Public Health, Welfare and Labor Committee- House

Members without objection the bills in red will be added to the consent agenda. Seeing no objections those bill with bills will be added. So we have a long agenda we're gonna get right into that. So the first item on the agenda is a concurrent Senate Amendment on H. B. eleven fifty five and I'll be presenting that so my advice to you if you take over. The representative like minutes is to concur in the Senate amendment is that right on a previously passed bill yes okay you're recognized thank you madam chair of. Members of the it is been a while since we ran this bill but if you recall other some members that didn't feel uncomfortable with the definition of a qualified researcher. And so on the Senate side they added that definition that's basically all it the amendment does you can see that there I'm not going to read it but they tried to of the lockdown the people who could get this data. And and you and would be capable of using it in a safe manner so I'd be it I'd be glad take any questions. Any questions committee. Okay and I do think we have a couple people here to speak anyone to speak against the bill. As Billy of Neil is is that it. Spilling a nail in the room yes oh I'm sorry did you have questions. So. The Amendment I'm sorry yep right that. Okay no no Billy o'neill. Derek Smith Sturch care to speak against the bill Amendment. Mmhm. They are they in the waiting room. I would assume they can hear us in their. Okay. Yep. okay sing NO questions and no one to speak for against are you close for your amendment. yes I'm close my for my amendment and I would have a do pass motion. Did did you want to I'm sorry did you want to speak against I didn't want to pass over you for. it's the amendment for the cancer research bill. Okay sorry. Sorry you want to close for your bill clothes make it make a do pass motion. The motion to the concur on the amendment thank you. Okay I have a motion do pass to concur in the Senate amendment all in favor say aye. All opposed your amendments passed thank you manager. Agenda next item under the regular agenda is HB fifteen oh two representative Charlene Fite are you ready to present your bill. Representative fight you're recognized. Thank you and I would like to bring to the table Mr Jeff trail vice president of the Arkansas association of the deaf as yes that would be fine. Colleagues it would if you would Sir please introduce yourself and who you represent. Would you like a chair. Hello my name is Jeff trail. I am the Arkansas associate is association of the deaf First bye bye as president and certified AT a specialist in here to represent Arkansas deaf and hard of hearing community. Thank you representive you're recognized thank you imagine that you are an emergency medical situation. Now imagine that you cannot understand anything that is being said by anyone around you you can't pick up on any facial cues are clues because the faces are obscured with mask that's what this bill is about the recent pandemic has been very difficult on all of us but especially on our death and hard of hearing population in the state of Arkansas. We have worked very hard to come to agreed upon language between the medical associations using the medical society and the Arkansas hospital association and the nursing home is neutral on this bill we have put a lot of proficiency and for things that can be done in the event that a mask must be worn that does not have a kind of a cut out for clear area we have said that other things can be done such as riding on a white board taxed many other provisions just so some sort of communication is available between medical personnel emergency personnel and individuals who are deaf and hard of hearing and then I would like to hear from Mr braille. I'd like to thank representative fight for working hard on this bill with us and I want to thank you this committee committee as well for giving me the opportunity to share today. Many of you have the opportunity to somewhat hide behind your mask. I can't see your face. I can't see your facial expressions or read your lips. These things are very important to us because we cannot hear your voices. I'm one of many. Who feel that our rates have been oppressed. Because hospitals medical centers pharmacists. And essential workers. Do not have to abide by the Americans with disabilities act in this case. We may as well throw the ADA out the window and close it. This doesn't give them a right to not provide an accommodation. To to health and safety. The reason I bring this up. Is because our way of life is as if we're going back. To pre civil rights we have no rights in this case. Some of you have may may have heard from those who an opposition of this bill. Citing cost of providing clear masks. To their employees. I'm frankly tired of hearing. We excuse me are tired of hearing that the deaf and hard of hearing people are expensive. To provide accommodations for. If they want some money. Or clear masks to to provide their employees. Tell them to go to FEMA. Because any kind of pandemic or catastrophe of this nature falls under FEMA anyways. We would like this state bill. To be focused on the deaf community on us on our community your people. Your community. We together. Can improve. And have better lives for our deaf and hard of hearing community. I'm asking you today. To support. And pass this bill. Because if you don't. You're sending a very loud message that it's OK not to abide by the ADA. I want to close my. Talk with the famous quote from Martin Luther king. He said the time is always right. To do what's right. Thank you for your time. Thank you a representative did you have anything to add. I think there a couple of witnesses here that were wanting to speak in support. All right assess the committee for questions first a committee of any questions. Okay seeing none of. Three we do have three people that are signed up to speak for the bill. So Malina Rivera. Would you come forward and would you get Jeff. Patagia prepare you in the room. Would you get Jeff Patay from the room as well. If you would go to the table there. A please introduce yourself ma'am and who you represent. Hello my name is Melina Rivera. I am a deaf interpreter here in Arkansas and I'm here representing our Arkansas deaf and hard of hearing community. Being a deaf person is not a choice. There's a lot of communication barriers that have begun since the pandemic began one of the most dramatic experiences was when my father in law choked on a piece of meat at home. On since September on his birthday my mother in law my wife and I called nine one one. And we tried the Heilig maneuver and CPR. The ambulance EMT teams firefighters first responders came they all had their masks on. My wife and I are both deaf we can't we were not able to communicate with them because of their masks we said please put your mask down. But they didn't want the one fire captain was willing to pull his mask down. But it was just so hard with all of the commotion. And we're trying to save our father unfortunately he didn't make it. And we felt completely stock and and dumbfounded not able to communicate this was a life and death. Moment. And the mask took the power away from us to communicate. Our our communication American Sign Language is it requires facial expression we can't lip read week we don't understand when there's a mask in place. We can't see facial expressions. So I'm begging you to please pass this bill. So that no one will ever go through that kind of experience this is one of the most traumatic experiences. And it's hard to talk about because it's still very raw. This clear mask bill will actually save our lives. Thank you. Thank you for your comments. Jeff pretty. You would come to the table would you get Samuel after contest Rison. From the waiting room. You would present this yourself. Good afternoon my name is Dr Sam matches and I live in Little Rock. A person with lifelong progressive hearing loss from the age of four I currently use character in France are you spoken English and American Sign Language and I benefit from reading people's lips. Last but not least I'm a license audiologist a professor of audiology and researcher on diagnostics rehabilitation and issues that involve barriers to communication including transparent or clear mask options. I'm here today to support. The house bill fifteen or due to that require face masks be worn by certain persons interacting with individuals who are deaf and hard of hearing. I was asked to speak today due to my research on mask over the past decade. There are two primary issues at stake here. The first one is obvious as the loss of important facial cues back and conveyed the difference between similar sounding words and non verbal cues. That despite a wide range of emotions and intense the second one is less obvious but most people are aware. That is masking my full speech I can make it less loud specifically higher pitch sounds of speech such an **** to P. H.. Okay the problem is further complicated by the fact that we live in a noisy world. And not everyone had the general American accent I certainly don't. Some people have higher pitched voices some lower some have southern accents in Somers speak English as their second language. Mascot made us painfully aware of further isolation and SFX on communication for all. Per for the deaf and hard of hearing it is even harder if not impossible. Fortunately my work is also demonstrated that visual access to the math using clear mask has shown improvements of up to twenty five percent and speech understanding with people who have moderate and severe hearing loss. Now they're getting that benefit from standard research trades as but if you know what the context of information as you can probably catch a lot more and this is all three being able to see facial cues on the pace. I believe this bill within this is a step in the right direction. Deaf and hard of hearing people have a right to communication and a right to accessible communication. I do not think it is on reasonable to ask the workers arrested in in this bill to have clear mask on hand when requested. Some of these are dispersible I've got three right there. You can buy this. Farmar obviously read usable and washable. What we just simply want to do is make Arkansas a better and safer place not just for people who are deaf and hard of hearing bye for all. But before I can cleared I want you to realize to what talking about here when we say daft were hard of hearing person. We're talking about children with hearing loss. Individuals who use American Sign Language as their primary mode of communication a rich and visual command grins bears to consider themselves staff for deafblind. School age children with newly diagnosed hearing loss children and adults with noise related hearing loss from recreational sports like hunt and loud workplaces that were read to degraded hearing over time. Adult for late onset hearing loss you're still working and trying to make a living wage. Individuals of all ages with progressive or second hearing loss from on manageable what I'm treated here disease as senior citizens what age related hearing loss with or without cognitive declines. And all people who use hearing aids or cochlear implants. All that having been said I urge you to vote in favor of house bill fifteen oh two to add to Arkansans growing track record of making communication and information accessible to all people who are deaf and hard of hearing especially during times of universal masking thank you. Thank you for your comments. is Jeff Patel here yeah that was my witness okay he's already spoken all right thank you that's all that we have signed up to speak for the bill and no one signed up to speak against the bill so are you ready to close for you bill I am some of you have come in after I made my opening remarks so let me again say this is agreed upon language between the Arkansas medical society the Arkansas House hospital association and the nursing homes are neutral on this bill we have made numerous accommodations such as being able to use text messaging typed messages on available electronic devices what board use hand written notes we just want some way that everyone can understand what's going on in an emergency situation so I appreciate a good vote. What's will the committee. Representative glad you're recognized. Thank you Mr chair motion from the past please. Okay you have a motion of do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries congratulations bills pass thank you Mr chair thank you Committee. A committee you we do have representatives Pilkington on the zoom call so he'll be able to vote as long as we can hear and see him. All right we're going to move on to. H. B. fifteen fifty age to be fifteen sixteen. Representative Boyd. A committee we're going to do fifteen sixteen first. Moved that up on the agenda. Representable you're recognized to present HB fifteen sixteen. Thank you Mr chair and I have some people who are going to join me you have got share for onion and county judge David Hudson who who will be here to assist with a presentation and then of course be available to answer questions but So House Bill fifteen sixteen is a simple bit this bill simple it's about options for law enforcement in our complex world this bill makes clear the option of a sobering center rather than jail with as much as seventy three percent recidivism and Sebastian County related to and talks and public intoxication intoxication type crimes it's clear the jail isn't working and we need to provide options which might lead to a path of recovery rather than just continue taxpayer expense so there are they in the room or did you want. They're in the room now okay if you all would go on to the table so judge her chin and stuff sure for any in come on up here. And. Let me. Representative wing would you move that chair but you down there to them he's got one already. Yourself and it's an honor to Simpson okay if you would introduce yourselves and who you're here to represent. Thank you for allowing me here I'm sure it'll be running from Sebastian County on behalf of a Justin Boyd to speak on the sobering center bill all right Sir of unity issues David Hudson Sebastian County judge here to support Justin Boyd on the sobering center bill representative you're ready to present. So judge hasn't had a I'm I'm opening remark okay Well as an honor to be here and I appreciate you taking time to listen. The legislation that we are proposing that you endorse would authorize law enforcement officers the discretion to transport intoxicated individuals to the sobering center. It was based upon the operation of the sobering center in San Antonio Texas the concept was simple divert these folks from being booked into jail to the sobering center with follow up to encourage treatment three benefits not using the jail bed no arrest record in encouraging these folks to seek help through appropriate treatment. The San Antonio sobering center was located next to their crisis stabilization unit which is used to divert the mentally ill from jail to short term treatment as you know Arkansas implemented for crisis stabilization units in two thousand eighteen located in Sebastian Pulaski Washington cricket counties CSG was contracted by the state to assist in developing the crisis stabilization enabling legislation these diversion programs have successfully operated with law enforcement officers using officer discretion. To transport mentally ill to a facility that individually the individual voluntarily goes to increase to enter for short term treatment sobering centers are the same concept so many many county jails operate over their bed capacity. In the use and so using the jail beds to house alcoholics not not D. W. eyes not not people violent alcoholics. People that have used alcohol that are not dangerous and they're not ballot takes up jail bed space that could be used for higher risk inmates so inspection county from our statistics show that we have forty to fifty people arrested per month that are in that category and that the the record show that seventy three percent of these people were certifies their re arrested rearrested they just. Focus of the the process back through the system continually with time attention and money to deal with them so and and typically with poor outcomes. so by enacting Sobers circumcenter legislation the option to divert these individuals from booking in the jails made possible for police officers and sheriff's deputies in establishing a sobering center would be up to the local county and city leadership in an appropriate treatment organization this legislation would provide the option to implement another approach to diversion rather than using jail. Appreciate your consideration. The sure you have some comments. Just very briefly thank you I want to seven a police officer thirty years and I think of this along the same lines as CSU which the legislature DHS and and and see actually all work together on and and the bottom line is the same people are tying up the jails and then they're tying up the courts they're getting fines are not showing up and they're coming back and it's really accomplishing nothing I I think of it as something a measure that could help us to get some people some some help and I really think of it along the same lines as a C. issue and I do want to say that we have an opportunity here to pass this legislation I realize it's it's a it's it's on funded at this point but we do have somebody who is willing to work with us and and we can be the the Guinea pig they're in Fort Smith and and see I I really believe we can make it work and I think it would have benefits for our state population as a whole thank you for for allowing me to speak. We're open to questions. So I have a question on just to understand what you're asking for here is just the opportunity to be able to open the center and then with that be would that same opportunity be open to other counties if they choose to do so. Yes and clarify that. Police would be able to transport someone to a sobering center rather than just the jail. Thank you any questions. Senate Perry you're recognized thank you Mr chairman. This subpopulations on the if you transport the. The person that you've picked up an they are intoxicated you taken to the sobering center once you release them they're no longer in your custody so what prevents them from this walking out the door actually they could along the same lines as a CSU or I can walk out so if they did And this is