most important jobs is protecting our children they are our most precious resource and so again we appreciate Senator Clark putting something in writing sending a strong message and taking a stand against these harmful forces and can really providing something that we can always go back to to see if we are fulfilling our goal in providing that protection and so we appreciate you as a legislature and what you're already doing through legislation many of the bills that you're working on this session are actually some of the issues that are in this resolution and so we thank you so much for that and again this is this is not a wall this is a resolution it's sending a very strong message and so our children are the are the next generation of lawmakers and so we just really appreciative of you and thankfully we can be a voice for our children because many times they don't have that voice all right thank you questions from the committee. All right seeing no questions what is the does anyone want to speak for against this resolution. Seeing none what is the will of the committee I have a do pass. I have a second all those in favor say aye. All those opposed thank you very much you have passed this resolution thank you madam chair thank you Committee yes all right going on down the agenda of senator Hammer we are ready for Senate bill one fifty two. I'm sure you might if the my guess not take your mask off down on this please thank you yes this Kim Hammer state senator president Senate bill one fifty two with chairs permission let my guest introduce yourself for the record please K.. My name's terra Fortner I'm a practicing PA in on Arkansas Academy of PA's legislative chair all right you are recognized Senator and manager have an amendment to the bill all right let's look at the amendment and there's anyone else in the audience that wants to see this amendment just hold up your hand and Mr price will come to you and give you the amendment struck. Corporate. You have. Anyone else that needs this The Amendment. I see a hand in the back. Okay there you go I thought I saw one. In the first going to adopt the amendment if you would explain the amendment Senator Hammer thank you measured you might but my guess student thank you probably have a good time a little more patient all right go ahead. And the amendment that is before you now is stuff that had been originally in the. Poe's bill or the bill that we had But we had mmhm amended to try to reduce some of that language but in some conversations with key players like the Arkansas medical society we decided to strike some of the garbage but keep some of that purpose so the first amendment if you see states the physician assistants will be considered the agents other supervising positions in all performance related activities so we kept that that language and if you go down this section twelve we at amended some regulatory language that tennis tickets to keep that last statement physician assistant shall notify the Arkansas State Medical Board of any changes or additions and supervising positions while ten quick within ten calendar days. All right ladies and gentlemen you have any questions on the amendment. Right seeing none of. What is the pleasure the Committee to adopt a motion to pass hi motion do pass all right second all those in favor of adopting this amendment say aye all those opposed thank you if you would to explain your bill as amended thank you measure I think we're on a hit on three main points of the bill for the second time but to leave time for questions and for get my guest explained those three points please Sir this bill is intended it's intended for PA's to be able to have a seat on the Arkansas State Medical Board and have representation and then and the other ask is prescriptive parity with nurse practitioners to have opioids schedule two for five days and that means has a refill only if if this has already been stated by the position and I have seen them in the past six months and the last December but it's too To be able to do things within an emergency order call time of death some other purpose just at dating our our bill with that Burbage so any other any questions all right. Ladies and gentlemen of the Senate do you have any questions. All right I don't see any questions anyone in the audience want to speak for or against the bill. I don't see anyone. Can you close for your bill senator I would just say measures that we have tried to work with all the partners involved in this and that's why we're sitting here able to present the bill as quickly as respectfully as we can because of all the backdrop and appreciate all the players Medical Society but it's been involved in discussion to get it to the product we've got thank you and I appreciate that as well all right so I don't see anyone that wants to speak for or against the senator has closed what is the pleasure of the Committee. But pass set second all those in favor say aye hi all those opposed thank you very much you have passed your bill thanks much. Alright ladies and gentleman. House Bill twelve fifty four are you running that as well the senator. Thank you have I tend to run it but representative Wardlaw was supposed to be down here okay and I think there are people in the room that maybe want to voice an opinion about this bill I'll be glad to get started all right money to do that okay thank you. And I believe we have an amendment as well and and again as I did before if you want to see the amendment the amendment on the house bill twelve fifty four please hold your hand up so that you can see this amendment before we get started. M. chairman I have like thirty seconds all right what they looked over thank you K.. Thank you. Are you ready senator. Senator Hammer you ready to present your bill your amendment let's go manager yes ma'am I'm sorry go ahead. So then I mean the amendments pretty self explanatory I think as far as except for as provided in subsection of this section. Also I think three is probably the key point purposes under subdivision a one of this section does not include only a patient center medical home model and that some language I think that was requested to be inserted in there but at the chair would allow represent Wardlaw has walked into the room right about whether or not he wants the memo on there or not can we are discussing the amendment go right ahead. Representatives would you state your name for the record please. I'm sorry madam chair I just walked in I have no idea what we're at on the amendment but. Was agreed upon through some house members at some concerns in patient centered medical homes agreed on for the house to to add to amendment here and what it does the amendment take make sure that no nurse practitioner can had a patient center medical that is digested Amendment. I'd be happy to take any questions all right any questions about the amendment. Would you identify yourself for the record presented Jeff Wardlaw district all right thank you any questions on the amendment all right seeing none. Do I have a motion to adopt the amendment okay have a man and a motion the second all those in favor say aye on those opposed thank you mate present your bill as amended. Thank you madam chair center. Give me to. So the original bill was filed just to take the referral process away for of or APR ends right now APR NC's Medicaid patients at a referral this bill would just remove that referral we amended bill twice a one time to take out there some scope of practice language in the very back of the bill we remove that in the House Committee and now with the second amendment they can't take over any patient center medical home so if purely just removes the referral and with that I'd be happy to take any questions. I guess I'm a little confused he says an act to authorize the Arkansas Medicaid program to recognize an advanced practice registered nurse it's a primary care provider yes that's the definition asked take place for Arkansas Medicaid to recognize the removal of the four consulting the Medicaid they went in and there was some concern in the public about the patient center medical home so that's why this last amendment had to be adopted to make sure we would allow and with the lead of the patients or medical did I see something about shall. So as she held in here somewhere. That. You have to tell me which law Immediacy. Yes the program. Maybe maybe the one I was looking at was explain this part there are some channels in here of the program shall we in person advanced practice registered nurse and continue with that thought and let me know what. Where we're going with that what it is madam chair I've spent my whole career here making sure that we don't pay nurse practitioner same as doctors so if you read the next line under that under B. B. line ten on page two says program shall not shall revert reimburses inspection tuition or nurse not less than the current reimbursement rate that we we don't go above that eighty percent that we pay on today number two there says it will pay a hundred percent of the out of pocket costs which are the tests that are run on those patients like X. rays labs and so forth. There's another set office down on line nineteen you want me to continue please. Please so what that shall we say and and that's the removal of the referral so that says they should recognize them as being a provider can. I don't know if this is the time to remind you that I put some information on your desk this came from DHS and a lot of times we hear help Medicaid patients can't see a physician and justice DHS to To tell us how many slots do they have for the Medicaid patients and I have asked them to do it by your senate district and if you would look at that and then I would like for it not right now but in just a few minutes after they finish explaining the bill I would like for someone from the H. S. to come and explain what this information is about but it's been a long time since we had something like this and we now one thing with me but I have thought many times could it be possible that with their nose slots left for Medicaid. Clients. In a physician's office in this this certainly in licenses all right You have finished okay all right thank you very much all right does anyone in the audience want to speak for or against. Limit I'm I'm getting a little ahead of myself just a minute. All right Representative to board law if you would go back to the table and I think the. The Committee members need to ask questions if they have any I would like to also when we have DHS come to the table I'm going to ask the committee to ask questions again if they have an so ladies and gentleman do you have questions of for representative Wardlaw our Senator Hammer all right you're recognized. Senator Solomon thank you appreciate your working on this I know you've worked with both sides of this could you just describe real briefly who you've talked to Tim to come up with this bill. In the very beginning was working with representative Gonzalez and he had worked with a few groups and and I've worked with the doctors and nurses on this bill and DHS extensively because when the bill came up the whole purpose of it was to prove that referral as I said and there were some unintended things in the original draft and bill had to be filed by certain deadline so we had it all those deadline so amendments couldn't be applied until that date in public health in the house and so it's been fun bill to run because a lot of drafting errors and different things that had to be addressed great thank you. And any other questions. All right seeing none we're going to go to those who would like to speak for and against. We have a common start to. With Leighton Wilford. If you would come to the table. And less you can introduce yourself for the. Record please and tell us who you are. See if your little but green button is on right there and pull it closer to you please thank you. My name is late Morford I'm a first year medical student at the New York institute of technology a college of osteopathic medicine at Arkansas state university. it with that being said I have to say my first year of medical school has not been what I expected. It's been isolating and stressful but I've always kept in mind the end goal and that's to become a physician who will help people live their fullest lives through the cheap and good health. So I've been afforded more time than usual to think about my future. this includes three remaining years I have left being a medical student three or four years residency one to two years of fellowship training fight use and finally having the ability to work as an attending physician. When you include my four years spent getting a bachelor's degree you can't count on both hands how many years it takes in total to become an attending physician. this length of time is different for other members of the healthcare team that was to practice medicine in that includes advanced practice registered nurses or APR ends. this bill allows the parents to practice at the level primary care physicians or PCPs the fact is there are large differences between the depth and length of training that PCPs receive compared to a P. R. ends I oppose this bill on the grounds that it wanted may be hazardous to allow a parents to functions PCPs and they do not receive the same level of training and to unfair they are granted the same functionality in less time that it would take a fully trained physician. healthcare is provided as a team any appearance or vital component that they bring to the table their own expertise but I don't believe that Clinton functionality PCPs appropriate for my state reasons on to thank you for your time and consideration and for the work that is being done to address health issues of this state. All right thank you any questions from the committee all right Senator Solomon. Thank you when you say people maybe harm do you have any data to support that since it's being done a lot of other states. I don't I would have to correct thank you. All right thank you so much all right that was opposed. And I believe Four people. All right we're going to have David Mitchell speak. A again spoke to speak for I'm sorry David Mitchell. your committee thank you so much for having me I do appreciate the chance to talk about this my name is David Mitchell I am an associate professor of economics at the university of central Arkansas I'm also the director of the Arkansas center for research in economics just state based policy institute I'm using my own they're not UCLA's. I just wanna remind people I think most people know that and peas actually provide excellent primary care we know that for over twenty years twenty years ago there's an article in Jammeh during the American medical association to randomized control trial putting some patients in primary care with nurse practitioners and some patients in primary care with physicians and guess what the results were the same and so the outcomes are what we actually care about and that's what I think is important there's tons of other studies so there's two articles the last twelve months and health services review there's just thank you we actually keep up and hello database of over a hundred articles showing how good and peas are in peer review journals journals so that that's not the question the question is Arkansas doesn't have enough providers fifty nine counties are completely designated as underserved or medically underserved by the US health resources and services association administration sorry. And fifteen are partially under service that way fifty nine plus fifteen that's that's almost all of the counties in Arkansas need more providers they need more providers as an overall number but also our cancers tend bill less healthy so anymore for that. would like to see more MPs moved into these underserved areas between two thousand nine two thousand seventeen the number of MPs per thirty five hundred in rural counties rose by ninety percent. Physician's fourteen point three percent so that the overall US student number that is pretty indicative that nurse practitioners are willing to work in rural and underserved areas. The main thing is if they can't see proper Medicaid patients in underserved areas for most people on Medicaid they can't be financially viable and they can't open practice if they can't be financially viable if we want to see nurse practitioners do good work we want help the poor star Kansans we have to let nurse practitioners actually see those people thank you very much when you take questions of course all right you do research is that correct yes ma'am but it's not for the university or is it so as a professor you have weird thing so what people see is a teacher see me teaching but the other half of my job is to do research okay so I have a paper under review right now looking at diabetic debridement which is kind of disgusting actually but fortunately I will have to download the data I don't have to do it that's the great thing about being an economist and we find that states that increases nurse practitioner's authority if you're diabetic agreements applying understand thank you but let me ask you this did you not say that to there are many of tell me again what you said about not having enough physicians and so what was the number you use yes so this A. U. S. health resources services administration that's the recover some ideas there data they said the fifty nine percent of the counties in our the fifty nine counties in Arkansas are underserved they don't have enough providers for the patient base they have. In fifteen are partially underserved so recorded other people's data not even my own. Arkansas does really needs more providers all right thank you very much appreciated at your recognized for a question Senator Solomon. Thank you good for you at the table again for studying this far number of years not yet this year and every year you study to and every