Public Health, Welfare and Labor Committee- House

if there's anyone here that wishes to speak for or against the bill and you haven't signed up yet please do that please sign up on the sign in sheet. without objection the bills that in red that are on the agenda will be added to the consent agenda. See no objections that's done. So we'll move into the first bill here H. B. ten sixty one represented Mayberry you're recognized to present your bill. Okay sorry. Would you back up a minute please I got one thing I can do before you present your bill. A committee we've got a a concurrent amendment from the Senate that we wanted to real quick represented Boyd. If you would be a good employees H. C. R. one thousand and two it's on the back of the agenda she should be real quick we want to get this out of the way a Representative you're recognized. Thank you Mister chair I presented this and I believe it was Tuesday and we just need to adopt it is a concurrent Senate amendment rather than a do pass for the whole thing so I would just make a motion well I guess we gotta give you chance as foreign against or something but yeah any questions. Seeing none anybody honestly speaking for against or for. Seeing the rate closed yes I'm close and I'd like to make a motion to do pass this concurrent Senate Amendment on house concurrent resolution one thousand two okay motion is to pass the concur Senate Amendment a discussion. Seeing none all in favor signify by saying aye All opposed nay moshing carries a graduations passed thank you Mr. All right represented Mayberry you're recognized for a second time. Sponsored. A Representative you have a spot Amendment. Go ahead explain that what's been passed down okay the that thank you Mr chair members I do have an amendment and all that is at this point very simple just adding some more co sponsors to the bill. All right of the. ET you heard the amendment. I have a motion do pass by. To buy represented Dotson. Any discussion on the motion. Seeing none all in favor signify by saying aye. All opposed nay. Your amendment has been adopted you may proceed to present your bill okay thank you members first of All I Want to say have Jody and trade from the hospital association here Senator Breanne Davis was supposed to be here hopefully she'll be here any minute now I'd like to take the opportunity first to think this committee for allowing us to talk about this a few weeks ago it really brought out a lot of very emotional stories we had a lot of testimony here that opened the eyes about an issue and after that meeting the ball got rolling and we had so many people willing to work together to find a solution to this and so I appreciate even that blizzard that we had because it gave us even more time to really look at the bill talk about it I cannot even begin to tell you the amount of phone calls text zoom meetings that we've had on this bill so we really have brought a lot of people together and thank you for not passing it that day and letting us have the time to work on it more it was a great decision. After our first meeting I asked senator Davis I said we need balance but how will we know when we find the balance and she made the comment she said. When everybody feels a little uncomfortable and I went you know that's a pretty pretty good way to to look at it because that means everybody is moving closer to finding the solution and and I believe that we have have done that does this bill bring things back to the way it was before coded now unfortunately cove it is here but we are moving the bar forward and we are lining ourselves more with CMS guidelines Rachel bunch of the healthcare association could not be here today I believe she sent an email to all of you and reached out to you to say that there they are in support of this and she also pointed out that we still have issues to work through this is a good starting point. But the good news that I want to share because others may not know this information and I want to make sure that this is is shared. Cobit nineteen cases in long term care facilities were down to a hundred and twenty four positive patients and a hundred thirty one positive workers this translates to only eight facilities across the state having five plus cases meaning that the vast majority of facilities in the state have zero cases. According to this bill and CMS guidelines a long term care facility shall accommodate and support indoor visitation beyond compassionate care that is wonderful news we're going to keep the ball rolling DHS has been instrumental in helping to draft this amendment and has been working with me again making sure we're aligning with CMS federal guidelines. I cannot say enough nice things about how encouraging they were as well as the department of health they are all here today if you want to ask more specific questions don't just take my word for it. I have had an untold number of emails calls in tax with the hospitals association and Jodi and Trish she is here to answer questions we have developed a great relationship working on this bill I also reached out to disability rights Arkansas and they to or in support of this bill you'll see that in the bill we specifically talk about people with disabilities we based a lot of this on some language from a bill in Oregon and also the health and Human Services department kinda gave an outline to Connecticut on things that they need to be doing to support people with disabilities and to make sure that were in compliance with the Americans with disabilities act and another really important item that was in the original bill we never got around to discussing it that I think is extremely important is that this also insures that clergy or lay person offering religious or spiritual support can also visit very very important I truly believe that this bill balances caution with common sense compassionate care care there's a lot in this bill and I'd be happy to take any questions. Hi there any questions from committee. Represented Dotson you're recognized. Thank you Mr represent Mayberry I just wanna thank you for taking the time and and there's a lot of emotional everybody want to vote for this bill there is just some some tweaks that need to be made and I I just really appreciate you taking the time and getting it right getting everybody working with everybody to address all the concerns and bring this good piece of legislation before's thank you. Any other questions. seeing none is there anyone in the audience who would like to speak against the bill. Okay we do do we do have one person signed up to speak for the bill. Paul Byrd would you come forward please. All right thank you. All right of seeing no further questions are you ready to close for your bill I am closed and I'd appreciate a good vote. I have a motion represented Monson of do pass as amended any discussion on the motion. The represented Boyd you're recognized. Thank you Mr I just really want to. Replicate would represent a Dotson said about thanking represented Mayberry for working on this this is something we all support but it's got to be in a workable thing for the citizens of Arkansas office of I just want to reiterate my thanks thank you I heard you loud and clear so thank you. Well I do believe this is a good blueprint for other people to look at and if we if we have a lot of hurdles in this meeting you can take it down work on it as you did and and make it a really good bill so the way it is a good bill any other discussion. Seeing none all in favor signify by saying aye. All opposed nay. Motion carries congratulations your bill is passed. Okay next item on the agenda is HB fourteen eighty eight percent of Gonzalez. You're recognized to present your bill. Thank you Mr thank you committee of house bill fourteen eighty eight is one of the governor's executive orders that were just codifying were walking stop protection it simply says if. If you can prove that you're exposed to cope with the hand and got covered at work that you can follow workman's comp claim and it also gives businesses and for protection. But it. A committee any questions. Represent Payton you're recognized. Thank you and have been. Trying to imagine my business career has nothing do with the medical field and I don't know of any infectious disease it was ever considered something that workers comp would would cover and as I read in the bill on the sections of code there already exist at the top of page three there's a paragraph already in code. That says compensation shall not be payable for any contagious or infectious disease unless contracted in the course of employment in or media connection with a hospital or sanatorium. So. My question is the paragraph you're adding in three B. regarding coronavirus is that still going to. Please be subject only to a hospital or sanatorium. we setting a precedence here were infectious disease becomes. Or something that can be compensated other than at a hospital or sanatorium. Well I think the intent was to. To make it work you could claim coronavirus other than a hospital or sanatorium To give the workers a little bit a level of comfort for going to work you know and that they could could be extra exposed but they have to prove that they did he'll contact from the the employee to make the claim and this this expires go and twenty twenty one it does it does sunset so unless we are on twenty twenty three I'm sorry it does have a sunset on it so it goes away unless we decide to re at this. And as it relates to corona virus I can understand but we've had infectious diseases for as long as you man he's been here and there are deadly infectious diseases every day trying to figure out where somebody caught it at home recreation or on the job is going to be impossible and I think that's why this section or code already had a provision that said compensation shall not be payable for any contagious or infectious disease. Other than if you're working in a healthcare setting you know and I just hate to see a set a precedence here where we start I mean you're you're protecting the employers from liability for attaining to corona virus but are you opening the door to liability for all the other infectious diseases. That's not concern. Yeah I don't believe so but with your will the chair will allow will bring Justin Allen appeared. Clarify the. Yep Senators yourself in the represent. Thank you Mr chairman names just now on an attorney here in Little Rock and I've been working with the business and health care community on these issues. The answer your question is no this will not open up a comp claims for other types of infectious diseases that that that I think I hear you referencing it will be limited to corona virus but it will be in all work or working settings not just health care settings the regular business settings in the goal here we we we did two things with this bill which is an executive order currently but we would like to see all codified is on one hand we made clear this makes clear that coved if you can prove that you contracted at work is a compensable work injury now sometimes that may be very difficult sometimes it may be very easy especially if you are in a healthcare setting taking care of people with covered so they can bring a comp claim for you know the lost wages the medical bills associated with their co that hopefully they're just sticking out of work for a couple weeks but we also know that it can be worse than that the flip side of that is the trade off for the employers here is this makes clear that if the employer knows that there's a a darn good chance in again in some settings they do know that the employee could be exposed to coding contracted it while it's a compensable claim it doesn't turn into a tort claim so the employer has this brings predictability for the employees and employer as relates to covered workers comp claims for the next two years as the Representative stated this will expire in two years so what that will do is put the onus on the next General Assembly when you meet in two years to look at the world what's going on with Calvin do we need to extend the east we need to let that let it expire we need to change it and extend it so that's the goal here. follow up. You're recognized. Thank you and appreciate you come to the table it's very informative. So prior to this executive order. And prior to this proposed change in the law. The only employers that would be. liable would be hospital setting and sanatorium is that correct that's correct. So we are bringing in all other businesses. Into a first time. Position of being liable for of infectious disease. A potentially and that's the thing is if nothing happens we don't have an executive order or legislation we have unpredictability is how the commission and ultimately on our court of appeals and Supreme Court would tree covered in a calm setting they might treated as a compensable injury they have not contrary to law yeah well did that might interpret it differently than that it certainly it happens so This Is predictability and the business community it is comfortable with that thank you know is it are they losing something here yes potentially but the trade off again is to make sure that it's not going to turn into a tort claim. Follow up. Media outlet represent about and ask his question written down you're recognized thank thank