simply another tool tool box it gives us as a police officer the discretion obviously if they were violent or could have committed other active would not be eligible so if they left at that point in time I was my my thought is it would probably be arrested and taken to jail and more than likely for instance of the discussions come up about the if if there was a disturbance and we went back and re arresting on so to speak and I think since initially it's a volunteer if you went back there would normally be criminal charges at that point so they would they would simply go to jail unfortunately just like someone that's in a mental health crisis if they were in a disturbance and they walked out to see issue until you can get before a judge that's the only opportunity the only place you would have so I think along the same line Sir this so this program is available in San Antonio. Correct thank. They run facility in San Antonio that was a model years ago whenever we trigger that facility many folks in Arkansas on how that the crisis stabilization unit diverted the mentally ill from being booked into jail which is the worst case place for mentally ill person jails are not the friendliest environment for those that type of personality and so they successfully implemented one there and had a lot of good outcomes a long term. Immediately by that facility was a sobering center in the individual's went in there they have qualified the officers had to have to have the discretion to take them there they would they would dry out basically and be encouraged to follow up with appropriate treatment so that kind of went hand in hand and they could share staff to some extent so there's some some benefits whenever you have that so that model had been in existence now private say twenty years person a like a concept that is seen how that's going to work and see if you're gonna have a lot of repeat offenders haven't have recalls where the officers have to go back in a rest in. So we want to get. And you discovered the funding for correct. Representable in. I initially initially no we have not figured that out and quite honestly in in Fort Smith we have a of center that's willing to try this out if this legislation passes and we'll we'll figure it out eventually if if there is a financial concerns would be something that may have to be worked out between the individual jurisdictions and whatever the centers are and in this bill doesn't address that but I have a center that is willing to do this now without any further funding from any source to try it out correct thank you thank you Mr chairman. Representive Allen you're recognized for a question. Thank you Mr chairman and thank you for for your presentation today I think what you're doing is a step in the right direction I know you're concerned about fund and if you're mayor of George McGill. Yes it is George McGill yes Sir okay he can bath doors to help fund the. But but I do have a question How will you determine if a person. this alcoholic. first of the person that steps out that had too much to drink and one night so how would you will you will have access to the person that records are with it with the show if a person is that uh been arrested more than two or three times for alcohol or drug abuse so how how would to all go about identifying that person. Well we absolutely do have access to those records within our county okay immediately because there misdemeanor arrest so actually that's a simple I call on the radio and they can say yes this person has been arrested however many times in the last few years but my my thought is on the on the sobering center if it was somebody that simply had way too much to drink one night it's still a perfect place for them and services if we can take them and then maybe this person has never been in trouble do we want to Salam with an arrest record and and going to court it might be a perfect opportunity to help them from having record also Sir effluents. Now let's talk about a person with mental illness so how are a person with mental illness will will the sober Senator have the capacity to counsel with that person or people to help that person. I think the CSU's have the complete have that opportunity already they have that mechanism in place and so what what we're actually talking about doing is partnering with our local with the western Arkansas counsel and guidance who also hosts are sobering center because they have got nurses on staff twenty four hours a day but I think that it is far as I think that a lot of these individuals have. Co occurring symptoms there is a lot of them that have substance use issues are suffering from mental health issues so that would at least give them the opportunity to see the the professionals that can possibly diagnosed him and get him some help. R. like ritual doing an animal before thank you. Representative Payton you're recognized. Thank you Mr chair first of all I'd like to clarify our own House bill fifteen sixteen. Everything in this bill is that has to do with authority to transport. I don't see anything it creates a sobering center or defines a sobering center to these already exist. No they do not exist and I think though this bill would give us the opportunity to create them and as I as I said we have a facility a local C. issue the western Arkansas accounting guidance at that hosts a C. issues willing willing to do this at this time with no additional expense as a as a just to see if it's a feasible a feasible on a feasible way to handle that sounds like a great idea I'm just reading the bill and the only definition that it gives is a sobering center may be associated with an acute care unit community mental health center or crisis stabilization unit. So just the language in this bill. Right to work creating a defined in the sobering center representative Payton under the very beginning as used in this section sobering center means a facility or setting providing recovery detoxification and recuperation from the effects of alcohol the focus which is treating alcoholics and persons who are intoxicated so it's not necessarily creating one but there is a definition of what a sobering center would be and then the the idea is that it would allow police to transport someone to a sobering center which there's a definition of rather than transporting to and then to the county jail right but these don't exist. There's not a sobering center in Arkansas this would be another option subject to the cooperation of the counties and cities that would want to move forward so the funding would be up to the leadership the local units of government entity based upon the cost benefit of having a treatment like this versus putting them in jail and other cost okay so so again you've got a definition so if if a police officer was going to take this route he or she would have to transport someone to someone that met the definition of a sobering center so while there's not one today if this is passed then there's going to be a relationship where I think this definition is going to be Matt. Okay thank you thank you for clarinet. All right committee any other questions. Seeing them we do have two people signed up to speak against. And I think one four. Thanks for. Thank you no this is fifteen sixteen sixteen yeah we went out order okay of. Carmen. Gretchen in the room. If Carmen Gretchen is in the waiting room when you come in please. And also mark with more it's not. Mark with more. Yeah I want to come in the room. Correct. So Carmen good jim is not there. I have a mark with more. I also have X. fresh. Now all right seems like they've left okay saying no more questions is anyone here will speak against the bill. For the bill. Represent every ready close for the bill. Yes Mr very quickly just a reminder that in Sebastian County there's as much as a seventy three percent recidivism rate related to public intoxication and this bill doesn't change anything other than it as a tool in the toolbox to help law enforcement and our county governments across the state manage their their jail situations hi this is bill is supported by the sheriffs association it supported by the association of counties and it's supported by the county judge association so with that said I'd appreciate a good vote make a do pass motion hi Committee the motion on the floors do pass any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries congratulates new bills it's. Thank you representative Pilkington. the representative Boyd you're recognized to present HB fifteen fifteen. Thank you Sir I will be as quick as I can with my opening and then I'll move out of the way here Our General Assembly passed to pass legislation to help manage rising healthcare costs in patients with behavioral health and developmental disability issues in June two thousand nineteen an insurance company anthem notify the Arkansas Insurance Department of plans to acquire another insurance County beak and hi anthem just coincidently owns forty nine percent of one of the passes summit and bacon owned sixteen point six seven percent of another pass in power this acquisition would give anthem influence in approximately seventy three percent of the past market based on numbers yesterday of the number of pass members yesterday I contend are legislature never intended for one company to have ownership in more than one pass our legislature publicly expressed concern with an insurance company to have ownership in more than one pass the acquisition that was done in December of twenty nineteen the acquisition closed in February twenty twenty so that was two months between when there was public concern expressed in a public health committee and then that the acquisition there are only three passes in our state and so now one insurance company has an ownership interest in two different passes so despite the testimony that you're going to hear today regarding the fire walls that that exist between beacon anthem many public signals are being sent which put a places is in question the veracity places in question the veracity of said firewalls currently can't unless the job opening on its website for a beacon employee so that sends a message to the public if nothing else Hey come to work for at the moment has your master's bacon as an anthem the big and chief operating officer reports to at the anthem's diversified business group or shared services company again you have someone on the inside with all the trade secrets that's not reporting over here in another company so again we can talk about firewalls but I just want to point out when someone sees something they can't answer. See something so if I see something over here make an and now I'm having a discussion with someone who are over here to answer them there's no way for me to not bring that and so even if I don't go well Hey they're doing this over and be a beacon and at some point when I have that that opportunity I'm gonna find a way that's just human nature the fact is when you see something you want again we owe it to the taxpayers to avoid any unnecessary questions of corporate integrity. Too much control by one in an entity is bad for both patients service and bad for taxpayers this bill in its simplest terms prevents any company from having ownership in more than one pass it also ends current ownership in more than one passed by January first twenty twenty three that said I'll do my best to answer any questions. Are there any questions from committee. Representative B. banks recognized. Thank you Mr chair of representative Boyd rather than forcing them to divest themselves of the ownership is it possible that we could pass a bill that would establish the fire walls that would in fact protect the the the very issues at your address trying to address here. I'm just I'd I don't know the answer I'm not an attorney I'm just asking that question. Representive Eubanks appreciate the questions very good question and we are all of us here are part of the government sometimes more government might appear to be the solution to this case I think that no matter what we do there's always going to be the risk because one human is gonna somehow interact in both places or have information whether it's financial legal Either way and I just don't know that we can write legislation that truly creates enough of a firewall to prevent the concern and again and again I think that if this were a larger market it might be less of a concern but there are three passes and so it some point if you have this person here even if it's a smaller ownership percentage what I don't know that that has anything to do with it though there's been allegations were allowed only on seventeen percent or sixteen whatever percent what difference does it make me at some point if this person is over here there's going to be information related I don't care what firewall so the answer is yes we could do that I believe that that is the effective in right solution or remedy the answer is no I don't believe that. Representative first you're recognized. At eight is there a risk that we that bacon would not be able to find another third party administrator and we would and it was just two passes by doing this. Representative Ferguson another good questions and and I just wanna be clear I I care about our constituents I care about that the clients or members of of these passes and I don't want to see you no problems there but the reality is we had plenty we had people bid on these we had three separate entities that came into this market ended this I don't have any doubt that if we pass this legislation that there will be another company to come in and and take beacons placed to Bobby can or or take beacons place however it works out I just think that it's we can't just say what we want you to do this I think there has to be a time line and and put in place and again I think there was a public warning I think that bacon and anthem have the opportunity to know and they chose to respond the way they did and I think that the responsible thing for this body to do is to Forward with this legislation. Representive Eubanks you're recognized. Represent void that the Arkansas insurance department have to sign off on that purchase or. Who gave them the approval to do this. Yes my understanding is the Arkansas insurance department has vetted this but there was also as I understand it in a statement made there were present this is what I'm under the impression of what's been portrayed to me and somebody can vetted however they want to there were no plans to make any other material change in the company's business operations corporate structure management and I don't believe that to be the case that there hasn't been significant changes. And any other questions. Seeing none we do have one person signed up to speak against the bill. Derek Smith. Are you in the room. Please go the table. Please introduce yourself and who you're representing. Good afternoon Mister chair committee my name is Derek Smith I'm an attorney with the Mitchell Williams law firm here in Little Rock Arkansas and I represent them. You're recognized thank you I'll begin by saying that at Mitchell my practices insurance regulatory law I frequently represent clients in their interactions with insurance departments throughout the country and today's comments or on behalf of anthem I do not speak on behalf of any individual pass and do not represent any individual pass. Adam is one of the country's leading health benefits companies through its affiliated companies Anthony anthem serves more than one hundred seven million people including approximately forty three million within its family of health plans. Adam is participate in the past program since the since it's inception as a minority owner and summit community care in March twenty twenty and then completed the national acquisition of beacon health options at the time beacon was the largest independently held behavioral health organization in the country serving more than thirty six million people in all fifty states. Through the transaction anthem indirectly acquired beacon sixteen point six seven percent interest in power. The other Arkansas pass I was a member of the team that represent anthem and its acquisition when it was refused by the Arkansas insurance department as required by Arkansas law. And one thing I'd like to point out is that the application was filed in June of two thousand nineteen and it was approved in September of two thousand nineteen and by the and when it was approved there'd been no stated objections to the ownership interest in two passes even though it was well known that would be the result of the transaction at the upon the approval at that point the companies were contractually obligated to close the transaction and then had no basis to back out. Anthems minority but interest in summit community care was known before the insurance department's public hearing on the transaction and acknowledged in anthem's testimony during those proceedings. Anthem also testified that it did not have the ability or intent to materially change the operations of empower or summit as a result of the transaction nor were there any changes any plans to make any changes and services offered by those entities again no one objected to or testified against the application and the insurance department approve that transaction September of two thousand nineteen. At the opposes house bill fifteen fifteen simply because it changes the rules of the past program in mid stream it threatens disruption for past members and providers and seeks to force asked them to choose between two legally acquired equity interest with no independent evidence to establish that any issue exists we've heard believes but there's been no investigation no study. That we understand that the bill is being presented in part because of competitiveness concerns but again no regulatory oversight body not DHS not the Arkansas insurance department has expressed any concerns to anthem suggesting improper cooperation or lack of competition between the two passes. And the remains committed to ensuring appropriate firewalls are in place to enable empower and summit to maintain separate operations and welcomes a competitiveness review or audit of those structures if it would be of interest to the committee for this body. At the mall also has concerns with the bill's requirement the entity with an ownership interest in more than one pass divest of that interest essentially be a a fire sale. If this bill passes the world knows that anthem will be required to sell one of its interests and thereby devaluing