year you've collected data and the data has consistently shown what to what you just testify for sector every year the data shows the nurse practitioners provide good primary care great thank you right thank it again you said that was censured data it was some I'm sorry that the the number providers is not my data okay all right thank you very much all right I'd like to call I'd like to call the representative from DHS to speak on the bill not not not for or against but just on the bill and I'd like to go over this information because I think this is part of our problem somehow some way we are getting of a Roni is information and so if ladies and gentlemen if you will pick up this information that then I had put on your desk it is of from DHS and it is current and if you would introduce both if you would introduce yourselves for the record thank you senator Clark white chief staff DHS. Good morning or good afternoon I'm Elizabeth and I'm deputy director for the Division of Medical Services. All right you're recognized just explain this information that we have today. And I was the one that ask you because I have been giving been receiving conflicting reports for several years and the I just thought this is very interesting and we can't make good decisions on the health committee if we don't have all of the current information and reliable information and so you're recognized. Thank you say what you have in front of you should be two separate documents one has that would you describe the numbers I've providers in each county as well as their Max case load and their current caseload so that tells you how many patients they can see our that they have told Medicaid that they will see and then how many are actually on their caseload all rights Medicaid patients the second is to assemble it points about that data that you will see there I'm a little bit of information about how those caseloads work I'm so patients can choose caseloads that are in there County physicians are in their county positions that are in a county next to them or they can even go a county beyond that so they they have their choice of physician as long as that position is accepting Medicaid patients and physicians can tell Medicaid that they will take patients from any county in the state of Arkansas and they can tell us which counties they want to take them from they can serve up to twenty five hundred page and Medicaid patients that's their panel size they can serve as few as five or as many as twenty five hundred and if they can show that there's a hardship or reason then they can exceed the twenty five hundred so that's how that works and and so that's what those numbers there are showing you. For each county there's a few things about these numbers that I do want to make clear this is what we currently have on file there's a couple of reasons this it doesn't always work the way we wanted to we want a little bit better reporting so we have a lot of clinics run by UAMS those clinics have a lot of physicians that work for them and those physicians there panels all go under that clinics social see here it shows that there's a hundred and sixty five thousand five hundred and eighty one ACT slots for clinics but those positions are working for those clinics don't always close out their panels with that so sometimes they're panel will still be open even though the clinic is really the one that has that part patients upon them so that can make the number look a little bit higher in that county as an incident at all than it really is so just bear that in mind as well but but as you can see here that's that's what our numbers are as to all right in the total number of both and open slots is how many. You get to that page. I can find out what. I found it sorry about that. It is. As. We have a total caseload of over two million and that two million two hundred and twenty four with five hundred and five current slots filled five hundred five thousand all right mind says at the bottom I'm sure this was that go ahead yes ma'am about one point eight million slots available that we're showing that's what we have one point eight million slots available Committee. So I'm just wondering why. We have is no one say this before but we need to remember to ask the pertinent information so that we can make good decisions. All right Senator Hammer. Thank you measure let me just request the one available openings as defined as what. So that is defined as the physician has told us how many patients they will see on their panel up to that twenty five hundred and they don't have all of those slots filled so it's the number of slots they've reported to ice that they they have left available. And you keep records follow up manager yes thank you. Do you keep record of whenever it is that a physician or. Nurse practitioner anybody turns down seeing a patient because during the debate over the years we've had this there been situations and personal calls were people said I can't find a position to take me I call but they won't take me do you keep record of how many turn aways there are I don't have that number today I do know that does happen physicians don't always report to us when they lower their panel or choose to stay to stop seeing Medicaid patients and so sometimes that that does happen that we think that they have open slots they call our help line to get a physician and we say that that position is taking clients and then they call the physician and they're told that not we ask that physicians to then call us and change their numbers where's where's that number represented I don't have that number on the sheet I'm sorry today but you get it in the totally I know that does happen I don't know if we keep a record of it but I can try but the vendor that does the call number to slide like to see that number please regards whatever happens today I want to see to turn away number please all right it's not time to jump in to say that amazingly happen to me. A call to certain doctor I said that I would like to make an appointment and the reception is set I'm sorry but Dr so and so not that I'm in that category but just getting an appointment he's not taking any new patients well I as specifically for the doctor a certain doctor would that not also be a reason to maybe S. the patient calls and ask for certain doctor and they have a full clinic and they don't want to take another doctor could that be one of the reasons why some people are turned away it's seat and that doctor or no other doctor. Yes ma'am I believe that does happen and then does it not also happened that to some tons of in the Medicaid world of some of these people are not choosing the I'm a medical doctor is that right. Yes ma'am we do have clients that don't use they are supposed to all right and then there was some other there was there were another couple of the reasons why. But anyway going on Senator Davis I believe you have a question. Thank you madam chair I was curious on that number of available if it means like in Newton County specifically in my district and it says there's over seventy one hundred I don't even think seventy one hundred people live in Newton County right now and I'm just curious and how you get that determination that number yes ma'am so like I said positions continues to take patients from any county so that position doesn't have to be in you county to take patients from Newton County and so it that number is reflective and the number of patients that physicians are taking patients from the county on their panel so it could. That makes sense. Maybe I'm not sure. So regardless of where the doctor is they can take patients from any county that I'm just but if there's not even that many people that live in Newton County. Like how do you get that number is it Dr Steve said there actually seen patients from Newton County. Thank you thank you all right Senator Solomon. Do you know of high need patients affect the reimbursement to the medical home model. In terms of the payments received by the medical homes. I don't if you don't mind getting back to you on that so make sure to give you the right information was gonna get away record vote I did not come here to talk about that today. And you about the amendment so we will get that for you just to follow up you mentioned there are several scenarios mentioned that you responded to possibly possibly do you have any survey our direct information that would support what you're saying might be possible scenarios are you referring to the examples I gave it to senator Hammer I don't have anything to their share also okay in several possible scenarios why people might do that some people might do that in your reply was to corroborate yet my but you have any. Figure data that suggests that one way or the other I do not have a survey no Sir I do I do have some stories that we hear from our contractor about when patients call and are not able to find a physician and. And that type of thing but I don't have any numbers to the last one do you have in the data that says the MPs with their rate of participation is in the rule counties that are listed here to win over how many employees are performance working with those positions yes I do okay thank you thank you madam chair all right thank you. All right seeing no other questions thank you so much for this report thank you. In just a minute did you of introduce yourself for the record by the way we know you yes yes ma'am okay all right thank. For all right we're going to we we did up against. We did four we did and we did for and to these people we speak on the record I'm going call Dennis yelping ten to the table please and I believe you are speaking against. Please state your name for the record. Ballinger and committee members thank you for allowing a myself my colleagues to be here today my name is Dennis shelving to and I'm a family physician from start Arkansas been practicing for more than thirty six years in the delta a past president Arkansas can family physicians and the Arkansas medical society current service a delegate to the national American academy of family physicians I like to speak in opposition to house bill twelve fifty four by representative Wardlaw action Wardlaw was we worked with them in the past and of compromised in some bills in the past but this one we cannot compromise on we heard testimony from my colleagues before new here future testimony and I agree with with student latent and his point earlier points I'd like to make or three. One the Medicaid program as always had the authority to make the decision who is the President medical home a manager they've not been forced to do this and they've chosen not to do this until this bill this bill forces Medicaid place less strain physicians we all have heard that before nurse practitioners with five to eight thousand hours of training some of them online with the physician who has property twenty thousand a plus hours of training this is not the the way the patient center medical home was designed the model was set up so that a well trained physician would provide comprehensive care would court may transfer of information care from specialists and subspecialists this bill would be a weakening of the patient centered medical home state of Arkansas number two has been tested in the past that the purchase bill was to remove the referral a requirement for Medicaid patients from their PCP they were saying and urgent care facilities in this reducing your utilization this is a case urgent cares or not the place to to get comprehensive care and not designed to be a patient centered medical home it fractures the care of the patient which is so important specially our Medicaid population some of them have chronic diseases and also our small children in the state of Arkansas. Number three the last point is access which sure we're hearing about right now. So is brought up that the the number providers in the state of as we've heard before need to be expanded by nurse practitioners but I myself in the seven partners I haven't Stargardt we have a partially fourteen thousand slot so or sales that we could see more of Medicaid patients across the state is you've heard to testify it's it's staggering one point eight million at a farm stand that right. Good news is that the legislators have supported finding of two medical schools in the state you hear about this sooner we have in the past only about a hundred sixty physicians that have a graduate medical school in a significant amount of those of them in this special and subspecialty feels. Two medical schools and Arkansas in Jones were enforcement they're gonna put out in excess probably three hundred new physicians the good news is that these medical schools are gonna primary put out Family medicine pediatrics internal medicine primary care providers others that also course have some specialists and subspecialists the future looks bright in Arkansas for the care and for access. and summer oppose house bill twelve fifty four because it adversely affects the Medicaid that patient centered home which is legislature has supported fully in the past and effects were for Medicaid recipients and state of Arkansas thank you madam chair and committee members for your time all right any questions all right Senator said Senator Hammer thank you measure and Dr thank you for server down and Stargardt refresh my memory I just can't pull it which county that is I'm sorry consult County So there's twenty two thousand open with a maximum caseload of twenty five five. And you have seven positions in your basement a physician's Cape do you all ever turn away any Medicaid patients none that I know of where facility of Baptist health and so we I take pretty much every patient comes in also practicing Clarendon which is in Monroe County at one time I had a very large Medicaid population as you can see I'm getting very old and so my practice has declined something that may be another reason why we're we're seeing a decline sometime for the few cases where this term now sometimes you get a maximum We've got three hundred probably plus doctors were two hundred and forty or so the doctors are going to come on board and a farmstand prep sixty seven percent reported primary care they're gonna there are a lot of money to stay in Arkansas a significant number most in Arkansas and help with our with the care of the Medicaid population as well as the rest of this. Okay that statement about to make I've got a I've got to make the statement with regard to the APR and as well to do the positions we we don't really know where they're going to end up practicing us it was a shortage in the delta. You don't have anything that. Definitely proves that those we don't turn a patient away in our clinic at Baptist health right but but I mean the physicians are coming out are actually going to end up in the underserved areas of the state we have patients from our area that are actually in medical school right now that that may may we are don't know for sure but may come back can they will they are they will and then I guess the last question we just put an amendment on this bill part of your argument was built around you know the Medical Center home model with the amendment thank that kinda levy age some of that concern or would you would you speak to that part of your. Because I I heard in your discussion part of the concern was about fragmenting the for the medical home model with the amendment that we put on there it kind of takes that out of the picture I think yeah we still have a concern with Arkansas Medicaid program shall recognize advanced practice nurse is the Arkansas State Board as a primary care provider that that is difficult to swallow okay all right thank you Sir. Thank you all right Senator Solomon. Thank you Dr I notice you're taking other questions. I noticed wearing a Baptist health checker you represent no Sir I do not represent themselves I'm not sure you also mention your medical a member of the medical society and my experience is that Medicaid generally follows the recommendation from the medical board that's what I've been told a number of times and that there are ten of the fourteen members of the medical board are also members of the medical society so are you representing the medical society also no Sir okay Sir thank you manager all right any other questions thank you so much thank you. All right we're going to go to. Julie one day again she speak for this bill. And if you would keep your a. Questions on the bill are your answers and comments on the bill please ma'am. Thank you for your microphone up close yes ma'am thank you again my name is Julie Wiley I am a nurse practitioner and elder Arkansas. The work in a specialty care clinic mythology take care of a lot of dialysis patients Medicaid PCP would definitely access care care for my patients personally take care of a lot of patients who are already on Medicare and Medicaid and they are actually over the age of eighteen and under the age of sixty five is really really difficult to help these patients find care providers most of the Medicaid positions those slots that are opening or usually for children or older individuals home we had to ask those questions about why they obtain this patience away they simply state that they cannot afford to take those patients so I would like to add that in response to the slot situation Medicaid provider for PCPs for nurse practitioners to serve already taking care of these patients I just simply are having a physician sign off on these patients Many of these patients need access to care to eliminate emergency room visits a lot of Medicaid patients I do not see the primary care regularly go to the emergency room for that care mmhm our goal would be to eliminate that and this would also open up more nurse practitioners to just continue to do what they are called to do which is providing the care currently our physician colleagues trust us to take care of these patients what are they