Public Health, Welfare and Labor Committee- House
Video
Transcript
3 documents
Bills discussed (14)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
HB1198
Act 449
· 6 mentions in agenda, chapter, transcript
Matched: “…EATE THE FULL INDEPENDENT PRACTICE CREDENTIALING COMMITTEE. HB1198 Penzo TO AMEND THE DEFINITION OF "PRACTICE OF CERTIFIED REG…”
|
TO AMEND THE DEFINITION OF "PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHESIA" BY REMOVING SUPERVISION REQUIREMENTS. | Penzo | Notification that HB1198 is now Act 449 |
|
HB1118
Act 306
· 4 mentions in agenda, chapter, transcript
Matched: “…TY IN BATTLING THE ABUSE OF PRESCRIPTION DRUGS IN ARKANSAS. HB1118 Dotson TO PROVIDE THAT SALES BY A COTTAGE FOOD PRODUCTION O…”
|
TO PROVIDE THAT SALES BY A COTTAGE FOOD PRODUCTION OPERATION THROUGH THE INTERNET ARE EXEMPT … | Dotson | Notification that HB1118 is now Act 306 |
|
HB1258
Act 412
· 3 mentions in agenda, chapter, transcript
Matched: “…E PROVIDED TO INJURED POLICE DOGS; AND TO PROVIDE IMMUNITY. HB1258 L. Johnson TO AUTHORIZE FULL INDEPENDENT PRACTICE AUTHORITY…”
|
TO AUTHORIZE FULL INDEPENDENT PRACTICE AUTHORITY FOR CERTIFIED NURSE PRACTITIONERS WHO MEET CERTAIN REQUIREMENTS; AND … | L. Johnson | Notification that HB1258 is now Act 412 |
|
HB1152
Act 790
· 2 mentions in agenda, chapter
Matched: “…ECLARE AN EMERGENCY. REGULAR AGENDA Number Sponsor Subtitle HB1152 Gazaway TO CREATE GABO'S LAW; TO ALLOW FOR EMERGENCY MEDICA…”
|
TO CREATE GABO'S LAW; TO ALLOW FOR EMERGENCY MEDICAL CARE TO BE PROVIDED TO INJURED … | Gazaway | Notification that HB1152 is now Act 790 |
|
HB1407
Act 369
· 2 mentions in agenda, chapter
Matched: “…ENDA *Bills in Red added 03-02-2021 Number Sponsor Subtitle HB1407 Lundstrum TO MODIFY THE METHOD OF CALCULATION OF THE STABIL…”
|
TO MODIFY THE METHOD OF CALCULATION OF THE STABILIZATION TAX IN CERTAIN CIRCUMSTANCES UNDER THE … | Lundstrum | Notification that HB1407 is now Act 369 |
|
HB1409
Act 368
· 2 mentions in chapter, agenda
Matched: “HB1409 Lundstrum TO MODIFY THE DEFINITION OF "WAGES" IN CERTAIN CI…”
|
TO MODIFY THE DEFINITION OF "WAGES" IN CERTAIN CIRCUMSTANCES UNDER THE DIVISION OF WORKFORCE SERVICES … | Lundstrum | Notification that HB1409 is now Act 368 |
|
HB1450
Act 357
· 2 mentions in chapter, agenda
Matched: “HB1450 Eubanks TO REQUIRE A HEALTH BENEFIT PLAN TO PROVIDE COVERAG…”
|
TO REQUIRE A HEALTH BENEFIT PLAN TO PROVIDE COVERAGE FOR EARLY REFILLS OF PRESCRIPTION EYE … | Magie | Notification that HB1450 is now Act 357 |
|
HCR1002
· 2 mentions in agenda, chapter
Matched: “…Coleman CONCUR IN SENATE AMENDMENT Number Sponsor Subtitle HCR1002 Boyd TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE…”
|
TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE PROVIDERS, LAW ENFORCEMENT, EDUCATORS, PUBLIC OFFICIALS, AND THE ARKANSAS … | Boyd | Approved by the Governor |
|
SB212
Act 430
· 2 mentions in agenda, chapter
Matched: “…ISTRATION AND LICENSING BY THE CONTRACTORS LICENSING BOARD. SB212 K. Hammer TO CREATE THE ARKANSAS PANS/PANDAS ADVISORY COUNC…”
|
TO CREATE THE ARKANSAS PANS/PANDAS ADVISORY COUNCIL; AND TO DECLARE AN EMERGENCY. | K. Hammer | Notification that SB212 is now Act 430 |
|
SB254
Act 401
· 2 mentions in agenda, chapter
Matched: “…PANS/PANDAS ADVISORY COUNCIL; AND TO DECLARE AN EMERGENCY. SB254 K. Hammer TO ENSURE THAT BUSINESSES ARE NOT PENALIZED BY TH…”
|
TO ENSURE THAT BUSINESSES ARE NOT PENALIZED BY THE DEPARTMENT OF HEALTH FOR THE BEHAVIOR … | K. Hammer | Notification that SB254 is now Act 401 |
|
SB258
Act 330
· 2 mentions in chapter, agenda
Matched: “SB258 Bledsoe TO AUTHORIZE NONMANDATORY MULTIYEAR REGISTRATION AN…”
|
TO AUTHORIZE NONMANDATORY MULTIYEAR REGISTRATION AND LICENSING BY THE CONTRACTORS LICENSING BOARD. | Bledsoe | Notification that SB258 is now Act 330 |
|
SB6
Act 309
· 2 mentions in agenda, chapter
Matched: “…RED NURSE ANESTHESIA" BY REMOVING SUPERVISION REQUIREMENTS. SB6 Rapert TO CREATE THE ARKANSAS UNBORN CHILD PROTECTION ACT;…”
|
TO CREATE THE ARKANSAS UNBORN CHILD PROTECTION ACT; TO ABOLISH ABORTION IN ARKANSAS AND PROTECT … | Rapert | Notification that SB6 is now Act 308 |
|
HB1408
Act 358
· 1 mention in agenda
Matched: “…estrictions designating areas as 'Members and Staff Only'. HB1408 Lundstrum TO AMEND THE ADVANCING WOMEN'S HEALTH ACT OF 2015…”
|
TO AMEND THE ADVANCING WOMEN'S HEALTH ACT OF 2015; AND TO REQUIRE THE ACT TO … | Lundstrum | Notification that HB1408 is now Act 358 |
|
HB1519
Act 509
· 1 mention in chapter
Matched: “HB1519 Eaves TO AMEND THE PETROLEUM STORAGE TANK TRUST FUND ACT; A…”
|
TO AMEND THE PETROLEUM STORAGE TANK TRUST FUND ACT; AND TO INCREASE THE BALANCE OF … | Eaves | Notification that HB1519 is now Act 509 |
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there's some in the hallway okay chair sees a quorum and again members we've got a full agenda today so we want to get
started on time so we're going to have to uh skip over uh hcr one 1002 representative boyd will be here a little bit later he's running the bill on another committee
So we'll move on to a concur amendment for HB 1118, Representative Dotson. Thank you, Mr. Chair. Representative, hold on just a second. Let me do a couple housekeeping things. Committee members, I want to remind you
that we can only have three mics on. So when you're through with your questions or whatever, be sure and turn your mic off. if there's anyone here that wishes to speak
for or against the bill and you haven't signed in please do so there's a sign in sheet down front without objection the bills in red that are on the agenda will be added to the consent agenda
Chair
Unverified
1:19
seeing no objections that's done represent dodson you're recognized thank you mr
Representative Jim Dotson
Unverified
1:24
chair members of the committee House Bill 1118 got a Senate amendment on the Senate side that added an emergency clause.
Everybody's already voted for it, 93 to 0 in the
Speaker 13
1:35
House. No of any opposition. Appreciate a good vote. Do you have a motion? Motion to
do pass. I have a motion of do concur to
the amendment. Any discussion on the motion? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay. motion carries
congratulations your amendments passed okay is representative gassaway here
i don't see him okay we're going to pass over that for now he may be presenting another committee so we move down to hb 1258 Representative Johnson, you're
recognized to present your bill. Do you have an amendment? I do. I do.
Representative Lee Johnson
Unverified
2:37
All right. And if the chairman is okay with this, I'd like to have Senator Hammer come and sit with me here at the
table, if that's okay. Yes, that's fine. Thanks. Okay, members, the amendment's being passed out. We'll give you a few minutes to look at that. Thank you.
Chair
Unverified
3:24
Okay, Representative Johnson, I want to
recognize you to present your
amendment. But first, Senator Hammer, please introduce yourself.
Senator Kim Hammer
Unverified
3:54
Thank you. Mr. Chair, Kim Hammer, State Senator, District 33. May I have permission to leave
my mask off, Mr. Chair, while I'm presenting? You may, as long as you have six feet away from Representative Johnson. Thank you. I'll be glad to.
Representative Lee Johnson
Unverified
4:08
Thank you. Representative, you're recognized to present your bill. Thank you, Mr. Chairman. So the amendment here, while it seems lengthy, these are relatively straightforward changes to the current bill. These are amendments that have been negotiated and
agreed upon between the parties involved in this process, and I'd be happy to answer any question about amendments.
I have a motion by Representative Eubanks to adopt the
amendment. Any discussion on the motion? Seeing none, all in favor signify by saying aye. All opposed, nay. Motion carries. Your amendment is passed. You're recognized to present your bill as amended.
Speaker 36
4:40
Thank you, Mr. Chair. Committee members, what you have before you today is a good
Representative Lee Johnson
Unverified
4:45
piece of compromise legislation. This is a piece of legislation that's the product of a lot of hard work by a lot of
people, and I want to thank everyone that's been involved in this process to bring us to the table today. I especially want to recognize Senator Hammer here on my left, who's agreed to be the co-sponsor on this bill. No
one's worked more diligently than he in the process of trying to
come to the table with what we think is a good bill for the state of Arkansas. The intent of this bill is very straightforward. The intent is to create a pathway, a legitimate pathway in Arkansas for nurse practitioners to practice free from a collaborative agreement with physicians. It accomplishes this task by creating a full practice authority credentialing committee under the Department of Health. This new committee will be composed of four physicians. Three of these physicians will be from medical schools in the state of Arkansas, one from each from the DO school in
Jonesboro and Fort Smith, UAMS, and then one would be at large. It would also have four nurse practitioners on the board, three of which would be from teaching facilities in the state of Arkansas, and one would be at large, all of which to be appointed by the governor. The primary purpose of this committee is going to be a first to try to receive applications for full practice authority and vet those applications. To qualify to apply under this new bill, a nurse practitioner will have had to practice in the state of Arkansas for 6,240 hours in
a collaborative agreement. That's the equivalent of three years. Once they've met that requirement, they can apply to this committee for full practice authority. In addition to overseeing the process of the application and issuing of certificates of full practice authority, this committee is designed to receive and field any complaints or concerns that might come up regarding full practice authority nurse practitioners in the state of Arkansas. Their authority over that process lies in their hands. So they can lean on the medical board and
nursing board for input and how they might adjudicate complaints, but ultimately how the complaints are adjudicated would fall to this board. This board does have the ability to suspend full practice authority certification, but they do not have any licensure authority over the nurse practitioners. That still lies completely within the realm of the nursing board. Additionally, there is language in this bill that would require full practice authority nurse practitioners to post signage where they practice declaring themselves as full practice authority nurse practitioners. If someone is denied full
practice authority, the committee is required to give explanation as to why a person might be denied a full practice authority certificate. I think that mostly covers the high points of the bill. I'd be happy
to answer any questions, if anyone has any for myself or for Senator Hammer.
Committee, are there any questions? Representative Cloud,
Representative Joe Cloud
Unverified
7:45
you're recognized. Thank you, Mr. Chair. Representative Johnson, just a clarification on the amendment, page 4, line 18.
Does that remove, it says now, the Arkansas State Medical Board or the Arkansas State Board of Nursing or both? No, so
Representative Lee Johnson
Unverified
8:02
what we've done is it says and, not or. So it still says medical board, and then it takes out the or language. It says and. So the intent now is that it can't go to either. It has to go to both. Thank you. Any other questions from committee?
seeing none uh is there anyone any audience who would like to speak against this bill anyone to speak for the bill seeing none representative you
ready to close i'm closed from a bill thank you committee appreciate it do you have a motion i
wish i did sorry i was going to try to sneak it in chair good try uh representative mcgee you're recognized for motion have a motion do pass by representative mcgee
do pass as amended any discussion on the motion seeing none all in favor signify by saying aye oh i'm sorry representative pilkington is joining us by zoom and he votes aye. All opposed, no. Motion carries. Congratulations. Your bill
is passed. Thank you, Mr. Chair and committee.
Appreciate all your hard work. Thank you, Mr. Chair. Okay, is Representative Gassaway here? Nope, still
don't see him. All right, we're going to move on to HB 1198. Representative Penzo, you're recognized to present your bill and we do have an amendment. Thank you, Mr.
Representative Clint Penzo
Unverified
10:04
Chair. If I could, I'd like someone to join me at the table.
Sure. if you would please introduce yourself and who you represent
Chair
Unverified
10:23
thank you mr chairman my name is slade bridwell and i represent the arkansas association of nurse anesthetists all right representative let's
give our members a few minutes to look at the amendment if you would. Okay.
Okay. Does anyone need more time to look at the amendment? All right.
Representative Penzo, you're recognized to
Representative Clint Penzo
Unverified
11:18
present your amendment. Thank you. Okay. We have a... This bill was initially clean, just striking a few words and adding a few words. We had some requests to add definitions. And there was also concerns over some potential issues with other bills that
could be passed this session. So we've added a definition of consultation. And I'd like a little feedback from the committee on the amendment as well. But we've added a definition for consultation, left it in the hospital, administrative, medical staff, and governing body can determine the guidelines on
what immediately available for consultation means.
So it kind of leaves it in the hands of the kind of local control. Also, we've got a
Do Not Codify section for legislative intent there in Section 2. This act does not limit and should not be interpreted to limit the right or authority or both of the health care facility to choose an anesthesia practice model.
So we were asked to kind of explain the legislative intent. So these are some of the, I won't say this is a compromise bill, but this is some of the language that was requested that we've decided to add to the bill. Committee, are there any questions?
Representative Kenneth B. Ferguson
Unverified
13:08
Representative Ferguson, you're recognized. I do have a question about the Schedule 2s. You know, my main concern has
been that they will go out and open up these pain clinics without any physician supervision.
This says they can prescribe Schedule 2s if they're doing any medical procedure. To me, that would mean if they're doing a ketamine block or anything else in an outpatient clinic, they could prescribe Schedule 2s in that situation as well without physician oversight. Is that correct? Am
Chair
Unverified
13:43
I reading it correctly? Slead could answer that. Nurse anesthetists don't have prescriptive authority and are not planning on seeking prescriptive authority. We are able to administer Schedule II drugs under the current statute.
We are able to administer, select and obtain those drugs as we do every day in surgery. So the difference between prescribing and writing a prescription and administering is totally different. So in response to a ketamine clinic, since nurse anesthetists do not have prescriptive authority, they would not be able to obtain a DEA number in order to obtain those drugs without being in consultation with, or as current statute says, in supervision with
a physician. A physician would have to be over that facility in order to obtain the DEA license to obtain the drugs. So eliminating the physician oversight wouldn't be an option because CRNAs don't have prescriptive authority. There are several ketamine clinics already with the word supervision in our statute. This language in this bill would not change that
what so would not change it whatsoever wouldn't allow for more or any less it would remain the
Representative Kenneth B. Ferguson
Unverified
15:09
same so it is just administration of is what you're saying yes
Chair
Unverified
15:14
ma'am it's for its administration only never prescribing we never want to prescribe all right any other
questions from committee on the amendment Representative, are you closing on your amendment? Yes.
Make a motion do pass on the amendment.
I have a motion do pass for the amendment. Any discussion
on that? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay. Motion
carries. Your amendment is passed. You're recognized to present your bill as amended.
Representative Clint Penzo
Unverified
15:51
Thank you, Mr. Chair. House Bill 1198, a little history on this. this is this is uh something that's been going on longer than i've been here um eight years ago i think uh to my understanding i wasn't here eight years ago but uh the the initial attempt was just
to strike uh under the supervision from from the bill it was later requested that you know we replace that with a word a different type of descriptive word on the relationship Coordination with, consultation, you know, over the years this has evolved and here we are in consultation with. One of the problems that was brought up two years ago was that the word that they chose then wasn't defined.