the value of that asset. Now the state is free to decide which with which entities it decides to contract but once it is agreed to enter into a contract and approved a contract the state should not in interjected self into internal business operations that have no impact on the service the state is receiving and so for these reasons respectfully oppose house bill fifteen fifteen. The representative Miller and you have a question. You're recognized. Thank you Mr chair of I'm sorry I forgot your. Name Sir I know you're there expect okay Mister Smith of and and don't take this personal but I know you're just listed off of a list of entities that you all had not heard from or your client had not heard from that have any concerns and I just of a bill for this I will put this in the form of a question but do you understand that this legislator is expressing concern about your client and its operations and pretty much the whole past program but especially about your client and so would you please deliver that back to the. Message is heard will be. No questions from committee. I have a question and I may be on a different subject you're not This is a transaction was back in twenty nineteen did you say yes Sir okay tell me if I'm wrong but I believe this transaction or anthem bought the canon was a national purchase is that right that's correct and deacon had multiple operations in multiple states the correct that is correct in a percentage of those were in Arkansas yes Sir so when the insurance commission approved that. were they aware of that I mean it was that information. A segregated down to that level. Was the insurance department aware of beacons interest and yeah I I mean I can see in a transaction like this where it's a national transaction. That that and minor amount of information might not be available someone is looking to approve a purchase. It's so under Arkansas law if you are seeking to acquire control of in Arkansas insurance company and for purposes of this discussion pass is considered an Arkansas insurance company you have to get approval from the Arkansas insurance department just for that acquisition and control is considered to be anything over ten percent so the fact that beacon had more than ten percent interest in the past required the Arkansas insurance department to review Adams acquisition of control of the past they were aware of the entire transaction they got to review the entire transaction agreements they were aware and it was testified to that anthem had an interest in summit it was clear no one testified against it notice of the transaction notice of the public hearings were provided to be can again there were no objections. Representative Johnson you're recognized for a question. Thank you Mr chair. fled on. Show my The lack of knowledge on on exactly how the passes work but maybe you can give me some clarity My understanding of the passes their provider led which means that ownership of the pass is a majority of providers. However I think I just heard you said say that you have more than ten percent is a controlling interest. Hey how's that work in that. Is anthem. Beacon whatever the entity happens to be. The empowers the past correct yes empowered and so the sixteen point whatever percent doesn't appear to me to be a controlling interest. But you just said it was so it can you help me understand that sure this is an oddity of insurance law the it's a sixteen point six seven percent interest by virtue of the law anytime anybody acquires more than ten percent of an insurance company they have to get approval that's just deemed to be control it's not actual control so in this past for instance the other what is that eighty four percent is owned by providers so in power with their sixteen point six seven percent I mean begin with that sixteen point six seven percent doesn't have the ability to control the board for control votes it's just being controlling it requires an approval so. Empowers not making or bacon whatever is not making day to day decisions on it. It's the board is made up of the providers and they're making the decisions but that is just an investment in. I am not not represent the past so I can't get into too much detail. The board is in control now I think the board has a contract with beacon health options to do day to day operations but again the board ultimately controls things that controls that contract and whether they help have not so B. can is actually the operational entity that contract by contract so it it's running the show. On a day to day basis and. At I. I'm assuming this is an investment that is is. Operable otherwise it would be invested in so who who where does the profits go is it evenly divided sixteen point someone percent interest going up percent profit going to be can and the rest going to the providers have how does that work that answer I do not know you have to have someone who represents either in power for one of the. Active investors thank you. Representative first you're recognized. Yes and I apologize to add know very little about the passes at I guess we have some added empower and total care just those three is that right. And maybe representative Pilkington answer this in the original legislation representative void Pilkington did we say that the insurance third party administration part could not be. All the same insurance company. The do you know about the original legislation was that designated that this could not happen. What I would contend is it was not anticipated to happen and what I would contend is the legislature is not one legislatures not bound to another legislature anyone you choose to do business with the state government there's always that risk especially when signals are being sent at a time thank you. Yes you're recognized and I guess I have a question for may either be maybe Derrick Smith are Justin what is the participation of the insurance company in these passes is it just third party administration or is it more involved than that on the you know dated a patient management. I don't know. Resented Eubanks you're recognized for a question. Thank you Mister chair Mister Smith I asked the the. Represent Boyd this this question there seems to be concerned with getting my concerns because the anthem has. I want to be can that there would be information shared back and forth that would affect the competitive. Operation of the businesses and I think that is legitimate You can ahead there seems to be concerned that there's not adequate firewall protection between. Make an anthem with regard to these two passes so I think people want to have some sort of guarantee that that information's not being shared back and forth and so can can you address that. Again not representing the passes and not involved in their day to day operations up I don't know if I can give a complete guarantee I can tell you that in the application before the insurance department anthem representative that there would be far walls in place. And the representative that they would not make any material changes to the operations of beacon. because of the transaction. Since the transactions closed anthem as for as far as I'm aware has kept those commitments it is not been informed by either of the regulatory body that oversees passes the insurance department for DHS that there any competition concerns and if those and and I can appreciate that those are legitimate questions and anthem would welcome an individual review of both plans to review for competitiveness. The representative Payton you're recognized. Thank you Mr so. If I remember right when we passed the legislation that created the passes. It had a restriction that. The insurance company could not own more than forty nine percent of a pass is that correct. It has arisen it has well I guess yes the providers have to own at least fifty one percent so we've talked about the past the. Your company owns sixteen point seven percent how much do you own another pass and the most forty nine percent the other guys so you've maxed out in one. And your own a portion of another seems like the spirit of the legislation that created the passes been. Violated their. It I would. Maybe can take a different view on that I think the requirement that the passes B. provider led was for that purpose for providers to control each individual pass and in both instances that is the case providers on fifty one percent of summit and well in excess of fifty one percent of empower. Thank you thank you Mr. I committee any other questions. Seeing none within the person thank you for your comments thank you thank you Committee so is there anyone here in the audience who wants to speak for the bill. Against the bill. Seeing none representive you ready close. Thank you Mr chair I would like to close and so I just want to point out again I'm I'm. We're kind of an awkward situation here because we don't have all of the day to day operational facts and I want to acknowledge that but also want to say that. You know they can appears to be a shell of its former self the following functions are now no longer performed under the full direction and control of beak and as I understand it okay so finance information technology facilities and procurement human resources government relations compliance fraud abuse audit communications legal portions of operation so we had one thing now we're working towards another and while I respect innovation in companies also we understand that as those changes are made those were made after the A. I. the performed its its function so you've heard a lot of discussion about the situation and really what it boils down to for me is this you know do we really want to allow empowers number one competitor summit to have a seat on on its board anthem was given public notice of Legislative concerned and still moved ahead knowing this legislation was possible let's do what's right for both patients and taxpayers and pass this legislation with that said I'd appreciate a good vote and make it do a motion to pass. Okay most on floors do pass any discussion on the motion. Seeing none all in favor signify Jeff discussion representative paid. Any other discussion. It's Irish yes we can you're recognized representative Pilkington. Thank you Sharon Ladyman I just wanna say thank representative Boyd for bringing this bill forward I believe that it is and the legislative intent that we had we create the passes back during the two thousand seventeen General Assembly and so. I whole. It's for this bill I think it's what the intention of the legislature was when we ask the server thank you I just. Thank you for your comments representative Pilkington. Any other discussion. Represent Payton you're recognized thank you Mr chair I mean I know some people like me hesitate about. What seems to be regulation but we created these passes a brand new type of entity and model and and it experimental at best and any contractor that's asking to do business with the state I don't see that as the state regulating to private companies they're doing business with each other and so I you know those that may hesitate to wanna. What seems like change the contract midstream are there was plenty of warning signals given that the legislature and the creation of the passes did not want. A significant portion of it controlled by one company and the fact that they own forty nine percent one pass that maxes out what had been the legislative intent so I'm voting for and I appreciate you following the bill thank you. Any other discussion. Okay seeing none the motion on the floor to pass all in favor signify by saying aye aye All opposed nay. Motion carries congratulations bills passed. Okay we're gonna move on down to HB fifteen eighty nine Senate bill you're recognized. A lot of family yes. Please introduce yourself and who you represent. Thank you Mr chair my name is Gerry **** and executive director of family council and appreciate you allowing me to be here thank you of members there is a an amendment coming around. A representative would you want to talk about your amendment Wallace being passed down you know you have a copy of it. Thank you Mr chairman with your permission I'll talk about the amendment. This is and I'm. To me this is. Okay I think it's going to work this time. This amendment he is is needed to avoid some unintended consequences with the bill it is a little bit technical I could explain it a little bit more as we go into the bill but the this is the bill reads it only exempted out procedures at the State Hospital hospital's medical school and so forth and what we need to do to make this work right is we just need to exempt out. A high any hospital we need to exempt any state hospital in the teaching hospital or any residency program in total and so really it the it it in a way it narrows the scope of the bill which doesn't affect nearly as much but we need needed to do that in order to avoid some unintended consequences so basically what we're saying is you and this would apply to you A. M. S. this would apply to the med school and this would not apply to the state hospital which again should make the bill a lot less complicated. Representantes and did you have a motion. I have a motion from accident Dobson to approve the amendment adopt the amendment any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries your management opted you may present the bill as amended. Yeah. I can tell you a little bit more about it to amendment Missy so. Prohibits government entities in Arkansas from engaging in transactions with abortion providers or. A day age of abortion providers. But I was gonna mention there were exceptions and that's what Jerry just mention the fact that the the exception dollar transaction with the license hospital state hospital a teaching hospital searches of. You A. M. S.. Have any questions so there's a lot more to tell you about it back to I'm looking for this but. Maybe you can ask me some questions what is bill containing the exception yes. Bill does not apply to transactions with a licensed hospital this bill prevents abortion providers or their affiliates from receiving municipal utilities thank shall have the electricity. The water the sewer other public services they'll still have that. The bill specifically exempts transactions involving utilities and other public services abortion providers could receive any publish the funded service or privilege that is available to them. All right Committee was there any questions. You have any other comments. Mr chairman thank you. This is this is a this is a very simple build. There are really only five to abortion providers in Arkansas that's Planned Parenthood and little rock family planning services what this bill does is say we're not going to do the government of Arkansas city county state is not going to do transactions with those with abortion providers that's really the crux of it and it has necessary exceptions in here I think that make the bill work properly I want to commend representative Dotson for finding this good law that had passed recently in Texas and was recently upheld by the fifth circuit court of appeals of their and so I think we can move forward with some confidence that this is a constitutional law. And you know that we know that amendment sixty eight prevents public funding of abortions and this is just one more step in that enabling legislation where we've already prevented state grants to abortion providers we don't do Medicaid reimbursements to abortion providers and now we're just saying you know what we're not going to do taxpayer resource transactions of any kind with those abortion providers and we exempt out those hospitals so that if you A. M. S. perform some abortions over there it won't prevent a hospital from interacting with you A. M. S. and so we just needed to carve out a little caviar there to help that situation so I'll be glad to try to assist in any way I can but it's it's a good law. What to say to the the whole thing is about prohibiting tax paid your resource transactions and or affiliate. And the I think it's good bill. Any questions from committee. Seeing none. Represented the red clothes reveal ready come I'm sorry we have we have someone signed up to speak against the bill okay Karen mystic music. Are you in the room okay he would go to the table please introduce yourself and who you represent. Push a button. Hi this would. Thank you for allowing me to be here. When they talk about unintended consequences I cannot get past a ten year old pregnant child in my brain. Maybe you don't realize this but the state of Arkansas does not allow dollars to go for abortion services. But imagine being poor here in the state of Arkansas. Desperately poor. With the ten year old child. Who is pregnant. There are professionals that work for the state of Arkansas to help families work through these terrible tragic situations. What the family needs at this time is professional help that can be available to them through the state agencies. Including case workers that may have to use their cars periodically. There's no one in the state of Arkansas accessing abortion care against their will. Because you might choose differently doesn't give you the right to force your religion on others after all even your family members and friends are accessing abortion care. There's a moral clarity to allowing choice around the pregnant ten year old child and allowing the professional case workers that are taking care of this tragic situation to make the best use of the state resources they can I'm not going I think you're wrong to try to get in the way and I'm not going to try to decide what the best choice should be in that situation. But our tax dollars are best spent helping them. It may not include having another baby when you're a ten year old child yourself I would urge you to please vote no on this punitive legislation H. B. fifteen eighty nine. And I'll take questions. I don't see any questions thank you for your comment. Okay is there anyone here in the audience who will speak for the bill. Against the bill. C. ninety ready clothes representative. What will the committee. I have a motion by representative Johnson do pass as amended any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries graduation representative your bill is passed. Okay we'll move on to HB fifteen seventy representative Lundstrum. You're recognized to present your bill did you want someone to come to the table. Okay that would come to the table. If you would introduce yourselves and who you represent. Yes. Hi Joseph back home with family Research