oppose is being recognized for what we do. All right thank you any questions. Right sing none thank you so very much thank you ma'am we're going to have a doctor ballot come and speak against and if you would state your name for the record doctor bell. Thank you madam chair could I take my mask on yes please. Thank you again madam chair and Senate committee members hi my name is Dr Bolles Simon I'm the president of the Arkansas academy of family physicians representing over fifteen hundred family physicians in the state as a permanent position myself and also on behalf of for membership we oppose the house bill twelve fifty four. As a physician our and nurse practitioners our primary focus is on patients health and well being and we sworn and are hypocritical or the to keep up their values off putting patients health and well being always at the center for care and remember that is a compromise on patient safety and outcomes we are present are wise to the legislature and this definitely falls under that category and I'm going to mention two reasons why this undermines all of our current affords one is we asked the physician's right under the most practitioners they bring in to the health care for the state of Arkansas and we just I sensitization we worked with the representative Johnson and also senator Hammer we appreciate their help in creating a property for certified nurse practitioners in expanding the pool of providers and the legislature approved a few years ago to medical school osteopathic medical school so we have three hundred medical students are in addition to that once commission to coming out of your hair masks are coming every year plus we just obey Senate just approved Uh the our house bill twelve fifty eight by a representative Johnson and senator Hammer and this really undermined since like pulling the rug under once you create a pathway for certified nurse practitioners well now all of us practitioners can do whatever they want what is the purpose of creating the certification process if you have to do that and we heard from the DHS there are the slots are not beige you so we have not been the membership slots we have coming pulled off board the physicians and this. Departments practitioners who are capable of taking care of these patients second point of opposition as we are this bill perfects the most impoverished in this state the Medicaid population and but we know that a lot of Medicaid patients have complex medical conditions I take it off diabetes patients with one pair that is good I would like source and that's not something I'm a laughable paying and I'm also a researcher I'm doing that there has been no studies showing in Arkansas that nurse practitioner without going through the certified pathway have better care are equal care that in the of traditional physician training part two a so we are in the middle of court would make and the opioid crisis we do not want to increase the pool all for a nurse practitioner school haven't been through the certification part to aide just approved by this Senate committee and also the two schools of this medical students who are ready to take care of this multiple complex patients served through the Medicaid slots which are a lot of them are and do you still so far about mentioned reasons I was personally and also for the fifteen hundred membership from the Arkansas Academy are far from a physician so I thank you for the opportunities I would be glad to answer any questions any questions for doctor hello. All right seeing none thank you very much we appreciate. All right that was against and I'm looking for someone that has signed up. to speak for but I think we're out of those And so I'd like to call those that are against entities so if Frazier in words would come and is Brianne online or. Pardon me. Okay well okay yes he's here right here okay thank you. Please a introduce yourself for the record. My name is Frazier Edwards I'm the executive director for the Arkansas osteopathic medical association and I would like to also echo the positions here in the room but senator Hammer in order to address the pipeline issue and how to how we have encouraged our students to go to these rule areas of need much like and crosses while that we've created a a pathway through our curriculum and both of the schools were in their third and fourth years they go and they do their rotations and what are called community hospital rotations and real primary care rotations those are required rotations that our students are required to do and we have affiliations with those hospitals we are also actively pursuing developing graduate medical education opportunities traditionally most people know physicians then this is national wide nationwide statistics physicians tend to stay within an hour of where they do their training we hope to exponentially grow that with the introduction of not just their graduate medical education but there you in the third and fourth year education as well so that has we're seeing that play out in places like hot springs we're also actively working with the Arkansas real health partnership and other organizations as well to create that pipeline of physicians right now there are over a thousand eyes to have the medical students in the state addressing the access to care issues that have plagued our state for a long time so today is actually a pretty good day to talk about this because it is match day but applied like to introduce student Dr Michael page to talk a little bit about his experiences all right you're recognized the chain committee members thank you for having me today soon Dr Michael page enormous for the Arkansas college of osteopathic medicine I'm originally from magnolia Arkansas. And I completed an undergraduate degree in nursing at S. A. you there magnolia and spend some time in Southwest Arkansas as an are in during that time I had many patients in the hospital in the clinic that could use that they care of a provider and so at that time I made the decision to not pursue education as a nurse practitioner through some of the online curriculum that was offered to me through that pathway but readily rather to go back to school to get more prerequisites to take the M. can to apply to medical school the reasons in which I decided to do that is because I believe that the training not only just the length of the training but also the indefinite so the training that I would receive in medicine as a medical student will provide me the best opportunity when I got through divide care for my patients in a real community as Frazier mentioned match day was today I was fortunate to match what I do not know where it will be in family medicine and most likely will be in here in Arkansas should I have to obtain my residency training outside of this state it will only be in one of the neighboring states and I will be coming back here to Arkansas to practice as a family physician when I'm done in three years with my residency training I don't think today's discussion from my viewpoint as having nursing school training and also medical education medical school is about scope of practice I think it's about responsibility and I think the only way to his shoulder the responsibilities of taking care of our Kansans that are my patients and your constituents is to go through the medical training that I've been through so that at the end of the day when it's two AM in the morning and I have to make a difficult call I don't have to question my education my training in that call I'm able to make it confidently thank you all right any questions from the committee. All right seeing none thank you so very much and next we have James hunt and Tim Goodson. If you would come up to the table please and you are opposed. No they're not they're. All right the Erica levy. And June. Looks like Nephi. All right. Okay. You can take your mask off please introduce yourselves for the record. Thank you. My name is Erica levy I am a third year medical student at MIT com at a state in Jonesborough Arkansas. And I'm representing medical students in the state of Arkansas. I spent the last seven years actively pursuing licensure as an osteopathic physician and although I'm from Kansas I've spent all of my adult life here in Arkansas and I've grown to love Arkansan our Kansans and I began here studying philosophy in Spanish at Hendrix I was volunteering as a Spanish translator at a free clinic in Little Rock and that's when I realized I wanted to be a part of this mission to fill the physician shortage in Arkansas and I tell you that because that was my mission it was also the mission of in my I. T. common that's why I decided to pursue my studies there one of the unique missions of anyway I T. as well as our con is that we aim to improve access to healthcare for the underserved and rural populations of Arkansas as well as the Delta region and I tell you this because this isn't just my objective it's the school's objective and it's many of my peers objectives that you've heard before our school has data about where students that match two and forty percent of them on the last match matched into family medicine twenty four percent into internal medicine with some in pediatrics this is a cumulative sixty percent and that is nearly quadruple the national average if Arkansas we're to follow the interior X. of you know retention in this state for residents from Jeannie this would be expected to be about a thirty percent turnover in the Arkansas that we would retain and brings me to my first concerned with H. B. twelve fifty four which is that the bill preemptively moved to fill a gap in the provision of primary care to our Kansans and we are already working on this the problem is that it takes anywhere from three to six years longer to produce and educate a doctor than it does a nurse practitioner and it is my view that we must continue to be patient as these future. Physicians are completing their training and joining the work force and although we do not have any direct data that might suggest where we would retain these physicians to whether it be you know one of our more populated cities or rural community I've reason to believe that will be largely rural because our school focuses on it as well as archon does diet curriculum as well as placement in rural communities and I will hand it over to Dr Rainer but I really appreciate all of your time and consideration here introduce yourself for the record please ma'am thank you madam chair and thank you to the committee for all of your service and for allowing me to participate discussed with the you about this bill today my name is Bree and Wehner and I'm both a registered nurse and osteopathic physician employed with and way too common Jonesborough and I'm constituents of senator Sullivan's. I just wanna take a few minutes to speak about my opposition to house bill twelve fifty four which is sponsored by representative Wardlaw I'd like to begin by thanking advanced practice nurses for their continued collaborative effort with other health care professionals especially in the fight COVID nineteen. they are very valuable team member to team based care however speaking from my own personal experience I don't believe that nurse practitioners have the depth and breadth of education to be designated as primary care providers or as the family practice team leader and a patient centered medical home as this bill intends. I can tell you that while nursing school helped me in areas such as communicating with patients and touching my patients in a therapeutic manner it did not benefit me significantly with regards to the depth of knowledge needed for biochemistry organic chemistry histology neuroanatomy physiology and pathophysiology that I had to master in medical school the subjects were not taught in nursing school to the depth that I needed on a daily basis to manage my most complex patients and that's what we're talking about with some of our Medicaid patients extremely complex individuals. In two thousand and six when I attended nursing school at a very prestigious nursing program in Missouri pharmacology was not even part of the curriculum. And so I learned pharmacology on the floor with my patients. Upon graduating nursing school have the opportunity to either continue my nursing education as it advanced practice nurse or to go to medical school AS one of our other medical students has already stated I chose medical school because I knew that I wanted to have as much knowledge as possible to be able to provide the best care possible for all of my patients and I wanted to be able to know that I have the knowledge to do so independently. Having worked with nurse practitioners in multiple states now including Missouri and Illinois I know that to their programs mostly or completed online with this few as five hundred hours of shadowing practicum additionally many schools allow that practice with practicum to be completed with other nurse practitioners or physician assistants and set up positions. Well they are a student they're not allowed to see their own panel of patients under supervision during their practicum and so their experience is very similar to that of our third and fourth year medical students. However after graduating medical school are graduates continue their formal education under prescribe physician supervision for an additional three to five years before they are allowed to practice independently this is to ensure that they have the knowledge and clinical reasoning skills to safely take care a very complex patients independently. My experience in working with advanced practice nurses is that because their education process is different. They tend to follow patterns of providing care instead of fully understanding the pathophysiology and its interactions with its comorbidities. Lastly I'd like to end by saying that Arkansas has taken great scribe strides excuse me over the last decade to work toward improving the health of its citizens and has really started to see improvement in the last forty five years which can be attributed to to any medical schools in this state looking for candidates that are from the delta in the surrounding states and who want to deliver quality health care to this region. it is by extensive efforts within the state to also increase the number of residency spots and residencies overall which are predominantly geared toward primary care if this bill is allowed to pass that has the potential to undermine and undercut all of these efforts if we want our physician residents to choose Arkansas is their practice location we must not limit their opportunities to practice when they complete their training and with that I thank you for your time and attention all right any questions. All right seeing none thank you ladies very much I have only one left of in effect call this person's name and there are others that want to speak on this bill of twelve fifty four please raise your hand but the last one I have is Erica levy. She's okay all right. All right I think some of you have signed up to speak up on another bill is that correct yeah okay. Yes. We have DHS come back to the table for one question please all right thank you. K.. You're recognized. Bill self is going to be handled. So we allow this bill to go through. And you get a nurse practitioner who gets a Medicaid patient. That has needs higher than what the nurse practitioner is able to do according to their scope of practice. How's that going to be handled in the Medicaid billing when that nurse practitioner has to refer that patient out to a physician because that patients needs has hit the ceiling of their scope of practice capabilities and how do you see that being resolved. We will not reimburse or something that's outside the scope of practice and generally so we will have to be able to pay for that referral to the to the physician so we will make that happen now that a B. based on diagnosis codes and other procedure codes and things like that based on their scope of practice I will have to set up inside of our system and we we can do that. Follow up measure yes so they will have to be even though a collaborative agreement is not required in this legislation they will have to at least be a spirit of collaboration between a nurse practitioner who's doing what they're for to do under this bill and a physician who a patient can be referred to. In the event that there's practitioner cannot meet the needs of that patient. I think that would be correct in that and to me S. as the non expert here means someone else to that even for physicians sometimes they need a referral to specialist and so they need to have those relationships in that network anyway so I don't see that as anything new but yes I would expect that APR into this bill it would need to have those connections so that when a patient has particular needs that can be it better caressed by specialist press one else that they can make a referral out for a thank you the manager all right any other questions. Seeing none thank you so much for coming back to the table. All right a. Ladies and gentleman you have heard. A. The bill you have heard the pros and cons and people against and for senator are you closed. Madam chair okay representative if you want to close for your bill we are ready thank you madam chair. Yes but I do want to close he was reference a couple times in this bill about patient centered medical home the amendment we just adopted was the agreed upon member from the house that took out the lead of the patient center medical so all those arguments were mute once that amendment was adopted while ago. It was also argued of a lot of times about the of this given them full practice authority no where in this bill does it change the practice authority of a an AP are in today. Lee Johnson's bill those common does that this bill gives on the more thirty they had today it only removes the referral process to see a Medicaid patient they can