That's why we added the amendment with definitions. There was concern over pain clinics. Therefore, we've added language to try to address that. The CRNAs do not want to add, you know, run pain clinics. So if we've got a lot of extra stuff in the bill this year to try to, you know, alleviate some of the concerns people have over the issues that have been brought up over the last several years.
um i'll let uh slade go ahead and and take
Chair
Unverified
17:21
over all right thank you committee members and thank you mr chairman nurse anesthetists also known as crnas have been administering anesthesia for nearly 150 years crnas are highly educated advanced practice nurses who deliver safe anesthesia care crnas have an average of a minimum of seven to eight years of education and training experience specific to nursing and anesthesia before we are licensed to provide anesthesia.
CRNAs must pass a national certification exam for entry to practice and be recertified every four years so we can stay current on anesthesia techniques and technologies. After in-practice, CRNAs must maintain 100 hours of continuing education every four years, have documentation of substantial anesthesia practice, and maintain current state nursing licensure. We must also pass a continued professional certification exam every eight years. CRNAs are qualified to administer anesthesia in any health care setting.
There are currently over 800 CRNAs practicing in Arkansas. CRNAs provide 100% of the anesthetics in critical access hospitals without physician anesthesiologist supervision. we also provide 90% of the rural anesthetics and 75% of the sex of all other types across the state in addition there are no physician supervision requirements in the United States military currently in the state of Arkansas CRNAs are required to practice under the supervision of but
not necessarily in the presence of a licensed physician licensed dentist or other person lawfully entitled to order anesthesia CRNAs are not required to practice under the supervision of an anesthesiologist. When an anesthesiologist is not present, which includes 100% of our critical access hospitals, the supervision responsibility falls to the operating practitioner. This could be a surgeon, a dentist, or podiatrist with virtually no anesthesia training. Physicians and dentists are forced to supervise a profession that they do not
have training and this has consequences. These include implied liability on a non-anesthesia trained physician that can lead to decreased access to care and increased health care costs. We feel that House Bill 1198 helps to alleviate these concerns as well as describe more accurately how CRNAs practice today without decreasing safety. House Bill 1198 seeks to remove the word supervision and allow CRNAs to practice in consultation with but not necessarily in the presence of a licensed physician, licensed dentist or other person lawfully entitled to order anesthesia. Unlike the current
statute we have today, we have defined what consultation means. Surgeons are not anesthesia experts nor do they claim to be. Surgeons do not prescribe the anesthetic. CRNAs are authorized by state statute to select, obtain, and administer drugs for anesthesia under the DEA of the facility. When surgeons are asked to supervise CRNAs, this can lead to perceived liability over the anesthetic anesthesia provider. However, we agree that surgeons are not liable for CRNAs
and that liability does not exist as proven by current case law. Also, we submit that there is not a documented case of a surgeon held liable for a CRNA's active omission or negligence. This bill does not shift liability from the surgeon to the CRNA. In current law, CRNAs are responsible for their own anesthetics. CRNAs carry the same amount of liability insurance as our anesthesiologist and surgeon colleagues. Still, by the sole definition of the word, the perceived liability still exists. In an article titled, Anesthesia
Policies Increasing Costs with No Improvement in Value, the author states that interest groups have written letters to surgeons warning them that they would be held liable for the negligent acts of a nurse anesthetist for decades. This is still true today. In 2020, a letter from the Arkansas State Board of Dental Examiners titled Dental Sedation and Anesthesia in Arkansas Clearing Up Misconceptions states when dentists are working with CRNAs, the nursing board's wording for the CRNAs is clear that they work under the supervision of the doctor. There are legislative efforts being made to change
this, but as currently stated, the doctor is the captain of the ship. Never accept assurances from a contract provider that the dentist is somehow protected. Specifically, regarding the use of CRNAs, however, the dentist contracting retains all responsibility for the proper use of sedation agents, the actions of the CRNA, and the total care of the patient. Additionally, in 2019, a letter from the Federal Trade Commission to the Texas Medical Board stated that supervisory requirements on CRNAs might expose physicians who delegate the administration of anesthesia and related services
to CRNAs to additional liability. Furthermore, the FTC states any such supervision requirements or increased liability may contract the supply, decrease the availability, or increase the cost of anesthesia services without offering countervailing benefits to healthcare consumers or third-party payers. The comment explains that the risk of these effects may be higher in rural or other medically underserved areas. So obviously between the case law and these published comments, our surgeon colleagues are confused where liability lies.
This unnecessary barrier can hamper recruitment, especially in our rural hospitals where surgeons currently supervise 100%. Asking a new surgeon just out of fellowship or a surgeon who has never worked with CRNAs but now has to supervise a specialty they know nothing about can deter someone from taking that position. Our critical access in rural hospitals operate on thin margins as it is, and we don't need any barriers in recruitment to provide the best care to Arkansas citizens regardless of geographic region. We want to remove supervision so that the language will affect the true nature of our relationship with our surgeons.
Legislators often wonder, what's in it for the CRNAs? And those answers are twofold. This will increase our ability to compete in the marketplace and will protect the current jobs of CRNAs. And here's how that bill does that. This bill will clarify that there's no liability on our rural surgeons, removing yet another barrier to physician recruitment so we can maintain the medical care of rural Arkansas constituents. This will ensure our rural hospitals continue to thrive and grow and those rural CRNA jobs remain stable.
Additionally, this will increase our marketability and ambulatory surgery centers and clinics by removing the implied liability so those facilities will have more flexible options and will want to work with CRNAs. Unnecessary supervision requirements limit CRNA's scope of practice, not necessarily in their day-to-day privileges, but limits their scope of practice of who we can really practice with. CRNAs deliver cost-effective, high-quality, and safe anesthesia care. CRNAs have been denied the ability to practice with surgeons,
not due to their performance or capabilities or safety record, but to unnecessary supervision requirements a surgeon must participate in. It's been documented that decreasing competition in the marketplace decreases the supply of providers, decreases access to care, and increases health care cost. Competition in the absence of decreased safety is a good thing. It leads to lower health care costs. CRNAs want the ability to compete based on their abilities and safety record and not be restricted by a word in statute that offers no countervailing benefit to a patient.
The end goal is not to take jobs from other anesthesia providers, but to create jobs. States have been removing supervision since 2001. That's 20 years, and there is no evidence of decreased anesthesiologist practice in those states. In fact, California, which was voted the best state to practice anesthesia in by physician anesthesiologist's own surveys, not only has supervision removed, but has opted out of the federal CMS supervision requirement.
CMS conditions of participation for Medicare Part A reimbursement which are the facility fees not provider fees require the supervision of a CRNA either by a surgeon or an anesthesiologist who is immediately available. This federal requirement has currently been suspended since March of 2020 as a result to mobilize the CRNA workforce in response to COVID-19 with the unnecessary red tape of supervision. This requirement has been in place since the early 1980s not as a quality control measure as stated by Healthcare Finance Administration, but fulfills facility billing
issues. The governor has sole discretion to opt out of this supervision requirement after consulting with the Board of Medicine, Board of Nursing, and making sure it's in the best interest of Arkansans. However, state language must be consistent first and not have the word supervision in the statute. If supervision is removed, we will ask the governor to opt out this requirement simply to validate the state statute. Opting out has no effect on provider reimbursement or allowing full practice authority. It's simply a requirement that must be met for facilities with CMS contracts to get
reimbursed for their services. If the governor opts out of the federal regulation facilities it can if the governor opts out of the federal regulation facilities can still choose to leave supervision in their bylaws if they so choose. If the governor chooses not to opt out of supervision then supervision will be required in facilities that seek Medicare reimbursement for their facility fees. Currently 19 states have opted out of this requirement including Arizona and Oklahoma in 2020. Colorado is a partial
opt-out where the governor chose at his discretion to not only to only opt out of critical access hospitals and rural facilities. Now nurse anesthetists are not trying to be physicians. In fact, as demonstrated through Supreme Court rulings, when anesthesia is administered by a nurse, it's the practice of nursing. When anesthesia is administered by a physician, it's the practice of medicine. We are two separate independent anesthesia providers, provider professions with overlapping scopes. House Bill 1198 does not
decrease safety. This has been proven in studies time and time again since the 1950s. Studies have concluded that outcomes in anesthesia are more dependent on patient comorbidities or health issues rather than the scope of practice model it was delivered in. Our opposition to this bill may present studies otherwise, but instead of debating studies, which we could do all day, the fact of the matter is malpractice insurance companies base their rates on risk and outcomes. CRNA's malpractice rates have decreased over 30 percent in the last three decades and over 60 percent when
adjusted for inflation. Malpractice rates have also declined in states that have removed supervision and opt-out of the CMS supervision requirement. Malpractice rates are also comparable in opt-out states that have opted out to the states that haven't. And according to a dentist colleague, his malpractice rates decrease when an anesthesia provider administers his sedation rather than himself. So based on the risk and the outcomes in the market, CRNAs continue to prove of their safety record.
CRNAs recognize that the opioid epidemic is not only in our state, but across the country. We recognize that opioid addiction could begin at the time of surgery. Therefore, CRNAs participate and implement enhanced recovery after anesthesia protocols as a multi-modal approach to decrease opioid use after surgery. Also, the first society of opioid-free anesthesia was started by a CRNA. We recognize that there is a problem we want to be a part of the solution. There's legislative concern that removing supervision
will create a pathway for prescriptive authority and even lead to full practice authority. Therefore, we have addressed those concerns voluntarily by only allowing CRNAs to administer Schedule II opioids in the perioperative, periobstetrical, and medical procedure period. This ensures not only legislators but the public that no matter what prescriptive authority bills may pass this session or in sessions in the future, CRNAs will only have the capacity to administer opioids in the above settings. There is concern that removing supervision is an attempt to remove the physician from
the anesthetic process, and that's not true. CRNAs will always have to have a consulting physician for practices that choose this language that we have defined. We also added language to show presence of physician involvement by adding the definition of immediately available. available is to be defined by the administrative staff, medical staff and governing bodies. Every facility is different in Arkansas and we gave the local control of this definition to the facilities to best fit their anesthesia practice. We selected this definition from language already in Arkansas Code, Department of Health
Rules and Regs for Hospitals and Related Institutions Section 30, D1 and 2. Additionally, according to the rules and regulations for hospitals and ambulatory surgery centers, A qualified physician must be the medical director of the anesthesia department. Removal of supervision will not change this code. Finally, House Bill 1198 is permissive, and we included that in the legislative intent. This act should not limit and should not be interpreted to limit the right or authority or both of the health care facility to choose an anesthesia model.
We believe each facility has a choice on what language, supervision, or consultation they want to use. Thank you, Mr. Chair.
All right, are there any questions from committee? Representative McGee, you're recognized.
Speaker 84
31:17
Thank you, Mr. Chair. You said a lot, and
Representative Richard McGrew
Unverified
31:21
I missed some because it's pretty detailed, but you mentioned that by doing this, it was going to remove a barrier to help recruitment
of surgeons in perhaps these critical access hospitals. I think that's the essence of what you said. Have you seen or do you know, I know of no surgeon that has not come to Arkansas based on the fact that they were going to work with the CRNA
Speaker 83
31:47
at their hospital? I've actually got someone
Chair
Unverified
31:50
here to speak to that i don't know if the appropriate time is now or during discussion or are they
Speaker 65
31:56
on the list to speak i believe they are yes i'd prefer i can redirect that later
okay thank you okay that's fine all right thank you representative allen you're
Representative Fred Allen
Unverified
32:15
recognized for a question thank you uh mr chairman and and thank you represent penzo for your bill i have a
question for your expert witness there. Could
Chair
Unverified
32:27
you give me a definition of what is opt-out? Opting out? Opting out is when state language, state statute is consistent. Opting out is when the governor opts out of the CMS regulation
to require supervision by a physician, whether that be a surgeon or an anesthesiologist who is immediately available. so state state statute must be consistent first meaning that the word supervision cannot be in the statute at that time the governor can then decide if it's the best in the best entrance interest of arkansans to remove supervision by after consulting with the board of medicine and the board of nursing if he writes a letter to cms stating that we opt out of that conditions
of participation for Medicare Part A reimbursement, hospitals no longer have to have supervision in their bylaws. Follow
Representative Fred Allen
Unverified
33:26
up. Does opting out save the patient and the taxpayers any money?
Chair
Unverified
33:35
Sure it does. It saves because CRNAs and their practices um you know it doesn't it may not always
there are certain situations where the opt-out could save money um it allows facilities to choose what type of medical medical model they want to use that medical model may be a more expensive model than the other one. The opting out also makes sure that critical access hospitals are able to recruit surgeons and maintain access to care.
Speaker 84
34:18
Representative McGee, you're recognized for a question. Thank you, Mr. Chair.
Representative Richard McGrew
Unverified
34:26
So hospitals are paid under Part A Medicare. Everybody turns 65 before you turn 65 you have to sign up for part a you don't have to take part b you can still have your own private insurance those rates are all set but a hospital gets paid for any service under part a medicare it doesn't matter if you're a nurse anesthetist or you're an anesthesiologist that hospital is going to be get paid the same so can you explain to me how that saves money and in part
b which the physicians and crnas are paid under they all get paid the same the rates are set So how can you say that this is a money-saving proposition that's going to be the greatest thing in the world? I'm a physician. Our rates are set. Our rates are set by Medicare and private insurers pay based on that. We don't have an opportunity to negotiate those rates.
Chair
Unverified
35:24
If we don't opt out, the supervision rule still applies, whether we remove it in state statute or not. So by removing supervision for the CMS conditions of participation, it simply just gives facilities more flexibility to choose economic models if they so choose. including their hospitals or their ASCs regarding their anesthesia department nothing to do with
their reimbursement nothing to do with my reimbursement but if they want to choose a different model a cost-saving model then they are able to do so representative cloud you
Representative Joe Cloud
Unverified
36:18
recognized for a question. Thank you, Mr. Chairman. I want to make sure I'm clear on the opt-out. So there's a mechanism to opt-out,
but my question, okay, so right now is the federal standard
by CMS to have the requirement of the physician supervision? Is that why
you would then even need to opt out is is that you understand my question yes sir what is the federal
Chair
Unverified
36:46
standard the federal standard was put in place in the early 1980s that said that that included that physicians if working with a crna a crna had to be supervised by a cr a physician which would either be the surgeon or an anesthesiologist that's immediately available it was put in in
the early 1980s, not as a quality control measure, but as a billing measure. And there's some history that goes back to that. As the years went by and we got into the early 1990s, a lot of CRNAs started working with physicians, with surgeons solely. CMS realized that there was no value in having supervision, this supervision standard in their conditions of participation. So in 1997, the comment period and everything started whenever the federal government started talking about
removing supervision out of the conditions of participation. And then by 2001, it was decided by the Bush administration that the power of removing supervision would go to the states. And that's whenever we saw the supervision removal out of the state languages first, followed by the governors requesting not to be included in that condition of participation following if that makes sense it is
Speaker 100
38:08
a two-step process it's a process at the end
Chair
Unverified
38:12
and the opt-out is totally federal
has nothing to do with i mean it has it goes hand in hand with state statute but the state to opt out validates state statute because like i said if we change if we change the statute to consultation and the governor doesn't opt out then any facility that gets medicare part a reimbursement will still have to have supervision so that's why the letter from the governor just validates the state statute that the legislators determine
Representative Clint Penzo
Unverified
38:46
any other questions from committee and i've actually got someone else here that can add to what Slade said, but we'll. Are they signed up to speak? They're signed up to speak, so it's same thing. We'll get to them. I was just letting everybody know that we'll touch on that with another witness.