Council. My name is Kendall Wagner in the internal medicine pediatrics physician in Fort Smith Arkansas. My name is bill Gurley and I'm not affiliated with anyone I represent myself. Thank you representive you're you're recognized to present your bill thank you colleagues This bill. Prohibit sex change procedures on children this bill protects children in Arkansas from gender reassignment procedures including puberty blocking drugs. And sex reassignment surgeries. I want to be very specific the world health organisation United Nations population fund and the American college of pediatricians and a long list of other organizations have clearly stated. The general mutilation is universally recognized and condemned I want to protect children and this bill simply states that anyone under eighteen in Arkansas. Is to be protected I brought with me some very special people today each of them has an incredible resume and not I they have introduced themselves but I think it's important that you know that not only do they have an incredible resume they can back it up so I went each of these people speak I would like for you to listen to what they have to say. And also be feel free to ask questions and they have to come a long way bill is come from California we've got folks from Texas take advantage of the knowledge that they bring to you today. Right to. Thank you Mr chairman members of committee and my name is Joseph back home I'm an attorney and a senior fellow with family Research Council gender dysphoria is a real and challenging medical condition those who experience it deserve our compassion and respect today we are here because gender dysphoria and the concept of transgenderism more broadly is now much more than a medical condition is also a social and the political phenomenon. The recent increase in those claiming to be transgender can only be described as astronomical in most western countries teenage girl seeking treatment have increased between somewhere between one thousand percent and five thousand percent a Gallup poll released in February of this year found that the percentage of those in generation Z. who identify as transgender is nine times higher than generation X. or baby boomers Brown University study found that referrals to trans gender treatment had centers had grown two thousand percent in seven years the same study found that among transgender teenagers more than one third of them had friend groups that were comprised of fifty percent transgender youths this is more than seventy times what would be statistically expected this form this phenomenon is known as rapid onset gender dysphoria it is not only a cultural phenomenon it is also now a business hundreds of new clinics exist exclusively to help people look like the opposite sex Planned Parenthood more famous for being the nation's largest largest abortion provider now claims on its website to be the second largest provider of cross sex hormones in America any recent interview a former Planned Parenthood employee described their interest in cross sex hormones this way quote transaction to find kids are cash cows and they're kept on the hook for the foreseeable future in terms of follow up appointments blood work meetings at sector whereas abortions are hopefully one and done situation she said. According to that same employee the decision to provide cross sex hormones to minors at the clinic where she worked with being made by a clinic manager who had no prior medical experience and whose previous job was managing at Wendy's however even if the treatments are provided by medical professionals they are experimental there are no randomized clinical trials on the use of cross sex hormones for these purposes but there are known risks those risks include blood clots cardiovascular disease high blood pressure diabetes and more beyond that interfering with puberty will always have an impact you can't pause normal development without lifetime ramifications even if puberty resumes they will be shorter smaller and generally less developed than they would be otherwise compounding the risk of these treatments is the fact that puberty blockers have not been found to improve mental health one early two thousand ten study reported quote gender dysphoria did not resolve as a result of puberty suppression and quote a more recent two thousand eighteen study reported that quote our psychometric data suggests the impact of puberty blockers on reducing psychological difficulties is limited and quote in the same way surgical interventions do not show long term benefits suicide rates cycle a second C. Africa morbidities and mortality rates mortality rates excuse me remain markedly elevated after gender reassignment procedures have been performed the most thorough follow up of sex reassigned people a Swedish study extending over thirty years found that ten to fifteen years after surgical reassess reassignment the suicide rate of those who had undergone sex reassignment surgery rose to twenty times higher than the rest of the population. Birmingham university in England reviewed more than one hundred studies of post operative transsexuals the conclusion as reported by the guardian newspaper in England was quote none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. The inability to provide proof of benefit from surgically or chemically altering your sex is why the Obama administration in two thousand sixteen refused to pay for it under Medicaid despite Rick there right receiving a request that its coverage be mandated they refused citing a lack of evidence that it benefits patients. This is undeniably a challenging topic for everyone involved but given the irreversible damage in the benefit and the lack of benefit these treatments provide the safe act is a reasonable and necessary response the alternative is a future in which thousands of former children look at themselves with regret and wonder where all the adults were thank you for your time. Thank you to the Committee for allowing me to. Thank you to the committee for allowing me to come in and speak to you today really wanted to present my approach as a primary care physician and and how I approach this topic and how I interpret some the terms that that you will see in the bill and that you will hear regarding the topic I'm interested pediatrics board certified in both I have a majority of my patients are adolescent pediatric medicine so and deal with I teenagers and adolescents who who are going through these types of situations in my practice and starting with some terms to identify first of all it's a. biological sex refers to mail versus female has determined by sex hormones again that'll structures non ambiguous genitalia both internally externally and then also they can generally determine sex hormones that a individual produces as well as their reproductive capacity can go into that term gender identity is a term that is more we subjective cycle of psychological to a room that is out referred to the self perception I or self identification with male or female characteristics and so that can help us form this discussion a little bat gender incongruence I'd look at that as where there is incongruence between one person's biological sex and gender identity so that we may also refer to that as their experienced gender as another way that we approach that topic gender dysphoria is actually a medical term it is defined by the American psychiatric association you can find it listed in the DSM five which is the diagnostic manual for the American psychiatric association and basically this is the status of gender incongruence that is associated with significant stress or impairment in social school and other important areas of function so you may have incongruence but it becomes what we would consider a disease when it causes distress an individual who is experiencing that pain congruence and then finally transgender it's a broad spectrum of individuals who identify or experience a gender other than that that that is associated with their their biological sex. If you look at the burden of disease for gender dysphoria and and that's where I would really want to focus add that description of forty percent of these individuals have attempted suicide in their lifetime that's nine times greater than the US average in twenty fifteen this was that publisher twenty fifteen U. S. transgender study produced by the natural the national center of chant transgender equality rates of persisted into adulthood so if you look at how many people who have gender incongruence or gender dysphoria and prepubertal our adolescent stages there somewhere between two to thirty percent of biological males who had processed with the incongruence into adulthood twelve to fifty percent of biological females in a meta analysis of ten studies that was actually published in the international review of psychiatry and twenty sixteen identified that approximately eighty five percent of gender dysphoric children experience remitted it's of their dysphoria around or after puberty so basically these children were no longer in congruence between their biological sex and their gender experience at that point in time so there was a large number of these children who who develop and on into out of in congruency. Jenner transition is a term where we describe a process of where a person experiencing gender in concurrency changes their appearance or self presentation from being consistent with an individual's biological sex to be more consistent with the individuals experienced psychological gender identity and there are a few things that can be involved in this process the first one is identified as social transition this may involve changing the person's name their clothing their health their hair style changing the public self identification and usually with the request and desire that others affirm this public identity moving beyond that if they're or medical procedures or medical interventions that have been used in gender transition one is puberty blockers which we'll talk about today these are supplemental hormones that basically prevent eight prepubertal child from progressing through through that to puberty interview puberty physical changes. there's also cross sex hormone supplementation essentially this is providing the different hormones that are not congruent with biological sex to the individual with the gender identity concerns. concern. Okay okay. And I think that we're move on to I think they wanted me to move on to the next person okay perfect. Skews me just meant Committee there some handouts that are coming around for you. Go ahead okay thank you Sir I appreciate you guys passing out the the handout so moving to that one of the side that you are seeing I'm not hold up this one because it's a little bit bigger apologize we don't have a screen to present one of the big thing one of the in puberty blockers you can see that a few people because you're used to block Kannada children releasing hormone that actually functions right here to put up to a Terry gland the pituitary gland is important and releasing hormones known as a losing hormone and follicle stimulating hormone that in acts at the at the gonads of the individual to produce a secondary sexual characteristics you'll be able to refer to your hand out those are just some of the typical male sexual characteristics of facial hair grows steepening voice and large that genitalia and then the female sex characteristics of breast development and pubic hair growth as well. in puberty blockade using the. Education such as Lupron I've also included a table of some of the side effects that individuals who are treated with this hormone can or excuse me this this blocker can experiences so you can see on the male side there is is standing of Pino on test testicular growth on down to disruption of normal brain development invites you to reference that table that's included in female patients you may they may experience be a blockade of normal breast development decrease blood flow to the back to the the external female genitalia and they also sometimes we'll have disruption of normal development of of psychosocial development as well. that next phase of of treatment that individuals may experience is the cross sex hormones so basically this would be taking a biologically male biological male and I providing to him for months most typical for in the female so estrogen for example the other side would be taking of eligible female and providing. Women such as testosterone I have also included a table of for you that you can see some of the document medical side effects that can happen when these hormones or use so for example acid exposure in males can lead to increased myocardial infarction cardiovascular disease increase risk of stroke increased risk of breast cancer and even prostate cancer and then on the female when they're exposed to testosterone they have also have increased of cardiovascular events hypertension as well as breast uterine ovarian cancers one of the things that I'd like to point out is that often times when females are provided especially the a testosterone it's actually in levels that are many many many times higher than physiologic so ten to forty times higher than what we would experiences physiological levels and so I if for any of you who are familiar I've included a diagnosis called PC OS in which that's where F. females often experience increased androgen somehow distress in the body from that and you can see that this hormone level is much higher and so. The of enclosing the last part would be gender reassignment surgery and there is a handout that has descriptions of of kind of both of those in and males and females but what I would like to point out is in a study that was performed in Sweden and twenty twenty a lot of two thousand eleven that was published in two thousand eleven you can see that all calls more about morbidity and mortality all cause of death for and for individuals who underwent gender reassignment was much higher than their cohorts who did not in this study and so some of that will be. Suicide risk some of that will be other cycle social things that are involved but there's a there's a large question about how much of this is actually related to hormone supplementation and and I have some of the procedures that these patients undergo I'm gonna yell my time there I do have some more information but I'll be glad to take questions if you guys desire when completed. Calling out of hold if we could hold for questions for just a minute I'd like for ability to talk for just a second he's taken some time off from their for base airforce base in California to come out here bill if you could take just a few minutes and talk about your story. I will thank you committee for the opportunity to speak. My name is Billy barely and I used to be transgender as a child I had the reoccurring thought that god made a mistake I'm a girl. Right before going to bed and every time I pray I ask god please make me a girl before I wake up. If I could have I would have quickly chosen any path to of transition me to female when I was young. Fifty years after passing the age responsibility I thought held for the disconnect between my mind telling me how the woman my body telling him with a man. Seeking help in doing my own extensive medical research the message I receive that I was that I had to change my body to match my mind. A decision another and any other path forward. I decided to take the therapist and medical researchers advice to change my body. I started on testosterone blocker notification my emotions were up and down my body with changing but I was supposedly on this new road to happiness and that made me happy. My first surgery I had penal inversion and Adam's apple shaved and Brochet. After the surgery the doctor and the nurses had difficulty stopping the bleeding from my new ****. My artificial **** with packed with gauze and a fan back with placed on my lower abdomen but the bleeding did not stop later my mom who accompanied me in my and they shared with me that going into my hospital room with awful the owner in the room with like that of an overly saturated tampon. I received a blood a blood transfusion and plasma and eventually the bleeding didn't stop. My two week stay in the hospital turned into a three week stay the change my **** to an artificial **** required two surgeries so about four months later I was back for part two my money was low at that point so I didn't have any family or friends accompany me I went through the second surgery on my own. After this I had additional feminization surgery but no matter how many I had every time I looked in the mirror I thought a man staring back at me I tried hard to resolve the conflict between my mind and my body but after seven years of trying in I had more problems at that point that I had when I started on the road of transition. The bottom line is that they're both in the medical researchers were wrong change in my body did not resolve the internal conflict and it did not make me happy but what it did to restrain my financial resources and left me with the scarred body I have fully transitioned back to mail I am happily married have two step daughters beautiful stepdaughters and I have peace of mind and body. Lastly I was past the age responsibility and made a horrible mistake in hindsight I am male and I was born into the right body that their prison medical researchers failed to help me with my underlying problems the identified me as trans gender and they were wrong. How often are they wrong. Thank you for your time and for hearing my testimony. Thank you for your comments. Colleagues I don't know how much more powerful you can state. The issue we have one more doctor here that's a pediatric doctor and I would like to give him a chance to speak for just a moment I'll give. Yeah. Please introduce yourself and be representative. Grady crosswind and. Although I am the campus adviser the Christian medical and dental association at UAMS I'm not here representing them I'm also the Arkansas state American academy of ethics to Patterson and I'm not representing them at this point the two things that I would add is you have to be eighteen years of age in the state to get a tattoo without your parents permission you have to be twenty one to buy alcohol. To allow children to undergo these types of decisions at such an early age has a mistake is a this is robin mention the I am a board certified pediatrician I also did a fellowship in adolescent medicine I had a practice in Dallas limited to adolescents for