you Mr so with this bill you are saying that an employee can no longer. Our tort claim is that correct no that they could still file a tort claim if the employer acts intentionally which is the law right now there's an intention intentional conduct exception to workers comp so they would still be able to do it what it is saying is knowing that there's a good chance you might get exposed to code that is not an intentional act so this this bill is making it more difficult. For them to file a claim but you never know what not electors compline bill will come up to work on I mean you could take that position but what it is doing is is saying for instance let's take a healthcare setting where the employee is working directly with somebody with COPD if we didn't change this law that employer if we didn't adopt this bill that employer knows that that employees going to get exposed to covered in if they know that the that that's can result into a tort claim because of intentional conduct that won't be able to operate it will be to take care of the people because the B. defending tort claims left and right but it still protects the employer employee by making clear you can follow compline and recover your lost wages in your medical bills but it's also taking away one of them want one because of if the only thing they can do now is filed workman's comp NO toward going. Then it's time a hand to the totally for me to the workman's comp only with two very nice to know so they could there's still an Avenue to file a tort claim if the employer acts intentionally and does so that we actually like since the man without PP okay I have three proven right of course okay and I think that's the situation now yes Sir. Resented Boyd you're recognized. Thank you Mr chair and I know you said this I just want to say it and then have you confirm that I understand exactly what this does so this puts in place in the statute if someone so if I have a restaurant list I have restaurant and I'm taking reasonable precautions to keep my employees safe from cove it but we all know coverage out in the environment so there's some risk no matter what precautions you take. It opens up the Avenue for a workers comp claim rather than only leaving open the Avenue for a tort claim with would you. Yes I agree or help me understand what I mistake yeah and I think that's fair and in the reality is if we don't pass this law it's possible that the commission in the courts would say employee this is an ordinary disease of daily life represent us another piece up will part of the language in here they may say co that is an ordinary disease of daily life and the employer was doing everything they could there's no comp claim there's no tort claim there's no claim to be had this will make sure that if the employee can prove I got at work I'm at home and I'm at work that's the only that's the evidence that they put on in they have evidence that there was somebody with code at work they've got a comp claim. Right now they may not have anything. This brings predictability is it ideal no but we're not an ideal situation but predictability helps tremendously. Skews me before recognized represented Payton for a question. Need to make the announcement if you're standing in the room you have to go to the holding area only people who are in the C. can stay in the room. I mean if you can swap seats or whatever But please go to the holding room if you do not have a seat. Representation you're recognized for a question. Thank you Mr and so you made my point. Currently. They don't have a workers comp claim under the provisions in paragraph two and three unless they're in a hospital or sanatorium setting. And I understand what you're saying about the the commission or the courts may not right may go contrary to the law but then if we're changing the law they still want to go contrary to it in that argument. Why do we even craft the law if there is we're gonna recognize that they may go contrary to it so I would argue that businesses have more protection under the current law the what they'll have with this change when it comes to liability also argue that. We are setting a precedent for infectious disease so people get the flu people get other infectious diseases wonder or when a we're going to start. trying to put a paragraph in there for every disease because under paragraph two and three is that currently exist all of those communicable diseases diseases of life it says in which the general public is exposed. All of those are exempt from a workers comp compensation unless it's in a. Health care setting. I certainly hear your point and there that that that's a valid argument however the biz it leased the business community that I represent has decided that accepting and acknowledging that code can be if proven is a worker compensable claim is worth the trade off of the threat of the potential tort claims in the lawsuits filed in court where the exposure can be much greater blood like to say I have seven corporations five storefront in this state and nobody has pulled me as a business leader to tax me where I stood on I don't know what association you're part of of my associations have an **** thank you Mr. All right any other questions from committee. Seeing none anyone in the audience speak against the bill. For the bill. Are you ready close for you bill represented. Yeah motion. We have a motion do pass any discussion on the motion represent Payton recognized. Thank you Mr chair colleagues I just urge you to take a closer look at this some will be vote no but you all just take a close look at thanks. Any other discussion. Motion on the floors do pass all in favor signify by saying aye. All opposed nay. Is have it translation bills passed we're going to modify the agenda a little bit censure at the table you're going to run HB fifteen twenty one for sent a represented McCollum so you're recognized to present the bill. thank you Mr this is another one of the. Governor's executive orders that codifying here protecting health care workers The made some changes that of. Allows facilities to extend hours for healthcare workers and things like that and just give them again liability protection for the for the healthcare workers. Unless it's an intentional act then they're still so. Any questions from committee. Seeing none anyone in the audience here to oppose the bill. Anyone speak for the bill. Seeing none you read the close them clothes make a motion to pass. I have a motion to pass any discussion on the motion. Seeing none all in favor signify by saying aye All opposed nay moshing carries graduation your bill is passed. Okay we'll move to S. B. two eighty nine Representative Smith. You're recognized to present your bill. Thank you Mister chair may I add remove my mask. Yes you social distance. All right. Joining me at the table is a. Attorney Stephanie Nichols I also have Senator hammer in the room and. I may need to step back and let him come. Help present this bill in just a minute but I appreciate you taking time out of your schedule an agenda to hear SB two eighty nine and it simply is an act to create the medical ethics and diversity act them for other purposes in addition to these two at the table I'm going to call doctor Greg Bledsoe and With your permission I'll step back and let the doctor Bledsoe come at this point and make a statement. Okay. Dr blood so if you would introduce yourself and who you are here to represent yes Sir thank you Mister chairman Dr Greg Bledsoe Surgeon General for the state but speaking as a physician and not for the governor on this issue the governor's officially neutral you're recognized. So I appreciate the committee allowing me to speak this is been an issue that I've wrestled with for the past five years and probably been one of the bill said I've I've no struggled with in my time the Surgeon General if the committee members were here in two thousand seventeen you can remember that I spoke against this bill and I was very adamant in my opposition to it and in two thousand seventeen I spoke against it for two reasons number one I thought it was a solution looking for a problem I didn't see a problem and the number two I was concerned about the message it might give members of certain marginalized groups in our society and I felt very strongly that we didn't want to be doing something that would because members of our communities to feel threatened or discriminated against or in any way opposed by what we're doing here but since that time in the last four years some things have changed and I've actually changed my position on this I'll be speaking in favor of it today and and I wanted just to give the committee a couple of data points first of all regarding the the discriminatory aspect of this are the concerns regarding discrimination. I've heard a lot of people say that this bill could be used to discriminate against broad groups and so if the physician didn't like a certain political party or didn't like a certain race or religion or you know some other group that someone was and that they could recuse themselves and say I'm not taking care of that group that is not contained in this bill in the least I've looked through every line of this bill this bill is procedure based if the surgeon for instance does gall bladder surgeries the surgeon would have to do gallbladder surgery on every group regardless so if someone came to them who is a member of the LGBTQ community or a member of different faith or a different political party and that surgeon did gall bladder surgeries that surgeon would be required to do that likewise if the surgeon didn't do a certain procedure this bill would protect against someone saying what you have to do this procedure on me for you know whatever reason and so I don't believe that this is discriminatory towards a group it's procedure base and it's lined out very clearly secondly the the thing that people are worried about is emergency care says nothing to do with emergency care so I'm I'm an emergency physician I still practice in a busy emergency department I've been an emergency physician for twenty years and we as a as a specialty take great pride in taking care of everyone so anyone who comes into an emergency department by federal law we were required to see and assess and we do that and we do that with great pride and so I feel very strongly about making sure that no group is discriminated against by any legislation particularly the US and I don't believe it does so emergency departments are still open. Now people can't be discriminated against based on the fact that they're in a group is procedure based and so after looking at this and talking to others who've looked at this bill who know the legal aspect of it a little bit better than I do I feel confident that this is not discriminatory that towards any group in particular and couldn't be used to target one group or another you know based on race religion sexual orientation and political party or anything like that and that's something that's very important to me the other aspect that concerned me in two thousand seventeen that I'd like to address is just the solution looking for a problem aspect I've had a lot of people who have called me and said you know do we really need something like this you know in in the state of Arkansas in two thousand seventeen I feel very strongly that we didn't matter fact I told family counseling others that if we don't have a problem we don't need to be creating legislation to solve problems that we don't have I think that's bad precedent as a political conservative I feel very strongly about not introducing legislation just because we can but a few things that happened in two thousand since two thousand seventeen it's it's caused me to change my position on this the first thing is is that when you look at legislation that's in other states I'm growing increasingly concerned that certain aspects of our health care is becoming increasingly politicized. In the state of California right now in in the California Senate there's a bill that's being hotly debated that would for bid pediatric urologist from doing corrective surgery on children who have Andy was genitalia or your reserve risks that are not properly formed in less there's a an imminent emergency and so you know in the past their children a lot of children who are born with abnormalities in their genital areas it has nothing to do with gender has nothing to do with sex chromosomes or or anything like that sometimes has to do with things such as cortisol deficiencies and and other problems that nothing to do with gender or crumbs on issues and the standard of care has always been that you correct those as soon as possible so the children don't have problems later it would regarding their genital you urinary tract and in the California Senate right now there's a bill that would for bid that even if the physician and the parents were in favor of corrective surgery and less it until the child becomes six years old or older and I think the the the of the the perspective on that is is that the child when they're six construct weighing in on their own healthcare and can help make a decision of whether or not they want to corrective surgery I think that's the intent of it but that concerns me that there's political station of that issue AS poin number one