already see the Blue Cross blue shield patients they can already see all the private insurance patients that's all this bill does now we amended everything else out of the bill with that I appreciate a good vote thank you madam chair all right. Ladies and gentleman of what is the will of the committee. Do pass. As amended as amended K. second all right all those in favor say aye. All those opposed. All right of ways and gentleman to be totally fair I'd like to of. Have a roll call I'd like to be on the I think that's the fair way to do today I've had some. At. That's it I feel like that's something that we can do today that will really make this a fair. A discussion so of Mister price would you please call the roll manager point of order yes. Correct me if I'm wrong but you need two hands to get a roll call number one and number two one just once just a minute is it just one is alright then secondly is that going to be the expectation for the remainder of the bills on the agenda because we've not done that before I will certainly do that. I think that's I think these are very important bills and I think that to make a mistake calling from the chair of is the and not something I want to do and some of these are very contentious and so I'm I'm making a decision from the chair that we're going to roll call each and every one. All right. You heard the bill. We will take the role okay. Senator Hester. Senator Hester. Senator Wallace. Hi hi. Senator Davis hi. Senator Hammer. Senator Solomon. Senator Gilmore. No. Okay I. Senator Flippo. Chairmanship no. All right. Six. All right ladies and gentleman your bill has passed thank you senator all right. All right let's go to the next bill. H. B. eleven ninety eight. All right to senator if you and your guest would identify yourselves for the record then you will be recognized to present your bill. Madam chair members Senator David Wallace district twenty two. Okay. Madam chair and members my name is kasha pay being. And your from I'm from Little Rock Arkansas okay in miniature I have three witnesses that are in the holding area because they come down please yes definitely thank you ma'am. All right you're recognized you are did you are presenting H. B. eleven ninety eight yes ma'am thank all right go right here. House bill eleven ninety eight member seeks to remove supervision from the nurse practice act and to replace. That word within consultation in consultation with to allow medical facilities to choose the model or them of and sees that works best for them with the facilities going to choose consultation or supervision that decision will be left up to the man who accepted committees which are made up of local positions in administrators of these hospitals so that's the crux of this bill. The nurse in CCL if this is have been running this bill for number of years. Each time we've had different suggestions they've changed award to removed a provision told they would need another word to replace it The use word coordination but they were told in the definition so we would look at this several times. They continue here for legislators are concerned about this and the for the one to amend a bill to include the presence of a physician. As well as a language clarifies they can only administrate schedule two narcotics in the surgery or the medical procedure period these events are also defined in the bill. The bill is also permissive allowing each facility the choice to retain supervision or to change to in consultation with this is closed the bill under the legislative intent. This bill does not create a pathway for pool prescriptive authority as stated by the opposition. Because of the current bills as we've seen to date to consider that but this bill does not do that. House bill eleven ninety eight is not about doctors first nurses if you vote for this bill you global facility choice in real access to health care and with that I'd like to introduce my first witness. A. Your. She can talk on the bill he's not that this you're not a she's not speaking for thank you for that he was on sale all right yes ma'am. Thank you. Thank you so again my name is kasha Padian I have been practicing as a certified registered nurse anesthetists for seventeen years. Nurse anesthetists have been administering anesthesia for a hundred and fifty years in the state of Arkansas there are approximately eight hundred practicing siRNAs. SiRNAs provide one hundred percent of the anesthetics in critical access hospitals we also provide ninety percent of role anesthetics and seventy five percent of anesthetics in office buildings across the state. Currently in the state of Arkansas also urinates are required to practice under the supervision of but not necessarily in the presence of a licensed physician licensed dentist or other lawfully person entitled to order anesthesia. Zero days are not required to practice under the super supervision of an anesthesiologist however when anesthesiologist is not present that supervision responsibility falls to the practitioner that is performing the procedure this could be a surgeon a dentist podiatrist etcetera surgeons dentists and podiatrists are not trained anesthesia providers they are trained in their specialty they do not prescribe the anesthetic so when you think about it does it really make sense to have a specialty supervising another specialty that he or she hasn't specialized in. If there is a complication intraoperative. If it is a surgical issue we defer to the surgeon if it is an anesthesia issue they deferred to us we are two separate specialties working together towards the common goal this is not disrupt this chain of commands. House bill eleven ninety eight six to remove the word supervision I know the House urinates to practice in consultation with but not necessarily in the presence of unlike the current statute we have to find what consultation means. Consultation is the manner in process utilized between a certified registered nurse anesthetist and a licensed physician licensed dentist or other person lawfully entitled to order in the seizure performing the procedure or directly involved with the procedure when working jointly toward a common goal of providing services for the patient. House bill eleven ninety eight will more accurately represents House urinates practice today. SiRNAs are authorized by state statute to select obtain and administer drugs for anesthesia. When surgeons are required to supervise zero names. This leads to receive liability for the anesthesia provider surgeons are not liable for steering nays and not liability does not exist as proven by case law. We carry the same amount of liability insurance as our physician anesthesiologist and surgeon colleagues. Insurance companies base their rates on risk an outcomes C. R. A.'s not practice rates have decreased over thirty percent in the last three decades which proves we are safe. The removal of supervision does not decrease safety. Outcomes in anesthesia are more dependent on patients comorbidities or health issues rather than the practice model it was delivered in. We want to remove supervision so the language will reflect the true nature of our relationship and this bill will accomplish this. Additionally the removal of this language will allow facilities to have more flexible anesthesia options if the words supervision is removed and replaced with in consultation with it will allow each facility to to decide what model works best states began removing supervision in two thousand one and as of last year nineteen of them have done so. There's legislative concerned that removing supervision will create a pathway for prescriptive authority. SiRNAs are only allowed to administer schedule two opioids in the preoperative intraoperative and postoperative period this insurance not only legislators but the public that no matter what prescriptive authority bills may pass this session or future sessions serenades will only have the capacity to administer opioids in the above settings I would also like to add that there is no supervision requirement in the United States military. In conclusion house bill eleven ninety eight is permissive and we included this and Legislative intent. Removing the word supervision will accurately describe what is currently happening in practice today it will eliminate any concerns regarding the perceived liability for the operating physician dentist podiatrist practitioner and it will also allow the facility to choose the language regarding the anesthesia model based on its needs thank you. All right ladies and gentleman you want to ask a either of senator or his guest a question. All right Senator Hammer thank you measure. What I need to know is if we put this into legislation thank create the pathway for that this bill is going to create. Does it force a facility. To have to go with the model that is being. Brought about. By this legislative action or can a hospital a clinic a dentist decide to go with a in the anesthesiologist the the. Facility will have their their option of only the way Senator Hammer. Follow up manager yes thank you So. The the outcomes historically and maybe set aside step out I'm sorry but that outcomes. Is there comparison based on proven data to show the outcomes are different. Based on what I think are for different models that are out there brandish these L. jester see in our age to there are lots of studies that that so there is no difference with this model but the outcomes are any less. But at the end of day it's gonna be up to the facility to make the decision and the and the policy of the first the policy of the foods facility can over ride the what is allowed in this legislation is that correct yes Sir that is correct thank you all right I'd like to ask a question of there is that. The group that says you want to do this. A nurse anesthetist want to do it because they have plans to open up thank you manage can could you speak to that please I'm sure that's not and you need to use an hearing that but would you speak to that please and yes yes madam chair We cannot open pain clinics we have to have a collaborative agreement with the physician in order to do that this bill has nothing to do with this opening pain clinics because we don't have prescriptive authority we would have to have a D. a number to order those medications so no ma'am we cannot do that and we can only prescribe medication for the patient during the procedure that we are performing their anaesthetic on so I might might my time with the patient starts in the preoperative period in into the post operative period one day for finished I haven't I have no authority and in this understanding correct me if I'm wrong but when you prescribe something you're using the physician's DEA number is that correct or or the facility that were working there all right all right thank you all right any other questions all right talked of Senator Solomon thank you did your work to negotiate this bill with those opposed to. I'm sorry I didn't hear the question this did you work to negotiate with those that may be opposed to it did you all try to get with them and sit down and work it out yes Sir we did that there were several meetings this session which was an improvement from previous sessions and we did makes several changes in the bill based on the request the the only thing that we were able to agree on it was removing the word supervision okay thank you thank you madam chair all right of any other questions from the committee. All right seeing none. thank you very much for your. For your help and understanding this bill we're gonna go to those who are for and against and like I said earlier there's several that have that. Wanted to speak for. Our against the other bills so I'm going to go down the list and if you have changed your mind or if you still want to be included please come to the table I'm going to start with the. Posed. And since you have already spoken for. A. Dr James hunt. And if you would and and wanna have Dr Tim Goodson come at the same time and you can speak Sir separately but of course you'll be seated there is he still here. He is not okay of we'll go right ahead a doctor hunts tell us who you are and where you're from thank you madam chair may review which living yes please. Thank you madam chair and members of the Senate public health committee my name's James hunt I'm an anesthesiologist with specialty certification in pediatric anesthesiology. Prior to going to medical school I was a critical care nurse for several years I applied this year in a school the same time I applied to medical school I was accepted to both and I chose medical school. As a doctor I worked at Arkansas children's hospital and was an associate professor of anesthesiology UAMS. I have trained physicians residents serenades Cerny students an anesthesiologist assistant students. Our work currently in pain management full time to go back to Arkansas children's hospital in at hot basis to providing us to use for patients with special needs. And I oppose house bill eleven ninety eight. I'll speak this with you this afternoon about Arkansas patient expectations of their surgeons doctors nurses and hospitals. Our current law says the legal standards for these high expectations in this bill changes and lowers that standard. The educational differences between doctors and nurses the Medicare opt out of the fact that it does not increase care. The critical need of subspecialty care for Arkansas children's hospital UAMS Washington regional Arkansas heart hospital another premier hospitals where our Kansans and out of state patients come for treatment in fact their advertising for pediatric anesthesiologists now in Springdale. Health care costs and how this bill isn't about saving patients money and finally COVID nineteen and its implications on this bill. But changing the words from suit under supervision to in consultation with the sound on the first page of line twenty eight this bill dismantles and up into the doctor patient relationship in Arkansas it allows nurses to administer anesthesia without any doctor's supervision our current legal standard supervision ranks in the middle of the third fifty states for stringency this proposed language in this bill will move our legal standard to the bottom of the states. Patients don't get to shop for other industries a provider there's no tree for free market existence. Which makes sense to use a vastly different promoter healthcare specialties. Patients have the ability to research their surgeon the primary per care provider even hospital however when the patient arrives at the hospital for surgery they're entities provider has already been decided by the surgeon in the facility. Patients rightly assume and believe that they are receiving the highest level of care and our current Arkansas statute provides for doctor supervision over nurses in the operating room in patients expect this level of care. Two years ago in Arkansas poll found overwhelmingly that eighty six percent of those polled said they want doctors to administer anesthesia or respond to an emergency during surgery patients rely on the wall to set minimum standards related to their care. Do not let nurses try to convince you that experience eagles training no doubt experience counts but never in their training to nurses independently manage a patient's care it's not part of their training I've trained physician residents so you're in a students and anesthesiology assistant students I know the difference. Doctors have more comprehensive and more experience more excitement comprehensive training and more experience the training teachers doctors to manage care independently this can't be disputed experience cooking the same recipe over and over again is not the same as training that allows you to change the recipe for success we build one from scratch according to patient needs doctors are trained and educated to do this not nurses. Remember I was a registered nurse before I went to medical school I know the difference between a nursing education and medical education nurses also say the doctors are not trained in anesthesia care and it also was wrong in medical school and residency doctors and particularly surgeons had anesthesia training as part of their comprehensive training for diagnosis and independent management of patients the Arkansas legislature is defeated this bill or related one at least at least the last five sessions will ask everyone to nurses keep coming to the legislature pushing this legislation every two years. Why because changing the key word supervision the consultation may trigger an opt out of Medicare regulations under the code of federal regulations of the underlying state statute provides a lesser standard and supervision which this bill does by changing the term to consultation on line twenty eight then the nurses can request the governor Hutchinson consider opting out of Medicare rules by writing to CMS this is the nurses stated purpose this is the stated purpose of their national organization opt out of the federal rules and regulations and what does this do for nurses why pursue a statute change and ultimately opt out well most facilities anesthesiologist reemployed to supervise nursing assist because surgeons do not feel comfortable doing so this is usually because they're doing surgery on patients who are complex enough for second up at increased risk for surgery or. Some water yes two point. But I'm sure I don't understand what we're talking about now has to do with this bill this is thank you for doing the same thing that checking what may happen well I think what's happening I allowed to. the nurse practitioner to speak and then give the history and say all of those things and I'm trying to do the same thing here since I started it but I will ask that you try to To speak on the bill please but. That was that it happened the first time thank you senator okay. All right continue please. This bill is