two years also have of five children and thirteen grandchild is due Thursday so I am invested in this particular topic as Dr Wagner mentioned it has really been an explosion of adolescents with this acute onset dysphoria and this term dysphoria churches could entered the the contemporary vernacular just in the last decade or so in two thousand thirteen until may the diagnosis was gender identity disorder and I think we accommodated the current culture with the change there were some letters of opposition that were shown to me saying that this is medically necessary that we're taking that away it's not medically necessary insulin is medically necessary to a diabetic with these treatments are not medically necessary they say that Farrer references to other bills about schools and sports that's not part of this bill don't be confused with that situation and this is not about children with ambiguous genitalia that's not the concern another concern was is this and we abrogated appearance right to make the wishes the that are in the best interests of their child has a pediatric anesthesiologist I give blood transfusions to children of Jehovah's witnesses when it's absolutely necessary to preserve the law. Hi so the state does put to limits and best interest of the child and there's a question about my using my religious beliefs in this this is about the science there's nothing in the bill that appeals to any religious stand Tucker this bill. And you will hear anecdotal evidence from people saying how is important it was to have all of this anecdotes do bring out your motion but I'm really trying to focus on the best evidence based medicine as I look at this and the science that gets there and one person complained about of what about the state legislating what a physician can and cannot do the state has done that forever I cannot kill you by it by an active euthanasia in this state without being charged with murder there are lots of things that I can't do that are legislated by the state for the safety of our your constituents and my patients and we can go back twenty five hundred years ago as I look at these ideas of what how we should treat people the property so that premium no necessary first do no harm. Thank you for your attention. Thank you for your comments. Colleague Sullivan it up for questions all right a representative Bentley you're recognized for a question. Thank you all so much for being here today I cannot think of a more important topic in my heart just breaks as I hear the story so I've got a couple questions if that's okay chairman first Billy can you tell us what would what would it will be even better for you to have that point can you tell us what would be a better path what would would you help the therapist had done for you at that point. You know I wish they would have dug deeper and they didn't they didn't dive deep enough and my problems identified myself as as a girl. And they heard that. and I'm fifty three years old I spent about ten years of mine life on and off but ten years total in in going through therapy. I had the precious not too long ago I heard somebody mentioned that we are all seeking and then I am seeking a acceptance significant and security and then hearing this I reflected back on how have I been seeking it is those things except in significant security and as a kid I had a lot of problems I was skinny skinny as a rail at a speech impediment I had a learning troubles I had I was in coordinated so when it came time to playing with the other boys I was always chose last or are not at all I like playing with the girls. In my mind in reflecting back in my mind I can see how those problems contributed to my false thought of I'm a girl. I wish there bills would dove deeper and identified these issues and help me with those issues then the encouragement to change my body to match my mind. Thank you very much less one more question yeah you're recognized so either one of the physicians I just. I'm just floored by the effects of the block of the hormone blockers and they give in excess of foremost conciliation of. Clarify for me these are the results that that are happening we do this forms ones which shared the pediatrician is there so. These are well documented. Real results of these hormones hormones affect every tissue in the body they affect the liver that affect the heart the investment sexual organs to the brain they're ubiquitous and claims that they are essentially safe and reversible are false they're just flat out false. Thank you so with that you would say that does harm yes even the and if if I can listen to your your first question if you do nothing for for children who present with with Festus Fauria as doctor Wagner said with ten to twelve studies the average is eighty five percent will align themselves with their biological sex by later teenage years so you're giving me the secure that Billy has just described horrific Lee and I can give the cure rate eighty five percent if I do nothing that's a considered expected therapy if you do of a repair to therapy with current not the not the psychiatric therapy that we had twenty and thirty years ago but if you have prepared to therapy at this point it's even you can even expect things to be better the issue sadly as so many parents and children are all only being offered what is termed Affirmative affirmation therapy and it says basically you have to take the proposed you have prepubertal box you have to take the cross sex hormones and that to me is an impingement on informed consent if you don't prison provide represent therapy expected therapy and affirmation therapy all three with the risk and benefits then you have abrogated your responsibilities a physician. Thank you. Representative Gonzalez you're recognized for a question. Thank Mr I guess any all could answer this question is it is there anything in this bill that would prevent a pediatrician from treating a child with gender dysphoria. I'm. Talk about providing any type of of. Treatment. referred to counselling amend anything like that with his or anything in here to that would prevent a pediatrician from. Yeah you're welcome to enter into this. Give me the there is nothing to provide what it what it prevents is the if the term is transition in in it so it's a surgical or chemical interventions and that certainly is prevent counseling is prevent conversations is actually on a list in the definitions of the exceptions of the things that you can do because there are there are there are ambiguous genitalia intersection divisions there are things that happen there there are disorders of sexual development that that are related but but are the but are more physical rather than mental and certainly there this is been very carefully crafted to make sure that doctors can treat real physical issues but what it does to stop short of this is allowing professionals to chemically and surgically a transition a child. Okay thanks thank you Sir so. As for is the only thing that prevents them from doing is assisting with the transition so they can treat them in any other manner yes this thank you I was searching for the word counseling can confirm that. Long representative cloud you're recognized for a question. Thank you Mr chairman and thank you all for being here to piggyback off of doctor gone sorry. Here we go. Representative Gonzalez's question for the for the positions. Assume that since you've a common given your time and expertise that you've read this bill is that assumption correct. Okay so my question is is is in any way does this bill prevent medically necessary treatment to the child or any type of essential medical services for that child thank you I'm happy to answer that I would say that in no way does this bill prohibit medical necessity or essential treatment to the child as Mister Gonzales iced I think kill compassionate care referral for counselling addressing the mental health concerns all of those things would be something that added that myself as a physician who cares for the children would to every day and with every patient if the if the the only thing it limits is is that transition and an essential care would be providing for their or their development there gross their nutrition but then also referring for at that support and the other cycle social support as well you know as has been referenced oftentimes the mental health concern is cited as a reason that the these treatments are necessary but even as recently as as last year and the American academy of pediatrics journal of the journal pediatrics children receiving puberty blockers were twice as likely to have had a suicide attempt in the last twelve months so we know that they that these children and these patients in these adolescents are still struggling and they deserve the best care to address that. As pediatricians Dr Wagner pointed out we are compassionate toward all of our patients and we are for social justice we are against bullying of these children where are a bit against discrimination against the children and we will provide excellent medical care when they're under our care. The representative Boyd you're recognized for a question. Thank you Mr chair. So of representative Lundstrum I just I think I have. One quick question just for a little clarity is they're they're obviously some things in the bill that the medical board couldn't regulate but I guess my question is the things that are medical procedures the referrals you know there's always evolution and medicine are with the appropriate body to put this in statute or should this be something really we should say Hey medical board go right rules that's that's my only question thank now I think we are the appropriate body we set rules and regulations all the time and we set parameters all the time where there it's nurse anesthetist Sir medical issues we we bring them in for it this this committee or the Senate public health we state what we can and can't do about a lot of different things whether it's what drugs you can purchase over the counter on alcohol or medications or what Dr McGee's presented today or anything that we present from the legislature this rises to that level kids in Arkansas need protection and this rises to that level. Representative first you're recognized for a question thank you Mr chair I I have a question for the two doctors have many patients have you all actually treaty with gender dysphoria. I will let doctor Wagner dress up properly my adolescent medicine practice was in the nineteen late nineteen seventies and it's a very very rare childhood incidents it is point zero zero five percent two zero four. The one five percent in males and a third of that in females so it's a rare occurrence if you look at Arkansas is population for looking at childhood dysphoria you would expect only twenty to sixty males to be affected and less than a dozen females to be affected so and since I've been primarily doing anesthesia for the last twenty to thirty years I have not taken care of those patients I did do ten years of craniofacial work so I know about working with children who have different images of themselves and what's appropriate to correct those so the answer zero you've never traded childhood gender dysphoria. To be honest I had enough different patients in my private office I cannot tell you whether I did or didn't I had ambiguous genitalia I had different chromosomes and I can't tell you if I remember specifically having one with gender dysphoria it would not be a surprise if I did. Section Ferguson I have I have been a practice private practice for seven years and enforcement most of the children that I have interacted with adolescents who are in that gender incongruence Zone a lot of them have not had I just for you they get by past seven years I've had two to three that I have referred for socket your second account saying or are OR two counselors who I would think that the criteria for dysphoria I have not been involved in any who were treated with hormones and it's my understanding there's no gender reassignment surgery done on youth in Arkansas anyway is that true. No there is not any surgery done on youth in Arkansas I'm thankful for that and hopefully this will draw that line in the sand before it have I mean are we a solution looking for a problem now I don't think so at all other states are starting to do this and starting to mutilate children and I think we need to stop it before it starts we should never have **** amputated or breasts amputated on children ever. Thank you any other questions. Seeing none. Thank you for your comments we have a number of people signed up to speak against the bill. we had for it but the four people that are signed up to speak for the bill already talked so the first person on the list is brand the eleven. I make a motion chairman forget started. Which motion as I could make a motion to limit debate to two minutes per person. We have a lot of bills in this committee would like to get there so. As well emotionally discussion on the motion to. Representive Allah yes. I understand that we do have a lot of people law to speak against the bill not a Beals but I don't think this is fair to the to the the the people that want to speak against the bill to limit their time when we have set here for the last forty five minutes and listen to those who are in favor of the bill. A representative Alan understand that we have sixteen people that they speak two minutes please I'll be about equal to what these other forced on but sixteen people were were on the agenda when it started I think that we will be fair with this which the limited at the beginning and and not have the and we have people that want to speak against it all I'm just saying that that we need to be fair with this. But if you wanna make a motion that you means we have a motion on the floor you wanna make a substitute motion Substitute motion limit the firemen's. Per person per person okay. Motion is. Not the. The motion and the substitute motion is to limit five minutes per person a discussion. Non. One point for your right thank you. All right motion is still is five minutes per person limit debate to five minutes per person all in favor signify by saying aye. Our All opposed nay. All right we go back to the original motion that motion failed. President of. This. There is a motion was two minutes limit debate two minutes. There is no discussion. All in favor signify by saying aye. All opposed nay no hi seven motion carries limited two minutes per person. You're recognized please introduce yourself and who you represent. My name is Bernie Evans I'm a parent of a transgender child here in Arkansas that does receive hormone therapy. I'm here to testify against HB one five zero if this bill is passed it could kill my son when I told him about this bill he literally said he would kill himself if this bill passed the reason why is because he would not be able to receive his testosterone and it would make his body resume is period this makes under pressed into the point of suicide when he was put on testosterone his anxiety and depression disappeared he has he is now able to live normal happy life **** of as his authentic self you should you you will be taking that away from him and will cause him to cause him his in M. and at death this would be the case with a lot of transgender children you are putting this putting in the same position suicide rates will go up within this community as a whole. If this bills passed is quite literally going to kill children in the state that will and the state will have blood on its hands I've pulled academic journals and. That back up the claims that I'm telling you about the suicide rates it is not the job of the state to tell me what medical treatments I can allow my child to receive this is a slippery slope to top parents hands when it comes to medical treatment as a whole. What would be next. I also have an impact statement that I would like to read to you but the main thing I would like to say is these are the children of the ones you could not kill these are the children of the people who could not fly these are the children of the ones who persevered and these are the fearless we could not that are strong and we are ready to carry on so please vote no on this bill. Thank you for your comments. The next person on the list is Courtney Frierson. Please lose yourself and who you represent thank you for the opportunity to speak my name is Courtney Frierson Arkansas residents I am a licensed certified social worker mental health he spent set specializing in care for transgender clients and I'm a sex therapist in training I have about a ten minute speech prepared so forgive me for speaking quickly. I adamantly oppose house bill one five seven zero because in my professional opinion it is based on incomplete and false information it further stigmatizes and damages already of our vulnerable population. And if made into law would criminalize lifesaving health care for transport you on page two one two three six the bill states the studies consistently demonstrate the majority come to identify with their biological sex in adolescence a twenty ten study in the journal of sexual medicine following seventy adolescents to used hormone blockers one hundred percent of them continued on to use hormone replacement therapy and later gender affirming surgery. The use of hormone blockers is considered fully reversible they know that not only by time for the child and family to adjust to the changes in the body and society in the school they also hold development of secondary sex characteristics like body here ministration deepening voice breast development but exacerbate dysphoria and make later gender affirming care more difficult. On page two line seven the bill claims trans children have already experienced psychopathology yeah there's no distinction between co existing diagnoses and pre existing diagnoses a twenty eleven qualitative study in the journal of clinical psychology finds that the vast majority of adolescents with gender dysphoria are not diagnosed with severe psychiatric illness. The bill correctly states there's a dearth of empirical research about trans people. We should be curious about that lack of research when a message is sent to a group of people is insignificant does not seconds and it's controversy it has a chilling effect on research and hospitals finally I'd like to say paraphrasing from a lock when you consistently here that you don't matter and you don't exist sooner or later you come to believe that I'll finally say my entire ten minute speech is email