point number two is I've had a number of friends of mine who are code close colleagues in the the world of pediatric neurology if come to me and said. That their national meetings they're getting increase political pressure placed on them and there's a growing number of acting additions in the Ivy League and other academic medical centers who are telling them that they need to be required to do sex change surgeries on children even if they feel like that is not appropriate this was something that I was not told prior to two thousand seventeen but I've had more than one pediatric urologist come to me and confidence and say that this is happening in their professional societies they're very concerned about it and there are a number of people who have who are expressing increasing concern about the political session of that issue. so that's changed but the the biggest data point to change for me that really made me stop and reevaluate this issue was after I testified in two thousand seventeen maybe eight months after my testimony I was at a social event with the leader of our Arkansas department of health who I won't name but pulled me aside and confidence and said that we were talking about budgets and issues in this issue of conscience came up in this individual pulled me aside so great there's something you need to know about this issue and they said in the last year of the Obama administration there was a high ranking one of the top people for the US justice department came through Little Rock and asked to meet with our department of health leadership and of course they said sure that's that's fine and there was no agenda given it was sort of a Hey I'm in the area can get together and they talk about a lot of different issues at this meeting and towards the end of the meeting this justice department official said you know we at the justice department in the Obama administration take discrimination very seriously in our department of health said bill we do too absolutely we don't want anyone tonight Care discriminated against and they said if you have physicians in the state of Arkansas who were doing mastectomies for cancer or for other types of medical care and they're unwilling to do mastectomies for sex change surgeries war if you have OBGYN for pediatric urologist re Rollo just who are doing corrective surgery on the genital region for any reason and these individuals are on willing to the sex change surgeries you need to send letters out to the physicians in Arkansas and tell them that that in our perspective is the US justice department there there are violating the standards of discrimination and they're at risk of losing their federal funding and this person came to me and said we did not know what to do with this we sort of sat on this and then there was an election a few months later and this sort of just died and went went away but they were very concerned that this could be resurrected and with this you know I will I guess. For lack of a better word clear and present danger and that this could be launched again towards the positions in Arkansas you know I I not only felt like I needed to switch my position on this bill but I felt obligated as the Surgeon General to communicate this to the people of Arkansas and to you guys in the House I think the the citizens of Arkansas need to realize that this was discussed at a very high level and that this is something that concerns me greatly that there are potentially recommendations coming from the federal government they could coerce are hospitals and other providers into saying to physicians okay if you're a pediatric urologist your urologist or you're a breast surgeon at you for you to have credentials to do surgery in our operating room then you're gonna be required to do the surgeries as well you're gonna lose your credentials are hospital One thing and one last thing And closing I would just say is coercing physicians or any other healthcare provider into doing things against a conscience is a very dangerous precedent Review fall on the political spectrum or whatever your beliefs are on specific issues if you are and and let me just say this very clearly if you're someone who feels like you need a sex change surgery you know even in that situation you do not want a person doing the surgery on you who was being coerced into doing it the it is highly imperative that we keep politics out of these discussions because these are the surgeries and other issues that sometimes are irreversible and if you're someone who is going to have a sex change surgery you want to make absolutely certain that the person who is recommending that surgery to you is doing so because they believe was the right medical thing and not because they have enough for lack of a better term the cold tentacle of the State wrapped around their throat choking them and telling them they have to do that I feel very strongly about that and I feel very strongly about it not just because you know of of all the things I've mentioned but because I believe very strongly that the members of the LGBTQ community need to have you know excellent medical care that is untainted by politics they need to know all the information before they go before a surgeon or physician is recommending things and keeping politics out of those discussions is absolute imperative for the state of Arkansas so I'm happy to answer any questions but for those reasons I've switched my my vote on this bill and bill strongly that it needs to be passed. Committee or any questions. You're recognized. Thank you the spearmint thank you doctor. For coming in I have a great deal of respect for you thank you. My question is that you said that this happened under the Obama administration which was five years ago the profit so what is to wait five years to bring it back up. Yes so this this test match a great question thank you represent Allen so this this testimony was given to me probably eight months after my testimony two thousand seventeen and in two thousand nineteen no one asked me about it no one asked to testify you know on behalf for against the bill the governor's office of always been neutral on this issue but this year I was asked to testify and and honestly I wrestled with my testimony about this I've been contacted by a number of people that I really respect to or in the healthcare profession some of them are are here today to testify against this bill and their their opinions on this bill mean a lot to me we're we're almost always unified on our perspective on issues and so this is been an issue that I've wrestled with very strongly but you know under the current circumstances and with the with the change in the administration of the federal level and the fact that I believe that you know in addition to that testimony I was given I've had these other data points that I mentioned all those things together made me feel like I needed to call for but former but yes you you did mention that after Obama left office it went away. You said that this this one away so my question to you is that's what brought it back I'm sorry what brought it back why are we here talking about it today when when you said that when Obama left office and it went away. Yes so are you saying this back now well I think it's been a change in Washington you will the two things the the fact that there's the for instance the legislation I'm sitting around in other states for instance the bill in California and then also the testimony of my colleagues and so those those were the both occurred in the last year to eighteen months and so that's been a change the by the ministration there's legislation now in the U. S. house that's talking about a lot of discrimination issues and I think it's very important that we as a country to do everything we can to make sure that people are discriminated against but I am concerned that some of these issues are going to be pushed into that conversation in an appropriate way and I think that the people of Arkansas need to be aware of that yes Sir thank you so much yesterday I have a great deal of respect for you and in your many many accomplishments thank you represent on. The other questions per Speaker. Senate where you're recognized thank you Mr chair M.. So question for use of heard you talk a lot about providers and the protections that they need but this bill also covers healthcare institutions and payors do you care to talk to those to you and tell me why you believe they need to be included in the bill so that yeah that's a great question I've asked attorneys to look at this bill too because I know one of the big there there's actually two big questions that I've wrestled with that I'd you know the one is the breadth of the bill which is what you're talking about that's one issue and then there's another issue which is you know could this amendment that amendment be added to include certain types of language that would make it seem less discriminatory or or give more protection I really unit. I've looked at those things I feel like you know I've come to the conclusion that that that this bill would not cause major problems but I would like to deferred that the line share the discussion on those issues to the attorneys and to the others who know these issues a little bit better than I do because I'm I'm not an attorney so I would just to further that if that's okay follow at Mr yes you're recognized thank you since when I turn by Michael years goes off the altered mental but. So would you be supportive of the bill say I filed a bill that just dealt with providers and took healthcare institutions and players out would you be supportive of that yeah that's a great question and what I've told people is is that what I want it will but I feel strongly about is is that I want the ability for healthcare providers to recused himself from procedures that they feel like they could they can be a part of that's number one and then the other thing is I feel very strongly I I want to build it does not target groups and so if we can put together a bill that does those two things I'm I'm fine with that but again you know I'm not an attorney and so I would deferred at my colleagues who are in support of this bill who are attorneys are legally trained but I think the key issue here is is that I want the ability for healthcare providers to recuse themselves if they feel like they can't in good conscience do a procedure but at the same time I do not want groups of people targeted because of who they are. Representa Boyd you're recognized. Thank you Mr chair doctor blood so you maybe just answer this with your last comment but I'm gonna ask it a little different way so. We all I mean you litter the federal government we know how many billions of dollars in health care that is being provided by the federal government in center the politics right so with that in mind this has been offered as a solution I guess my question for you is what lead you to believe this is really the solution for Arkansas all Arkansas that this legislature because obviously we can't mandate with the federal government does right so could you just speak to that directly as to why this is the best solution sure and and again I that's probably more of a legal question talking about state versus federal law and and how we you know how we go about you know sorting those things out I'll just say this is that the op I'm not a hundred percent sure how you know the federal precedent but how that would work out if we passed this and then the federal regulations change but I do believe that this would give us a chance and it would give us some protection more protection than up in the physicians and the nurses have now again that's that's a legal issue that I think the attorneys need to weigh in on on the specifics but my opinion is is that right now we don't have a lot of protection for these changes that have occurred in the last few years and so that's that's why I've come on board in support of this. All right single single more questions thank you for your comments thank you Mr. At this moment I would like to ask that Stephanie nickel present some information to the Committee on this bill. Okay please enter this yourself and who you're here to represent. Take care I'm sorry Mister chair may I have permission to remove the mask while I'm speaking you do if you keep six feet distance between you and Mister Smith there yes Mister chair thank you I'm Stephanie Nichols I'm from Jonesborough I'm a lifelong resident of Arkansas and I'm legal counsel for alliance defending freedom and I've also worked in the state since twenty twelve on a pro bono okay basis for religious freedom and conscience issues I'm also a Christian and that informs my perspectives and it means that I absolutely do believe in health care for all people and serving all people so I have reviewed and vetted the bill and also looked at national issues involving medical conscience because I wanted to make sure that there was no conflict with that ability of absolutely everyone to be served and get the healthcare services that they may but you know the most important thing when you go to pass a new law is the question of why is this undated so if I could share a few stories with you when medical providers discovered that you're working on medical conscience issues they start to come up to you and I