not about cost savings to a patient because the patient is bill the same if the nurse anesthetists supervised by the surgeon or anesthesiologist your call saving involved here is potentially to the facility and nurses are hoping to pocket some of this money. If the facility is saving money that should be a good thing right but that's also wrong it's already been shown that price per secretary increases about two thousand dollars per secretary in opt out states opting out doesn't improve access to care because there's already a surgeon in the waiting room to supervise institution now. The Arkansas college of surgeons also disputes the supervision of anesthesia is a barrier to recruitment states of all the states that have opted out there has been increased access and decrease and increase costs. Proponents of this bill say surgeons can't be recruited to rule Arkansas because of perceived liability by surgeon supervising anesthesia and this that and the status is surgeons don't wanna supervise in anesthesia because they want anesthesiologist there they want doctor present in reality surgeons bill practicing real Arkansas because or fewer I. see use in critical care facilities available there's less access to specialty services and specialty equipment. Most importantly the changing the legal standard supervision consultation rate increase liability due to the poor wording of this definition despite the language on page two line twenty seven real tort reform cannot be enacted in this bill and opponents of the bill want real tort reform but doctors will join in urging this passage the language found on page two it lines twenty five twenty eight is unfortunately just window dressing on the liability issue. If you also look at the language of the bill online one page thirty three it discusses perioperative and postoperative care of patients throughout Arkansas this bill would expressly provide for a hospital's medical director or doctor any doctor to console with a ceremony to open a pain clinic arguably for peri operative and post operative care this is happened in other states that have lowered their standards this is happening now in Piggott Arkansas since this bill ran last legislative sessions here anymore Clark is opened and advertised a pain clinic in conjunction with the Missouri in Arkansas hospital. More of these paying clients will pop up in Arkansas because this is about making money. At the expense of patient care this bill is about making money siRNAs in this bill's backers will be able to open pain clinics any doctor could council not a doctor who specializes in pain management ultimately this bill is about cents on the dollar and it makes no sense. In fact in states that have opted out cost per secretary actually increases because of the unforeseen complications that arise during surgery related anesthesia right now Medicare most third party insurers pay the exact same amount furnished user regardless of the provider whether it's a doctor or nurse or both there is no healthcare cost savings for patients in passing this bill. Right now the federal government actually pays rural hospitals extra money to employees here in a is for surgical services it's called the roll pastor program in ninety nine percent of anesthesia and are real Arkansas's administered by nurses but they are currently supervised by doctors remember this bill removes that critical doctor supervision and changes supervision to a lower standard of care consultation. Wine during a pulmonary pandemics such as COVID nineteen would nurses and airline corporate interest continues to push this legislation why would they hired a lobbyist advertise on Facebook right op ed articles and an incorrect is it or push a full on campaign for this law change there is a news here in a school opening at UAMS in the fall and will be an additional supply of searing As in Arkansas they're already eight hundred series in Arkansas there will be more jobs soon serenades practicing now fear influx of the news hearing aids on the job market over the next couple of years and the associated increase of competition potentially there or nearly a thousand osteopathic medical students in our schools in Fort Smith and Jones were poised to graduate. These providers may choose anesthesiology as a profession and then it will be even more competition for anesthesia services unless this bill passes. This bill serves as a deterrent to medical students to choose anesthesiology as a profession Arkansas is already considered a donor state of medical specialists this bill increases the exportation of doctors trained in Arkansas and would diminish the patients standard of care all at the same time you cannot allow Arkansas the sacrifice patient safety and doctor supervision of nurses during surgery for dollars and and competition by providers there will be more providers there are no health care costs saved by the patients The savings if any would flow to the hospital doctor hunt to hate to interrupt it you need to get this plant my final point speaks to COVID nineteen. Over three hundred fifty thousand Arkansans have had our Kansans have had code over twelve percent receipt population and these are just the reported cases. Ultimate unfortunately more people will get covered in the coming days and more people will die COVID patients will still need surgery and some of them will need surgery during their COVID illnesses to try and save or protect their lives a recent international study shows if you have covid you have up to twenty five percent higher chance of mortality during surgery this is sobering the B. more studies coming Arkansas doctors already have been creating protocols to address when it would be safer to have surgery and because of the effects of an institution's further in COVID patients. Doctors in hospitals I've worked in the fact is we simply don't know the long term effects of code on our patients but we do know that having Covin surgery increases your risk of serious complications and even death therefore I urge this is not the time to change the healthcare delivery system and remove doctor supervision over nurses. For these reasons ladies and gentlemen of the Senate public health committee I emphasize that patients have high expectations of their doctors surgeons hospitals and nurses patients expect and rely on Arkansas law for the high legal standard don't vote the lower standard voting for this bill. There are vast educational and training differences between doctors and nurses nurses don't have the education or training to build or alter the recipe for patients specific needs without supervision Best interests of Arkansas patience striking the key words supervision in favor of consultation does not reduce health care costs or save patients money and finally in three hundred and fifty eight thousand at least or cans of had covid no it's not the time to read over Turner tried and true health care model while COVID brings more danger to surgery in patients all right thank you so very much I have a question Senator Hammer thank you ma'am care doctor hunt thanks for being here today would you hit back on that point you mentioned something about opening pain clinics and you cited a situation but we're in the legislation doesn't allow and where is it currently happening that a hospital is currently under the current law allowing a scene or a two run open up a pain clinic so you're the previous witnesses that spoke for the bill actually reference that they can use the DEA number of the facility there employed by there's nothing in the bill that prevents facilities from opening pain clinics and hiring ceremonies to run those clinics. But under. What I'm understanding that this bill specifically says that it can only happen during certain times that that that schedule to use can be administered. And that it has to happen in the facility itself in my. Maybe the sponsor the bill can address that because I'm I'm taking the is specifically says only in the clinic. I'm under current Arkansas law the pain clinic is open and procedures are performed then the procedures count as a perioperative. operative space so it's able to be done now even without this legislation under supervision yes Sir thank you all right thank you any other questions from the committee saying none thank you so very much thank you what we're going to those that are for all right to Brad Pitt if you're here today come to the table please and you will a few would introduce yourself for the record you would be recognized. Thank you all very much hi my name is Brad Pitt's. First it thank you appreciate your time and energy on this I know you've heard this every two years That a little bit about myself I'm on here I'm sorry here in the state born and raised here have an agency business here we we're based in Little Rock we practice all over the state Texarkana Bible to Jones Burrel over been built on the problem we see patients everywhere and I would like to comment on this as a boots on the ground provider myself and my team absolutely increase access to care every day that we work we're out there seeing patients without fail every single day so and supervision only hinders that the word supervision I give you a quick example here and I do not want to take too much of your time but they are part of our practice is with pediatric dental population highly under served population all across the state that these guys can get in because of other reasons Medicaid reimbursement for facilities and so forth but we go to them to go to their region we go to their hometown we take care of these patients at an overwhelmingly that's the my favorite part of the job we are Very grateful the patients are very grateful that we're able to do this so maybe early twenty twenty maybe like twenty nineteen the Arkansas state dental board Arkansas state board of dental examiners sent a letter to the genesis of this The nursing and I quote the nursing boards wording for siRNAs is clear that they work under the supervision of a doctor true they are they're our legislative efforts being made to change this the doctor is the captain of the ship never accept assurances from a contract provider that the dentist is somehow protected specifically regarding the use of C. RNase this contracting retains all responsibility for the proper use of sedation agents the actions of the C. R. in a in a total care of the patient so basically what that and so this all stems from the word supervision and there's lots of things implied here that are not accurate they're supervising is correct but the details of our anesthesia the details of what we do is anesthesia providers has nothing to do with them as a dentist or for physician that supervising us and so what that did immediately drove a wedge between a patient care we we lost disabilities we had a facility that had a huge backlog of patients And it came down to the very end makes a patient scheduled and the the Dennis backed up and said I really don't understand supervision I know you give me all the case law I know the case law says I'm really not liable but it was very unclear the water continues to be muddy the this bill just really clears all this up and not only that it It accurately it accurately describes how we practice day it describes our relationship with the physician and the dentist and And really that's it I love that answer any questions you have some you have any questions Committee. All right seeing none thank you so very much we're going to the opposed now and Dr Fred meadows if you're here. And doctor meadows if you could be a little consignors two minutes all right. We appreciate to the last witness you're out here yes please and introduce yourself for the record please. I will my name is Dr Fred batters and I'm a practicing cardiovascular surgeon with over thirty years of experience in Little Rock I oppose house bill eleven ninety eight this bill affects health care in the larger cities of Arkansas I do receive patient referrals from rural Arkansas all the time and a work jointly C. RNase an anesthesiologist on all of our operations. There are unintended consequences of this bill. It will eliminate the legal requirement for C. R. nays to be supervised by physicians in every hospital in the state. That will be a negative impact on training future anesthesiologist here and for the practice of the specialty dwindling your access to advanced surgical care currently available for all our Kansans I know the importance of the anesthesiologist input on evaluating and managing patients before during and after surgery not only in my practice but in others the anesthesiologist represents the final checkpoint. The patients pass through on their journey to the operating theater this is a vital function it requires a medical doctor's training experience and judgment to assure that that patient should undergo the plan procedure. Parkinson's presenting for surgery now or sicker than they have ever been. Co existing medical diagnoses and frailty adversely it impact responses to an incision surgery resulting in increased risk of complications or death. Anesthesiologist are critical to this comprehensive risk assessment and appropriate planning and counseling of patients and families. With medical training and expertise siRNAs don't have the doctors have the authority to go toe to toe with the surgeons if the procedure needs postponement. Anesthesiologist on my team or commonly called by the sea are in a for the surgeon to deal with serious problems once the operation is already begun. Complexity of illness combined with increasing complexity of surgery requires an all hands on deck approach. This system is not broken. We must maintain high standards of patient care not lower them thank you all right any questions. All right the senator Hammer you're recognized thank you Richard Dr I'd like your perspective on something and give you a chance to comment on one comment that's been shared maybe not the table but elsewhere your role Arkansas you do not have the in the anesthesiologist that's in the room it gets down to where it's just the C. N. R. A. and the doctor perform the surgery and the doctor is you know maybe have to put somebody to sleep or hasn't been involved in that process for a long time their trust on the C. N. R. A. because there's not and the doctor into building even. How do you how do you deal with that situation given the fact the C. N. R. A. is the only one in the building during the procedure or in the operating room and there's not a in the anesthesiologist how do you resolve that well I've never practiced in rural Arkansas. And so I don't have to deal with that I do have a great amount of empathy for the rural hospitals. Because. They do lack the resources to provide the highest level of care and I do have sympathy and empathy and I think the critical care access hospitals deserve special separate attention possibly but this. In terms of the practice of complex surgery in this state and there's a lot going on in Northwest Arkansas about this right now that you all know about and one of their it points. Is increasing subspecialty care and they're looking at this is the economic loss to northwest Arkansas because they're they're losing patients are coming to places like the medical mile right here on Markham. Okay felt manager yes the in the first in the facilities that you practice and and you've been practicing how long thirty years in the facilities you practice in. Do they all have in their policy that it will be in it and the anesthesiologist that is the head of the team yes okay all right thank thank you thank. Meadows I have a question Senator Hammer reminded me of this so you have a surgeon that is doing his thing. And then you have a. A nurse anesthetist and something goes wrong who is responsible. For. In that situation if the patient. expires because of lack of the. Whatever just an emergency at the head of the table well as you know in the Arkansas medical malpractice environment everyone is. Okay frequently everyone is named when the plaintiffs get involved but I can tell you we are a team we have shared decision making and this is a proven concept in contemporary medicine that has absolutely improved outcomes and to compromise the highest level of collaboration when the patients are sicker than they've ever been. Is stunning to me that we're even discussing it. All right thank you so very much I appreciate your time okay we have a question Senator Davis. Thank you madam chair and I'm curious and didn't CMS to spend at the supervision requirement in March of twenty twenty. I can't speak to that okay you have to refer the question to one of my anesthesia peers okay thank you all right thank you. Appreciate your time thank you all right we're going to for and to see Chris Rame Roemer all right if you go the table and tell us who you are and where you're from. Remove my mask you please do. Good afternoon thanks for your time money was Chris ram I am the CEO of the Mississippi County hospital system which consist of great river Medical Center of ninety nine bed acute care hospital in Mississippi County Arkansas in a twenty five bed critical access hospital SMC at Osceola and I'm for the bill we have had over the past twelve years we have been have not had the resources to employees anesthesiologist and we have been on all see our name model for those years in over those it has presented some issues over time about implied liability or different words for it of a few years ago are orthopedic surgeon retired and we sought the the A large hospital groups somewhere else to provide a one day a week clinic one day a week Anastasia I mean one day a week secretary for orthopedics and a clinic and as we negotiated the agreed they wanted to do that and then when it came to. Getting a contract implied liability came up and it's not that they had issue with C. R. nays providing their care of because siRNAs provide the care currently even where