to each of you so I appreciate if you would like to read it again my name is Courtney Frierson I urge you to vote no on this bill it does. Attacked. Thank you for your comments. Cynthia Martinez. Since the in the waiting room. Also a Gary Wheeler are you in the room wait just a minute you're not up till next I just wanna make sure you're in the room. Please go to the table and introduce yourself and who you represent. What those. This year you will if you want to go ahead and go to the table notice yourself and who you represent. Thank you my name is Gerry Wheeler I'm a physician I represent the Arkansas academy of pediatrics chapter has over four hundred thirty members our national organization has over seventy thousand members want to point out that while you have heard a little bit of information today I do want to thank you for your focus on the safety of children we share that common ground however I think that because of misinformation misunderstanding that you have received you are considering a bill that as other people have said will dramatically harm children concerned about the issues representative Alan has raised about representation and the issues that representative Boyd has raised about whether this is the appropriate focus. I've been in academic medicine for many many years children's hospital UAMS there has never it seems extraordinary that we would try to determine whether procedure should be done or not which or medical procedures in the setting. We don't need to because these issues have been settled already by the American academy of pediatrics the American college of a beach in the American academy of child adolescent psychiatrist and many other groups have signed documents related Lee within the last few days. advocating that gender affirming therapy be done that it has a huge scientific support and you'll hear more about that from Dr Michelle Hutchinson shortly who will testify as a physician taking care of these children specifically about these issues. So. This is the wrong place to have this discussion number one number two the message of this bill will be harmful we do know that children will is fifteen seconds. I would ask you to vote no on this bill I want the children of Arkansas to know that the American academy stands with them in opposing this bill which reduces their value and I think that you should again support the physicians and others that will speak against the bill following thank you. Thank you for your comments. sent the sent the Martinez is not available Hey Janet McAfee. Justin Sarlo if if he's there is not in the room then get them from the waiting room as well. Second statement would like to speak against. Yes that in the statement. But is not here. He can't he can't give his time to someone else sorry. Janet Carthy. Okay Christians so so well. Person so all persons so. If you would get lance Love Me here as well. Okay wait just a minute to get one at A. B.. Please go to the table and introduce yourself and who you had represent. Hello everyone thanks for letting me speak I'm person so well and I represent myself and the transmitter to kill children and teens of Arkansas. Thank you for allowing me to speak on this important matter. As a licensed clinical social worker in Arkansas I have worked with several teens experiencing issues related to this bill you can see that it makes me emotional because I've been there after suicide for them. In my experience the care for this bill would eliminate and be detrimental to the. The bill sorry the care that this bill would eliminate would be detrimental to them. As a mental health professional I have seen the harmful consequences. Denying gender affirming care. This bill only furthers harm for teens and absolutely does not accomplish the supposed to call to keep teens safe. A study shows. Thirteen transgendered tens are fifty six percent for. More likely to have suicide ideation and thirty one percent of them report previous suicide attempts I've worked with kids who have had multiple suicide attempts before they were able to get transient or care. Different ways such as hanging hills gun to their head. Gender affirming care Candace decrease in does decrease the statistics however denying gender affirming care only increases seized members. This is why this bill cannot pass. To truly keep all of our teams safe allowing access to gender affirming care must continue. Three kids in the last three years have died that on hold. They were not able to get gender affirming care I've seen a decrease in kids needing to go to the ER after suicide attempts fifteen seconds a decrease in hospital admissions to acute hospitals. This bill also will save the state money if it's not passed. To be able to get access to care that's preventative and not after death. Thank you thank you for your comments. Lance lemaire. Could you give them the hunter from the lake okay. Please enter seventy represent sure I am lance live our I represent myself and my niece may. So a couple weeks ago there is a bill in this committee and one of the discussions on that were three questions about a bill the first question being will allow discrimination to any group. Let me define discrimination according to Merriam Webster discrimination is the act practice or an instance of discriminating categorically rather than individually. This bill is categorical in its denial to transgender youth. It is not individual. I also quote brandy brown it is hard to hate close up. I know the representative this year do not want to hate so I changed that to it's hard to understand from a distance you heard from medical professionals one of which did not deal with you for the last fifty years and even that was so connected the canny remember if any of them had issues with this another that maybe had a half a dozen. It's hard to understand from a distance. You to all work on a thing like this and I'm going to quote some statements from their governor another great conservative state. These kids are just trying to stay alive. He said I I apologize for getting a little emotional. But when you spend time with these kids it changes your heart's in important ways. And so I want to improve that message and see if we can find a better way to work together. If you have not sat and listened to transgender then you don't understand. I remember when I discovered my nephew I see what the ninety seconds. I had two options because that is new to be include my mind. I found a friend who understood to help me this under the difference between gender this congruence and dysphoria and the outcomes that come from that thank you very much and I hope that you consider getting closer than further away thank you for your comments. In the hunter please enter seventy represent. My name is Andy hunter I'm representing myself. I am a local gay black male and a drag artist who is an ally for the trans community H. B. fifteen seventy is extremely dangerous and properly researched and a step back for the state of Arkansas the verbiage alone is disheartening an offense of starting with the name of the bill and the use of the word experimentation. This is This exported in H. B. six fifteen seventy arm probably research starting off with the very first one the state to the APA American such archaic association says that the American population that experiences distress with their biological sex ranges between point zero zero five percent two point zero five point five point zero one four percent adult males and point zero zero two percent two point zero zero three percent adult females I can't seem to locate this is this is to stick on the APA but I can find this if you do a quick search on Google and it pops up for wikipedia. We should not be basing our lives our children off of a wikipedia statistic. The AP AP a actually finds long term mental health benefits of gender forming health services for trans individuals and have spoken quite often against trans bands. They even have a guide for king for trans and gender nonconforming individuals the Williams institute of school of law in two thousand sixteen did a study and concluded that about one one point four million people identify as transgender in the United States and this number continues to grow we had some men that came up and spoke about the growing of trans individuals but did not speak about how it's affecting them or affecting our community it at all and there's no negative effect a study actually showed their ardent are negative of health impacts from the lack of early support and that seventy three percent of trans women and seventy eight percent of transmission surveyed first identified gender dysphoria by the age of seven the child mind institute concluded that health come a complications are higher if you wait till after puberty and sex because only have ten seconds left this bill is extremely extremely dangerous to our trans youth we need to set aside our personal feelings about this and realize that these kids are ready or just pinned up against the wall they grew up they don't understand what's happening here time is a and thank you so much thank you for your comment. Michelle Hutchinson. The pool is a little closer because I'm short. Hi hi Michelle Rebecca Hutcheson MD PhD hi here heard me to represent myself and the almost two hundred transgender kids that I have taken care of right here in Little Rock Arkansas over the last three years I moved to this state with the express purpose of taking care of this vulnerable group of children I am a board certified pediatric endocrinologist and I work with hormones everyday and by the way one misconception I want to put very clear in your mind is this business about puberty blockers being dangerous we've been using puberty blockers for fifty years I'm pretty children with precocious puberty I guarantee you if one of you in this room had a four year old daughter who was beginning to menstruate you would want me to use a puberty blocker and that child and that is what we do because a four year old should not menstruate and there's no copious copious numbers of publications showing that the use of puberty blockers in very young children for length of time of up to and over ten years is safe so please don't fall into that trap of somehow this is an unsafe medication we use it and it's after a provincial and we've been using it for years some other things that I want to try to make clear up some misconceptions your representative who spoke earlier name the American college of pediatricians as some sort of source of reliable information that is not a reputable medical organization it is actually listed as a hate group on most sites in this country number two this idea that children show up and suddenly or transgender it's just so absolutely false I'm getting ready to publish a paper to cover that exact topic in fact by the time the children come to my care they have no they were transitioned trans gender for up to eight to thirteen years the average is actually eight years that they've been aware of their gender difference by the time they come to see me in clinic this is not a phase fifteen seconds just drive dreamed up the last thing I don't know if it's going to be one three six or twelve but children will commit suicide after you pass this bill that's a guarantee. Thank you for your comments well I have a question representative where some more than happy to to help out of symbol you're recognized. Thank you Dr Hutchinson correct Dr Hutchison yes yes Hey thank you for being here today thank you for your testimony I do have a quick question so when you look at your referrals to your clinic are they evenly distributed across the state do you have more on just from Little Rock do you have I mean can you help me with your referral base is absolutely wonderful question and I can tell you that we have not advertised this clinic most of our referrals actually come from word of mouth hearing from other children and other families we do have a few pediatrician to do referred to us and the referral patterns have been surprisingly quite diverse I have a lot of patience for instance in Jackson up in the sorry and pine bluff and coming from the northeast part of the state I think that was a bit surprising we have so many patients up in the Fayetteville area that we had to open a second clinic and we travel to Fayetteville to accommodate the number of patients that are up there it's it's surprisingly been every walk of life every race color ethnicity and as socioeconomic status is represented. Thank you again but when gonna question represent Ferguson you're recognized yeah and I do have a question about the suppressing hormones of why is that why did you choose to do that in a child instead of waiting until adulthood yeah I think that's a fantastic question well obviously in our children with precocious puberty we do it because we don't want them to be you know mistreating a young age that's a separate issue I'll be quite Frank with you we use very very little puberty blockers in my practice because the children by the time they come to us are well into puberty the average age of children starting a cross sex hormones in my in my clinic is seventeen we are not doing radical experimental things with these children we are very patient very slow paced we give these kids a lot of time we're and nobody's in any hurry in fact I've had it a couple times had to slow a couple of families down because I felt like they were pushing yeah I don't think I want to answer specifically your question the the puberty blockers are to slow down the pacing of the east that's what we call secondary sexual characteristics so for example a trans girl doesn't want to grow a beard and a trans boy does everyone have breasts and the puberty blockers give you time to slow that process down while you do intensive psychotherapy and psychiatric analysis and work with the child to make sure that this really is the right decision and to get to the point where the child is actually old enough to make that decision because these are life changing decisions and they cannot be done quickly and so all we're trying to do is buy that child sometime that's what we're doing. Representive Allen you're recognized. Thank you Mr chairman the doctor how much of your time is spent with counseling with these keys that's a fantastic question so we follow the protocols that are published by all reputable organizations like the American academy of pediatrics for example and intensive ongoing psychotherapy is absolutely required for each one of these children in fact I will tell you if the child is not plugged in with a therapist for regular psychotherapy they can see the door we will not treat them and I've had a couple of I've come to blows with a couple of months over that'll be on it's not fun but it's intensive psychotherapy is absolutely required and I will tell you and I am proud I am proud of the fact that several of our kids have decided they are not trans I consider that a win I consider that a major victory it means we're doing it right and that and and anyway I I just can't brag enough about how great the team is but yes intensive psychotherapy is absolute required thank you for your comments. Thank you thank you for deferred for listening thank you. rhumba ya move. Please come to the table and lose yourself and who you represent. Hello my name is room by I am the director of intransitive a transfer of any session here in Little Rock and I'm one of those people that crossed over like they said I'm transgender and I don't know how counselors are in California for the person sitting here by in Arkansas they're wonderful as you've heard it takes a lot of time for you to be approved to be able to get a hormones even if you're older rate and clearly is reversible otherwise we will be calling this gentlemen she instead of he but I what I I say from the how terrible this bill is I want to remind you that the US Supreme Court has recognized time and time again pass constitutional right to care custody and control of their children Arkansas even has vaccine exemptions for religious and philosophical reasons so you need to think about that in the way that this bill is worried thank you cannot take away appearance right this is Arkansas is surprising that a group of Republicans would want the government to come in and just take away parental rights where's it going to go next how is it going to affect what witness who don't even want to celebrate the kids birthday and have you been around a kid who doesn't get their birthdays celebrated will then the government come in and say you have to celebrate that kids birthday where's it going to stop we cannot open that door this is a conservative state. We do that separation let the parents have the right to choose what they want for their children. Even the Bible tells us. that good parents love their children and commend them just as Jehovah god commanded his son and James eight one nineteen tells us our heavenly father listens to his servants and he pays attention to their feelings parents do well to learn from him and listen to what the children have to say fifteen so this parents care they sit and they listen in the same way that god sits and listens to us and they made those decisions together so did not take away a parental right to choose. What they do with their children how they raise their children and how they love their children thank you thank you for your comments. Okay ma'am sorry. The Savannah Colson. The way. Also will this year's. You would get them from the waiting room as well. Please introduce yourself and who you're representing my name is Amanda Colson and I'm here as a private citizen representing myself. H. B. fifteen seventy the so called safe act is a bill that if passed would directly and immediately threaten the safety of trans youth in Arkansas the world professional association of transgender health has clear guidelines in their standards of care the treatment of all transgender people including transgender adolescents this bill zeroes in on physical interventions of the central gender affirming care while completely ignoring all the mental and social aspects that are explored before these physical treatments are made in fact the W. pass states that before any physical interventions are considered for adolescents extensive exploration of psychological social and family issue should be undertaken no children no child guardian her medical professional ever Johnston medical intervention such as surgery or whole modern hormones as a first line treatment for transgender adolescents and