start to share their stories and these are some of the stories that a personally been shared with me the medical student who wanted to be an OBGYN but experience so much pressure against her beliefs that she had to go into a different field six parents high pressure meetings with med school faculty and discriminatory harassing comments she also experience suggestions that only certain residencies were appropriate for her due to her Catholic beliefs now I want to stop right here and say this was not a student in Arkansas but I think we might be naive if we think that things like this are not happening anywhere in our state and this is how she feels about protecting medical conscience she says I can say with apps. Lou certainty that if I felt that my religious beliefs were protected without a doubt that there were consequences for organizations and programs that penalize religious people for not providing non essential services my options in medicine would have been much greater I was practically pigeonholed into a career that involves the bare minimum patient interactions simply because I felt so afraid that being a Catholic would prevent me from getting a job and would have career ending consequences for my family that statement that that's that's a client I have from a very conservative state I do believe issues like this are everywhere a young physician's assistant shared with me her story of being fired from her job because she refused to dispense abortion causing drugs I have visited with the doctor who is experiencing severe stress over being asked to provide referrals for medically unnecessary mastectomies for teen girls as part of sex change operations it's important to note that a card has issued guidance bulletins advocating surgeries for teen girls as part of gender transition in some cases so that plays into the fact that they're starting to grow much more pressure on providers to perform procedures they may have a conscientious objection to or to refer for those procedures. in Jonesborough let let's talk a little bit about what's happening right here in Arkansas advanced practice nurses have been asked by patients to go about gender transition hormones for minors against their conscience beliefs also I'm I'm sure you're probably aware of this but Arkansas children's hospital has a new gender transition planning so the pressure is now on for primary care advanced practice nurses and doctors throughout the state to provide referrals for that surgery for those certain services and surgeries now is it is important to note that this bill it does not outlaw. Any procedures neither does it provide an affirmative right to do our procedure and is viewpoint neutral so let's take for example the example of conversion therapy that something that lots of providers have a conscience objection about that this bill would also provide the right of a provider to decline to provide something like conversion therapy it works on both sides of the spectrum. you know what we're talking about how much the world is changing and just to put a picture on this I may pediatrician appointments for my children in Jonesborough recently and I got asked if my ten year old daughter to see identified as female I got asked about my eight year old son does he identify as male so that shows you that there is definitely a hot button contentious issue that providers in Arkansas are going to have pressure to provide prescribed drugs they may not believe it or provide referrals I don't believe in and I believe there's enough diversity in our society that we don't have to force providers to participate in services they don't believe in there's a free market you can access those services elsewhere we gained a lot in America if we make sure that there is a room for us all another point to consider about Arkansas law did you know physician's assistants have been having to give out abortion referrals as part of their jobs our current abortion conscience statutes don't make clear the right to decline referrals another very important thing we have existing conscience protections for abortion and contraception so those are already in place but in some ways that they are sealed against liability against being sued but in some ways they're right in name only because people almost as if people think they have more rights than they do under those statutes if a doctor or nurse loses their job right now for refusing to participate in an abortion or give an abortion referral there is no cause of action in that statute that allows them to access the court system so that's a problem if we want to continue being the number one pro life state and the nation. I guess one thing I really wanted to address. As far as safeguards in track records because that is what I wanted to look at is an attorney I can't come before you and recommend this bill with a straight face unless I've done the research to say okay I have there been unintended consequences throughout the country the two states that have similar bills are Illinois and Mississippi and I did some legal research I'd like to share with you so the Illinois case has been in place since nineteen seventy seven and the Mississippi law since two thousand four so I wanted to do a case law research and see how many cases on West Los show up is being brought under those this is this is my one page of results. Many of those are just the different stages of the same case so they're they're seven unique fact patterns there they involve things like objections to abortion sterilization and contraception and cases brought by pro life pregnancy centers that's the majority of them so we don't really have this major hot bed of litigation and I also wanted to show you our research to see if under the Illinois and Mississippi laws if anyone had claimed what you do with the discrimination cases you bring that under federal or state discrimination law I wanted to know has anybody tried to use a conscience law to get out of its discrimination case. And these are my results zero zero throughout all those over forty years the Illinois law has been in place in Mississippi since two thousand four the other thing you want to make sure about for patient protection is to make sure that you can't let you something like this to get out of medical malpractice claims. So I research to see if the conscience law had ever been used as a defense to a medical malpractice claims. These are my results four zero again so when you hear those claims there's no track record to back that up and I would ask you as you carefully consider this bill to decide based on evidence of what is happening in the real world instead of a parade of horrible and I've read the press on this I've looked at social media and I do know that there are some crazy outlandish claims against this but I think it's important to center the conversation where the debates actually are it's not about providing emergency medical treatment that's exempted it mandated in the bill what it is about and I I do give credit I found this post from the young Democrats of Arkansas women's caucus and they spoke accurately about the bill they discussed that it would it would limit the conscience objection to certain procedures this is what they had to say thank of doctors denying it they think it's a bad bill but this is these are their words thank of doctors denied abortion. Thank of doctors the nine gender affirming care to trans individuals now what that means is doctors declining to preferred gender transition hormones sometimes for minors doctors declining to perform gender transition surgery sometimes for minors they said or think of doctors did nine certain end of life care that's code word for doctors declining to participate in euthanasia or assisted suicide so I do give them credit for bringing the conversation where the actual conscience objections are. So one question we have about this is how is it we're going to get this law into place and then there's going to immediately be a lawsuit now. The ACLU and other similar organizations these laws have been in place in Illinois and Mississippi for Illinois over forty years Mississippi since two thousand four the ACLU has filed now lawsuits because these laws do not have a discriminatory impact and if they did have a discriminatory discriminatory impact I would not as an Arkansas lawyer want to fit my reputation and name on the line backing a bill that would have that impact. this bill also offers solid emergency protections which means that you cannot decline performing an emergency medical procedure as defined under M. Tallis and I would like to read to you just how broad that as defined under federal law we want to define emergency broadly so we use the invalidate Phoenician and intolerant choirs the screening examination so you must see the state of that patient as well so screening examination required and it's an emergency medical condition defined as a condition manifesting acute symptoms of sufficient severe severity including severe pain so even pain counts such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health in serious jeopardy series impaired impairment to bodily functions or serious dysfunction of bodily organs what that means an application throughout the hospitals throughout the country is that you have to be very careful to air on the side of pre providing the treatment like that even covers antibiotics if you show up with an infection antibiotics are amended to merchants the medical treatment under the M. Talinda Phoenician so what you to take note that there is that safeguards built into the bill. another question that we have been asked is what can't we rely on existing federal law to protect against this and there is title seven for employers but there's a there are a couple of reasons why that is not sufficient one it is only limited to the employer employee contacts so it provides no liability protection and we are seeing in America we see lawsuits for doctors who refuse to perform gender transition services or sterilization we see lawsuits like that so I think it's important for Arkansas to provide that liability practice liability protection so doctors can practice with peace of mind I mean the other thing is under title seven your employer only has to grant you an accommodation if it's a religious objection and for some people they don't have religious beliefs they can point to you but ethical concerns which are centered more around informed consent and things like that and the other issue is if your employer can show anything more than a demand of miss Barton they do not have to grant the accommodation so I'm sure that we have several hospital systems and institutions in the state who are generous with their employers but just as a legal standard that's not enough you have cases throughout the country where nurses have been pulled into abortion saying Hey you're the only nurse on staff who can do this and it's often not a true emergency situation then they have that on their conscience for the rest of their lives it's a big deal that that we provide more protection than demand of miss minimal protection for employees the other thing I would say about federal law is the other recourse you have a is charged D. which is the church amendment subsection day itself and no individual shall be required to perform or assist in the performance of any part of the health. Service if his performance or assistance to the poor performance of such part of such program or activity would be contrary to his religious beliefs or moral convictions that's incredibly broad right so what's the problem why can't we just rely on federal law because there's no cause of action in there just like there is not in state law so your recourse is to file a claim with the federal HHS according to their own testimony to me they move at the speed of a glacier area and honestly they're very unlikely to ever take up your case and you can't break it in the court on your own and you also have to look at you know quite honestly this current administration is hostile to conscience rights they refused to defend the federal conscience laws so it would be naive and unrealistic to think that medical practitioners can file a claim with the federal HHS and get recourse under that. The other thing that I would like to point two is with every statute we pass we rely on courts to interpret them reasonably. We rely on that with constitutional rights as well the second amendment doesn't mean you can go around shooting people every rights is subject to reasonable court interpretation so there's a great case from Illinois that shows a lot about that you can't conscience objection yourself out of a job you can't make your employer go out of business you have to read the conscience statute according to legislative intent. And this is this is a case in Illinois that provides some great guidance the legislature could not have intended to require the employer to pay an employee for performing now duties at the work place and there might be an instance where the objection employee is the only employee who performs the particular duties the legislature could not of been to did that the employer effectively cease its operations leaving no one employed at the business we are obliged to construed the statute in a manner that avoids such absurd and reasonable