All right. Representative Gray, you're recognized for
Representative Michelle Gray
Unverified
39:15
a question. Thank you, Mr. Chair, and I know we've talked before. Help me understand how this bill does,
how it doesn't allow you. I thought you said something about we put in here that it doesn't allow you to do pain clinics. That's not your intent. And I'm struggling to see how this does
Chair
Unverified
39:35
that. Could you explain that to me? Well, the word pain clinics is pretty subjective. If we're talking about pill mills that are in what we would think is a pain clinic, somebody independently running one, that's just not a possibility for CRNAs. That's why we put that they could only administer schedule two basically in surgery, in OB, or if I'm called to do an
emergency airway and intubate a patient in the ICU, I can, I'm allowed to give them some sedation before I do it and some pain meds, so I'm not hurting the patient, obviously. So pain clinics, independent, we'll just call them freestanding pain clinics, if we can, are not a possibility because CRNAs would have to have a consulting physician in order to even get the drugs. Secondly, we don't have prescriptive authority. So a pain clinic, I can't even conceive the idea of, because we cannot write prescriptions.
Now, are there CRNAs currently practicing interventional pain, chronic pain management in the state of Arkansas right now? Yes. And they're under the supervision of a surgeon. Whether we agree or not agree that that's within the scope of practice, that's what the national certifying body says it is. um the the people who are doing this also have been um had their privileges approved at their own facilities by physicians they aren't doing this independently so physicians have approved
them to do this on their medical executive boards and that department still has to have a supervising medical director so there's physicians all involved in this process so the pain clinic when we talk about writing pain prescriptions that simply just cannot happen even even with a supervising physician because nurse anesthetists do not have prescriptive authority i can't write tylenol prescriptions nor do i want to
Representative Michelle Gray
Unverified
41:35
much follow up and then i'll be done yes you recognize thank you well and that's so the the wording in here says medical procedure, I think, or other medical procedure. I'm struggling to find
it here. Medical procedure. So there are things in a pain clinic that are outside just pill popping or prescribing pills, right? I mean, there are procedures. So if you ever were to get prescriptive authority, you then would be able to essentially open a pain clinic.
Chair
Unverified
42:07
No, ma'am. If we got prescriptive authority, you could still only administer, not prescribe, as it states in the amendment. And basically, I don't want to use the big words, but when we're treating surgery patients, when we're treating our pregnant patients, and for a medical procedure. Medical procedures could be if, for instance, a dermatologist wants you to come in when they're doing lasers and wants you to sedate their patients for them.
Representative Michelle Gray
Unverified
42:38
I meant when you, if, so we change this this year, next session you come back and you want prescriptive authority. So once you get, if you got prescriptive authority, this opens it up to
Chair
Unverified
42:52
practice independently in pain clinics. No, ma'am. Because even with prescriptive authority, we are limiting, and it says in this administering, not prescribing. It's two different concepts. I'll come back. I'll come back. Thank you. Okay.
Okay. Any other questions? Anybody? Seeing
none. Okay, we have seven people signed up to speak, three, four, and four against. So we'll start that process. I would ask you, when you speak, to be specific and not repeat what's already been discussed. So we will start with against Dr. Wakey.
Speaker 116
43:43
Are you in the audience? Dr. Whaley. Whaley,
sorry. Would you get Chris Ramer to come to the room? come to the room please introduce yourself and who you're representing
Heather Whaley
Unverified
44:26
May I please take my mask off to speak? Yes, you may. Well, I am representing the Arkansas Society of Anesthesiologists. My name is Heather Whaley. I'm from West Helena, Arkansas, back when it was West Helena, Arkansas. I was born here. I've lived in Arkansas my
Speaker 124
44:45
entire life, and I plan on dying here. Can you pull the mic a little bit closer to you, please? I've never been told I'm quiet.
Just pull the mic to you, that box. There you go. Thank you. Okay. I
Speaker 124
45:06
am an interventional pain management doctor, and I practice in Jefferson County. So I'm
Heather Whaley
Unverified
45:14
just going to go on the opioid issue just for a moment since I have so much experience in specialized care in that area. I get patients frequently that have exhibit drug-seeking behavior, and they get very irritated when I have found the dirty urine screen
and they still want me to write opioid medications, and I refuse. And their answer to me is, I'll find somebody else that will write it. Well, if we open this Pandora's box of increasing the number of opioid prescribers, then they're going to go there and it's against the medical advice of a specialist. So the more we have it's just we're setting ourselves up for failure and I'm sorry but that's near and dear to my heart. I have family members who had addiction issues so it is really
really near and dear to my heart. So I was raised to say what I mean and to be plain spoken. I very much oppose House Bill 1198. I want to speak with you about the following. Patient expectations from their surgeon and hospital reflected by polling data. Education differences between doctors and nurses. The opt-out that the proponents of this bill want.
Speaker 130
46:38
Healthcare cost and finally COVID and its implications on this bill.
Heather Whaley
Unverified
46:45
By changing the four words from under the supervision of to in consultation with, this bill dismantles the anesthesia care team model in Arkansas. It allows nurses to administer anesthesia without any doctor supervision. Anesthesia services are a little different than the majority of health care services because patients do not shop for their anesthesia provider.
No true free market exists. Therefore, regulations for anesthesia must be in place to ensure all patients are receiving a high level of safe care. Generally, everyone here gets to research their surgeon or choose their primary care provider. When you show up to a facility, be it an ambulatory surgery center or a hospital, an anesthesia care provider is already assigned to that room or case.
Patients assume at that point that they are receiving the highest level of care. Two years ago, an Arkansas poll about anesthesia care found overwhelmingly that 86% of those polls said they want doctors to administer their anesthesia or respond to an emergency during surgery. A vote for this bill is against what the people of Arkansas want. These four words in the current statute matter. I'm a little nervous and a little
Heather Whaley
Unverified
48:23
mind I'm going to drink water. So to speak to the educational differences, I feel like you guys all got hammered with that information two years ago. It is vast. I calculated the hours between medical school and residency and it was just under 14,000 hours of clinical time at UAMS, VA or Children's Hospital. It is gratefully different. Do not let the
nurses try to convince you that they have the experience. Doctors have both more training and more experience and this cannot be disputed. A little bit about me again. I've been in health care for 23 years.
Speaker 133
49:10
I mean do I look like it? I thought somebody would just be like no. I started
Speaker 124
49:17
as a nurse's aide, went to nursing school, went to medical school. So I've been through a nursing education
Heather Whaley
Unverified
49:22
all the way up to BSN. Excuse me just a minute. Oh, I'm sorry. All right, proceed. Having gone down those roads
at 29, I kept thinking that being a doctor was a thing that was my calling. It's what I wanted to do since I was very small. Things happened in my personal life that I had to make money and darn it I did. My mom's a nurse. I've got two sisters that are nurses, grandmothers. I'm proud that I'm a nurse but I wanted to be more. I wanted to do more. I wanted more responsibility and I wanted to make a difference in a bigger way. So that's why I went to medical school and I'm very
proud of it and it this does not diminish anything the CRNAs they have also trained really hard but I take great pride in being a physician I worked really hard for it I don't have a trust fund it took eight years of my life I had two kids during it because I was older I don't recommend doing that and a lot of debt so I just feel strongly that Arkansas needs doctors to be in charge of the patient care model. I can promise
you that I care. Every patient I have ever taken care of I care about. Heck, during COVID it's hard for me not to hug some of them when they start crying. Nurses say that doctors are not trained in anesthesia care and that's just false. In medical school and in residency doctors, particularly surgeons, have anesthesia training. We also have pharmacology training integrated into every single course in medical school and during training. I would like to
speak now on the opt-out. The Arkansas legislature has defeated this bill or a related one for at least the last five sessions. It's like a bad penny. We all ask why do the nurses keep coming to the legislator and to push this legislation every two years. I know you have to be sick of hearing about it. Under the Code of Federal Regulations, if the underlying state statute provides a
lesser standard than supervision, like in this bill consultation, then the nurses can request that the governor consider opting out of the Medicare rules by writing to CMS. The governor must say that the underlying statute supports the the opt-out, and that opt-out is in the best interest of Arkansans, even though Arkansans said, no, that's not what we want. This is their stated purpose. This is the stated purpose
of their national organization, to opt out of the federal rules and regulations. What does this do for nurses, and why pursue a state statute change and ultimately opt out? without doctor supervision for anesthesia, the nurses will be able to negotiate higher fees for their services and higher payments from hospitals. They will be able to open pain clinics operated without doctor supervision. I heard the gentleman speak earlier. This is actually out of the
AANA handbook, primary principles and issues, primary principles, their goals for 21 through 2022 removing restriction restrictive position involvement prescriptive authority is number two on their issues and list ordering drugs and tests providing pain management services so that whole thing is just a load of bull ability to access medical imaging resources including the ability
to supervise radiologic technologists. Excuse me, ma'am. Representative
Allen, you're recognized. I'm sorry. Thank you, Mr.
Representative Fred Allen
Unverified
53:30
Chairman. I'd like to make a motion to limit the discussion on both sides to three minutes per person. I've got three minutes left.
All right, committee, we have a motion to limit discussion to three minutes per person
on both sides. Any discussion on that motion? Not including questions.
Does that include questions, Representative
Speaker 87
53:56
Allen? Yes, that's including questions. That includes
Representative Clint Penzo
Unverified
54:00
questions. Okay. Well, I'm okay with personally limiting this debate, but I'd like to allow... I've got a hospital administrator here that can answer several of the questions that were mentioned. So personally, I'd like to do a few... If this doesn't pass, I'd like to offer a substitute motion that it doesn't include questions.
But I'm okay with limiting the debate to two minutes, or discussion, or three minutes.
So do you have a substitute motion? I do. His motion does include questions. I would like to make a substitute motion that it does not include questions. Does not include questions. The motion on the floor is three minutes per person per side, does not include questions, so there'll be a time for questions. Any discussion on that motion? you recognize represent
Representative Kenneth B. Ferguson
Unverified
54:54
Ferguson I tell you I'm opposed to
this because we sat here the other day and listened to the positive side for two hours and then we weren't given any time to listen to the opposition I mean and he's on the fourth side you know in once more time I'm sorry but I don't think it's fair to the opposing side to give them all this time to present the bill and answer questions and then we don't give the people who've driven in to testify, time to testify and get questions answered.
Representative Carlton Wing
Unverified
55:26
I'm opposed to this. Representative Wayne, you recognize. Thank you, Mr. Chair. So does this mean that if we are asking a question of a person speaking, that that does not count against the time allotment? The three minutes is just for the people who have signed up to speak. They can give a three-minute speech, but if we ask questions, it does not count against that time. Am I understanding this correctly? You're understanding that correctly, yes. Okay, so it would appear that that would then give us the opportunity to find out what we needed from these people who have come and spoken.
Is that correct, Representative Ferguson? Does that answer? Oh,
Representative Kenneth B. Ferguson
Unverified
56:04
sorry. Yeah. I just think there aren't that many people signed up, and I don't see any reason to not hear
the complete discussion. All right, the motion on the floor is to
limit three minutes per person on either side.
Questions are not included in the three minutes, so there's open time for questions. Does anybody not understand that motion? Anybody got any further discussion on that motion? Seeing none, all in favor, signify by saying aye. Aye. All opposed, nay. No. I'm going to say the ayes have it. What's that
Speaker 151
56:57
mean for me? Do I get to keep talking?
Because he got about 13. Okay. I'm going to give you two more minutes
Speaker 154
57:16
to make your presentation. You're recognized. then i'm going to skip ahead to covid it's what's scaring all of
Heather Whaley
Unverified
57:26
us is why we're sitting here like this and everybody's uncomfortable 322 509 as of yesterday patients have or have had covid just over 11 of our state population
those are the reported cases we don't know how many non-symptomatic patients there are that are in Arkansas. Unfortunately, more people will get COVID in the coming days and will die of COVID. These COVID patients will need surgery. Some need surgery during their COVID illness to try to save their lives. There's one international study just published that says if you have COVID, you have a 25% higher chance of mortality during your surgery. It's pretty sobering. Hoping nobody needs surgery when they do get it. Our family had it.
It's terrible. There are more studies that will be conducted. It's just too early to know the entire effects of COVID on all of us. Every day, doctors are creating protocols to address when it may be safer to have surgery after COVID because of the effects of anesthesia and surgery on the COVID patients. The fact is, we simply do not know the long-term effects of COVID-19 on our patients. But we do know that having surgery increases your risk of serious complications and even death. Therefore, I
Speaker 124
58:40
urge this is not the time to change the health care delivery system
and remove doctor supervision over nurses. We're in a pandemic. And surgeries were kind of pushed back. How much time do I got
Heather Whaley
Unverified
58:53
left? I can get more in. You
Speaker 154
59:01
got about a minute and a half. I can talk faster than I thought I did. All right. Cost. There's no savings to the patient or the government. The only people that save with this bill are the facilities. And that never goes back to the patients or the government.
Heather Whaley
Unverified
59:22
Medicare most third party insurance pay the exact same amount. I'm basically agreeing with Dr. McGee what he said. It's not a savings for anyone. So that point is just completely absurd. Right now, the federal government pays rural hospitals extra money to employ the CRNAs for surgical services and to pay them more. That happens in rural Arkansas right now. It's called the Rural Pass-Through Program, and I agree. 99% of anesthesia in rural Arkansas is administrative by nurses.
You have 15 seconds. Right now, doctors supervise those nurses
Speaker 154
59:57
in surgical suites in rural Arkansas. I'm done. Your time is up. Representative Boyd, did
you have a question? You're recognized. Thank you, Mr. Chair. I just
Representative Justin Boyd
Unverified
1:00:16
want to kind of get to the market. I realize there's some controversy about whether this allows CRNAs to have pain clinics or pill mills or what have you.
I'm making an assumption that you do write opioid prescriptions that people take home. And so knowing that in the current environment today, I just would like to know if your patients have trouble filling those prescriptions anywhere. And if so, if you add other providers to the market trying to weed out, I want to be careful and sensitive how I say this, but not pill seekers, but patients who really have pain where opioids really might be the solution.
and I know we can debate whether that's ever right or not, but let's go forward like there is a subset of patients that benefit. So if you add more people to that market who are looking to write those prescriptions, what does that mean for your patients right now? I mean, does that make sense? I'm not quite sure. Are they going to have a
Speaker 172
1:01:21
harder time finding places to fill their prescriptions because there's going to be more prescriptions in the market? I don't believe
Heather Whaley
Unverified
1:01:28
that's the case. The hardest place to get my prescriptions or my patients is Walmart. They hate Walmart and Walgreens because they're getting real stingy and doing seven-day supply, which just seems like a ploy to make you come in every week and spend more money at Walmart, right? So I don't think that that won't be an issue. It's the throw out enough bait, you're going to catch a fish eventually, right? And that's kind of how these patients are with a lot of physicians. The more you ask, the more you nag, the more you beg, yeah.
Representative Josh Miller
Unverified
1:02:01
Representative Miller, did you have a question? I did, and I can be brief. Thank you, compadre. Ma'am, are you a
Speaker 130
1:02:18
practicing anesthesiologist right now? I am an anesthesiologist by training, but I specialize in pain management, interventional pain management. Are you practicing though right
Representative Josh Miller
Unverified
1:02:24
now? Yeah, I will. Okay, I was just asking. Yes, sir. May I have a follow-up, Mr. Chair?
Yes, go ahead. Okay. As an anesthesiologist, and you were talking about you brought up COVID a minute ago, and everybody hates COVID. Heck, yeah. You know, sucks, whatever. But are you and all the other anesthesiologists actually administering the drugs to patients now because y'all are more highly trained or certified or whatever than are the APRNs to do so during this time of pandemic and crisis?
Heather Whaley
Unverified
1:03:06
Not that I am aware of. We're supervising just as we always have done. But they're still doing the
Representative Josh Miller
Unverified
1:03:11
work. during the pandemic? I feel like we're all
Heather Whaley
Unverified
1:03:14
doing the work because now anesthesiologists have been shipped over to also ICU and care since kind of the cardiopulmonary doctors that take care of the medicine.
Speaker 154
1:03:23
Right, but I'm just saying, the pandemic hasn't
Representative Josh Miller
Unverified
1:03:26
changed them from doing their job just like it hasn't y'all from doing your job. Is that right? I don't believe I said that, but no, I agree.
Representative Justin Gonzales
Unverified
1:03:38
Okay, thank you. Representative Gonzales, you're recognized. Thank you, Mr. Chair. You said you were representing some association when you
Speaker 136
1:03:52
came in. Could you tell me again who
Representative Justin Gonzales
Unverified
1:03:54
that was? Arkansas Society of Anesthesiologists. Okay, okay. Could a follow-up? Yes, go ahead. Okay. Could you point me to exactly where in this bill that it allows, will allow CRNAs to write a prescription for an opioid that they can walk out with and carry to a pharmacy and have filled?