they are it is the implied liability that that that that precluded that from happening so we no longer have orthopedic surgery in our a county Mississippi County is ruled council of garden really one of the top one or two most difficult places in the state to recruit maybe in the nation lots of reasons but many of these advanced practice bills accrued critical for our ability to provide services the quality of care is is not been an issue its long established that C. R. A.'s provide company quality care it's really the the opt out option and the implied liability that become an issue for up for us and. The the physician mentioned earlier pain clinics for C. R. Nays we I am familiar with paying clicks for CNA's we actually have one they right no prescriptions there the their ability they right no prescription they don't the only thing that that they are able to do is do procedures that blocks Blake Shinn's those surgical procedures that reduce pain we write no prescriptions they have nobility right prescription in our clinic so um. One of the that issues come up in our of clinic as well but I'm for the the bill as it provides access to the crease because it does decrease costs for hospitals and one critical access hospitals will rule hospitals run on such a tight margin the expense that that that it does save helps provide support and putting back in two resources into the hospital. Yes Senator Hammer one question thank you Mr the. So the whole time you been operating under C. N. R. A. status yes what your outcomes have you have you seen compared to other facilities that are under different model what is your outcomes we had no negative anesthesia outcomes and and you know it's still studies over nation show that the actual. Care that is giving it really is is the procedure of anesthesia it is primarily given by siRNA so we we see the same outcomes and even during covid. That it hasn't changed because the CNA still give Anastasi when during cold so that the practice of Anastasia really hasn't changed for us thank you all right any other questions sing none thank you so very much for your testimony all right of we're going to. opposed to an doctor Kevin Spence. Okay you had the you can remove your mask if you would please Sir and tell us who you are and then you're recognized to. Talk about the bill thank you senator Bledsoe and thank you committee members my name is Kevin Spence I practice at unity health in Searcy and I've been anesthesiologist for thirty years I'm passionate about my profession never would I oppose a bill of what I propose a bill to remove patient safety to make money but this is what this bill is asking you to do. This bill diminishes the care of our Arkansas patients your job is legislatures is to protect the health safety and welfare of our Kansans this bill cuts to the very core of your duties and you should vote no on this bill. This bill is about rising risking Arkansas patient safety for dollars it lowers the state's legal standard for nebulous consultation standard it tears down the health care model that I have practice my entire career. This bill removes a proven practice model going from one hundred percent zero percent required supervision why change it nothing is broken. This is not about a lack of rule healthcare. This spot the sponsors of this bill have painted it in those terms but it is wrong. I believe in the in the nurse's goal is to be able to negotiate higher fees for their services and higher payments from hospitals hospital costs will actually rise under this bill would it surprise you to learn that an out of state hospital owners right now have negotiated contracts without out of state C. or in a company for Arkansas hospitals to attempt to cut costs by removing anesthesiologist this is happening in our state. That temporary savings does not flow to our patients those cost savings go to the out of state see on a corporation my anesthesia group estimates the physician supervision is budget neutral at my hospital there's no economic reason to destroy the supervision standard. This bill does not provide more real access to care there is no proof that it will if we have a known practice model that we can guarantee you it works it's proven it's what we're doing every day. Ninety nine percent of our cans and do not even know this bill is running right now when a patient makes a relationship with the physician one of the basic duties of me S. position is that I'm going to have oversight and I'm going to supervise their care this bill removes that right as a physician for me to supervise my patience care and my patient doesn't even know if. One other thing I would like to add is the goals of the C. R. in a from their brochure they would like full practice authority. They would like for prescriptive authority if they would like to order drug tests provide pain management services and the ability to supervise radiology technicians so that they may point implants spinal stimulators FOR these are their express written goals in a brochure they're gonna tell us exactly what they want to do. So again this this bill is not about access we're not going to increase access. But we are gonna definitely decrease are lower speed at lower our standards that we currently all have for everybody doesn't cost anybody anything we already do on it and we know what works why would be possibly remove something we know is safe for our patients. Thank you I'm happy to answer any questions any questions from the committee. All right seeing none thank you so very much. All right to the board Calhoun to speak for. All right of then let's see there is someone that a committee mispronounce or name of certified registered nurse anesthetists up is set to I don't know what it's Mr Mrs paid be played beyond. Okay all right of. Then going on with the for. I'm I'm sorry I don't have anymore for is anybody here that once that have signed up to speak for this bill that I have not called that I have not called all right then I'm going to against of Dr Tim good sent if you would come forward. And you can remove your mask if you would like and the tell us who you are and where you're from. Thanks to both of them committee member okay would you pull your sport you're a. Microphone up a little bit make sure its own is better that's much better lead and didn't have the buttons. Hello my name is Tim Goodson urologists good stars with Arkansas urology haven't twenty years of experience or more with both doctors nurses the provided a stage for our group my partner Miller's active board of Arkansas urology for almost that whole twenty years of service chief of staff in the medical sector committee at a major local hospital. Of my group and I urge you say no on a house bill eleven ninety eight. About fifty percent of our patients are from rural Arkansas. And we pride have practiced clinics in many small towns around the state. several years ago. My partners and I decided to approve our patients quality of care. As we performed a procedures and surgery. And of course a seizure services required to take care of our patients. We set out to build outpatient surgery center in little rock and have done so call the center Centerview surgery center it's been operation three years. part establishing our our current center we performed a lot of small procedures in our office with minor sedation in use this new Star services as well supervising those nurses. with new starter sooner we added Dr Indy is the jollity oversight to our model. We determine if this edition was budget neutral for our practice additionally this was a cost saving measure to our patients because they weren't paying hospital facility for a mismatch of less expensive to do a procedure or surgery center that is a hospital. The improving the quality of care is with a substantial including the care exercise bar any sees you all just providing or supervising all of our surgeries and procedures. It's important for our prices have other doctors skilled in trying in anesthesia including a nurse providers to provide supervision. Available for pre procedural violations. You anesthesiologist recognized many specific challenges to the patient's health they assist with the difficult intubation is inductions of the incision and most importantly their their hands on to provide help in skill with crisis happened and I do regardless of how good your planning is. NO two that you not always determined who's appropriate surgical candidate and who isn't based on my relationship with that patient. SiRNAs do not have a pleasure relationship. hi centers are contained in our law Barker current law provides was supervision is what the legislature should endorse. Our medical group in myself urge the Senate public health committee to do so by saying no on this bill thank you thank you any questions. Seeing no questions thank you very much for your testimony thank you senator all right uh we have just three more who've already spoken on another build up to the. But to Frazier it Frazier Edwards. And if you could come just with Frazier added words Michael page and there is a Jean medley if you wanted to come and all three of you sit there together. That would be good. Do you want to come up as well. You can sit. Yes bring a chair that's good things binding treasurer average again I represent the Arkansas osteopathic medical association we are against this bill I spec positions for those who don't know you you heard many of my previous arguments for addressing access to care and and I echo the sentiments of some of the positions here I've already testified but I see that osteopathic physicians represent a separate branch of medicine they are different from indie colleagues they attend osteopathic medical school osteopathic physicians went out and earned their individual practice rights and full scope of practice rights from educational equivalency through oversight for their accrediting bodies as well as the US Supreme Court and oversight of all of those we also again it here to ACGME which is graduate medical education say all that to say us back positions went out and earned the rights instead of trying to legislate the rights through scope of practice bills and they did it the right way through educational equivalency models so that we. Could keep the patient's best interests at heart and again a student doctor Mike pages here to answer any questions as they to talk about education or any of the things he's gone through but I'll let him speak as well once. Thank you chair and committee members okay if I speak from here yes thank you you all know my background as a nurse on body with that again I also spent some time as a surgical technologist in the O. R. so I'm about two years of training on top under some training in the O. R. as well as my time in medical school I think it's important to keep in the oversight with the anesthesiologist so that we don't shift the focus of my future colleagues away from Anastasia as a specialty if if R. C. R. A. colleagues are able to practice on abated in the rural areas are anesthesiologist Indian DO colleagues may decide to practice elsewhere as a physician who wants to go back to rule Arkansan practice in family medicine will likely be primary and see certain sections which are much needed in the rule areas I want the oversight of an anesthesiologist in my O. R. I not only wanted but I need it and if I am left with siRNAs practicing in these rural areas with no oversight it will endanger my future patients not only them but the lives of the baby that I'm trying to deliver so I would ask that you keep that in mind and I do second the physician's toss earlier that it is the job of this committee to consider the future of patient wellness as you do your job thank you all right thank you all right of. Jean Madeline June that they need from Little Rock I have no medical experience I'm coming to you strictly as a citizen saying that I have a problem with the wording of changing supervising to consulting. If someone that could be a patient one day I would certainly not want someone to consult about an anesthesia that may. Put me to sleep or may kill me I think that it's more comforting to a patient and to a citizen to know that we are being supervised we go and we find the doctor that's best qualified that's recommended and then you put your trust in that person and then that person you trust them to find the perfect the people that are going to be there with him and he's going to be there of observing supervising and performing so this is why I'm against it I would much rather have someone supervising than consulting thank you all right thank you any questions for all right of center today this thank you madam chair I was curious if you guys knew how many hospitals in Arkansas currently do not have anesthesiologist practicing their. Again I can't give the exact number All right you're recognized over eighty percent have an. One hundred percent supervision in this state right now position over eighty percent of our anesthetics with so that's important it's a great question. I would also you know that's and in my opinion that's an access questions again I can talk to about the pipeline that is currently being developed and is we are so close the fruition of that occurring through the pipeline that we are creating through medical education at its highest level in these real communities well as and that's what I'm sorry no go head and it is important station I think because I think like we're having the conversation that this will take away oversight anesthesiologist and that's not the case it's it's that a doctor or an anesthesiologist with supervision and so it's not. It is that they're being supervised also son with and maybe doctors that don't have extensive and medical training like an anesthesiologist does so I understand the argument was just anesthesiologist but it out is also a medical doctor in the ring. So it may have one follow up questions please and I'll ask you guys if you know and do you know and I as I understand it CMS suspended the supervision requirement in March of twenty twenty you guys know that to be true that is correct okay so that the my question and. Is if CMS was willing to spend the supervision requirement and and we're talking about COVID and safety concerns and have you guys advocated national level and do you think CMS is endangering the lives of people across the country I think that they were trying to address a pandemic and for this legislative body to assume the responsibilities and roles and. And everything else that goes along with CMS is. Dangerous because CMS I I'm how long will that go on we're still in the pandemic we are coming out of it but this body of legislators are not largely not health care professionals that practice that attended medical school or in most of them did not attend those different types of training so if those while they may be suspended I don't think that they remove them and to take authority away from CMS or not recognize what they have put in place and the model is working and has been working Y. remove that and give authority to legislative body that. Doesn't have the experience or the knowledge that say CMS does. Okay thank thank you I have a question and skews me I have a question of for those of you at the end of the table up as a general surgeon going into the surgery suite of would you not agree that he will have his focus on what he's doing on the patient and to. If there's an accident or something goes awry at the at the head of the table of would you not agree that he might jeopardize his part of the surgery by running to help of someone at the head of the table a nurse anesthetist or someone like today. Yeah I would sit in order page three to the I think so and and I think even as a citizen I would rather have an anesthesiologist at the head of of that operation of me putting me to sleep than a than a C. R. and I know it happens in a lot of places a lot of instances but there is that oversight and there's that comfort as a physician and if any of you were being put to sleep I think you would want to to know that the person with the most advanced training possible known to man is is at the head of that procedure so standard page yeah I would I would second those brought You know much like they say it takes a community to raise a child it takes a team to take care of a patient and you've heard about the hierarchy model that we have in medicine today and how that promotes patient safety a lot of things in surgery were actually adopted in safety wise from the airplane industry checklist that we have so forth and so on and just like they have mechanics and pilots and stewardess and different people forming different roles based on their training and based on what they been told and taught to do so do we in medicine and having that oversight whether you're general surgeon a family practice physician doing sections whatever be having that oversight from an anesthesiologist of a C. as a C. R. nay is a back up and when medicine is being practice with the end goal of patients lives on the line a backup is always a dang good thing thank you all right please engine anymore questions all right Senator Hammer. Madam chair I'd like the gentleman who provided information Bacall to the table and state his name for the record please all right and then I have a question all right and not sure who that what's. All right. So my name is Kevin spent two and a anesthesiologist. Your question yes ma'am thank you manager would you restate your comment a minute ago when the question was asked about eighty percent coverage and a hundred percent coverage in state would you would you yes so he's right now by law we have a hundred percent supervision whether it's by the anesthesiologist or by a physician so it are not in CCL sorry so a hundred percent physician supervision. We have eighty percent greater than eighty percent coverage by anesthesiologist covering that this state