for and just results and that's the row Haas verses Martell case in Illinois and they're statute is very similar to the statute sponsored by Senator hammer and Representative Smith. Another question that has been brought up is why include institutions and payors. And really the reason there is for liability protection institutions are probably more likely to be sued on conscience issues from the outside the from the inside and you do have those cases I've mentioned earlier were institutions have been sued for not providing sex reassignment surgeries or sterilizations ordered rare cases there's even lawsuits over abortions so that's it's it's mainly a liability protection thing but it also does provide the right of a practitioner with that institution to be to have their job protected in situations of a sincere conscience but late for payers that provision is really self limiting in the sense that I do not see that most secular insurance companies will be taken advantage of that and the reason why is you have to be able to point to conscience believes in your by laws and policies and governing documents now you can see how a religious organization like take for example the little sisters of the poor case a group of elderly nuns who provided or or a group of nuns who provided care for the elderly poor they were sued for not wanting to prescribe to cover through their health plan abortion causing drugs to their employees none of their employees complained but several states ganged up on the and so you to them now I I do know that you know federal law does trump state law I'll say that right now but I think we definitely don't want a situation in Arkansas where you know religious organization is sued because they have a reasonable conscience objection and just one particular thing that I don't want to pay for what we want to hedge against that but the Arkansas bill the Arkansas hospital association they had some great comments and under this bill which is an improvement over the Mississippi and Illinois bills health care payers have to file. I will their conscience objections and really that would probably have to be done at every state due to contract law nothing about this race is contract law but I do like that provision of this law. let me say that sorry there is so much that I wanted to cover today and I know that I have talked for quite a long time but are there any questions that I can answer for any if you represent a great you're recognized for a question. Thank you Mr chair there so much there I'm not even sure where to start exactly but you keep mentioning Mississippi and Illinois Illinois law and I know they have some similar tendencies right but they're not exactly the same so like Mississippi all puts in exclusions for race sex all of those things we don't do that in our bill so how can you compare the two equally well I'm so glad you brought up that question that is actually one thing that I intended to cover but in the many pages before me and how long I've spoken I didn't get to that so I appreciate that the reason I compare them is very similar is this they're both very broad they protect hires institutions of medical practitioners and they actually are so as broad as this that covers health care provider any individual who may be asked to participate in any way in a health care service and they defined health care service as any phase of patient medical care now keep in mind that doesn't cover housekeeping janitorial services the person who makes your coffee it's the same why in the Arkansas law it's medical care any phase of medical care but she pointed out that the Mississippi law does have a list of protected classes they are race color national origin ethnicity sex religion creed or sexual orientation. I thank you run into the risk when you start to include a list of protected classes you run into the problem that that implies that discrimination against people who are not in the list of protected classes is okay and what I want you to realize through carefully reading the law that we propose which does not have a list of protected classes just like Illinois is a very liberal state does not we keep that very clean and tidy and limited to health care services so for example let's say political organizations or any other organization you're a part of you can't be discriminated based on that and I think in a world with such. Division and hostility right now I don't want to leave any room for like okay these are these are are protected people that over here outside this list of protected classes these are not protected people I think the Arkansas like the Illinois law gets it right in that sense the Illinois law does have a provision that we do not have it has it has a compelled speech amendment which was added in twenty seventeen and there has been litigation on the compelled speech amendment because pro life pregnancy centers sued because they felt like the amendment would require them to discuss the benefits of an abortion and do abortion counseling so I the Arkansas law is superior in that regard because we've kept the core of the Illinois law that Representative Smith and senator hammer have left out that part that resulted in litigation. Quickly pointing out the Illinois health care law is extremely broad to just like this one health care means any phase of patient care. And it runs a list of procedures and ends it with or other care or treatment health care personnel means nurses nurses aides medical students accept or or any other person who furnishes or assistant or assist in the furnishing of health care services. I would be concerned about this law if we did not have the track record of showing how it plays out in reality. Follow up. Yeah you're recognized okay thank you Representative thank you so again that I appreciate your answer and you had a whole bunch of stuff in there but you still did not answer my question how can you compare what we are doing to the Mississippi law if it has a broad class of people that they will not pertain to a how can you eat captain you compare the tape well I feel that you can that that doesn't that doesn't mean it has a broad class of people that the law does not apply to you it's just a disclaimer because there's nothing in the core language of the Illinois Mississippi or Arkansas law that does allow discrimination it only allows you to turn down particular healthcare service. You know what never mind Mr Jerd thank you. Senate more you're recognized. Thank you Mr chair Like Representative great I think I have a long list of questions but we'll just I'm so I'm trying to figure out which one is most appropriate since you're at the table as opposed to should I say one for represent or what have you so but I do want to ask you specifically because you're the you're the attorney and I might wanna ask somebody else to. Why again I'm back to why is this the right size the right thing for Arkansas I mean. I personally want to protect conscience of people but I also wanna make sure we are doing our due diligence if we don't look for those unintended consequences sure okay so I mean it's seven pages a new government that didn't exist before and so there are a lot of potential consequences when we do that so. Everything from that I heard from doctor Bledsoe and I really think I've I've heard from you his revolved around someone who can write a prescription so why does this have to list every person who might ever be employed in health care except I don't think I saw someone who might write a check you know and be you know. Because you know that somewhere else so why not limited to say physicians and. Physician assistants and nurse practitioners and you know for one not just identify because I've heard specific procedures of concern that I think we can all recognize and we can all go. Yeah I see how that could violate someone's conscience right so or why not identified specific procedures and even add a clause or anything that can be reasonably determines that might violate a conscience what why does it have to be so broad. I think those are great questions and I and I appreciate those Representative Boyd I think one thing to keep in mind as far as how broad it is is that that's the exact type of definitions we have under Illinois Mississippi law and have been there since nineteen seventy seven in two thousand four without the unintended consequences so we have a track record and then the other thing is church today which is existing federal law that I read earlier it's very very broad and I guess the other thing is technology is moving so fast that I could not even come up with an exhaustive list I could try but it would be obsolete by the time you got this law passed an example right now is right now did you know you can have a baby with three parents genetically like that something that I can see providers having some objection to participate and you know there are there are there is extensive medical research going on right now some of it involving aborted fetuses that's very prevalent in the research community there are things were not even aware of and sometimes we don't know how are a conscience issue and two years later you know so I think we have the track record of Illinois Mississippi existing federal law to show that we don't have those unintended consequences so for that reason I can't come up with a list of people who should not be protected I think a good question is who do we not want to protect under this law let's take for example the scrub tech should the scrub tech be forced to lay out instruments for an abortion you know maybe her Cup maybe that doesn't violate her conscience but maybe it does should she not be protected just because he's lower on the socio economic scale you know I think we can I think we can do the best we can as Arkansas and look at the evidence I know anytime that you're passing a new law it's your job to guard against those unintended. Quinces but I would ask that you carefully consider the track record that I've laid out today and that's you vote based on the reality of where we are and what we can show from evidence and case law instead of there's always going to be a hypothetical parade of horrible's and if I could if I could find any research showing that that was a legitimate concern I could not in straight face come before you and recommend this law Mister chair I'd like to step away from the table and have another attorney come and set to help answer some of these questions with your permission Mr Lewis brown. All right. For. Thank you for your comments your presentation Mr Ramsey would entities yourself and who you're here to represent. Yes you may. I am by my name is Louis brown. Push the button there on. Thank you can hear me. Great my name is Louis brown I'm an attorney and I'm here to testify as an individual my own behalf. You're recognized thank you. again I'm here to testify to offer my personal and professional perspective as an attorney and as a former political appointee and the prior presidential administration at the US department of health and Human Services office for civil rights were a bigger sleep enforced federal civil rights laws across the country and health care I'd also like to say that my family owns land a small plot of land in the State of Arkansas my grandfather was a big country and Fisher and used to come down Arkansas to go hunting. The right to life and the rate of conscience are the two pillars upon which all American civil rights stand if you lose one or god forbid lose them both our civil rights in America will collapse the right of conscience historically has been essential to the advance of human freedom of in civil rights in America. The call of conscience the moral and religious convictions of Americans is the reason why we abolish slavery it's the reason why we abolish Jim crow segregation it's the reason why we had an advance of racial justice in America. In health care conscience the moral and religious convictions of thousand to put upon thousands of Americans. Have galvanised these medical professionals to care for the sick to serve the port to serve the vulnerable we seen this very dramatically in the last fifty I guess really twelve months where thousands upon thousands of medical professionals doctors nurses physicians assistants Tax EMTs many of whom serve at faith based hospitals have given up their lives or put placed themselves at extraordinary grave risk to serve people they may never see again. Faith based hospitals and professionals of faith are vital to the care of the sick and the vulnerable particularly in many African American communities within the United States it often times the only resource they might have at least in some communities is that Catholic or faith based hospital that stating that don trout down trodden poor community when everyone else left why because of their moral and religious convictions of serving the poor of serving the sick regardless of the financial outcomes regardless of the bottom line regardless of whether they would make money off of the deal. Faith based health care represents at least twenty percent of all American health care delivery in the United States. We do not as a country and even probably most likely in Arkansas have the capacity to combat public health care crisis now or in the future without