Speaker 153
1:04:11
Can you show me in the bill where it says they won't? I'm sorry. I'm
done. Thank you. All right. Seeing no further questions, thank you for your comments. Okay, Chris Ramer, would you
come forward, please? would you get john jones is he here in the audience is he in the waiting room you mind if i take my mask off you can take your mask off please
introduce yourself and who you're
Speaker 189
1:04:48
here representing uh my name is chris ramer i'm the ceo mississippi county hospital system which is a two hospital system northeast arkansas 99 bed acute care hospital, rural hospital, and a 25-bed critical access hospital. And Melissa Moody from the ARANA asked me to come and talk about some of my experiences as a CEO and the challenges of recruitment and retaining in northeast Arkansas, probably one of the, arguably one of the toughest places in the state to recruit physicians and providers to. And we've been an all-CRNA model
for 10-plus years, and 10-some years ago, it became cost prohibitive to employ an anesthesiologist, so the decision was made at the time to go with an all-CRNA model. It's been very successful. They do a fantastic job. About four years ago, we had one of our ortho physicians, who's been the only ortho we had for several years, retired, and we started seeking out services of orthos to replace him
and we engaged with a large group out of Jonesboro to provide one day a week clinic and one day a week surgery at our facility and it progressed through and they decided they wanted to do it until it became apparent that we were an all-CRNA model and they implied that they could not do that because of the implied liability that came with an all-CRNA model, even though it's not a true liability. That has become a problem for us
because we no longer have orthosurgery at our facility. Critical access hospitals and rural hospitals in Arkansas operate on a thin margin, especially critical access hospitals. And the cost savings for CRNA model are, and the changes in this bill are that some places and some providers require reimbursement for the, quote, supervision.
So, there comes with a cost. And CMS, that is a billing requirement, not a quality of service. they do nothing in the process of providing anesthesia, they're only required to sign it because that was the CMS requirement at the time that a physician signed the billing requirement. So that was a billing requirement. And so that's how it would save rural hospitals and continue to operate.
The CRNA and advanced practice quality has been established through multiple studies over long periods of time. As I said, we're an all-CRNA model, and they provided a great service for it, and that's all I have. Thank you. Representative Bentley, you're recognized for a question. Thank you for
coming here today. It's very important to me
Representative Mary Bentley
Unverified
1:07:54
that we get good access to care in our rural hospitals. So can you repeat again, will this bill help you?
Do you feel that this bill will help you to provide services for my constituents in
Speaker 189
1:08:07
rural Arkansas if we pass this bill today? Yes. So often when you recruit a physician, one of the sticking points becomes the implied liability that you get in Arkansas that other states don't have. And we have experienced that with ortho and other surgeons that we've recruited, we've tried to recruit over time. And it provides continued care. and there's a cost savings component to it for hospitals.
All right, any other questions from committee? Thank you for your comments. John Jones,
would you please go to the table? And we need Bart Calhan.
I'm not sure if I pronounced that right. Yeah, he's here. He's here, okay.
All right. Mr. Jones, you recognize? Dr. Jones, I'm sorry.
Speaker 200
1:09:11
How's that? You're on. Okay. I've been in practice here as a general sergeant since 1979 and two years before that in the Army. I've been here to, I was asked to discuss what might happen in the operating room with this new model. And whether it's good or bad,
Speaker 201
1:09:28
I definitely think it's a bad idea. And I'll tell you why. I have picked one problem that might occur in the operating room of a real emergency. Now, there are a lot of them that happen, can happen unfortunately, but this is
Speaker 200
1:09:43
just an example. It's called a tension pneumothorax. Now, that's what that is. In the chest cavity, If there's a hole in the lung, air can get out, and it gets into this closed-space cavity, and what happens? It pushes the lung down and makes it collapse. It also puts pressure on veins that come from the neck. There's decreased blood flow to the heart. The heart has less to pump out. The blood pressure falls, and because there's poor oxygenation with a collapsed lung, there's decreased oxygen in the blood.
So those are the two bad things that could happen, And if it goes on without being treated immediately, they could have an arrest and either and possibly even die from it. It's a real emergency. So how's that handled? Well, if I'm operating as a surgeon, CRNA may tell me, listen, the blood pressure's down. I can't oxygenate them. I don't know what's going on. And I could look up and see immediately what it is with the dilated veins in the neck from the obstruction. because we've seen that frequently in the emergency department
with fractured ribs that may puncture the lung and have the same effect. So I would go up there and say, I think this is a tension pneumothorax. The CRNA may say, no, I think it's something else. There may be a difference of opinion. It'll delay treatment if the surgeon is not the supervisor. Also, the surgeon does a lot of other things besides that. He tells his nurse, Judy, he said, I have to leave the operating room wound. And I tell her, put pressure on this artery where we've been working and just hold it until I get back.
I'm going to scrub back in after I take care of this problem. I also would tell the circulating nurse I need to crash cart right now in case we have a cardiac arrest. And I may tell another aide, I want you to go get the pulmonary cart where I need all the stuff to do a procedure. Now, this procedure is by putting a big needle into the chest and letting the air out. You have to have a certain needle that's on that cart. You have to place it in a certain place so that you don't injure a big blood vessel, maybe even hit the heart with it.
It's a procedure you have to learn how to do. You have 15 seconds. Oh, good grief. At any rate, so that is obviously it takes a leader. It takes somebody in charge, a supervisor, not a CRNA who does not know about all these other questions. And to be a consult, if they ask for a consult in the operating room, who's going to ask for it? How are they going to get there?
Your time is up. Sorry. Okay. Representative Boyd, you're recognized for a
Representative Justin Boyd
Unverified
1:12:20
question. Doctor, I just, over here, I just want to clarify.
So if, I'm just trying to digest what you just said. And so if a physician anesthesiologist would be there, were there and present and a pneumothorax, how would that look different than if it were a CRNA? I'd struggle with what the difference would be. I don't think a CRNA would know how to tell
Speaker 200
1:12:41
my nurse to put pressure on that or tell somebody to go get this or that cart that I need because they don't do it. I think you need a leader that knows all about the moving parts of an emergency in the operating room.
Representative Justin Boyd
Unverified
1:12:56
Yeah, you can have a follow-up. I just, I'm struggling. So let me ask it like this. If you're the surgeon, you're in the operating room, and you have a physician, anesthesiologist, who is the team
Speaker 200
1:13:11
captain? Well, that's the whole thing. I think you need to have a doctor or a surgeon as the team captain to coordinate all of these different problems that you have to handle to fix the problem. Representative Wayne, you're recognized.
Representative Carlton Wing
Unverified
1:13:28
Thank you, Mr. Chair. This procedure that you talked about at the beginning, does that typically take place or is that a routine procedure for our critical access hospitals in the
Speaker 209
1:13:38
rural parts of the state? No, it's not very often. But if there is an
Speaker 200
1:13:43
emergency trauma with chest compression, they may not identify that in the emergency room, but you get into the operating room and there could be a broken piece of bone sticking out that would stick the lung and it may happen later on from the initial evaluation. So it's an emergency.
You didn't have time to send them to Little Rock
Chair
Unverified
1:14:03
or Fort Smith or somewhere else. Okay, thank
Representative Justin Gonzales
Unverified
1:14:10
you very much. Representative Gonzalez, you're recognized. Thank you, Mr. Chair. Just a couple questions I'll ask them together if that's okay. One, have you ever worked with CRNAs? And, two, how would this bill remove the operating physician from being the leader in that situation, in that surgical room? To me, I mean, that still stands.
You're still, whoever that surgeon is, is still leading that surgery room. Well, there may be a discrepancy on
Speaker 200
1:14:37
what's going on. The CRNA may say this is not a tension pneumothorax. this is a low volume causing that or maybe some kind of problem with the endotracheal tube to give them the low oxygen and they may dicker over this what's going on and which would delay treatment for it which could be which obviously would be diagnosed more readily by the surgeon
Speaker 215
1:15:02
who manages though. Do you have a question? I mean
Speaker 84
1:15:14
Representative McGee do you have a question? the witness. Yes. You recognize that. Thank you, Mr. Chair.
Representative Richard McGrew
Unverified
1:15:20
Dr. Jones. Yes. I'm a surgeon and I would like for you to expound upon this as an operating surgeon. Are there instances where do you perceive, perceive with this, that there could be instances where you as the operating physician either ordered, asked, or requested of a nurse anesthetist to administer a certain drug,
whatever that drug is, and that nurse anesthetist could disagree with you and say, no, I don't think they need that. Now, that may be the consultation they're talking about, but in the end, could critical time be lost and could patient safety be sacrificed
Speaker 200
1:16:01
in that situation? Yes, and I think that the surgeon should know about these drugs, but certainly not like a CRNA.
They wouldn't know the dose. We are trained in pharmacology, and we do have a lot of experience over the years with anesthesia. CRNA would know better about the drug, you know, the specific drug, but they couldn't manage all the whole problems in the operating room with that going on. You need a supervisor. You need a chain of command. Representative Miller, you're recognized. Thank you, Mr. Chair.
Representative Josh Miller
Unverified
1:16:43
Dr. Jones, I appreciate your expertise and what you do. I'm trying to
wrap my head around the argument here. I've read the bill, and I don't see where the bill removes a surgeon from the room. Now,
I've had a lot of surgeries. several. And I've always, I mean, I've never, there's never been any doubt about who's in
charge in the operating room. That's you as a surgeon. And if you've ever operated on me, thank you. But not that problem. But
how does this bill change that? And I know you said a minute ago, you know, well, there may be some discrepancy about what, but I mean, at the end of the day, the surgeon's still a
surgeon. He's still a quarterback. I don't see how this bill is changing that. Can you
Speaker 201
1:17:42
explain that? Well, I would say this. If the surgeon's not the team
Speaker 200
1:17:46
leader, CRNA may disagree with him and want a consultation. Now, that may mean asking for another crna another anesthesiologist or maybe even another surgeon to come into the room and consult you don't have time to do that you may not even find one of those people in the operating room you can't this this model of getting a consultation for help is not a good model you need a supervisor there that can say no we don't need this let's go ahead and do this
Representative Josh Miller
Unverified
1:18:21
to expedite the problem treatment. Kind of a follow-up, Mr. Chair? Yes. Thank you. So does that, okay, in that situation, what you
just brought up, does that supervisor need to be you as the surgeon or does it need to be the anesthesiologist who may be on hole 15? I think it
Speaker 200
1:18:49
should be the surgeon. i think they're better qualified to take care of all the problems but an anesthesiologist there
would be better qualified than me to take care of the drugs that need to be administered doing that right but
Representative Josh Miller
Unverified
1:19:02
if the anesthesiologist is not there in the room you're saying it needs to be you but you just said the crnas probably know more about the the drugs than do most surgeons Yes, but the other problems he wouldn't
know about. That's why I want a good team when I'm going to have surgery. Thank you, Mr. Chair. Representative Cloud, you're recognized.
Representative Joe Cloud
Unverified
1:19:27
Thank you, Mr. Chair. Dr. Jones, thank you for being here. It seems like one thing that most people here agree on is
the surgeon is the quarterback, the surgeon is the captain of the ship, whatever terminology you want to use. So the previous discussion was concerning liability, that if this passes, then the surgeon, whether it be general or orthopedist or whatever, would, even though we've established medical legally, they're going to be the captain of the ship, but they're not going to be liable.
So I just, as a surgeon, I'd like for you to address that. Would you, if this passes, would you feel more like you have less liability in any surgical situation? I'm going to
Speaker 200
1:20:14
have to pass that question on to the rest of our team. I think I'm not enough of a lawyer to go through the nuances of this or that related to liability. As it is now, I do know if something goes wrong in the operating room, I'm the one that's in charge, whether I like it or not.
All right, any further questions? Seeing none, thank you for your comments. Bart Callahan? Calhoun.
Calhoun, I'm sorry. Come on forward to the table if you would. I'll pass my time if
it's okay. You want to pass? Yes, sir. Thank you. Let's go to Stata Bidwell. I may have mispronounced that name. He's already testified.
I'm sorry. Okay, so we'll go down to the against. Carol Meadors. Would you make sure JW Palouche and Frazier Edwards are in the room? Check the waiting room. You're recognized. My name is Carol Meadors
Carol Meadors
Unverified
1:21:34
and I graduated with a bachelor's degree in nursing, worked in the operating room as a registered nurse, completed medical school,
then an anesthesiology residency. My operating room experience encompasses 40 years, and I practiced medicine in Arkansas for 30 years. I oppose Bill 1198 for the following reasons. Currently, the conduct of the anesthetic follows a chain of command. Ideally, there is an MD anesthesiologist who is present and supervises nurse anesthetists. In rural hospitals and elsewhere, there is no anesthesiologist, and the surgeon has ultimate responsibility for the patient. This bill will cut off the head of the chain of command and leave all anesthetic decision-making in the hands of a nurse.
This is true in Little Rock and in Batesville at White River Medical Center. Two, this bill would abolish the anesthesia care team model employed in Arkansas for decades. All current nurses, technicians, and surgeons are conversant with the supervision model, which is not a high standard compared to many other states. What does consultation mean? We don't even know, and it is still not spelled out in the bill or amendment. Does it mean the nurse may or may not ask advice of a doctor? What if the nurse decides not to follow it?
The wording is too vague, and it puts the patient's life in limbo. I oppose this bill because it changes the legal standard, the medical condition of participation for the hospital from supervision to consultation. This is a lower standard. It is a race to the bottom. Hospitals will have even more difficulty attracting specialty-trained anesthesiologists and surgeons to our state. For example, Arkansas Children's Hospital in Springdale is attempting to recruit a pediatric anesthesiologist, but this law throws a wet blanket on that process. Why? Doctors want to practice in an environment with high standards, where they have a lot of support,
not where low standards are the norm. Our pediatric and adult heart transplant programs will suffer, and adult cardiovascular surgical service will suffer because all those doctors are recruited from out of state. And what happens in the large centers of the state affects all citizens, because all deserve the option of having specialized surgery in Arkansas without facing the prohibitive expense and danger of traveling out of state for care. Also, there is an APRN bill that will give CRNAs prescriptive authority if passed. And it's before this committee by now.
It is never a good time to encode lower standards and looser language when it comes to caring for Arkansans when they are most vulnerable. Thank you. Any questions from committee? Seeing none, thank you
for your comments. J.W. Plouch, please come to the table. Please introduce yourself and who you represent.
Speaker 240
1:24:24
Good afternoon, my name is J.W. Plouch. I'm captain with the Bryant Police Department and represent the Bryant Police Department and law enforcement. Today, I'm also joined here today by one of my colleagues, Sergeant Todd Crowson, who's over our drug take back program. He's not going to speak today, but he is here if there is a question on our drug take back stuff. I know there is a, you know, opioids and drug dependence are a problem in Arkansas. Arkansas has the second highest prescriptive drug prescribing rate of opioid prescriptions
in the country at a prescription of 85 prescriptions per 100 arkansans i know y'all were looking to pass a current resolution on 1002 to change some language and i anticipate that y'all are going to support that one and if y'all do law enforcement appreciates that support i know y'all haven't passed it yet because the representative wasn't here but we oppose house bill 1198 because any chance to put any more opioids or narcotics on the streets is detrimental to the state of arkansas
The bill read in combination with other bills, like Senator Hammer's bill, Senate Bill 186, could provide for more prescriptions to be written by increasing the number of prescribers. This is the last thing we need in our state. Bryant police officers know firsthand about the problem of opioids on our streets. Over the past 14 months, we have saved over 20 people just by using an arcana loan. just yesterday we saved an eighth grader from a narcan save that's how bad the opioid crisis is
in arkansas last year the bryant police department collected over 350 pounds of medication in our drug take back program and that's almost about that much annually so even what's being prescribed is not being used it's being put back out on the streets or being turned back in i'm against this bill that would enable more opioids or other narcotics on our street and this would be bad policy for Arkansas and join me in opposing this bill. This is also a stepping stone for the through their association to give them full practice authority. Thank you. Any questions?