so there are definitely areas where there is not an anesthesiologist but during that surgery there is a physician supervising and if I could clarify something I think something that becomes so confusing we start talking about supervision it's a duty of a physician to supervise the care of the patient that's what we do we diagnose we treat and we supervise your care you come to me you and I have a relationship. And I'm supervising you and you know I'm going to take care of you from start to finish it's my duty that's what I do this law takes away that duty it takes it away from me it says you can supervise every nurse but you can't be part of the scare of the nursing message you cannot supervise Mike here once I go under that nursing assist care. I don't I mean it's I don't know I just can't it's a funny lauded me and like that's what I do you're just taking of law and saying no you can't do this you cannot supervise that's what we do that's what a patient expects that's what this lady was trying to say that's what we expect when we when we make a relationship with you if you go to an A. P. R. N. you know you're going to an A. P. R. and right if you choose a midwife you know you should chose a midwife if you come get doing a seizure and you don't know your your your physician is supervising your care you don't know that that's what what sorry that's what this bill and I'm so sorry I get so passionate about this but no it is it it's just absurd what I when I read this I'm just like it's not about as I practice with siRNAs my whole career we have a great practice a great relationship I need them I need them to be able to take care of my patients they extend my care every day I know every patient that comes in my facility I understand what you guys are saying about the rule access I understand it but this bill doesn't fix it it does not fix the problem this bill is illogical it takes to troops and it can make the illogical conclusion we're concluding that this bill will give you access and rule Arkansas it is not going to change access but what they're coming at us in the back door and go in we want to change this word so we can opt out that's what they're telling you we can opt out so we can make more money that's all they're saying it's call this bill is a we have a great practice model right now it works safe it's beautiful and you're telling me you want to take it away why why we want to play thank you Sir. Okay you can go ahead at thank you I just so but it could be that a facility such as the CEO of Mississippi County where they're having trouble getting someone to come. It could be that a facility could right into their policy regardless of what we do sit in this room that an anesthesiologist or MD has to supervise the C. N. R. eight that they could still be hospital policy that could not be over ridden by this law is that correct Senator Hammer you are correct but one just point something is a it allows it okay it allows it and then you as a consumer you go to that hospital you get different care and different availability thing you to another hospital so that this this thing is not the same all across the state right now you have a hundred percent supervision by a physician and when you an act this law you're going to have hospital be offered something else is something else. There's a better way to fix this there's a better way and language is offered but it was refused because they wanted the whole state to be without supervision I was not privilege to the compromise language I cannot speak on it I know nothing about what was offered but I'm just telling you guys this is an extreme answer for a small problem we can do better than what we're doing this is this is uprooting whole state it's a pretty everybody its up recruiting recruitment abilities you you want anesthesiologist here yes we want them here Dr matters testified he needs specialist here this is going to Turkey these young people from going into my specialty. It's it's a it's a to a tri city it is a trustee we do not need this legislation thank you Richard thank you so much for you testament okay do you want to ask a question senator senator so if I'm sure my question would be to the other two gentleman we were here particular the student that testified it sounded to me like they said that if this bill passed we hear in this committee would be responsible for any deaths that occurred could they please come to the to the table explain that comment place. Thank you for questions Senator Solomon. my comments regarding your responsibilities or this responsibilities of this committee were misconstrued I apologize for that I simply want to make the point that I stood by the bedside of many Arkansans both inside Arkansas as a nursing as a. Privilege to serve them as a medical student. And as the physician pointed out I care about it's the reason that I went into nursing is the reason that I I'm going into family medicine is the reason that I want to go back to South Arkansas practice there is because at the end of the day I want to make sure that they make it home whether that's out of my you are off my or table or whatever it is and so that's not the responsibility of this committee is not the responsibility of a as me as a physician it's all of our responsibility as our Kansans to take care of one another and I think we have to burden that responsibility together by making smart decisions and I urge this committee to consider all that's been said today and make the best decision if they can't when I heard you say it was that we weren't smart enough to make that decision. We do want to hard enough and that if people died it would be the fault of this committee so are you saying that that I missed heard you because it's all on video and on tape so if that's not your point please clarify yes Sir at I did not make the statement that you were not smart enough to make that decision. Senator Solomon I I think if the clarification was if there is an opt out and the pathway that does exist for this bill that is it has to get through this committee for children understand on that is is you and I think that that is the responsibility of this committee agreed Oppelo video input to it that's true thank you thank you madam chair all right the lady thank you so much for your testimony all right ladies and gentleman we have come to a time when it's time Senator put up for you to close if you'd like to close for your bill. Thank you madam chair members. It's been a long time since my has been provided that much. All my life I've heard. One definition of insanity is to keep doing the same thing over and over and over again. Here we are in the state of Arkansas is we're not last and medical categories here to you in the bottom ten percent. And so we're just doing the same things over and over and over. I've got a really good hospital in Mississippi County. They can attract a surgeon. The. Could could not get a It sees this to come to that place in a hundred years public. We have we got to do things differently to help our rural areas. Ninety other states doing this already. I don't see a huge outcry that they're doing it wrong US military's done it I probably been on the nafta one those guys. This bill. Opens up borough health. It will help our areas that cannot have the benefits of being an. Little Rock or being in Northwest Arkansas our current model is not working. This bill. Is not suited to anything he gives a facility in option to where they can choose consultation or supervision is left up to the facility that knows its area and this people best in with that madam chair I appreciated nine closed all right thank you all right committee we come to that time it's the end of this okay he we have a motion to pass it second but a. I'm going to ask for call the roll call so we have the the motion in the end of the second call the roll. Senator Hester. Senator Hester. You senator Wallace. Senator Davis. No. Is it. Senator Hammer. Senator Solomon. Senator Gilmore. Senator Flippo. Share what's on no. All right ladies and gentlemen of senator Wallace congratulations your bill has passed thank you so much alright ladies and gentleman we're going on to our next bill so all of you who are here for that bill it is the house bill eleven thirty four and I see representative Boyd ready so if you would introduce yourself for the record. we're excited to hear your bill. Madam chair representative Justin Boyd and I have a house bill eleven thirty for which a senator Gilmore and I are both the sponsors of and if you're okay all star presenting the bill and I do have back up but for expediency I'm only calling them if you have questions over my head okay in your starting with house bill eleven thirty four yes ma'am all right reckon you're recognized so eleven thirty four eleven thirty five or kind of companion bills but as we stated I'm starting with eleven thirty four and eleven thirty four and I want to state for the record I am a pharmacist so just so there's no lack of clarity on that for transparency I need to say that in the beginning this bill changes pharmacists ability to administer vaccine per protocol to patients seven years or older to be able to prescribe vaccines to patients three years and older we worked with pediatricians to get agreed to language on that first patients three to six years of of age the pharmacist must with the exception of fluent covered vaccine participate in the vaccine for children program and recommended well child check to a pediatrician or or other licensed primary care provider at least once a year this bill allows a pharmacist prescribe unnecessary medications in case and make you reaction to a vaccine is is well because about one in a million times with most vaccines there there is a risk of an anaphylactic reaction and you have to be prepared for that so with that said I'd be happy to answer any questions. All right any questions from the committee. All right of noticing no questions from the committee is anyone in the audience want to speak for or against. All right. Do it did I see a hand back there. All right NO one wants to speak for or against all right of. Questions from the committee. No questions okay Senator Hammer would you would you define supervising physician because we just went through this big long debate in this other field would you hit on supervising sent me into building within arm's reach or what does that mean Senator Hammer I appreciate that question so of course I would say every profession is different but as a loan for me to talk as a practicing pharmacist for minute not as a legislator but I've always taken that to mean in it And based on my experience support experience with the board of pharmacy that means in the same building that means within proximity to not necessarily overseeing every last move that is made so you know I can be at the computer right here filling a prescription and my technician can be counting prescriptions down here and so I'm right there if need be on site if there's an issue I'm there to answer questions there if there's a problem but that's the way I interpret supervision from a board of pharmacy standpoint thank you mention all right any other questions all right seeing none and there is no one that wants to speak for the bill what is the pleasure of the Committee do pass to have the second. All those in favor say aye. All those opposed congratulations you passed your bill thank you madam chair. But the next one. thank you this is the companion bill to house bill eleven thirty four by Senator Gilmore is the the Senate sponsor and for expediency again I'm just gonna go through this very quickly what this does is it allows a pharmacy technician to administer only vaccine so not other medications just vaccines or immunizations under the supervision of a pharmacist it does require that the the technician will have training that current program that is in place is a three hour online program covering storage delivery and administration and as much about what not to do as what to do a qualified person so that be a pharmacist or physician must do a skills confirmation with them after the other education with that said I'm open for any questions any questions from the committee all right seeing none does anyone in the audience want to speak for or against this bill. All right seeing none what's the pleasure of the Committee have a motion do pass to have the second. All those in favor say aye all those opposed congratulations you have passed your bill thank you very much all right and the last one on the agenda house bill ten sixty nine of who is running that bill you are okay Senator Davis. When you get settled we are ready to introduce yourself for the record we are ready to hear your bill. Thank you madam chair Brianne Davis state senator for district sixteen. All right okay sorry so. And this bill allows pharmacists to dispense oral contraceptives for up to six months. And the pharmacist must also refer a patient to a PCP or gynecologist and and they also have certain pieces of data that their space to report so there is a day that data reporting mechanisms that will be kept by the department of health. And there will be training required for the pharmacist and if a patient they will scream the patient to see if they've been seen by a doctor within the past six months and if they have not that's when they're allowed to dispense for six months. And. The bill is pretty clear on an. And the process of pharmacists are supposed to follow but I want to talk a little bit about why and this bill so important to me and why I think it's a necessary to pass. And there are several other states Hey to. Already have bills like this in place California Colorado Hawaii Idaho Maryland you Hampshire New Mexico Oregon Tennessee Utah Washington and West Virginia. In the states you can clearly see that the number of teen pregnancies has been reduced once this these pieces of legislation if passed say for example in Arkansas if you look at our twenty fourteen data which was the most recent available a couple months ago. We had almost eighteen thousand and wanted pregnancies in the state of Arkansas that's thirty six percent of our pregnancies in the state. Based on the number of portions that were performed that year you can conservatively say that twenty five percent of those unwanted pregnancies were terminated. Studies project and data shows there will be seven to twenty five percent fewer unwanted pregnancies because of this policy. What that means an actual numbers is reduction of anywhere from three hundred and thirteen to one thousand one hundred and eighteen abortions yearly in the state of Arkansas. We are the number one this pro life state in the nation based on the policies that we pass. However we have the Select you'll see this out to every member of the committee. You can see that in Arkansas I'm an eighteen and nineteen year olds we have a birthright of seventy two point four out of every one thousand births the national average is forty point seven. Among fifteen to nineteen year old in the state we have thirty eight births per one thousand and the national average that's at twenty two point three. We are well above the national average. And I think at some point we have to ask ourselves if our policies are working. If our goal is to reduce the number of abortions in the state of Arkansas which I think that is the goal of all of us on this committee then we need to check the data that we need to see if the policies that we have in place are matching our outcomes and in this case they're just not. We shouldn't have the highest teen pregnancy rate in the nation yet we do. That's why this bill I think it's so important to increase access to birth control for those who are eighteen years old and older it's just up to six months as I said and after that they have to be referred to a physician and see a primary care doctor or gynecologist with that I'm happy to take any questions any questions from the committee. Yes senator Hammer thank you ma'am chair one of the things I wanted you to address is the matter of getting. The prescription but then having to go to. The doctor I think it said within six months is that right to renew that. They're only allowed to dispense oral contraceptives for up to six months okay and I have to get a referral okay how do how we going to track people jumping from one pharmacy to the other without ever seeing that doctor because I'm thinking there's some side effects to some of the. Birth control pills that are given and could you address that just how all that's gonna work out yes and that was Aston in House public health as well and that's not a dressed here so that can certainly happen and I think we can look to see with the data that we collect and to see if we need to make changes and next time annexation. But or we can address that maybe through the rules process. Thank you Mr all right any other questions. All right seeing none I have three people that have signed up to speak against I don't have any speak for so going down the list of road man's. Speaking against ten sixty nine. Entered into tissue Sir for the record please. Good afternoon madam chair and committee members rose man's you all know me as the executive director of Arkansas right to life today home gist representing myself Arkansas right to life is neutral on house bill ten sixty nine. As a pro life advocate for the last thirty three years it is my opinion that this is not a pro life bill is the sponsor has stated. It was pro life organizations like Arkansas right to life would not be neutral. It was pro abortion House members like those endorsed by Planned Parenthood and who speak against every pro life bill would not have voted for it. It was. It would not be advancing the agenda of Planned Parenthood and other abortion providers to increase access to oral contraceptives as you've heard in testimony here before in this committee. People opposing. Bills. You