professionals of religious or moral convictions and without health care entities of fate we just don't have the capacity the infrastructure to be able to handle. My perspective and enforcing federal civil rights laws again across the country and is a graduate of historically black law school has been that there are three primarily aids serious ongoing issues of bias and discrimination in the healthcare system the first one that I think perhaps is the most serious and severe is discrimination towards folks with disabilities. and persons that are chronically ill aged elderly and you saw that during covert in terms of some of the triage protocols that hospitals had that in some cases unfairly discriminates against persons with disabilities are persons that happen to be older as opposed to basing it on medical criteria and taking individualized assessments. The second is ongoing some level of ongoing bias and I think at times to straight discrimination towards Latinos in different parts United States and the health and Human Services contacts I've seen that and the enforcement on that it in it at least one state and sought in two states that was pretty severe. The last and I think the most serious above all. is the persecution and the coercion that's going on to the medical professionals all particularly faith particularly of moral conviction right now in the United States and it's everywhere it doesn't matter if you know the state is ninety percent Republican or ten percent Republican and ninety percent democratic doesn't matter it's happening absolutely everywhere. This severe persecution that I think is going on is a particularly potent for pro life faith based individuals who are driven by the moral and religious convictions to care for the sick the poor and the vulnerable I've seen this with the physician's assistant who was fired for Catholic faith at a Catholic hospital I seen this with a medical student who's been persecuted at a public university because of her religious convictions I've seen this when I commonly and this is very pathetic and sad to me and our country I calmly talk to Catholic medical students who say I'm just not going into reproductive health I'm not going to go on the OBGYN because I don't I'm afraid and I don't want to do it that's the America that we live in. It's a shame. And and the reason why that we have such trouble getting medical professionals and medical students to testify about it is because they're scared. It's a shame. The problem is that too much of the health care industry has made the agreement that we just do abortions that we just do transgender services we don't care about your more religious convictions and if you want to keep to those moral and religious convictions you can get out. That's the reality that's the reality that's the dirty secret. Existing federal civil rights laws defending protect patients from discrimination. You don't have to cross reference the entire criminal code for the criminal code to apply to this bill you don't have to cross reference all federal civil rights laws for this federal civil rights laws to apply in this bill. Thank god we have title six of the Civil Rights Act that protects patients from racial and national origin and ethnic discrimination and healthcare we have title nine which project protects against discrimination based on sex we have five oh four of the federal rehabilitation act which protects against discrimination based on disability we even have the emergency medical treatment and labor act which protects against discrimination based on the ability to pay. The sky will not fall because of this bill and it should be understood in the context of the robust civil rights protections that prohibit unjust discrimination it's very important we don't have to cross reference the whole thing the judge will a judge that has a case in front of him in the State of Arkansas will read all of this together in the context of the federal and state laws that apply. One of the federal civil rights laws at that that we have in one of the most important civil rights or the federal conscience statutes these statutes protect the moral and religious convictions of doctors nurses medical professionals medical students and healthcare entities today. Particularly as a Stephanie said the church amendment right now health care entities should be applying by. They should be in compliance with the federal legal obligation to protect the moral and religious convictions of the medical professionals today if they're not in compliance they're in violation of federal law today. What this legislation what it does not do it does not create a significant material change in the legal obligations of existing medical health entities in the state of Arkansas it does not do that this bill will not cause the sky to fall what this bill does do. Is create a remedy for our Kansans to have the right of conscience. Vindicated here in the state of Arkansas instead of relying on beer collapse like I used to be in Washington DC your people should be able to have such a vital secret right vindicated in the State of Arkansas in state court here in Washington here in Arkansas. That's vital you shouldn't be such a vital rate to so many pro life our Kansans so many people of faith or of moral religious conviction shouldn't be depended upon a process two thousand miles away. Where there is a right there should be a remedy such a vital right of conscience a basic civil right should have a remedy as I said in state court. The right of conscience is healthcare is one of the most vital civil rights issues of our time because it determines it determines whether civil rights and human freedom will survive and in the healthcare industry I think that this bill in the state of Arkansas as part of the rebirth of civil rights and human freedom of our country if you look historically at nations how do they lose their freedom they give up conscience they give up more on religious convictions and the legal defense of them an education and they do it and health care this bill will re birth the civil rights it will ensure that you and dignity is protected in the state of Arkansas and I can not recommend it to you more highly thank you. Represented more you're recognized for a question. Thank you Mr chair again I have a long list questions because they're seven pages of legislation here so but what I want to ask you specifically I hear lots of things that resound very well that they come to my heart they speak to it and and I I but that doesn't mean I don't have concerns about implementation of this legislation. So it's some point the church has a responsibility to educate its members right. And at some point the government. Is used as a short cut. To for any shortfalls unless I church I'm not talking about Jesus and any other I'm talking about the people in the church I wanna be very clear I'm not talking about a failure of the church I'm talking about a failure of the people within the church. So why is it that with all the money involved in healthcare in hence all the politics why is it the role of the state government today to to do that why is why is this the right solution verses let's go convince the federal government to quit spending so much money in health care and let that be more of a personal responsibility again when that. Do that so those are my questions if you will thank you. Okay sure no I think that's a very good question I think there's a couple things in there if I could I think the first thing is that I I really believe in federalism. And You know there's a there's a tradition in our country of trying to take care of the problem closest to the problem for Catholics we call it subsidiarity. And part of this bill is saying it's such this is such a fundamental issue that impacts the care and the freedom of doctors to provide the best care consistent with what they believe to be right and Josh. It shouldn't that be dealt with closest to the issues closest to the problem I should not be dealt with in Arkansas and not in Washington DC that's the number one number two we have a tradition in our country which I think is good of giving giving the ability for people that are victims of civil rights violations to go to state court to vindicate their rights we provide that remedy traditionally the problem is and we see this is that there's not enforcement mechanism for federal conscience protections it's a process that is dependent upon HHS and I oversaw the civil rights division HHS it can work but it takes time it people just don't like your version of civil rights who cares what the civil rights laws say they're gonna do what they want to do and it you know that's not just me saying that but the current presidential administration has said that they have a very different view of of the just don't really meaning fully believe in moral and religious convictions and health care they just don't believe in it. And and and that's just the reality of it and this is speaking of someone that used to work at the DNC. and so by even more so let's have an enforcement mechanism that's consistent with traditional civil rights where people can go into state court in Arkansas and have their rights vindicated what I think will happen if you pass this bill actually I'm I would bet the farm on it is that there won't be much litigation. Health care entities will be it will and Arkansas will tighten up their policies to ensure that they really are complying with existing federal law because they're not worried about being sued. Currently they don't really care because they know that their people don't can't really do much about it this report a plot this provides an enforcement mechanism that will get health care entities in the state Arkansas whipped into shape and will stop it will prohibit or at least minimize issues like the Surgeon General talking about from happening here in Arkansas. Mister chair. Mr chairman address representatives believes question with a statement from an Arkansas med student showing why it's relevant to making sure yes yes Sir I'll I'll try to I'll try to read fast this is from an Arkansas med student named chase upon reading this bill it seems to me that it's complete purpose is to protect from discrimination any entity that on the grounds of conscience would refuse to perform a treatment. Many of my colleagues I believe this bill would permit entities to be discriminatory towards patients not just treatments I do not take that to be the case and therefore in favor if I had a patient plenty to get an abortion but they needed other health care such as a treatment for glaucoma I would gladly seek to give them the most competent compassionate glaucoma care that I was capable of I would however on grounds of conscience refuse to perform the abortion I would not be refusing a patient on grounds of personal belief and I believe that is not what this bill would permit the question is over services not patience this bill permits me to refuse a service on grounds of conscience but I do not believe it would allow me to refuse a patient on grounds of conscience if I if it allowed discrimination of patients I would be opposed the specific wording of this bill says to decline to participate in a health care service on the basis of the conscience of the medical practitioner this leads me to believe that under this bill a doctor would also be permitted to refuse to participate in something resembling the Tuskegee experiment a stain on America's history and the experiment researchers treat participants who were predominantly black into believing they were receiving free health care from the government while observing House syphilis damage them over the course of decades I do not know whether any doctors participated against their will but this bill would protect their ability to refuse to participate we need more doctors standing up against such experiments and practices and I believe this bill would help I thank you for your time. Thank that Arkansas med student makes the best case that I can make for why the most vulnerable which is students in Arkansas data solution close to home and We do not need the experimentation of medical procedures that is coming down from the federal government to be mandatory for Arkansas matter nineteenth state thank thank retirement here representing graded you still have a question you're recognized yes thank you Mister chair. C. reconcile this together so. It's Arkansas would you said Arkansas as an employment at will state. I actually don't know for sure an employment at will state yes the Representative or okay so the. Where I go with that is I supervise a urology clinic so let's say I hired nurse and that nurse decides to week see in that although sixty percent of my client bases may feel that she does not want to any longer participate in the care with that involves male genitalia. So tell me how based on this statute that we're looking at I can't move her to another department I can't fire her I can't produce her pay I can't there's nothing I can do with her except now have to hire another nurse to cover what she refuses to see and I'm afraid what you're going to tell me is. We'll just go ahead violate law and see she said use but I I don't want to take that chance so can you tell me how exactly I'm protected as an employer in this absolutely