Chair
Unverified
1:26:42
Representative Dotson, you're recognized. Thank you, Mr. Chair, right here
Representative Jim Dotson
Unverified
1:26:49
in front of you. i mean i've been listening to the testimony back and forth on this and reading through this bill um did you get a copy of the amendment that was adopted on i heard it in there a while ago but didn't get the actual copy okay well in the first couple lines of it it says a certified registered nurse anesthetist may select obtain and administer schedule two drugs only during the
and I'll period of period obstacle and medical procedure period and then there's a period after that so I fully hear what you're saying and and I completely agree with you as far as the the the overall fight against opioids and putting additional prescriptions out there however that's not what this bill does so at least as amended it says that these folks can only administer during those
medical procedures at least that's why i'm reading it and i just wanted to get clarification from you that that and if you see something else i understand it i kind
Speaker 240
1:28:04
of i understand it that way to a certain extent but i understand that their their national organization is seeking to do full authority and by different bills that are being presented removing that supervision from a doctor could potentially open up then the ability to do prescriptions well that would be my understanding and I'm not a lawyer not a
legislator but it's just kind of the way I read the bill and what may happen in the future but we're talking about this bill specifically and so why change something that you know is going to change something else it won't change anything but you removed if you're removing a supervision from something to where all they got to do is consult the next bill all that does is now we can move
Representative Jim Dotson
Unverified
1:28:50
to the next bill that opens up you're the next bill at the next time but for this bill in particular that's what I'm asking questions on thank you
seeing no questions thank you for your comments Frasier Edwards if you would come to the
table if you would introduce yourself and who you're here
Speaker 249
1:29:24
to represent. Push your button there. Can you hear me now? Thank you. My name is Frasier Mr. Edwards, I'm here representing the Arkansas Osteopathic Medical Association.
For those who don't know, osteopathic physicians are fully licensed and have an unlimited scope of practice in a multitude of different fields. You can have anything from a primary care physician to a neurosurgeon to an anesthesiologist and everywhere in between. We are a separate branch of the, we're different than MDs, we are DOs. There are two osteopathic schools in the state. have over 1,000 osteopathic medical students in the state currently right now. I've heard a lot of discussion about access to care. Simply put, based off of our community-based teaching model
that we utilize in both of our medical schools and what is traditionally applied at osteopathic schools across the country, we are doing everything we can to solve the access to care issue in the state of Arkansas. We send students to just about every hospital in the state of Arkansas whether it's CrossFit Arkansas or Camden or Northeast Arkansas or rural areas as well as large metropolitan areas as well. Simply put
we're against this for a lot of different reasons. We feel as if this diminishes the availability for or the it diminishes the capacity for students to maybe want to pursue medical school. If there is another avenue that has less oversight, less regulation, less cost pursuing a medical a different degree program that allows them same individual practice rights with the possibility
for the same reimbursement and a lot less headache, why would they pursue going to a medical school, whether it be osteopathic or allopathic? It is, it's dangerous in my opinion. And I think when you talk about wanting to opt out, you're taking power away from the authority and cms and placing upon legislators who don't often practice in health the healthcare
industry nor understand its intricacies and how the practice of medicine is applied in the hospitals to me that's a that's a dangerous practice so go ahead
Representative Justin Gonzales
Unverified
1:32:02
representative gonzales you recognize for a question thank mr chair do you realize that that CMS recognizes opt-out and
allows opt-out? Sure. And implemented opt-out during the COVID pandemic? To address a pandemic. Okay. So we're not overriding CMS and we don't have the ability to do that. Thank you. Any other
questions? Seeing none, thank you for your comments.
All right, committee. That is everybody that signed up for or against the bill. so
Representative Clint Penzo
Unverified
1:32:35
are you ready to close representative i am thank you um i'd like to point out a few things um i mean it's i'm i'm i guess i'd like to say that i'm disappointed or maybe should congratulate the lobbying team on the other side for convincing the bryant pd that uh this bill allows people to
open up you know pill pop and shops that's that's not right never was the amendment that was added was just to clarify that it didn't do that that that was there was phone calls made to probably everybody in this room that if if the stars line up just right and this bill and this bill pass and this happens and you know the Razorbacks go to the final four then they can prescribe medications or you know open up a pill shop and it's going to affect the opioid crisis and
everybody's going to be handing out pills to the schoolyard children that's that's not right and I'm disappointed that y'all were misled and you came down here to speak against this bill which has nothing to do with the opioid crisis. When an orthopedic surgeon is doing surgery, he is the specialist in the room when it comes to surgery. Okay?
The CRNA, if he chooses to use that anesthesia model, is the anesthesia professional in the room, the specialist. So for them to say that the CRNAs don't know what they're doing, the other states that have gone through this process and opt out, why are their medical malpractice rates not through the roof? If it's not safe for the patient, that would be represented in the insurance rates
for medical malpractice in other states. That's not shown in other states that have done it. So that argument's flawed. You know, CRNAs are trained to recognize these problems. Sure, they didn't go to medical school. But if there's an emergency during surgery, there's a surgeon in that room. And if, so there is a doctor in the room that can, it's a team effort.
And that's what we've got to realize, that it's still going to be a team effort. I mean, I worked in health care. I mean, one gentleman sat at the table said we're not – alluded to the fact that we're not qualified because most of us haven't worked in health care. Well, there's a lot of us in here that have worked in health care. There's a lot of us that have been patients. And I would say that's probably more important that, you know, we've experienced this as patients, family members as patients. We know what it's like to be a patient. So don't come in here and tell us that we're not qualified to make these decisions.
I mean, I'm glad we have some medical professionals in the room. We've got a couple of doctors. I worked in physical therapy for a little bit. We've got a couple of pharmacists. We've got one guy. Thanks for joining us on Zoom. He works in health care administration. We've got nurses. I mean, a lot of us, but more importantly, we've been nurses. Anyway, just like to ask everybody for a good vote. Thank you.
Speaker 65
1:36:01
Do you have a motion? Motion do pass.
As amended. Okay, the motion on the floor is do pass as amended. Any discussion on the motion? Representative Ferguson, you're
Representative Kenneth B. Ferguson
Unverified
1:36:18
recognized. It shouldn't surprise you all that I'm opposed to this. I mean, it's working as it is. There's just no reason for the bill. As he pointed out, there's never going to be a situation, or there shouldn't be, where there's not a doctor in the room. The liability issue, I promise you, is not the issue in getting surgeons to rural areas.
The reason you have trouble getting health care people to rural areas is a maldistribution problem is because they choose lifestyle over going to a rural area where they're going to have to be the only surgeon on call by themselves seven days a week. They want to go places where there's a four or five-man group where they can share a call and have a life, you know, have a life and be near schools and other things. This maldistribution of health care, you're not going to get surgeons to rural areas because you passed this.
It has nothing to do with liability. And I hope you heard this. The anesthesiologists and the anesthetists get paid exactly the same. So it's not a payment issue. You're not going to save money. You're not going to get surgeons to rural areas because you passed this. Representative Miller you're recognized.
Representative Josh Miller
Unverified
1:37:33
Thank you Mr. Chair. I supported this bill two years ago.
I'm obviously supporting it again. The point I want to
make right here is what's happened in here today has really been ugly and and honestly shameful, because the opposition to this bill has something so far up their crawl, they don't want to see it passed. And I don't think there's anything in this bill that should scare anybody about all of a sudden people are going to go to dying in
operating rooms at an unforeseen rate. But to go as low as to mislead our law enforcement folks who are busting their rear ends, keeping our streets safe and doing all the things that they do. And they don't have time to study every bit of this. And to go as low as they did to convince them that this bill, if passed,
is going to just add fuel to the fire of the opioid crisis is crap. And you ought to be ashamed of it. I don't even know who the
opposition is. But you ought to be damn ashamed. Thank you. Any further discussion? Okay, I've got a comment. I hesitate to say this, But I'm not, well, semi-worked in the medical field, but I'm not a medical professional.
I'm an engineer. I've told people that before. And the way I, when I listen to this discussion, and please don't think I'm taking this away from doctors. I understand the education and the work that you have to put in. And I understand the difference in a nurse and a doctor. I've had multiple surgeries and had some really good doctors and nurses, thank God. But when I look at this, I think of my career, and I've been in this situation to where I'm an engineer and I'm supervised by some guy who's figuring out how many motors we can make in an hour.
He doesn't know squat about what I know, and I'm being supervised for him. He's trying to tell me what to do. and on multiple occasions I've disagreed and I've wrote notes and all that to protect myself and I see that this way if I have a doctor in the room but he's not a specialist in the field then I don't want to be supervised by I want to be supervised by a person in my field who knows more than me so that's the way I look at the discussion here I just want to make that comment Any other further discussion? All right. Seeing none, the motion on the floor is due pass as amended. All in favor, signify by saying aye. Aye. All opposed, nay. All opposed, nay. No. Motion
Chair
Unverified
1:40:44
carries. Your bill is passed. Thank you, committee.
All right, we're going to go back and pick up HB 1152, Representative Gassaway, if you're ready to present
your bill. Representative, you're recognized to present your bill.
Representative Jimmy Gazaway
Unverified
1:41:13
Thank you, Mr. Chairman. And I have three witnesses here with me today, and I would ask permission to have at least
one of them join me at the council table, Officer Eric Johnson with the Jonesboro Police Department. Yes, he may
come forward. Mr. Johnson, for the record, if you would introduce yourself and who you
Officer Eric
Unverified
1:41:40
represent. My name is Officer Eric Johnson with the
Representative Jimmy Gazaway
Unverified
1:41:46
Jonesboro Police Department. of you may proceed. Thank you, Mr. Chairman. Colleagues today, I have House Bill 1152, which would allow for the emergency medical
care to be provided to injured police dogs who are injured in the line of duty. It also would create immunity for those emergency medical personnel who would provide for that emergency medical care transport to the injured police dog and makes an exception to the Veterinary Practices Act, which is really why this bill is before this committee in order to allow for that to happen. Again, I have with me Officer Eric Johnson, and we called this law Gobbo's Law after the
heroic Jonesboro canine officer who was injured in the line of duty in 2018, and I think Officer Johnson can explain the incident and everything that happened, and ultimately, why this bill is important
Officer Eric
Unverified
1:42:49
and necessary. Officer Johnson, you recognize. Thank you. December 11th, 2018, my canine partner and I responded to a shooting in Jonesboro City Lemons. After several hours of negotiations with the woman, negotiations failed.
She was observed with a firearm in the residence. A decision was made to deploy my canine partner to try to apprehend her without any injury to officers or her. once that decision was made I put my ballistic vest that my dog had on, deployed him in the residence she shot him five times point blank range and hit with every round immediately pulled my partner
out of the apartment she was in and thankfully I was able to carry him downstairs to my vehicle So to check him for wounds, he obviously was shot bleeding from his abdomen. And he had multiple gunshots to his chest and shoulder area. Like I said, five rounds that she fired, all five hit my partner. EMTs and paramedics were on scene.
We were so close to a medical facility, I transported him myself to the vet, which they saved his life only for him to pass. About a year later, last year, in January, he passed due to complications. Thank you for your comments. Thank you. So I think the
Representative Jimmy Gazaway
Unverified
1:44:39
question you may have is, so why do we need this law?
And so let me tell you that prior to the session, I was approached by Paragould police officer Jason Bolling about this issue. This was after Gabo had passed away. And he explained to me that canine officers are injured very often in the line of duty. They do some of the most dangerous tasks and important tasks that our police officers are involved in, whether that's drug detection, bomb detection, search and rescue, and it's not uncommon,
unfortunately, for them to incur some kind of injury in the line of duty. And so what this bill does is it makes the most limited, narrow exception to the Veterinary Practices Act that you could imagine. Basically, it says that a medical, I'm sorry, an emergency medical services personnel or provider may provide emergency medical care to an injured police dog who is injured in the line of duty. So again, it's not every medical provider that can provide this care.
The type of care that they can provide is they can't provide general veterinary care, but only emergency medical care, only to police dogs, not every dog, not to your family pet, and only to injured police dogs who are injured in the line of duty. And so I just don't know how you get much more of a narrow exception than that. The bill also specifies that, obviously, that emergency medical care can be provided or emergency transport so long as there's not a human that needs immediate emergency medical care or transport.
As much as we love our dogs, we don't want to prioritize them over human life or humans that may be in need of care. And then the last part of the bill basically provides immunity for the emergency medical personnel and providers who provide this type of care because they're basically acting as good Samaritans. If that dog is injured in the line of duty, they can take that dog to a veterinary clinic or hospital for care.
And if on the way there, they're providing treatment and care to the police dog and the police dog passes away, we don't want them to be liable for that because they're just doing the best they can to stabilize them and to help them until they can get them to the veterinary clinic or hospital. And so they would be immune if there was a bad result that happened in that instance. And so that's what the bill does. Also, Mr. Chairman, I have another witness here, Officer Charles Jones, who's with the Truman Police Department.
He's also a canine handler and happens to be a paramedic and an EMT. And I'd ask permission of the chair that he be allowed to come and make some comments this time as well. He can come forward. please
Speaker 268
1:47:54
introduce yourself you represent yes sir my name is Charles Jones I'm a officer with the Truman Police Department I'm a paramedic licensed in the state of Arkansas I also carry certifications
as a flight paramedic critical care paramedic and a tactical paramedic and I bring the tactical paramedic portion up because one of the things we're seeing now across the United States is various agencies are actually starting to train paramedics, primarily tactical paramedics, specifically in how to care for some of these law enforcement canines. Last year, there were 21 law enforcement canines that were killed in the line of duty. This does not include the ones who were injured in the line of duty. And when I talk about an injury, one of the first things they taught me in canine class
when I was going through to become a handler was dealing with a Belgian Malinois, and these dogs have no ability to stop. They will keep going as long as you will allow them to, and one of the things they told us early on is you have to watch your dog to keep them from having a heat stroke because they will literally keep going until they fall over. So there's all sorts of injuries that it doesn't just have to be gunfire. There's all sorts of injuries and emergencies that these animals may experience and in my department we are blessed to have two canine officers there
the cost to replace even one of those is something that would cripple our budget just the cost of the dog alone somewhere between eight to fifteen thousand dollars depending upon the pedigree of the dog and the amount of training that's gone on with the dog then you've got the handler expense a minimum of 80 hours that that officer has to spend and that's simply to get the ability to handle that dog and be able to detect what's going on with the dog and what signals they're giving us. So there's all sorts of expense that goes into this, veterinary bills,
food, all sorts of things that a department has to continue. It's a very, very valuable asset and one that as a police officer I'd certainly like to protect. As a paramedic who happens to have had several dogs over the years personally as pets, when an animal is injured, assuming all other personnel on scene including victims whoever it may be that's injured as soon as all the people are taken care of as a paramedic we want to reach out and help any way that we can it's interesting that a lot of our paramedic work some of our training when i was becoming a
paramedic back in 1992 one of the things i did was go work with a vet and actually intubated cats because it's one of the closest things we can do for an intubation that mimics that of intubating an infant and i've actually had the good fortune to work with other vets in the past to be able to practice some skills on dogs again because they mimic a lot of kids and how we might be able to increase our skills there so great working relationship with vets historically the paramedics and emts i think i probably speak for the vast majority if not all who say we would be in support
of this. Thank you for your comment. Thank you. Any questions from committee?
Representative Jimmy Gazaway
Unverified
1:51:01
Seeing none, representative, are you ready to close for your bill? I am. Thank you, Mr. Chairman. Thank you, committee. Again, this bill makes the most narrow and limited exception to the Veterinary Services Act that I think anyone could imagine. Again, emergency medical care provided by an emergency
medical services provider to provide emergency medical care transport to an injured police dog who is injured in the line of duty. So it is the most narrow of exceptions. I think it's a good bill, and I would appreciate a good vote and a motion at the proper time. Representative Johnson
has made a motion of due pass. Any discussion on the motion?
Hearing none, all in favor signify by saying aye. All opposed, nay. Motion carries. Congratulations, representative,
your bill has passed. Thank you for your comments. Thank you, Mr. Chairman.