may be interested to learn that Margaret Sanger first founded the American birth control league in nineteen twenty one. And later in nineteen forty two it was renamed Planned Parenthood federation of America. You might ask yourself why as early as nineteen fifty five. I inherited begin to advocate for abortion law reform. In nineteen sixty the first oral contraceptive pill was approved by the FDA we all know what happened in nineteen seventy three. Over the last forty eight years there have been approximately sixty three million abortions in windows plan here it is the single single largest abortion provider in our nation and receives over five hundred million dollars in government funding each year. This legislature has a bill before it right now to once and for all keep Planned Parenthood in Arkansas from receiving another dime of taxpayer dollars through Medicaid reimbursement the governor told us yesterday at the March for life that he was ready to sign that bill. The demand for abortion is the result of failed contraception no contraception. I'm sure the sponsor genuinely believe this as he stated and she has stated that increasing access to oral contraceptives will reduce abortions but after sixty one years of the peel and many developments of in birth control the data still shows that contraceptives fail and when they do women turned to abortion. Macher Institute the former armor armor planned parenthood reports that in twenty fourteen fifty one percent of abortion patients or using a contraceptive method in the months I became pregnant most commonly condoms or short acting hormonal methods like the pill. Planned parenthood's website. I just checked it today list a total of eighteen different birth control methods ranging from seventy one to one hundred percent efficacy and has a direct apps that you can get from them that will deliver birth controls right to your front door. In case you're curious there was only to birth control methods that they listed as one hundred percent effective used all the time and that's our course I don't know what that is in abstinence. All is listed on their website is ninety one percent effective and that's if it's taken consistently according to directions. At a time when contraception is already widely available and experts have reported that contraceptive use in the U. S. is virtually universal among women of reproductive age you have to ask yourself why are we still having millions of abortions and why he is Planned Parenthood still demanding increased access to contraceptives. Could it be that the abortion rate has fallen to lower than it was in nineteen seventy three. I ask you to not help the advanced planned parenthood's agenda and vote no on house bill ten sixty nine thank you have any questions from the committee. All right seeing none thank you so much the next person on the list for it heart junior. And he is also speaking against. If you would to identify yourself please for the record madam chairman good afternoon ladies and gentleman it's been a long afternoon I'll try to be distinct. this bill right now is well it is my name is Fred Hartman attorney in little rock Arkansas on its I'm a solo practitioner. were solely for myself I'm not here on behalf of any organization. I have worked around the state I will give you my CV but I've had a lot of experience. Around the state but is in German this bill is now a ill advised is potentially. Disasters. First of all first teenage pregnancy noted that it only addresses years eighteen and nineteen. The rest of the teenage pregnancy is not an address by this bill as far as Arkansas's high rate of teenage births. There is an interesting fact which is there's never any distinction made between how many of these persons are. In the context of marriage and how many are out the facts of the matter is and I don't have the exact statistics here today are Kansas tend to marry early consequently the ten become pregnant earlier. That's part of the equation we never hear that discussed president gentleman's mismanaged told you this is not a pro life bill what this is is the bill is going to expand the distribution of contraceptives. This is the fact of the matter is is these contraceptives are very dangerous drugs it is not my opinion this is the FDA's opinion. Read the inserts all kinds of things strokes heart attacks resolves aquaria of of it not all the time her present but from from these from from the use of oral contraceptives Furthermore oral contraceptives do nothing whatsoever to address sexually transmitted disease we haven't heard anything at all about that the fact of the matter is there is in general what this bill will do will expand the use and distribution of contraception it will not reduce pregnancies it will not reduce pregnancy Dr John rock. Developed oral contraceptive in nineteen sixty in for sixty one years we have been heard we've been told is miss men's testified. There was going to reduce pregnancy is going to do support the results are right there for anybody wants to have a quite the contrary this is going to continue that that's the last thing that we need this is a bill is not about women's health this is a bill about the long green. The bill is going to help not all pharmacist because most or a lot of we're not gonna be willing to do it and there's a witness who will testify or explicitly on this very shortly what is going to do is going to help all grades this is going to help Walmart this is going to help CVS's who can help Kroger. This is going to help our care the co sponsors employer that's who's going to help the average individual pharmacist is not going to be able to face the possible liability and the per keeping requirements this bill entails so this is not this is not even about helping pharmacist this is a bill about helping large pharmacies who are already making a whole lot of money here making hand over fist there's a gentleman it's simply not worth risking the health of the young people of Arkansas due to adopt this bill this going to line the pockets of people who are already well let me close with one final observation the gentleman among my checkered legal careers and working in legal aid I worked at a time of Central Arkansas legal services office when they had an office down the road I worked in Jonesborough legal services of northeast Arkansas I'm not gonna go into the details but a significant part of our practice as you may know for knowledge of legal aid dealt with pregnancies unwanted pregnancy is the senator mentioned. Ladies in general I can't give you the details but a lot of these women overwhelmingly women that we representative for women who were taking contraceptive they were on birth controls and resulted in and and and baby the board notices a door spent for the debate but this was not with the intention this is so when I speak to you about an intended consequences of pregnancies it's not just theoretical not something I read I have represented women who are in that situation thank you ladies and gents thank you questions Senator Hammer you're recognized thank you thank you madam chair you say practitioner you're an attorney or could you define practitioners use active saw yesterday I might by state bar number seven five zero five five okay manager do you think it's sometime we get the pharmacy association representatives in the room to is is there someone here. The pharmacy association bill. I'm not and I want to see that all right figure out what you get to the table thank you Mr thank you manager. Right thank you all right the. And you are to speak for or against. Against the bill on March of off all right thank you. You'll come to the end of the table and you are you did sign up so I was getting to you anyway but please the identify yourself for the for the committee for the record thank you madam chair and and Senators I'm a pharmacist and Contraceptives or the are also dear to my heart the exact opposite as Senator Breanna here. But I'm gonna tell you want a little bit okay so Two thousand and nineteen this bill was presented to the this committee without the amendments that Pilkington added to it the last five amendments and I was going to testify then they didn't get to because at the last minute it was withdrawn supposedly because he did not have enough votes on the committee I believe to committee members were here missed by Senator Wallace and senator Hammer I believe they were both there and so I'm going to get to get my talk now it's not a long one not at all I agree with the other two speakers this bill is not a pro life bill. And the drug that they're asking pharmacists to dispense is not a it's a dangerous drugs. It's a drug that has killed people. I'm not saying that pharmacists are not able to prescribe and they're the best trained of all the medical professions and drugs we go to school for six years so we we you know we couldn't write for inhalers we could ride for high blood pressure meds many states do patient have the diagnosis you come to your pharmacy and we can fix yes but birth control pills. I mean it's dangerous and The amendments to the bill that were added at the last minute US or added to hopefully make it a pro life bill and those amendment said it prevents pharmacists from giving an abortion referral. And it also makes the pharmacist verbally tell the patients who are getting oral contraceptives that there is a possibility that they could cause the death the contraceptive or OC's birth control pills of the unborn child. And so. It does occasionally do that and then They want the patient to sign an informed consent and before a pharmacist could write the prescription okay so your average pharmacist is not going to have time to do all this. You know they don't have time to do it properly they don't get to see the patient's medical record they have to have a form filled out by the patient's name and get this there's eighteen counter indications for birth control pills eighteen do you have a liver disease do you get blood clots what is your age do you smoke I could go on and on the insert of Yasmin which is one of the most popular birth control pills is twenty eight pages they've also been involved in multiple lawsuits. Personally I have a friend that she couldn't come she has children that she thought we were going to go around to picking up at school if I knew it was this late you probably going to made it but she made a statement saying that she had a stroke when she was twenty six years old and she was the mother of two children and was on birth control pills not to prevent contraception but because appearance or mass that she had been on the hill maybe a year year and a half when she had a stroke and she had the classics Drug so her husband knew to give her a meeting at least to a hospital where they took care of her she it wasn't I see you for six days you know I had to learn to do a lot of stuff over again but by the grace of god she is fine now the doctors determined that what cost her stroke was for oral contraceptive that she was on at the time I also have a thirty two year old daughter who had a friend that as an accountant in Dallas and she was working at her big huge office when she collapsed and died from a pulmonary embolus which they also tacked on to birth control pills so it is a dangerous drug guys and if you don't believe me look up the insert and Pharmacist concurrently right for now locks down which has one Conner indication and no warning you know what that is that's a drug that Connor acts opioids saves lives lots of them okay they can also prescribe nicotine products to stop smoking most of them are over the counter but they can also do the inhalers and the nasal spray again one Connor indication and one warning guess what the warning this. These products are nicotine and you know you're not helping your addiction by you know if you continue to use these or if you take twice as much your mix products you know I mean get get it done get an inhaler or whatever so that's that on the yes men it has seven Conner indications at and nine it with another nine listed under blood clots blood clots is really really bad I mean and then nine different things under a blood clot women with these nine different conditions have a chance of getting a blood clot and it has thirteen different warnings I'm not going to go into you guys can read them it's just dangerous so your average Joe in the world community is not going to be dispensing this because they won't have the time the money or the effort but guess what they don't have to you know why the eighty H. E. eighty H. has ninety three health clinics ninety three clinics they're not in all seventy five of our counties but they're in like seventy I believe and all of them have an advanced practice nurse specially trained in women how they can not only give oral contraception patches now they have a new contraceptive to hate that a woman and service is bad general reading are you dis you name it the eighty eight can give it to women free they have insurance they bill their insurance company if they don't have insurance it's free no cost and they're all over the state so it's not that the world places the women aren't going to get it I don't understand why why the big deal is that pharmacists should be writing far I mean. I just don't get it you said that you thought that women needed access will. When I was twenty five I was on birth control pills this is also why it's important to my heart and I was unaware eight and and I got pregnant on birth control pills I was a pharmacist guys what kind of pharmacist gets pregnant on a birth control pill that's just plain stupid that's what I thought anyway guess what I did. I got an abortion. Nobody had to know it took me thirty years before I let it the capped out of the hat of what I had done and you know what I'm not the only one I work at a pregnancy center where we get women young women I'm really young that are unexpectedly pregnant and they come to us and we ask them up on their intake were you taking contraceptives guess what the over well mean majority are taking nothing that's why we have a high teen pregnancy rate in Arkansas because the teenagers are using contraceptive and when I mentioned to them that all I would do that that's bad for your body. Or I wanted a baby these these children need education. We need to get in the schools and teach abstinence and tell them you know. They just need help but contraceptive oral especially oral contraceptives are not going to help. I know some of you think that this is going may Mrs those of you would have to wind it down we've got one more okay because it'll only take a second time I guess what I'm saying is. It's not a pro life bill and if you think you're voting for this bill because it's pro life it's not and I'll end on that all right thank you so much are there any questions. I see no questions thank you all right ladies and gentleman of would you like to close for your bill. Senator. Thank you. Yes I'm sure thank you and. I just wanna say that FM all the horrible things that miss men set about birth control and we're treating then I don't understand how in the world Arkansas right to life could be neutral on a birth control bill thank goodness men's three weeks ago and she told me that Arkansas right to life their official position as they are neutral on all birth control pills and that's because all the horrible things that were said just now about birth control or simply not true. And think about the military wives and people moving in from other states that have a lag time and finding a doctor that need a birth control prescription. This absolutely as a pro life bill as I said we're talking about data that we have that shows that it reduces pregnancies between seven and twenty five percent that means anywhere between three hundred and over eleven hundred abortions in the state of Arkansas a year that the pro life bill with that I close and ask for a good vote all right is it in the form of a motion yes it is all right I have a motion to have a second. All right all those in favor say aye hi all those opposed. Right congratulations you have passed your bill we have one more thing to do before we are adjourned and STURCH. No no this was not this is the scope of practice. The. Senate bill two ninety five. All right you're recognized and might want to ask you to introduce yourself Scott Flippo senator for district seventeen. Canonized thank you madam chair and thank you members This body come back with the it we fail to get the M. eleven engrossed a law we were here last week and so and since that time made one other amendment which is the what you have in front of you so with the time I'd move adoption of the. You've heard a motion to have a second all those in favor say aye hi all right the motion is adopted all right members so what this what this is it's at the behest of the department of finance administration and so it just just languages simply says that and I will put this in a layman terms that different a and DHS shall not be you know you know you know deemed response you know deemed violating the tax procedure act and that section twenty six dash eighteen dash one oh one also known as a confidentiality clause for sharing relevant financial data about these welfare recipients. And with that be happy to take any questions all right any questions from the committee. All right seeing none does anyone in the audience want to speak for the bill against the bill. Seeing none. And the clothes for your bill the Bill pass all right we have a motion to pass we have the second all those in as amended. Hi all those in favor say aye all those opposed you have passed your bill ladies and gentleman I just have one thing to say before of we are adjourned I thank you very much we have been here a long time and I S. I think I can't tell because Senator Hammer has is mask on I think everybody smiling. Is that right. There we go all right thank you