represented right and that's a great question honestly if she does the services for female patient she has to do it for male patients you either do the services or but that's not included in here you don't specified that she can't discriminate based on gender the only thing that you can do is declined to do a particular service you can't base that declining never procedure based on any characteristic of a there are services for mail that are different than females so she could discriminate two males based on certain services. I would imagine that that would be a very heart conscience objection for a court to take seriously because you know the procedures would be very similar and I guess I go back to the Illinois Kleiss K. saying you know and there might be an instance where the object to exacting employees the only employee who performs the particular duties then they're out of luck they don't get the right to put you out of business it is essentially want me to get sued in order to not I mean that's what you're doing is saying you either you do what you want or you follow this the best you read it so I either have to hire someone else to do what she refuses today or I have to essentially go to court if she so chooses to take it out for represent graph I could you know respectfully the religious and moral convictions are protected and federal law. I for institution not for that employee it It is implicated is protected for that that that employee currently under federal law it is and so that what you're talking about is just not happening it's not happening or existing federal law I don't think a change that's really not a material change for your urology clinic when it comes to that procedure would change anything at all with this bill be passed which it's not happening currently they are protected under the church Amendment church D. you have an obligation to protect our more latest convictions healthcare providers want to work they want to serve their patients they're not doing that date and no one wants to file a lawsuit you have a hard enough time getting people to file federal civil rights claims in federal court people don't want to do this they want to serve they want their head down and get it get busy work and caring for people so it's a it's a having under existing federal law even though that rate of conscience protected I don't think would happen if you pass this bill. Represented when you're recognized for a question. Thank you Mr chair right over here I I heard and appreciated the comments of our US Surgeon General blood so what he had to say and my question revolves around the key fundamental issue is is this bill procedure based or patient based and that with the right of conscience can and discriminate against procedures or patients and that's a very very important delineation to make and I heard Bledsoe also heard the the letter that you just read as well that that kind of address that issue Mister Bledsoe said that it was very clear in the bill and and some of us have had a hard time finding that same level of clarity in the bill can you help us with that very fundamental issue is gay is that can somebody discriminate against a patient that they might have a lifestyle disagreement with verses the procedure. Thank you for that wonderful question and the answer is absolutely not and I would not be here speaking in favor of legislation that would allow that if you could turn to seventeen eighty five oh four this is the core of the bill. A medical practitioner health care institution or health care payer has the right not to participate in a health care service that violates his her or its conscience you can not target a patient you can't target that refusal based on who that patient is or how they live their lives and I believe Arkansas values reflect the ability of doctors and nurses to decline to perform particular services which is what the bill does but no where in it doesn't allow you to make that decision based on the patient who is showing up in your clinic for services but I thank you for the opportunity to address that the quick follow up Mr yes you're recognized so the there's no ambiguity then for any provider to say anything contrary to the to this now healthcare service is the only thing in the bill the core language in the bill and there's no loophole language that allows anything other than a healthcare service to be what you decline today and would some of what you had said Mr brown about the the federal laws of discrimination applies and that this does not supersede any federal law regarding our commission does and it would be read in conjunction with that in a in a federal court or state court they would be sending more on a severe violation of federal law to discriminate you know based on the person this is just as to at conscience objections to the service very explicit thank you very much both of you thank you represented board you're recognized. Thank you Mr chair I have two legal questions and then I'll I'm I'm done with legal questions if that's okay so legal question number one for either the attorneys here I brought this to the bill's sponsors attention but I just wanna ask your legal opinion while you're here at the table Page six line seven talks about emergency medicine I've drafted had multiple bills drafted and weak and I see from our drafting attorneys that anytime we reference federal law without giving a specific date so when you talk about impala there's a specific date but then it goes on to the next line it says or any other federal law so I do have a concern if it because if we vote for this we pass it we obviously wanted to hold constitutional muster so the way it's drafted I am concerned that there could be a constitutionality concerns and that's fine you can just say yes no whatever but I I want to point it out okay so. Sure I I think that we're pretty safe there I think the you know the reference to the emergency medical treatment and labor act was placed in there to make it to give reassurance to you all as legislators that Hospitals are obligated to stabilize a patient if they come into the emergency room or to attract like to physically transfer the patient if for some reason the service can be done regardless of ability to pay but and so that was just in there to make it hyper hyper explicit that law and all federal civil rights laws would apply regardless of whether we place it directly and that legislation or not and so I I think there's not a constitutionality issue at all here and the Mr Boyd to further I mean represented Boyd I'm sorry to further address your question for you know federal law would supersede state law so they would have to work in conjunction together but there might be certain cases now I so believe in Arkansas that to me that would be unfortunate but this doesn't change that that's already the existing principle that federal law supersedes state law there is a little bit of a legal question in areas where states grant more protection of constitutional rights then the federal government that has been protected under the federal government and that is one of the things that Representative Smith and hammer or trying to do with this bill. Okay okay I'm not going to belabor the point because I'm trying to help you with what could and and I'm not be flat wrong okay but the when you read see there any talk about right of conscience it seems to delegate the state's authority to the federal government. It's fine when you say January first twenty twenty one but then you go on with that next statement and it seems like it then delegates the state's authority to some other federal law that we don't know what it is and I'm I'm just I've been told by drafters right or wrong but that might be a constitutionality concerns on it but you know it's fine you have the information do with that is you please or not thank you that's all I care about their now it is my second legal question the so. I'm I'm still concerned to have a small business I'm not talking about a large hospital where I have lots of labor and I can plug employees here and there so I'd imagine in a rule Arkansas I've got one. Provider want one physician or nurse practitioner and one nurse okay and now the the nurse has decided. It violates her conscience or his conscience I should say either his her conscience to administer an immunization that was created from at a descendant sell wine from an aborted fetus so what in this case how do I handle that because it's enough for the business where it really might disrupt operations I don't have anybody to play again and so I please help me get past that concern. I I think I would reference that Illinois case and there's you know this law is a balancing of interest you're not always going to get everything completely perfectly right and it may be unfortunate for the employee in that circumstance but you're exactly the type of you know small business that's referenced in that Illinois law that says I mean in the Illinois case law that says you have to read this according to legislative intent and there's you can't interpret conscience in such a way that drives the employer out of business especially if they're small so there there is going to have to be that balancing of rights now the question is you know why don't you just say in the statute conscience has to be you know interpreted reasonably because that would get the bill to get the bill you get that in front of some judges and there's no longer any conscience rights so we have to rely on courts in some but but honestly based on my research of the case law showed you that one page list over forty something years this law will rarely be used but it's likely to be very critical and important in someone's life when it does but that does not neglect my concern for your business and the Illinois case law honestly brings me comfort because that's exactly how I would expect the Arkansas case law if I was an attorney I guess let's just think procedurally for a minute it's a big deal to file to file a lawsuit you either have to pay the Attorney out right or you have to have such a good case that that attorneys willing to put blood sweat and tears and so much effort and energy into that lawsuit I would not take that case and I don't think most sign attorneys would because I would say okay this law is similar to the Illinois case law like case laws out there of course just like any other law it has to be interpreted reasonable it has to be interpreted according to legislative intent and the legislature did not intend to drop out small businesses so thank you for that question and I hope that that address at least some of you are concerned it is a balancing to. Interest and it's important to have this discussion citing members I don't want to limit anybody's ability to to speak or to answer specific questions we have a less than an hour I mean we are against a hard deadline to to get people out of here to prepare for the session at one o'clock and we have twenty people signed up to speak on this bill so I would just ask that you know everybody questions and answers be as specific as you can and will try to get through this if not we're going to carry this over to another meeting President Johnson. You're recognized. Thank you Mr chair so I have represented wing brought up and that you pointed in the bill on page five two. One six twenty four nineteen twenty where you talked about this is specifically tailored toward health care services. and I just want to I've been trying to look through this and you alluded to the fact that since the specifically targeted to services it does not apply to treatment of persons however sometimes and and bills like this You put that into this the bill or the statute so that this does not give a right to someone to deny. I am by a person only the services and and the specific services or what you're talking about they they have a right of conscience to exempt them from so I I I I I have a conscientious objection to performing an abortion as a physician I can't be required to do so but that doesn't leave me from obligation to to treater whatever other conditions might be that's that's what I heard you say however. Where in the bill does it say that that. The person still they they're still required to treat the person or other things M. Representative thank you for that question like honestly you will not find that specific statement in the bill because it's actually not needed because all that's covered by the bill is the right not to participate in a health care service let's take a pediatrician for example to seen a patient the patient's a minor who is seeking both hormones and gender reassignment surgeries that pediatrician concise I can't be the person to refer you for this or to prescribe these drugs for you based on the contents of objection but continue to come see me when you get sick continue to come see me for your well checks the that's the way that's the way this law would work. I understand that's how the law should work and but what I've heard you say it repeatedly is what we're going to depend on case law of judges if it gets in court and how they interpret what the legislative intent is and and I've been doing this for a little while now and and. I'm not attorney but I I keep repeatedly being told that the words in the matter though