Thank you, committee. All right. Representative Boyd, if you would go up to the table and present your a consent concurrent amendment or concurrent
Representative Justin Boyd
Unverified
1:52:18
resolution amendment. Thank you, Mr. Chair. I hope this is the last time that procedurally we have to come back and do this. We've already approved it like three or four times. This is just an amendment to a Senate concurrent resolution. It's an amendment to
a Senate amendment to a House concurrent resolution on House concurrent resolution 1002. Representative, do you have a motion? Yes, I'd make a motion due pass. Do pass this
amendment. Is there any discussion on the motion of due pass? To concur. To concur. Exactly. Any discussion on the motion? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay. Motion carries.
Representative McGee, you're recognized for a point of personal privilege. Mr. Chair,
Representative Richard McGrew
Unverified
1:53:06
we're all here, and we all shared in the excitement of Representative Pilkington's newborn child. If that child is at home, we'd need to get a picture here. How's that?
Representative Aaron Pilkington
Unverified
1:53:28
that. Good job. It is feeding time, so we'll come back later. we'll
Speaker 250
1:53:33
representative we'll catch you later yeah we'll come back another time
Speaker 279
1:53:39
all right committee we're going to move
on down the agenda lost my place here okay SB6 representative Bentley you're recognized to present SB6 Chairman, if
Representative Mary Bentley
Unverified
1:54:00
it's okay, I'd like Alan
Speaker 282
1:54:10
Parker to join me.
Okay. I think there's a number of handouts that we've got there, so we'll give Phil
a minute to get those handouts down a lot. All right, committee, we've got a couple of handouts.
Speaker 288
1:54:32
Those will be coming around. And is it Mr. Parker? Yes, Your Honor. Would you introduce yourself and who you represent? My name is Alan. May I take off my mask? Yes, you may. Thank you. My name is Alan Parker. I am an attorney. I represent the Justice Foundation. Okay. Thank you very much. Thank you.
Representative Bentley, you're recognized to present your bill. Thank
Representative Mary Bentley
Unverified
1:54:46
you, Chairman. Thank you, colleagues. Today is a
very special day, a day that we get the opportunity to save not only thousands of lives here in Arkansas, but millions of lives across the nation. I'm really excited to bring forth this bill. This bill, SB 6, is very much like a bill, the trigger bill that this committee passed out last time that we were in session. This bill is an act to create the Arkansas Unborn Child Protection Act and for other purposes. This bill today has a sponsorship
and the support of the Arkansas Right to Life, the Arkansas Family Council, the Catholic Church of Arkansas, Arkansas Faith and Ethics Council, Arkansas Prayer Caucus Network, the Justice Foundation, the National Association of Christian Lawmakers, An American Speaks, Student for Life, Faith to Action, Governor Mike Huckby, Life Legal Defense Foundation. You'll see on there also a new letter from James Robinson. And many of you know James Robinson, but he was the survivor of a rape
and almost was aborted and was not. And now he is a missionary and he provides wells all over Africa and different places. I've helped him get wells for children in Africa. So because he was saved, now we see children all over the world that are saved due to him being saved from the abortion that his mother went to get. And you can read his story as well as many others that you'll receive in a packet that's being handed out from Phil. And the last group that I'd like to say that supports this bill is the Arkansans across the state. Arkansas is the most pro-life state in the nation and never have our constituents or
Arkansans ever voted for abortion in Arkansas. They have supremely supported opposing abortion, but they have never voted for it. Even with Amendment 68 that we have in our Constitution, our candidates do not support abortion. They support life, and that's what this bill does. It's protecting the lives of unborn children. So I'm going to go through the bill briefly, and as far as the legal aspects go, we'll let Mr. Parker handle it. He's much more adept at the legal aspects than I am. So we're going to go over this bill. And the reason we're bringing forth this bill, and I will say unashamedly,
I'm hoping that we, Arkansas, will be the start to the end of abortion in America. And that's what the bill is for, to help us get to the Supreme Court. So some of the things that we're presenting today are to prepare this bill for that. It is time for the United States Supreme Court to redress and correct the grave injustice and the crime against humanity, which is being perpetrated by its decision in Roe v. Wade, Doe v. Baldwin, and Planned Parenthood v. Casey. The United States Supreme Court committed a grave injustice and a crime against humanity in the Dred Scott decision by denying personhood to a class of human beings, African Americans.
The United States Supreme Court also committed a grave injustice in the crime against humanity by polling the separate but equal doctrine in Plessy v. Ferguson, with the redrew legal protection from a class of human beings who are persons under the United States Constitution, African Americans. A crime against humanity occurs when a government withdraws legal protection from a class of human beings resulting in severe deprivation of their rights up to and including death. And Brown v. Board of Education, the United States Supreme Court corrected its own grave injustice and crime against humanity created in Plessy v. Ferguson
by overruling and abolishing the 58-year-old separate but equal doctrine, thus equal legal rights to African Americans. So we know that, believe it or not, there's been overturned in the Supreme Court 200 times. And so we want to have overturned Roe v. Wade, which is a poor legal action that has taken place. action that was taking place. Under the doctrine of starsi deceases, the three abortion cases mentioned in the subdivision of this section meet the test for when a case should be overturned by the United States Supreme Court. It's because of significant changes in facts or laws, including
without limitation, the following things. And these are things I want to address. Why do we want to see this overturned at the Supreme Court? And these are things that I will address quickly. The cases have not been accepted by scholars, judges, and the American people as witness to the fact that these cases are still the most intensely controversial cases in American history and at the present time. I know annually many of you, as I do, attend the March for Life, and we see that the case for life in Arkansas is growing, is not getting less, it's growing stronger and stronger. With ultrasounds and other things where our new, our younger generation can see inside
the womb, we're seeing the strength for life growing stronger and stronger, and the support for abortion getting less and less. The next thing for a reason to overturn this case is new scientific advances have demonstrated since 1973 that life begins at the moment of conception and that child in a woman's womb is a human being. I know that when I was in nursing school, way back when, 1983, as my nursing instructors tried to support abortion, they would say it's just a clump of tissues. And today, without doubt, we can see that there's absolutely false
statement. We can look at ultrasound and see that little baby at very few weeks having a heartbeat and moving arms and legs in just a short amount of time. We know that there's not a blob of tissue as a human being, and today we're here to protect the life of that human being. The laws in all 50 states have now changed through safe haven laws to eliminate all burden of child care from women who do not want to care of their child. So we know that not only is there a child in there, that child, if the woman is not able to take care of the child, she doesn't have the finances to do so, at a time in her life she's not able to care for that child, through safe heaven laws she can safely give that baby to someone else to raise. There's millions of people
across the state and the nation that would love to adopt that child. Public attitudes favoring adoption have created a culture of adoption in the United States, which many families without long periods of time to adopt newborn infants. I know that even my own life, I have a brother that was adopted. And without my brother, I don't think that I would be here. My mom had gone through miscarriage after miscarriage after miscarriage and was finally able to adopt my brother. And after the adoption of my brother, she was able to carry my sister and I. So I see that adoption, not only does it help that baby, I attribute my existence, even being here, to the adoption of my older brother.
so before the united states supreme court decision of roe v wade arkansas had already enacted prohibits on abortion and authorized the refuse to perform perform participate consent or submit to an abortion and that's what we talked about earlier about arkansas constitution amendment 68 set the policy of arkansas to protect the life of every newborn every unborn child from conception until birth and that public funds shall not be used to pay for any abortion except to save the life of the mother. Our Kansans, again, have never voted to support abortion. They've always
voted to support life. We, here in this legislature, have passed the Heartbeat Protection Bill in 2013. In 2015, 17, and 19, we've passed more bills to protect life in Arkansas. We, again, with Representative Dotson, passed another bill this session already to help a mother when she's at the point of maybe doing an abortion to hear some support that she may not have to do that abortion. So we passed the MLA even here this year. So we continue in Arkansas to support life. And this is another bill, again, to make that even further to protect life in the state of Arkansas and around the nation.
The Department of Health reports that 2,963 abortions took place in Arkansas during 2019, including abortions performed on out-of-state residents. And the state of Arkansas urgently pleads with the United States Supreme Court to do the right thing as they did and one of the greatest cases, Brown v. Board of Education, which overturned a 58-year-old president of the United States and reversed canceled, overturned, and unnulled Roe v. Wade, Doe v. Balton, and Planned Parenthood v. Casey, is the intent of this subchapter to ensure that abortion in Arkansas is abolished
and to protect the lives of unborn children. That, my friends, is the purpose of this bill. I do want to go over one other thing before I turn it over to Mr. Parker here, is that we have, this bill in no way tries to stop contraception of any kind, and that's why we have the section there on page 4 at the end there versus lines 30 through 35. You know, back in 1973 when this bill, when Roe v. Wade was passed, there was not a morning-after pill for those folks that had been raped
or incest had occurred. We didn't have the morning-after pill. We have it now. It exists now. We have a form of contraception called an IUD, and that's why we have that little bit of time there, so that women that choose to use an IED were not outlawing that, were not outlawing any type of contraception. This bill is to end the horrible thing of killing children in America. That's the purpose of the bill, and we're hoping that we can move it forward to the Supreme Court. And then I'll let Mr. Parker go over some things, and then we'll take questions from the committee before
we have witnesses. Thank you. Mr. Parker, before you present,
we have Senator Raper here, who's the Senate sponsor of the bill. Senator, if you want to set it to table, you're welcome to do that. If you don't, that's
Representative Mary Bentley
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2:03:30
fine with me. I asked him to be here in case of something that came
Speaker 288
2:03:36
up that he thought we needed to clarify, so thank you. Mr. Parker, you're recognized. Thank you very much, Mr. Chairman, Representative Bentley, members of the committee, thank you. I am a former professor of law and I'm licensed to practice law before the United States Supreme Court and that's where most of my practice
is today. I'm the president of the Justice Foundation, a 501c3 nonprofit public interest litigation foundation. A more complete bio on me is in the packet of materials that we gave you right after my testimony. I represent thousands of women injured by abortion in America. I'm submitting into your record of this testimony in the bill, 108 sworn legally admissible written testimonies of women from Arkansas who were injured by their abortions.
These injuries include physical injuries and psychological injuries that come from the trauma of participating in what is a crime against humanity, taking the life of another human being. We're putting a total of 4,661 legally admissible testimonies from women all across the country. And what I know about what abortion does to women comes from women themselves who've had abortions. That's why I give you their testimony. And I've listened to many, many thousands of them over the years.
Having reviewed SB 6, I'm of the opinion that this is an excellent vehicle for improving the health and safety of women in Arkansas and moving toward a more just and humane society. Since Arkansas already has a safe haven law now, as does every other state in the United States, no woman in Arkansas or anywhere in the country would have to take care of an unwanted child if the bill is passed. The problem of unwanted childcare was the central problem of Roe v. Wade and the reason
why many women get abortions. I was in the trial in Texas when Amy Hagstrom Miller, the owner of an abortion clinic there called Ho himself testified on the stand, no woman gets pregnant to get an abortion. It's not a positive good. In the material I've given you, all nine members of the Supreme Court in the Gonzalez v. Carhart case said abortion is a difficult and painful decision. And now we have the opportunity to take advantage of the law of stare decisis and present to
the court the opportunity to move forward to where we help take care of women and children and provide a more just society. That's what the five legislative findings are clearly about. I also represent the founders of the moral outcry petition, which is simply a petition to the Supreme Court based on these same legal reasons, which we have presented and will present in amicus curiae briefs, but which the state of Arkansas would present as a party in the
Supreme Court. We already have 350,000 plus signers of the moral outcry petition. About a quarter million of them were rolled out in the Senate the week before this. So obviously abortion results in the loss of infant life. Even the Supreme Court acknowledged this in Gonzalez v. Carhart in 2007, when they admitted, based on the testimony of women submitted in a brief that we submitted, 180 women hurt by abortion, some women come to regret aborting
the infant life they once created and sustained. It's the first time the Supreme Court has moved to calling it something other than a fetus or a potential life. They called it infant life in that case. And that's an advance in their thinking, an advance in the thinking of most people. In 1973, the court said at this state in the development of man's knowledge, we don't know when life begins. But since then, we've had an explosion of scientific knowledge. That's one of the findings in the bill. For example, as simple as DNA, which didn't come out in the court use
until the 1980s, positively shows that the child in the womb and the mother are separate, living, unique human beings if you sent samples from Beach to a DNA testing lab. We also know from sonograms, which came out in the 90s, which represented Bentley referred to, and many forms of genetic testing and genetic advances that came about in the 2000s. So it's undeniable, even the abortionists admit that it is a member of the species Homo sapiens from the moment
of fertilization. And all of us believe in human rights. When do human rights begin? When you become human, you become human when the sperm and the egg join together. And so So it's time to present that evidence, but also the fact that would eliminate the reliance interest. And that is the safe haven law in Arkansas. Under the safe haven law, within 30 days after birth or at birth, if she's in a hospital, she can simply leave the baby at the hospital when she decides to leave.
There's no cost. There's no obligation. It's free. So it's equally available to the rich and the poor. no reason to travel to another state. It answers the problem of I feel and there are many reasons why women have abortions. I've listened to many of them. I don't condemn any woman that's had an abortion. We seek to give help, counseling and healing. But many say I can't take care of a baby or some say I don't want to take care of a baby. She doesn't have to justify any reason whatsoever.
It's her right under the law to give that baby, relinquish the baby to the state. Then finally, does that mean that there's going to be a burden of child care on the state through foster care no there's actually one to two million people families women in america who are waiting to adopt newborn children they feel they can take care of a newborn child whereas perhaps they may not feel capable of being a good parent to an abused and neglected child but they are ready to adopt it so this is a loving solution let's have justice for the child mercy for the mother
and love for the families that are waiting to adopt newborn children which would more than take care of the problem of abortion on an annual basis thank you we'll we'll take
questions thank you chairman all right committee any questions from the committee Seeing none, we do have a number of people that are signed up to speak for or against the bill. Committee we have 20 people signed up.
So we will start with one person against the bill, Maureen, Representative Payton, I have a motion on the floor, a do pass. Any discussion on the motion? Representative Wardlaw, you're recognized. I'm very supportive
Representative Jeff Wardlaw
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2:10:48
of this bill. But it's also very important that these 20 people drove down here
to testify one way or the other.
And I think as a committee, we should take their input, whether we agree or disagree. disagree. They drove here to give us their opinion. We got elected by the people of Arkansas to hear their opinion and I think we ought to hear it. Do you have a
substitute motion that limits time? I would ask the sponsor the
Representative Jeff Wardlaw
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2:11:12
motion to pull, withdraw the motion so we can hear testimony from the public. Representative Payton, what's your decision?
Speaker 304
2:11:26
Okay, seeing no Representative Boyd. Am I allowed to give
Speaker 172
2:11:35
a substitute motion at this point? Anybody can do a substitute motion. I'd like to substitute that we limit to testimony to two minutes per person. Two minutes per person
per side, does that include questions? Not at this point. All right. We
have a substitute motion of limited debate to two minutes per side.
Speaker 307
2:12:03
Did you say it included questions? I'm sorry. Two minutes per person per side is what I said.
Per person per side. Yes, but that does not include questions at this point for my motion. Does not include questions. All right. So y'all know the motion.
All in favor, signify by saying aye. Aye. All opposed, nay. No. Motion carries. First, we have Maureen Manchero. Sorry about that.
Please come to the table. Would you get Nona Ellington in the
room, please? You're recognized. Introduce yourself and who
Marin Manseau
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2:12:46
you represent. Is it on? Yes. Okay. Can I remove? Yes, you may remove your man. My name is Marin Manseau, I'm here like for myself and I am a very new Little Rock resident. I just arrived a month ago from France. Abortion is legal in my country since 1975
and before this date when it was illegal, abortion was still there. there. Sorry. Legislating against it doesn't reduce the number of abortion. It just makes it less safe for low-income people, because higher income will usually go in another state. In France, for example, you had a lot of buses just traveling to other countries. That's how it was. So if we agree that legislating against abortion doesn't reduce the number
of abortion, and that our common goal is to have less abortion, in Arkansas, other alternatives exist. And they have proven their efficiency, like improving an easy and affordable access to contraception, knowing how to use it correctly, providing sex education, and many others you can find. I also want to remind you that being pregnant can be a risk. My mom got an intern hemorrhagia just after I was born and she could have died if my dad didn't
reach the doctor on time because he was in the corridor. Oregon has the third highest maternal mortality rate in the US. I also want to say that choosing to have a baby is also expensive. My cousin-in-law Jessica will need seven years to pay the debt of her very... Yeah, 15 seconds. And making it affordable to have a baby and fighting against poverty will certainly help reducing some abortion for economic reasons and I just want to finish on this point that a baby
unwanted will not live in a perfect loving family thanks to the adoption system. Right now the foster system is overwhelmed in Arkansas. Your time is up.