no trans kids receive medical interventions without parental consent. Image. Assuming as such only perpetuates the holy underserved. Undeserved stigma around trans youth and lead to problematic bills like this that you one of our most vulnerable groups of human beings out of life saving care all while setting a dangerous precedent for the rest of the country's youth in a gender affirmative care model pediatric providers offer developmentally appropriate care that is oriented towards understanding and appreciating the use gender experience providers youth and their families follow the agenda from this care model all work together in a partnership to de stigmatize gender variance promote the child so forth organize access to various methods of care and offer education to families address complicated emotions questions concerns and ultimately advocate for the community spaces are actually. If one claims to care about the safety and well being of children that must include our trans youth in awhile as well the safety act not only fails to prevent protect them actively harms them transgender children should be supported nurtured and cared for whether in their schools and their. Thank you. Thank you for your comments. Will open this year's. Please introduce yourself and who you represent the will of the bill I guess. In the room. You would get them from the waiting room you may proceed president my name is well overseers I am the founder of the young trans women's project an organizer at the center for artistic revolution he for against my testimony I want everyone in this room to know that I'm an out and proud transgender women I have had no hesitation about my gender nor is my gender mental illness. I have known I was a woman since being a child I have been living in my truth for almost six years now I'm coming here today to ask you to vote no on H. B. fifteen seventy this act implies that young transgender people are not actually transfer and rather or mentally ill this is not true and is not supported by hormone therapy replacement doctors and many other organizations which I will not name because I'm sort on time I have been on hormone replacement therapy since I was thirteen I have had no harmful side effects from estradiol spironolactone or projects around the commonly used hormone replacements for transgender women having access to hormones was life changing for me and if I had not had access to that I would probably not be alive today. This bill is extremely harmful for transgender kids And hormones are absolutely medically necessary the staff so that this that so that they lower suicide rate it's already extremely difficult to get on women's when you're under eighteen it makes it even more difficult in most trans people have trauma surrounding health care when I was sixteen I was already scared of doctors and hospitals because I have been treated badly and health care settings because I was trans I had an illness for my mom for several days before finally going to the ER and even though she worked in the ER I was still made to be to feel uncomfortable by doctors. Healthcare is a human right so what is the army that any legislator with legalized discriminating healthcare especially for children because bottom line is our children. Arkansas senators for the bill frame as if it is nearly fifteen seconds or if that will be your I am restricted I'm in the end with this change center people are beautiful transcendent the poor powerful transient people are sacred and the words a math major with we're still here and I ask you to vote no on this bill is anyone have any questions. Thank you for your comments. wolf. Bill this. Please go the table in addition self in the represent. I am Office no seven yeah that's how I represent myself in the trans community. and I'm here I'm a trans person who needs transform healthcare today I'm here to cut through the manipulative spare on reveal the balance of this monstrous bill I point my finger at you and call this what it truly is it is propaganda fear mongering and oppression this bill will cause human beings trans being so children's death all this bill serves is to create anxiety out a problem that doesn't exist it's incredibly difficult already for adolescents under eighteen taxes this type of health care requires parental X. consent already which renders this bill absolutely unnecessary this rips away our freedom to choose what is best for us limits liberty of children and their parents as well as on their minds medical professionals alike even the very name of this bill is intentionally misleading I can promise you that if a supportive process had been the norm when I was a child instead of this outdated rhetoric discards of attempted suicide when not adorn my body to the state the trauma wouldn't live in my bones that I work to overcome to this day thirty nine percent of trans kids attend suicide more than twice as likely to its attempts suicide a session heterosexuals children I am part of that thirty nine percent some transcripts were not so lucky as I and I hope that they finally found that piece that legislators who support this bill so brutally into mainly snatched away from them with these kinds of bills so I beseech you to please vote against this murderous bill the options for transforming health care to principally always be left to the people themselves and not legislators there are hundreds of studies such as one conducted by the Rady children's hospital clinic in San Diego California finding that there is a high need for treatment of transgender youth sixty two percent of the transfusion the study reported feelings of depression and anxiety with some even having self cutting and harming history the study found that mental health significantly improve once allowed access to that and to this life saving healthcare that includes experience and College as seen psychiatrists primary care providers insurgents if you would just call your bill what they see what it is oppression then perhaps I would actually be able to finally say something good about you at least I can say you were honest. Thank you for your comments. Holly Dixon. Please enter seventy represent. Good afternoon my name is Holly Dixon I'm the executive director for the ACLU of Arkansas. MMC thank you on behalf of the ACLU of Arkansas and all of our members we strongly oppose this bill. This is the bill as you have heard will harm transgender youth who are already one of the most vulnerable and marginalized populations that we have in this state and in this nation. The bill runs contrary to the advice of the medical care providers you've heard from who care for these kids and provide care to these kids. The bill is unconstitutional. It takes away the rights of parents. In conjunction with their children and their medical care providers to make individualized personal private medical decisions. On a case by case basis. It's dangerous. We ask that you please listen to those who have spoken on behalf of their children on behalf of their patients and most importantly transfused themselves uphold the constitution reconsider your support for this bill if your sponsor and please vote no thank you thank you for your comments. Chris at Teague. Please enter lose yourself and who you represent. My name is Chris added I'm a father in Arkansas I'm a lawyer in California. Before I speak to the committee I would like to address the transgender youth of the state of Arkansas as a real father does a real father of a transgender child no matter what happens here today no matter what happens here today you are loved your loved no matter what happens today we will prevail over this injustice. I come here today knowing full well that nothing I say will persuade this committee your hell bent on passing this bill and running it through the rest of the legislature you know that this bill is unconstitutional and will not survive federal courts the Supreme Court has already found the transgender Americans are protected from discrimination justice Neil Gorsuch joined by five Supreme Court justices who still sit on the court that six that's a majority right that it's impossible to discriminate against a person for being transgender without discriminating based on sex and discrimination based on sex violates our U. S. constitution you know this bill will further stagnate our state's economy diversity and inclusion are good for business discrimination imposes enormous productivity costs and exerts undue burdens no academy in the history of the world has flourished under policies of hatred Business will leave this state new business will not come to this state remember North Carolina. As a business owner who pays tens of thousands of dollars in taxes to this state and who employs transgender workers I'm offended that you would squander our limited taxpayer resources paying lawyers to defend this infantile nonsense in federal court. Maybe you claim to live according to the Bible in your Christian religion so you've certainly read Romans sixteen thirty three what Paul asks you know the mind of the lord. Those of you would pass this bill it to the full House claim to know the mind of god. There are more genders than you are aware of their more biological sex then you are aware of you do not know the mind of god I sit before you as a fall your time as a constituent of voter who will voter time the child every person affected by this bill. Your time is up. Would you would you move him from one table. Our our children. Very important to the level of competition in. You had two minutes like everyone else your time is up Sir thank you for your comments. Would you get senator Cormann Grisham. Carmen Christian. In the waiting room. Your love well it's unrealistic. Your love. We will prevail against this injustice. Please go to the table is yourself and who you represent. Can you hear me now okay I'm Cartman Angelica I am here to represent myself and other transgender people that I know. I first actually want to address the representative of people on Friday here my the China is not mutilation and neither is any other agenda affirmed or created the China so I think when they use language like this it's very clear that they are relying on the science or the backing of any literature. And Furthermore. As someone who's studying for her bachelors of science in nursing is about to be like a registered nurse and may is embarrassing to be licensed under state that is possibly going to legalize discrimination and to add more one of the core components of nursing is evidence based practice and the evidence is clear providing hormone replacement therapy is one of the best preventative actions against dysphoria for transgender children. Any major association including the American medical association the American nursing association and the American psychological association agreed discriminating against transgender healthcare isn't best practice but it's clear that not everyone here is done their homework. I had to pay out of my own pocket to then make up for all the things that testosterone had done to my body because I had a provider when I was a child who would not listen to me when I needed my hormones I was fifteen and I remember it clearly I'm sorry for Billy or whatever his name is but that is not the story from most transgender people most transgender people in the transition early Lee a very happy life Hang for the children who if this bill goes through he'll have to go through the suffering of his or else and go through it I want to thank you for listening me and I hope you vote against this and I also want to say it's kind of ridiculous that you allow those people to speak for so long and you're only giving us each two minutes so congratulations on that thank you for your comments. The ex fresh. Please introduce yourself and who you represent. It's X. free one my pronouns are they them I'm actually an agent or a non binary identifying person I work as the executive director of Lucy's place as the only operating homeless shelter in the State of Arkansas that addresses homelessness as a crisis since the epidemic within trans and queer communities. Continuing sorry who's stuck actually an online. Continuing off of where actually my employee Carmen and did I do find it quite a shame that you have reduced the amount of time of your call community members to speak to two minutes but you allow people from outside of the state to take up thirty five minutes and more of your time I'm gonna continue and not rest there though I have one claim that I decided to make OR one specification for the healthcare provider who falsely attempted to offer their expertise from UAMS yet have not cared for a trans person in their time at UAMS unnamed caring for trans youth when the and that when they enter hospitals after suffering a tax is not compassionate care it's negligent in the last year I responded to over ten calls of incidents where there was someone lying in the side of violence I've only worked in my position for eight months I moved here a year ago. And I have already experienced more than five use they have attempted to take their life just calling the organization I work on behalf of and we're centered in Little Rock these calls came from Fayetteville they came from Missouri they came from Ohio they came from Oregon. Is needless to say that's wishful thinking for me to have hope that we as a society could have protected Bray list on who was a trans girl who was murdered in Little Rock Arkansas last year it actually has not been in fifteen seconds thank you. I hope is not to wish for me to believe that we can protect children like willow and my car men who are here and able to speak for themselves and maybe think proactively about the children like Braylon who no longer are here and cannot speak for themselves due to legal transphobic violence she was murdered and there was not an answer for her murder your time is I'm asking you to think proactively and not re actively I'm asking you to think about me in my position and I'm asking you to care for the people who work on behalf of your community your term care for people who would otherwise be neglected ties up. Thank you. All right committee that's everyone that is signed up to speak against the bill. Let the record show that more than forty minutes was given to the people who oppose this bill that was more than equal to the people for the bill. All right no one else is signed up representive are you ready to close for your bill. You're recognized. Thank you colleagues I know it's been a long evening I want to thank you for your time I'm one of the first address one of the things that that people have said. The parents first of all we do take take take quite a few things as parents that we have to follow the laws first of all we can even take your baby home from hospital without having a car seat. We don't allow people under eighteen to have alcohol tattooing drive certain drugs smoke going to a casino rented vehicle purchase cigarettes buy a lottery ticket rent a hotel room open a bank account by real estate look at porn vote when an apartment sign themselves out of school by medication such as cough syrup. This bill. Well it's been labeled a lot of things. It does see these children they are valuable their precious incredibly precious it sees them as incredibly precious. That's why it's important to protect these children because you can't go back. They are incredibly vulnerable that's why we need to run a bill like this. They can make these decisions when they're over eighteen and they're adults and they can think about with the decisions that they want to make and they're capable of making those decisions. But the first rule of medicine is do no harm. They can get counseling this doesn't stop counseling from occurring. But it does stop the hormone puberty from happening those puberty blockers from happening it does stop surgery from happening. On a child H. high heeled. There's no reason to do that to a child. Any blockers on a child. Those are things that we don't need to do. This doesn't stop counseling. I think one of the quotes that I read and research was quite interesting said this could be the greatest scandal in medical history. Can you imagine what some of these children may attend ten years from now the talk about suicide that's real that is real these kids need real health care they are truly vulnerable and we see them this bill sends that message that we do see you that's something that needs to come out of this conversation. Their precious and they're valuable. And I want you to remember that I think at the end of the day one of the things that I think is most important it's not the titles that we have in the money we make for the buildings that we might build are the great things that people might do but we're judged by the actions that we take to protect the innocent they can do nothing for us but we should protect them and Arkansas's children are worth protecting. This bill does that and with that I would ask for a good vote. What will the committee. Representative Bentley you're recognized. I make a motion to pass. I have a motion do pass any discussion on the motion. Representative person recognized. I know this is I know this is hard and I would I would almost guarantee that none of you in this room on this committee have ever had a friend who is transgender and really understand the ramifications and what they go through the way I read this bill a primary care physician could not even referred for specialty care of any type psychological or any other thing. Eight the. At the every you've listened to all the Arkansas positions of people who treat these people in Arkansas and they have all told you this is a bad bill you need to leave this to a parent said the medical community to decide what's in the best interest of these children that doesn't mean I mean there's no gender reassignment surgery done on children already we know that and they're not they're not always given hormones having that's a decision with the medical community you all know as well as a day this is driven by the outside lobbying group that it's no longer favorable to discriminate against blacks and gays anymore so they speak transgenders for this session. Ultimately this bill is intended to make life more miserable and discriminate against a tiny minority of kids I beg you to vote no on the S.. I'd like to address that that is simply not true you're not on the committee. Any other discussion. I have discussion chairman yes you're recognized I would just say that the heart of this bill is people