Any questions from committee? No we did not limit questions. Any questions from committee? Seeing none, thank you for your
comments. Nona Ellington, please come forward. Ryan Foster, would you bring Ryan Foster into the room?
Please introduce yourself and who
Nona Ellington
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2:15:21
you're here to represent. Yes, my name is
Speaker 315
2:15:24
Nona Ellington. Thank you, Mr. Chairman and committee members, Representative Bentley and Senator Raypert. I'm here in support of SB6. I would like to start off with making a statement that the rape and incest topic keeps coming up with this. It may not be an issue here, but it's a horrific thing to force or coerce a woman, especially a young woman, a teenager,
and to get in an abortion as a result of rape or incest. I am a victim of date rape when I was 15 years old, and this is my story. The rape was horrific enough as it was. I was so young, I didn't even realize what was happening. I was under the influence of drugs forced by my boyfriend, and so that was a very scary situation. After a few weeks, I realized that I was pregnant.
I went to Planned Parenthood, and they told me that because I was so young and still in high school, I needed to get an abortion. My sister and mom took me to get that abortion, and as a result of that one abortion, I was no longer able to have children. Instead of being able to have children, I had five miscarriages. Three of them were tubal pregnancies that required emergency surgery and very near-death experiences.
It was a horrible time for me. The abortion itself was excruciating. The anesthesia was not complete. You have 15 seconds. So I could feel and hear everything that was going on. My insides were being ripped out. That is more violence than the rape itself. and so it did not pay for me to have an abortion. It did not fix my situation. Instead, I have no children. Thank you for hearing my story. Any questions? Oh, questions.
Seeing none, thank you for your comments. Thank you. Ryan Foster, please go to the table. Melinda Chisholm, please get her to the room. please introduce yourself and who
Speaker 318
2:17:52
you represent my name is ryan foster i'm with the ozarks coalition we are an anti-extremist organization that operates here in the state of arkansas and doing so successfully for about three years i've come before this committee today because i'm
concerned about this bill it seems to just be nothing more than extension of christian extremists in this state to put their will to extend their influence into the daily lives of every Arkansan citizen unnecessarily. These bills have a potential negative side effect for a lot of people. We're very cheap and we say it's like ISIS or we say they're extreme in the way they want to control and regulate women's bodies. All I'm asking the committee here today is once again remember we are Americans. We live in a secular society. Your religion does not dictate what laws
are written in your government. We need to maintain that as our forefathers put forth. Thank you. Any questions from committee?
Thank you for your comments. Melinda Chisholm, please come forward.
Amy Thomas, are you in the room? Please get Amy Thomas from the waiting room.
Please introduce yourself and who you represent. May I remove my mask? Yes, you may. Thank you.
Melinda Chisholm
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2:19:08
My name is Melinda Chisholm, and I'm here representing myself, really. I am the director of a pregnancy center in Marlton, Arkansas, where I've led multiple, multiple women through studies to help them to heal from the trauma of abortion. and um but but more than that today i'm here to speak on my own trauma when i was 16 years old
my husband my boyfriend and i made the decision to have an abortion we thought it's legal it must be okay um and i won't ever forget the the nurse who held my hand while that abortion was going on as I screamed out from the excruciating pain that she talked about. She held my hand and squeezed it and said, it'll be over soon. Well, I can tell you it wasn't over soon.
In fact, the ripple effect of the abortion, the traumatic aspect of that would go deep into my family. I had two children later in life And my anger at myself, my shame, my regret, my depression, my anxiety and anger outbursts and acts of rage, it trickled into their lives and it hurt them tremendously.
I have a son who's 31 years old, is in prison right now for crack cocaine addiction. I have a daughter who's in the grave from an opiate addiction. You have 15 seconds. These things trickled into my family. And it is at a mass rate in the United States, trickling into homes and families. 60 plus million people. Think about that. Wrap your mind around that, what it's doing to our society. It is a crime against humanity.
Your time is up. Thank you. Any questions? Thank you for your comment. Amy Thomas, please come to the table. If you would, get Paul Bird into the room if he's
not already here. Please introduce yourself and who you're
Amy Thomas
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2:21:39
representing. My name is Amy Thomas, and I'm here with Arkansas Abortion Support Network.
Please pull the mic a little closer. You're
Amy Thomas
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2:21:53
recognized. I could use my time up here and spit facts to you guys about abortion, but that's not what I'm going to do today because you've already heard it repeatedly. So I'm going to appeal to you from the heart and tell you my personal story, which is that at 16 years old, I was raped by a classmate. He pinned me down despite my desperate nose and left me to clean most of his semen off of my own body with my underwear.
I was in utter shock and tried to act as though the whole entire situation didn't happen until a month later when my period never showed up and I had to ask my mother for a pregnancy test. Mercifully, it was negative and my period started the next day, but if it had come back positive, what I didn't know at 16 was that my body wasn't designed to carry a pregnancy. I have severe endometriosis and I was born with a unicorn uterus, which is essentially where you're born with half of your uterus a pregnancy could and with my other
chronic illnesses very likely would kill me if it were to ever occur under this bill at 16 years old i could have been forced into carrying my rapist child and unknowingly been handed a death sentence i a 16 year old child would have died and my story is not unique with one in four women being raped on average and 1 in 10 women suffering from endometriosis on average. You will be sentencing countless people to death, including young girls like I was. I implore you to think of them.
Thank you. Any questions from committee? Seeing none, thank
you for your comment. Paul Byrd, would you please come to the table? and Chilo
Klein. Please get them to the room. Please
Speaker 326
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introduce yourself and who you represent. Thank you, Mr. Chairman. My name's Paul Byrd. I'm an attorney here in Little Rock, Arkansas. I'm here for myself. I have represented several women in the past who've been injured in an
abortion. I don't think I can add anything you hadn't already heard from Mr. Parker, but I do want to relate an experience that I had with one of my good friends. We got into a debate on abortion and I can tell you this person is the most sincere compassionate person I know and we got to the point where we were about to lose a friendship and I said well I just know
one thing. God knows that I love you. And he and I calmed down and I realized that what we have here are compassionate people on both sides of an issue. There may be some that aren't sincere, but we have compassionate people on both sides of the issue. And I certainly believe that if compassionate people can come together, we can solve these problems. My heart goes out to some the testimony of the people you've heard here, but I believe if we look at what human is being
affected and that there's a human right that's being taken away, our compassions can be turned the right way, but then we ought to turn and compassionately work with the people who are on the opposite side of the fence and try to solve some of the problems that they see. And that's
all I have. Any questions from committee? Thank you
for your comments. Cleo Klein, I'm sorry if I mispronounced your name.
If you would, please introduce yourself and who you represent.
Chloe Klein
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2:25:33
Rose Mims, in the room, if you would get Rose Mims from the waiting room. Hi, my name is Chloe Klein. I am representing myself, but I am a pre-med student at Henderson State University. Roe v. Wade did not create abortions but made abortions safe. When abortions were illegal in 1965, 17 percent of all maternal deaths were due to unsafe abortions. Since Roe v. Wade was enacted, the maternal mortality rate due to abortion has dropped to less than 0.001 percent.
SB 6 will undoubtedly raise the maternal mortality rate in Arkansas as women will have to resort once again to unsafe abortions. I find it antithetical that this bill claims that it will protect all human life when the lives of women are being ignored. Supporters of SB6 are not focusing on reducing abortion rates. If they were, Arkansas would have better sex education and women would have access to affordable contraceptive care, which have both proven to significantly lower abortion rates and improve the lives of women. Women's lives are at stake if
SB6 is passed. I ask you to think about the women who are obtaining abortions. Most of them are in the situation as a result of Arkansas's inadequate education and health care access. I ask you to think about the women who have been raped, who are not supported or represented in this bill. Voting yes to SB6 means that you are failing women. If SB6 passes, our rights, our choice, and our lives will be ignored. Please vote no for SB6.
Thank you. Thank you for your comments. Rose Mims, if you would, come to the
table and get Jackie Warner from the
Rose Mims
Unverified
2:27:32
waiting room. Please introduce yourself and who you represent. Good afternoon. I'm Rose Mims, Executive Director of Arkansas Right to Life. I'm here simply to tell you that I do support the SB6 and would appreciate a good vote in support of it today. Thank you.
Thank you for your comments. Jackie Warner, please go to the table and get
Tony Rose from the waiting room please. Please go to the table. Introduce yourself and
Speaker 336
2:28:12
who you're representing. My name is Jackie Warner and I'm here to represent all women. First of all, thank you for letting me speak today on the floor. Also, happy Women's History Month, the irony of me being here yet again having to fight for my rights that have nothing to do with any of you. And I want to point that out.
I would like to give my testimony on my experience about my abortion. It was the best decision I ever made. The experience that I had at Planned Parenthood was phenomenal. They were supportive, gave me all the information I needed. And when I had my abortion, it wasn't that bad. I took a tiny pill. I didn't bleed any heavier than any of my other cycles. Didn't even fill up a full overnight pad. Hurt a little bit.
morning sickness was worse. But it was the best decision for myself and the fetus. I had no life to give a child. And you know what? Kismet happens. Condoms break. Contraceptive doesn't work sometimes. And the fact that you would take away my right to make choices about my body is sick. The problem here is the lack of education in school. I have taught. I have gone. I've taught in the elementary schools here in Arkansas. I've gone to school here my entire life. I was never once taught about sex education. I found out from peers, from the internet, nothing from
professionals to tell me how it was. And let me tell you, kids don't know anything from what I learned out there. So we need to follow suit such as Colorado, Hawaii, California, New Mexico, Oregon, Tennessee, and Washington, and allow for pharmacy-prescribed birth control. We also need get on the train of issuing IUDs. You have 15 seconds. My 15 seconds, I will say I own my body. My body is not a political playground and it is not a place for legislation. Do not pass this.
Thank you. Thank you for your comments. Tony Rose, if
you would go to the table. And if you would get Dr. Alexandra
Baselka-Bush from the waiting room, please introduce yourself and
Tony Rose
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2:30:40
who you're representing. My name is Toni Rose. I'm co-founder of An American Speaks and state director for the Congressional Prayer Caucus
Foundation. The most difficult decision some of you will have is the decades-old problem of wrestling with rape. And the exceptions that some of you will hear are really wrenching in terms of personal experiences. So what I'd like to talk to you about is those exceptions that have been in pro-life bills for decades.
For some, the fact that this is a baby is all that you need. But for other people, we need a little more discussion. And I've got numerous studies that I'm going to touch, just touch on, to tell you that those exceptions are not good for the mother either. As far back as 1978, a study by Sandra Markham found that victims of rape had numerous reasons for not aborting, including the feeling abortion would be another act of violence against their bodies.
Then we skip to Elliott Institute's study of 2000. Nearly 80% of women who aborted their children after rape reported that abortion was the wrong solution and only increased their trauma. None of the women who gave birth to a child conceived in rape expressed regret or wished that they had aborted instead. In that same study, 43% of rape victims said they were pressured by family or health care professionals. so while there were countless women that experienced guilt you have 15 seconds
wow for aborting none of the ones that had their child was sorry she had the baby so what's changed is the internet sex trafficking child rape on social media and according to a 2015 letter study almost 90% of trafficking victims had come in contact with healthcare providers who failed to recognize or turned a blind eye to victim circumstances.
Thank you. Thank you for your comments. Dr. Alexandra Baselka-Bush, please go to the table. Is she not there? Okay, let me go
on then. Allie Taylor. Is Allie Taylor in the room? Probably the waiting room.
Speaker 349
2:33:32
She's here. She only waits there. You can't feel bad. Please go to
Allie Taylor
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2:33:49
the table, introduce yourself and who you
Speaker 352
2:33:56
represent. Hi. My name is Allie Taylor. I am co-founder and president of Arkansas Abortion Support Network.
Thank you, chairman and committee members. I oppose SB 6. As you know, banning abortion doesn't end it. Banning abortion only makes it unsafe. And really, trying to ban abortion in the state ranked 47th in maternal mortality seems extra punitive and cruel. It's shameful. Banning abortion doesn't do anything to address a single issue that could actually help reduce
the need for abortions, as many have already said. It doesn't do anything to improve the circumstances of living, breathing Arkansans. But ultimately, banning abortion is big government at its worst. This is the state reaching into the most private, intimate decisions a person can make about pregnancy, birth, and parenting. This is the state saying it knows better than you what's good for your body, health, and life in this most profound and personal experience. If we allow
the state to make this decision for us, what's next? Wrapping up, I'd like to say that I do not regret my abortion. 24 years later, I am still grateful that I had the option and that the state wasn't arrogant enough to think that it could make this decision
for me. Thank you. Thank you for your comments. Senator Rayford, you're recognized to speak for
Senator Jason Rapert
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2:35:40
the bill. Please introduce yourself again. Thank you, Mr. Chairman. Senator Rayford, District 35. I appreciate you for recognizing
me today. And I want to thank all these members. I'm looking at members out here that have time after time again have stood for life in our state. We were just named the most pro-life state in the nation. As I sit here and listen to all of this testimony, Mr. Chairman, we failed the country. We failed our fellow man. We've allowed a situation to develop and a mentality based upon lies that these babies are not human beings. It's resulted in 62 million deaths in this nation,
innocent little babies. All I would ask you to do is do what's natural. Stand for life. When I closed on the Senate floor, I rarely go to the well, frankly, and quote any scripture. But Deuteronomy chapter 30, verse 19 through 20, Mr. Chairman, says that I lay before you this day a choice between life or death, blessing or cursing. And I think that God and I think fellow man are to choose life. Thank you, Mr. Chairman. Thank you for your comments.
uh amy thomas would you please get amy thomas from the waiting room and caroline morgan i'm present caroline uh you
want me right yes wait for miss thomas please
Okay, Caroline Morgan, please come to the table. If
you would get Jackie Warner from the waiting room, please introduce yourself and who you represent.
Caroline Morgan
Unverified
2:37:56
Yes, sir. Good afternoon, Chairman Leidyman and members of the committee. My name is Caroline Morgan. I am a mother, and I live here in Little Rock. I am testifying against SB 6. I am not affiliated with any particular agency or group. I am just a very concerned citizen who is standing up for the constitutional right to safe, legal, and accessible abortion here in Arkansas. In my readings and prep work for this testimony, I found a passage in this book by Jenny Brown, without apology, that I'm going to read with a few minor edits.
For women to have life, liberty, the pursuit of happiness, and a chance for equality with men, we must have full rights to abortion. This legislation, SB 6, aims to take away that right from us and our daughters and our granddaughters. Women's liberty to determine our destiny is at stake.
Speaker 206
2:39:04
That's all I have, thank you for listening. Thank
you for your comment. Jackie Warner, please come to the table if you're in the room. Get Jonah Marion from the room, please. Is
Speaker 297
2:39:33
Jackie Warner in the waiting room? Okay, Jonah Marion.
She's not there either. Okay, I would ask you all to go get Julie
McDonnell, Karen Musick, Sidney Roush, and Taylor Gessert and have them come in the room. We've got empty chairs. So that's four people, Julie McDonnell, Karen Musick, Sidney Roush, Taylor Gessert.
Are there any of those in the room? Julie McDonald, please go to the table to make your presentation.
Please introduce yourself and who you represent. May I remove my mask?
Speaker 371
2:40:48
Yes, you may. Thank you. Hi, I'm Julie McDonald from Greenbrier, and I appreciate the opportunity to speak with you all today. I am representing myself. First, I think we're all aware that this bill was created to challenge the constitutionality of Roe v. Wade and other decisions concerning abortion at the Supreme Court. For that to happen, there will be a lot of litigation costs, and that litigation will take a lot of time.
I admit I'm a pro-choice Christian woman, not because I want a woman or family to ever be in the position that they need to make this difficult, intimate decision. I am pro-choice because I believe in free will and that God designated women to have this decision-making power. I think we can all share the goal of wanting to reduce abortion and reduce the number of
women who feel they must make this difficult decision. My ask of you is this, is passing this bill the best way to accomplish that? there are things that you all can do immediately to reduce the number of abortions and protect women at the same time. Providing access to contraception, to appropriate sex education, and addressing the reasons why a woman might consider abortion in the first place has been
proven to reduce abortion in other states. If we truly want to save the lives of the unborn, there is middle ground to be found. We can act immediately to save lives, or we can wait on expensive litigation in a long process that will result in an unknown court decision. 15 seconds or we can begin right now with effective policies to save the lives of the unborn
i ask your time is up sorry i ask you to find that middle
Karen Music
Unverified
2:43:07
ground and vote against this bill thank you for your comment karen mystic
please come to the table please introduce
Speaker 378
2:43:26
yourself and who you're representing good afternoon my name is karen music and i'm from little rock i represent myself and the
Representative Ashley Hudson
Unverified
2:43:31
arkansas abortion support network of which i'm a co-founder i've spoken to some of you guys numerous times about abortion. And when I speak, I feel like we're in a battle. But I still think we have more in common than not. I think we all dream of the same things as each other, a better future for our families. I also support reducing abortions. I'd rather see a woman not have to make that choice. But is reducing abortion no longer the goal? Is this your
this bill that would deny an abortion to a 10-year-old child. Not every pregnancy is God-ordained. The simple math makes that so. This is a religious question, that you would take away the chance of freedom from a 10-year-old child whose pregnancy is most assuredly not God-ordained. there's nothing pro-life about that arkansas is not a third world country i urge you to vote no
Allie Taylor
Unverified
2:44:42
on sp6 thank you for your comments sydney roush please
go to the table please introduce yourself and who you're representing
Speaker 382
2:45:05
thank you chairman excuse me I'm going to remove this because I do tend
Speaker 384
2:45:14
to mumble good afternoon my name is Sydney Rash and I'm an attorney here from North Little Rock
I'm not here representing any organization today today I'm here to ask you to vote against Senate Bill 6 this bill is an unconstitutional embarrassment to the state of Arkansas and attempts to set a dangerous precedent that tokenizes the struggles of black Arkansans I'm not here to argue about whether anyone on this committee supports abortion or not. What I'm here to say is that we are allowed to have different opinions on these issues, but one thing remains the same. We all want to see fewer abortions in Arkansas. This bill isn't the way to do it.
This bill does make many statements which attempt to compare the struggles that black Americans have faced since the days of slavery to the issue of abortion in an attempt to somehow get this issue to the Supreme Court to overturn Roe vs. Wade. This is disturbing in so many ways because these issues are not the same. In 1954, when the Supreme Court overturned the separate but equal doctrine in public schools in Brown v. Board of Education, it was not contemplating the difference between a fetus in utero and a fully developed six-year-old child, it was contemplating the difference between a black six-year-old child and a white six-year-old child who deserved the same right
to education. They were comparing already existing humans to already existing humans. This is not the same thing. By struggling to compare the issue of abortion to the separate legal doctrine and struggle it does. This bill exploits the struggles of black Arkansans and tokenizes them with disgusting racist rhetoric that would be an embarrassment to Arkansas if it were made law. Even groups that do not support abortion access have expressed opposition to this bill because of its racist undertones and blatant disregard for these struggles. This bill does not help the cause and takes Arkansas backwards instead of forward.
Further, this bill will cost Arkansans taxpayers hundreds of thousands of dollars to defend in court and will never be implemented. You have 15 seconds. Thank you. Previous similar bills have been blocked even by conservative federal courts all over the country and this will be no different. This bill is bad for Arkansas and bad for Arkansans. This bill will not stop abortions. I ask you to please vote no on this bill today and start working on real ways to reduce the number of abortions performed in our state. Your time is up. Thank you
Speaker 77
2:47:21
for your comment. comments taylor gessert please introduce yourself and who you're here to represent
Taylor Gessert
Unverified
2:47:37
my name is taylor gessert and i'm here to represent myself as a woman who does not regret her abortion ladies and gentlemen of the public health committee it's my honor to come before you today to ask you to oppose the passage of SB 6. Let me make myself abundantly clear when I tell you that SB 6 will not end abortion in the state of Arkansas. It will only end safe abortions done in a sterile clinic environment by licensed physicians. Women will still seek out unlicensed
abortionists, which will result in many of them dying of a perforated uterus or infection. The state of Arkansas cannot be the most pro-life state in the country until they first care about the lives of women who will die seeking out illegal abortions if SB 6 becomes law. A fetus under 22 weeks is not viable, cannot survive outside the mother's womb, and is not more important than the mother who is a living, breathing human being. The United States is not
a theocracy and the great state of Arkansas is no exception. Legislators' religious beliefs are not and never will be a valid reason to control the lives and the bodies of women. So I implore each of you to trust women and show us that you value our lives as much as a non-viable fetus by voting no on SB 6 because we will not go back to wire coat hangers. Thank you for your time. Thank you for your
comments. Okay committee that is all of the people who are here to speak
on the bill. Representative, are you closing for your bill? You ready to close for your bill?
Representative Mary Bentley
Unverified
2:49:26
I'm ready to close my bill. Colleagues thank you today and I just want to thank you for the hard
work you've done to help women and children in this state. We have health clinics in every county in Arkansas. 75 counties have a health clinic where women can go to get contraceptives to get health care. We do have access to contraceptives, and this bill will not stop that. We have emergency contraceptives with
after that we can take as well. So I want to remind you of that, and we do have human beings created in the image of God living inside a mother's womb, and that's what we're here today is to protect those lives and protect the lives of thousands of women. You saw their testimony here, women whose lives have been hurt through abortion, physically, mentally, emotionally, women who will never be the same because of what have happened, the grit that they went through. So I appreciate your support today for women and infants in Arkansas. And with that, I would ask do pass on this bill.
Thank you. Okay, committee, the motion is do pass. Any discussion on the motion? Representative
Representative Kenneth B. Ferguson
Unverified
2:50:28
Ferguson, you're recognized. Thank you, committee. and I know most of you will vote for this but even if you're pro-life this is a pretty extreme pro-life bill most people want exceptions for rape and incest just like we talked about if there's incest of a young child and those things have been brought up but the other thing that has not been mentioned
there's rarely but often situations where a child has such severe fetal anomalies that they're not going to survive at birth. And in the case of this bill, if that physician does an abortion to keep that mother from having to carry a child that's not going to live at birth all the way to birth, they will be fined up to $100,000 in 10 years in prison.
I urge you, even if you're pro-life, this is a very draconian pro-life bill. Any further discussion from the committee? Seeing
none, all in favor, signify by saying aye. Aye. All
opposed, signify by saying no. The ayes have it. Congratulations, Representative. Your bill
has passed. Okay, committee, we're going to be here for a couple more minutes.
Representative Lundstrom, are you ready to present HB 1407? You're recognized to present HB 1407. Thank you, colleagues. I
Representative Robin Lundstrum
Unverified
2:52:12
will make this short and sweet. HB 1407 basically modifies the calculation for the stabilization tax. In unemployment, there are two taxes. First is the stabilization tax, and the other is the unemployment tax.
Both are paid by the employer. The stabilization tax is a tax of 0.02% is what this bill is offering. Basically, this will save about $10 million on businesses in Arkansas, and there's no impact to GR, and this will happen in 2021. or excuse me, 2022.
questions. Any questions from committee? Representative Wardlaw, you're recognized.
Representative Jeff Wardlaw
Unverified
2:52:56
Representative Blunstrow, where is the Department of Workforce on this bill? Have they commented? They are supportive. This is
Representative Robin Lundstrum
Unverified
2:53:01
from them. There are two of these bills to help businesses, and they are supportive of both bills, and they would be here. They have been here waiting, unfortunately, time. We pay them to five, right? Yes, we pay them, and they are working, and they would be here Thursday, but I'm here just trying to push these bills right on through, so they have been very helpful. Any other questions from committee?
Seeing none, is there anyone to speak against the bill, for the bill? Seeing none, are you ready to close for your bill? I'd appreciate a good vote. What's the will of the committee? I have a motion do pass. Any discussion on the motion? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay. Aye. Motion carries. Congratulations, your bill has passed. You've got one or two
more, I believe. Yes, I do. HB 1408, you're recognized to present that bill.
Representative Robin Lundstrum
Unverified
2:54:06
Thank you. HB 1408 basically codifies current existing practice. Aye. I'll take it. HB 1408, currently it codifies existing practice. We do not reimburse abortion providers in Medicaid and this has been going on for about since 2015. This just would put it into current law. Any questions from the committee. Seeing none, are you ready to close for
your bill? I'd appreciate a good
vote. It's current practice. Representative Cloud? Motion be passed. Have a motion do pass. Any discussion on the motion? Seeing none, all in favor
signify by saying aye. Aye. All opposed nay. Motion carries. Congratulations. Your
Representative Robin Lundstrum
Unverified
2:55:03
bill is passed. You're recognized to present HB 1409. 1409 is the companion to 1407. As I said before, there are two unemployment taxes. When an employer pays an unemployment tax, they have a wage base that is $10,000 and is calculated off the previous year's
unemployment. As you can imagine, that's going to be a wild year if they calculated off this last year. This would cap that base to $10,000. It would not go up to the $11,000, and there is no GR, but it would save employers $20 million, and this would take effect in 2022. Any questions from committee?
a motion on the floor from Representative Warlow.
Do pass. Any discussion on the motion? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay. Thank you, Representative Pilkington. All opposed, nay? Motion carries. Congratulations, your bill has passed.
Thank you, colleagues. Thank you for your time. Committee, thank you for your work today. You've done yeoman work. We are adjourned. What? Take your trash.
Speaker 402
2:56:21
What about that baby? I thought you were out of the
Speaker 251
2:56:33
room. Here comes the baby. I was looking down the list, John. I overlooked you. I
turned off the screen. I apologize for that. I guarantee you next meeting.
Agenda
CONCUR IN SENATE AMENDMENT
Number Sponsor Subtitle
HCR1002 Boyd TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE PROVIDERS, LAW ENFORCEMENT, EDUCATORS, PUBLIC OFFICIALS, AND THE ARKANSAS COMMUNITY IN BATTLING THE ABUSE OF PRESCRIPTION DRUGS IN ARKANSAS.
HB1118 Dotson TO PROVIDE THAT SALES BY A COTTAGE FOOD PRODUCTION OPERATION THROUGH THE INTERNET ARE EXEMPT FROM THE DEFINITION OF "FOOD SERVICE ESTABLISHMENT"; AND TO DECLARE AN EMERGENCY.
REGULAR AGENDA
Number Sponsor Subtitle
HB1152 Gazaway TO CREATE GABO'S LAW; TO ALLOW FOR EMERGENCY MEDICAL CARE TO BE PROVIDED TO INJURED POLICE DOGS; AND TO PROVIDE IMMUNITY.
HB1258 L. Johnson TO AUTHORIZE FULL INDEPENDENT PRACTICE AUTHORITY FOR CERTIFIED NURSE PRACTITIONERS WHO MEET CERTAIN REQUIREMENTS; AND TO CREATE THE FULL INDEPENDENT PRACTICE CREDENTIALING COMMITTEE.
HB1198 Penzo TO AMEND THE DEFINITION OF "PRACTICE OF CERTIFIED REGISTERED NURSE ANESTHESIA" BY REMOVING SUPERVISION REQUIREMENTS.
SB6 Rapert TO CREATE THE ARKANSAS UNBORN CHILD PROTECTION ACT; TO ABOLISH ABORTION IN ARKANSAS AND PROTECT THE LIVES OF UNBORN CHILDREN; AND TO PROTECT ALL HUMAN LIFE.
CONSENT AGENDA *Bills in Red added 03-02-2021
Number Sponsor Subtitle
HB1407 Lundstrum TO MODIFY THE METHOD OF CALCULATION OF THE STABILIZATION TAX IN CERTAIN CIRCUMSTANCES UNDER THE DIVISION OF WORKFORCE SERVICES LAW.
HB1409 Lundstrum TO MODIFY THE DEFINITION OF "WAGES" IN CERTAIN CIRCUMSTANCES UNDER THE DIVISION OF WORKFORCE SERVICES LAW.
SB258 Bledsoe TO AUTHORIZE NONMANDATORY MULTIYEAR REGISTRATION AND LICENSING BY THE CONTRACTORS LICENSING BOARD.
SB212 K. Hammer TO CREATE THE ARKANSAS PANS/PANDAS ADVISORY COUNCIL; AND TO DECLARE AN EMERGENCY.
SB254 K. Hammer TO ENSURE THAT BUSINESSES ARE NOT PENALIZED BY THE DEPARTMENT OF HEALTH FOR THE BEHAVIOR OF THEIR PATRONS OR CUSTOMERS DURING THE CORONAVIRUS 2019 (COVID-19) PUBLIC HEALTH EMERGENCY; AND TO DECLARE AN EMERGENCY.
HB1450 Eubanks TO REQUIRE A HEALTH BENEFIT PLAN TO PROVIDE COVERAGE FOR EARLY REFILLS OF PRESCRIPTION EYE DROPS; AND TO ESTABLISH THE ARKANSAS COVERAGE FOR EARLY REFILLS OF PRESCRIPTION EYE DROPS ACT.
HB1519 Eaves TO AMEND THE PETROLEUM STORAGE TANK TRUST FUND ACT; AND TO
INCREASE THE BALANCE OF THE PETROLEUM STORAGE TANK TRUST FUND REQUIRING A REDUCTION IN THE PETROLEUM ENVIRONMENTAL ASSURANCE FEE.
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH, WELFARE AND LABOR COMMITTEE- HOUSE, Mar 2, 2021 | Agenda | 2 | Official source ↗ |
| Handout 1- The Justice Foundation (SB6) | Exhibit | 13 | Official source ↗ |
| Handout 2- Arkansas Right to Life (SB6) | Exhibit | 29 | Official source ↗ |
Speakers
Representative Jack Ladyman Chair
Unverified
Chair
Unverified
Representative Jim Dotson
Unverified
Speaker 13
Representative Lee Johnson
Unverified
Senator Kim Hammer
Unverified
Speaker 36
Representative Joe Cloud
Unverified
Representative Clint Penzo
Unverified
Representative Kenneth B. Ferguson
Unverified
Speaker 84
Representative Richard McGrew
Unverified
Speaker 83
Speaker 65
Representative Fred Allen
Unverified
Speaker 97
Speaker 100
Representative Michelle Gray
Unverified
Speaker 116
Heather Whaley
Unverified
Speaker 124
Speaker 130
Speaker 133
Speaker 87
Representative Carlton Wing
Unverified
Speaker 151
Speaker 154
Representative Justin Boyd
Unverified
Speaker 172
Representative Josh Miller
Unverified
Representative Justin Gonzales
Unverified
Speaker 136
Speaker 153
Speaker 189
Representative Mary Bentley
Unverified
Speaker 200
Speaker 201
Speaker 209
Speaker 215
Carol Meadors
Unverified
Speaker 240
Speaker 249
Representative Jimmy Gazaway
Unverified
Officer Eric
Unverified
Speaker 268
Speaker 145
Representative Aaron Pilkington
Unverified
Speaker 250
Speaker 279
Speaker 282
Speaker 288
Representative Jeff Wardlaw
Unverified
Speaker 304
Speaker 307
Marin Manseau
Unverified
Nona Ellington
Unverified
Speaker 315
Speaker 318
Melinda Chisholm
Unverified
Amy Thomas
Unverified
Speaker 326
Chloe Klein
Unverified
Rose Mims
Unverified
Speaker 336
Tony Rose
Unverified
Speaker 349
Allie Taylor
Unverified
Speaker 352
Senator Jason Rapert
Unverified
Caroline Morgan
Unverified
Speaker 206
Speaker 297
Speaker 371
Karen Music
Unverified
Speaker 378
Representative Ashley Hudson
Unverified
Speaker 382
Speaker 384
Speaker 77
Taylor Gessert
Unverified
Representative Robin Lundstrum
Unverified
Speaker 391
Speaker 104
Speaker 402
Speaker 251
Speaker 365