here in this the state that want to protect children to think that we want to give hormones would make a child infertile and to know that eighty five percent of those kids if they have given great psychiatric care would reverse that decision how do we think we can give this dangerous medications to children think it's safe I would say that we can treat kids we love kids this is about love and is about loving children six ACT with this bill was about and I'm definitely going to vote for it thank you for bringing it forward for president of Austria. Any further discussion. Okay motion on the floor is do pass all in favor signify by saying aye. Those opposed say nay. The ayes have it congratulations your bill is passed thank you colleagues. We have two hands okay have a roll call. Representive cloud. Yes. Representative Davis. Was I don't know yes. Representative Perry. Yes those are no no sorry. Representative Penzo. Yes yes. Representive wing yeah yes. Representive Pilkington. The representative Pilkington. Representive Coleman yes. Representive Allen. No. Representative Boyd yeah. Yes yes. Representive Gonzales. Yes. Representative gray. Yes. Representative Bentley yes. Representative Payton. Representative Miller. Representative Miller. Representative Dotson. Yes. Representive make a. No. Representive Eubanks. Yes yes. Representative Wardlaw. Yes yes. Three four. Twelve to pass. Representive your bill is passed. Thank you. Okay of I promise we'll get out here by six o'clock we get a few more minutes so I'm gonna try let a few people run their bills representative Penzo H. B. fifteen forty eight. You're recognized. Thank you Mr. you have an amendment yes. Okay committee the amendments come around you want to go ahead and explain your amendment wants come around. Will. Yes let's just say the The Amendment was an amendment was requested by DHS to all agreed to language if the for good DOT the Amendment doll. Disconcerting the Bill that's acceptable the committee. This. So you making a motion you I'll make a motion to adopt the amendment. I feel is that is that kosher. Can can the president make the amendment to accept. The motion. All right just checking I don't want to mess up so we have a motion to approve the amendment in discussion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries the amendment has been adopted you're recognized to present your bill as amended thank you Mr chair L. bill fifteen forty eight as the personal care Medicaid reimbursement act this is a non controversial bill with no no no opposition I'd be happy to. Explain in detail. Or or anybody can make a motion to pass at any time. I don't wanna be the one that does it so. this is this bill or relates to personal care services I wanna say we've have worked on this bill with DHS and believe we have language that satisfies both the Department. In the home care industry the bill is intended to accomplish two things for personal care services first is intended to address the difference in payment rates between personal care attendant care and respite care the services are essentially the same in other words a person comes into the home to provide a non secure assistance to a client currently the services are paid at a different rate even though they're essentially the same service this bill will bring the payment rate into parity with personal care rate is important the DHS is been working on this as part of a our choices waiver in this bill would simply codify the process second it would protect the industry against potential change in the minimum wage by tricking triggering a rate review study only if the new minimum wages higher than existing Arkansas minimum wage. DHS provided language on on timing of the rate review and we have inserted language that would make the rate retroactive but only to the extent allowed by federal law minimum wage section is important for this industry because of the ongoing discussion in Washington about a potential change in the federal minimum wage enclosing the bill brings parity to personal care attendant care and respite care rates and provides a mechanism for a new rate review if and only if the minimum wage goes above the current Arkansas minimum wage we've worked with DHS on the language I believe we have incorporated the majority there changes to make the bill acceptable to them I would appreciate a good vote. Committee any questions. Seeing none of the whole representative okay sorry you're recognized for a question of xenograft thank you Mister chair outside and back here I think my question I know I've talked about this already but I think my question maybe for DHS so I understand the need for this and so I get that my question would be most healthcare sectors if there is an increase in minimum wage are going to need some sort of reprieve as well so and I know we're currently we're on a three year cycle where every provider tight. essentially is reviewed at some point during those three years but if you're the one at the end of the three years you might not survive the three years of a fifteen dollar minimum wage you know four dollar increase so could you tell me what your plan is to expedite it for all sectors of healthcare and not just personal care. Please introduce yourself and who you represent. Thank Mister Clark what would four million services. A reserve grade I can't say there is a definitive plan in place yet I think that depends a lot on the specifics if the federal government does increase the minimum wage attend on is there a phase in schedule one is take effect whose apply to languages number question what to look at in the other element is if it is a large enough increase that affects enough providers that may create a revenue issue know that we may have to come back no do you also revised budget numbers so all that state we recognize that could be a significant issue for a number providers around the state if and when the federal government does raise that and we're going to work through that with everyone recognizing that it is to put a lot of providers a very difficult position. One quick follow up for my. Is there any other sector in healthcare the age would be as impacted as personal care is essentially do I need to do we need to run a bill for any other sector and healthcare. The others will be affected but I think this personal care is unique in that they're that they're rate that is their expenses those minimum wage workers and so I think they part more than anyone had are most impacted by okay thank you. Committee any other Questions. But we do have one person signed up to speak for the bill Luke Mattingly. All right thank you. saying no further questions from the committee you may close for you bill I am Mr make a motion to pass I have a motion do pass any discussion. As it is amended. I have a motion on the floor to pass as amended any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries graduation your bill is passed thank you Mr okay we're gonna try to run through some people have waited patiently over there so we're going to representative hawks is not here I don't believe. We'll see in here representive rye we're gonna move his bill on to the next agenda. Representative Warren and senator Hammer SB two twelve you're recognized to present SB two twelve. And we have an amendment correct. Yes Sir Mr that's correct all right we're going to pass out the amendment. Is it simple enough that you could go ahead and presented beforehand or do you want to. The. I think I'll I'll let my expert witness here senator Hammer would you please introduce yourself. Thank you Mr members committee Kim Hammer of state senator district thirty three you're recognized thank you Mr The Amendment I was approached by a member of this committee and asked to add this language it just bring some accountability factor as far as utilizing the center of excellence at children's hospital for panda pandas and also it requires report to go before a LC Committee and that's what the amendment does Mr. What's will committee. Represent board. Motion to adopt amended I have a motion to adopt the amendment the discussion on the motion. You're recognized Robson Wardlaw. Thank you Mr as a committee well knows most folks on the House floor know I've always been against of task force in general and I approach Senator Hammer about a week and a half ago I think Senator was not in time means nothing to me but I approached him and asked that we keep this within the committee structure this amendment achieved that gold the bureau was already allowing staff to help on the first part of this amendment to help with the. With the Beaumont's not working right but with the council that they were already getting information from so they agreed to to continue that staff so that's this amendment allows us to use the committee process that's already in place and I appreciate sponsors of intelligence that and thank you representive cloud for represent an amendment. All right any further discussion. Of the motion is to adopt the amendment on favor signify by saying aye. All opposed nay. Motion carries the amendments been adopted you may present your bill as amended. Thank you Mr chair for two years now we have had a group including two representatives and two senators working on a problem plaguing young people in our state. Ians pandas is an acute disorder that causes inflammation on the brain as a result of having had stripped. I personally watched young man in my own community spiraled down. And his family lose everything they had taking him to doctors seeking to find answers. They finally found the answers but they did not come easily the treatment was found in good health was restored to the young man I know due to this being so new insurance. Real quickly refused to pay for the treatment the young man I know has had so many trials waiting for approval of treatment or and or drugs for his condition it's been heartbreaking to watch. This Advisory Council was set up two years ago you A. M. S. and children's have been instrumental in getting Arkansas on the map as a regional center for pans and pandas the legislation was only good for two years we need this legislation to allow us to continue doing the work that we've already started there's no known cost for this I want to give a kudos to senator Hammer senator Hammer not both come from communities where we saying kids that have dealt with this his ended up. Committing suicide. And the this is a very real problem there's a real solution so but he has done incredible work in getting this going and progress with children's and you a mess so I want him to be noted for the work that he's done. Wardlaw. That. Okay any questions from committee. Seeing none anyone here to speak for against the bill. For the bill. President will recognize. I have a motion do pass as amended any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries graduation represent your bill is passed thank you Mr thank you Committee thank you. Representative Lundstrum Senator Hammer. you have another bill here if you wanna. If you're if you already to present S. B. two fifty four. Are you ready to present that. We can present that I have a shorter faster one as well so we can we can do both you're recognized SP which one would you like first S. B. two fifty four all right as B. two fifty four is an act to ensure that businesses are not penalized by the department of health for the behavior of their patrons basically this puts people back in there Line. And it's a pretty straightforward bill senator Hammer would you like to. Okay okay you'll. But. All right We do have. First off committee of any questions. Okay single questions but we do have someone signed up to speak against the bill. A man Gilmore and Lawrence you. Bill would come forward. Please introduce yourself and who you represent. Thank you members of the committee Mister chair marshy and general counsel of the department of health we just want to be consistent because we did testify against this bill in the Senate and and we appreciate a representative Lundstrum and senator Hammer and working with us on this bill we assisted with some of the drafting and and made some changes and we just disagree with the fact that there's a word inside and the bill itself where it says that we unfairly penalized been as businesses and we we I do not believe that to be true we try to work with businesses throughout the pandemic and so we just had a problem with that word unfair thank you. Thank you thank you Mr chairman Gilmore department health Alec of misuse said our enforcement efforts have been extensive and we educate quite often with our first go to is not to penalize of the business owner or their customers so as misuse that we appreciate what working Senator hammer and and trying to make the bill change a few things here and there but we do. We do take our job seriously this may have some impact going on the road with I know there's some language and issued talked about that talks about it being the Unfair arbitrary things like that the the concern is going for this may have an impact with some of our enforcement efforts in trying to set a precedent and so we understand the issue the business owners been through it's it's not easy I get that but we do DO wanna speak against the bill so thank you. Thank you. All right is there anyone else who will speak for the bill against the bill. A. What Matt. Revson Wardlaw you're recognized for a question. One second Mr. Only one second Talk to me more about this unfair boarding and. Tell me we have yet has the sponsored. And willing to the man that word out or if you all approaches sponsor with that. We have talked to Senator hammer I think that part is not in the The fight section. I thank from the Federal Republic head the So it wouldn't be and statute but someone could go back and look at that but Senator Hammer has been has worked with multiple times on this and so that. It's a it's a bill so I don't wanna. That's that's a decision for him and the other sponsors Mr do you mind if the sponsors senator Hammer answers that question no senator Hammer you're recognized. Please restate your question. Senator Hammer have you Work with the health department on that one word or thought about amending that one word. They were is the last step for that process to take place if we wanted to take place yes Sir as best my memory serves me and if I may qualify my answer by saying that the health department I have worked well together will continue to work well together I appreciate them appreciate the job they do they're not thankless position with regards to that one particular word when the amendment process was going on. At and again I do not remember that we talked about that were specifically during the amendment process but it was brought up during committee on the Senate and so there was discussion on that point so to answer that's my answer to question if allowed like to expand on why the word might need to be left in there please. If the chair what a note. Yes you can follow. Please explain sure some of the discussion occurred on the Senate and was with regards to the process that we had in the involvement of the rules that were made and we were as the legislative branch not really included in that conversation so I guess the usage of the term unfair as it would be applied would probably be the point of discussion we have legislation that now is coming through the pipes that is going to address some of that unfairness I think that has occurred some of that unfairness was maybe not intentional maybe it was created by design the one thing I would like to point out about the bill is it does not prohibit the health department from enforcing what is there it just causes them to direct their attention toward the patron and not toward the business I think that's an important distinction also I'm not sure where it is in the process up Paul judge for not being sharper but we have passed legislation least of the Senate that's going to restore the fines that were charged against the businesses I think that should eliminate some of the some of the concern I'm not sure where that is on the house and but but I know which of these cleared out of the Senate that was the bill that Rep Senator Solomon rand so if I'm sorry. His or her okay so anyway with regards to the usage of the term unfair that would be my explanation thank you senator thank you representations you have a question yes thank you Mr and so as we talk about the term unfair is it possible that the enforcement was not uniform across the board. Independent private small business versus the big box stores. Based on testimony heard another bills I think that in my opinion would be a fair conclusion based on the usage of maybe the term in consistency thank you thank you Mr. All right. Of committee I think we're we're and here's anymore questions. Seeing no questions any anyone else here to speak against the bill or for the bill. Seeing none. Your motion. I have a motion of do pass by representative Dotson any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay moshing carries congratulations representive your bill is passed thank you represent Lundstrum I will let you present. S. C. R. five if you're I can be very fast or I will by everybody the first round. Would you repeat that please. You're recognized I will be fast and I will back up that Ladies and gentlemen as you are very well aware that we have a contact with the Marshallese of the islands and I would like to S. Jeff Williams if he's here or a representative from the governor's office. Sorry never mind all right this is a contact with the Marshallese islands we bomb their islands many years ago and they still need some healthcare from what we did in those actions and this is a resolution encouraging the governor and he obviously is supportive of this and has been supportive of the Marshallese islands and their health care so with that I would appreciate support of this resolution to continue and to help them get the health care that they need. Is that enough. Mr Williams you have a comment. All answer any questions you might have. If you would introduce yourselves entrance table for tonight Jeff Williams on a with the Department payment services. All right any questions from committee. Sing ninety one here speak against the resolution for the resolution. Pretty close for you bill yes Sir. What's with that I will have a motion of do pass by representative Wardlaw in discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries a graduation your resolution has passed thank you colleagues I appreciate it.