the words in the statute law they matter each word carries equal amount of weight when a judge is considering that the the words that are actually in the statute outweigh whatever perceive Legislative intent happened to be I mean you might correct me if I'm wrong but I didn't go through years of law school to do that I just. Years of writing a law I've been told that it is that. Wouldn't it be better to put that in here so it's explicitly written in law and there is no or open to interpretation by some judge whether you support in the future I would I would say this to that point that is where you could potentially run into unintended consequences because if you draft a class of certain people that you can't discriminate against what happens with the protection of those that you forgot to include in the list so I think it's safer legally to take the Illinois approach which is our longest standing conscience law in the nation and just have the language has the right not to participate what not to participate in a health care service that way you don't open it up to the climate where you have no rights under this not to be discriminated against because you're not a member of one of the people included in the protected classes I think with all due respect this is the safest approach legally and it's been a safe approach in Illinois there's been no claims of discrimination under the Illinois statute enacted it still has to be interpreted in conjunction with existing federal and state nondiscrimination laws like Lewis pointed out this doesn't erase non discrimination and civil rights laws in the state and the federal law so they have to be read in conjunction but you're right the the words of a statute matter but I believe this is the Superior approach because you would need that language if there was anything in the statute that did create the right to target a person but if you read the statute there in through there is not right to target a person there's only the right to decline to perform a healthcare service and represent if I could add you know I just I have real time experiences on cases that I was really angry about where it was discrimination on race Sir disparate impact there on language or whatever and healthcare entities are and I really mean this they're very good when there is the threat of loss of federal funding for the threat of lawsuit on ensuring on giving their employees proper guidance. On what the federal or state laws are that they have to comply with particularly when they're worried about losing federal funding for the worried about getting sued so I think that you know when when there is a strong remedy like there is in this bill the understand how all these civil rights laws or compliment Terry complementary and to how to give their employees sufficient guidance so that no one to unjustly discriminated against. All right. Seeing no further questions at this point again Representative Smith were running out of time so your presentation present what you compare that and I appreciate that thank you all for your comments. Represents if Smith you're back in the hot seat there. Committee thank you for your patience I think you've heard a lot of great testimony this morning from some really sharp minds. At this point I think it would just be better if we kinda land to this Huge airliner and bring it to a close but I am open to a few questions but the the legal minds are the ones that really have the correct answers and you've asked quite a few of those so I would have to defer back to them or to doctor Greg Bledsoe who is back in the room but We we do have some people I know they've signed up to speak for against so if you want me to move that away we can move to that. Area of the bill let's do that thank you. Okay as I said we have a number of people here to speak for against and I'm on a maybe go out of sequence here in the way you signed up. So on the list of people to speak against we have one two three four five six looks like. is there anyone here to speak against the bill who has traveled from out of state if you are please related raging in. Hello. All right we're gonna just go down the list and Annabella took. Sorry. A Representative Bentley you're recognized I'd like to make a motion to expropriate. Yes you're recognized for motion I like to limit debate to ten minutes for each side. They can divide up how they wish but ten minutes for each side for debate and we can get to vote on this. I would recommend that some people travel a long ways I would like to have limit per person. Senate is it that some minimal. There's another do we have the number how many on the force and how many people do we have on the four twenty on the sign. Three. Six against. He prescription. eight against. And twelve four. Twenty. Two minutes per. What's your motion I would make money can buy the I'll make a motion right now two minutes per Speaker on both on whoever's here okay. I have a motion to minutes limited debate to two minutes per Speaker any discussion on the motion. The question was. Question. Those include questions that's represented billing. I would say yes including questions two minutes. Represent person recognized. Thank you. Sorry. E. I might decide to the incoming very thankful for people come in to testify for and against it if we could try to not repeat the same information I'm sure many of you are going to stay the same things and we've listened to a lot of for testimony so but I mean I I I would sort of. I would sort of like to allow some time for questions on the opposite side since we've not really heard that at all. All right any other discussion. Representation recognized. Are we reserving at time for close. We have to have a close okay thank you but again Committee if we don't get this done we will carried over to the next meeting. On file with the media consideration okay. But we will have a close yes Sir all right seeing no further discussion all in favor signify by saying aye. All opposed nay. Hi seven you're recognized man. Thank you very much I appreciate the opportunity to yourself all my name is Annabelle amber talk you probably know me from my prior service as a justice on the Arkansas Supreme Court. I'm appearing today on behalf of the health policy advisory board for the Arkansas center for health improvement you have been given a list of our board members before this meeting. Members please hold and your discussions or go out the room. Okay as currently drafted SB two eighty nine is a complete erosion of all patient rights in fact patients are not entitled to any information under this bill even what service is being declined. It overrides all licensing requirements and standards of practice for doctors and most importantly under this bill patients have no right of redress. In some S. B. two eighty nine is devoid of any patient protection and is an open license for doctors to discriminate based on a patient's actual or perceived group membership I have been listening to the prior presentations and I understand that it speaks to services but the problem is an having worked in the courts all of my career. There is no way for a patient to prove. That it is. Not it is only services because the patient is not given any information there is no disclosed no requirement of disclosure to the patient as to what services are not. Okay I I will tell you just in closing that this is a bill that knee is totally out of balance between patient rights and medical providers thank you for your time thank you thank you for your comment. Okay speaking for the bill Joanna Thomas. Please introduce yourself me representing I'm actually not speaking in favor of the bill I don't know how they got that down. Yes please thank you mask off your list is speaking in favor if you wanna speak against Percy okay I'm actually speaking against my name is Dr Joanna Thomas and I'm or representing the national association of social workers. I'm a licensed certified social worker and board president of the Arkansas chapter of the national association of social workers I'm here to today to address my professionals concerns with Senate bill two eighty nine there are serious issues that I know will impact all health profession should our state the only state in the union allowed this to become law. Nearly half of our Kansans forty one percent live in rural areas nearly double the national average the vast majority of our state including the capital city of little rock has been designated by the health resources and services administration as medically underserved areas and health professional shortage areas in the primary health dental health and behavior health domains what this means is that we don't have enough doctors nurses dentists pharmacists social workers and other health care professionals to provide services to individuals in metropolitan areas let alone the rural communities I know this because my job is writing multi million dollar grants for community mental health centers to recruit healthcare professionals to Arkansas to serve those rural counties last year this state one five federal grants twenty million dollars in funding from the substance abuse and mental health services administration I'm writing three more of these grant applications and other twelve million dollars in funding I tell you this because we are having significant issues staffing these programs. I come to you with this information because the need for health care professionals is quite frankly desperate if this bill becomes law we're going to have an even more difficult time recruiting health care providers as this bill currently stands well there's a clause proposing the healthcare providers would not be civilly liable for refusing services based on conscience rights the production does not exist within our fifteen survivability policies should healthcare provider BC that provider would be person would personally incur the cost of defending himself in court. We respectfully ask the committee to vote no on this bill. Thank you for your comments. But to speak for the bill David Smith. Please enter self. Later in members of the committee and Dr David Smith I'm a public medicine physician for thirty five years of his cardiologists. So much been said today I just wanna make one observation that I have not heard before. The fundamental purpose of a physician is to restore health restore health so when you think about all the conversation we're talking about things that are not aimed toward restoring the health of the patient to the concerned about somebody coming in no matter what their gender race orientation whatever that's not really at issue here it's about we have a fundamental obligation to restore health nothing changes but throughout history we've also had a right of conscientious objection conscientious refusal going back to the the credit growth that's what those were about there were certain things that were not in the realm of restoring health so I would urge you today to help us as physicians in Arkansas continue to conscientiously refuse and appropriate procedures and anything that's not for the restoration of health of our patients. The questions. We do have time for one question in my has one. I thank you for your comments. Okay speaking against the bill two will syrup Pattillo. I hope I didn't butcher that name are you in the room. Deputy director. You would you see if he's in the holding room I'm gonna skip over. Yeah. A. Forty the. River. Okay mark I'm sorry I haven't buttering that your name please introduce yourself ma'am. Thank you the morning. One of the S. everybody. A pleasure to be here my name is that I put to you that appeared on the active with Arkansas United. And I'm gonna be reinvested really quick. Sorry I was running from the other room. Arkansas United is a proud member of the Arkansas copy of health equity commission which is co chaired by the Arkansas department of health and you H. M. M. S. it has been working since last spring to offer guidance to the state. Three. programs and policies that could address that disproportionate effect of copied on vulnerable communities here in Arkansas. I'm here today because both we at the Arkansas United and the members of the equity hill Commission. This is a committee are strongly strongly opposed to as B. two eighty nine. We fear that is B. twenty nine is too broadly. Write in hangul result in one of about community including Americans getting tonight help it Health Services. We want to make sure they want to make you aware during copy that we had any the members of our community come to us ensures that they within ninety days than. Because they arrive a health service centers it's begin Spanish. The rationale for the night will be in that section that they do not have formal status it has did not the surf couldn't quote or we're not worth it could on both of service. We still hear cases from the Verisk immigrant groups about being turned away from services I told directly that they are not welcome here current quote fifteen seconds thanks Sir to date we when we get these cases with the commend them and then take them to the appropriate state agency and lead us to seek resolution we fear that it would be twenty nine could be used to justify these types of interactions and would limit us to foresee can resolutions for those individuals in the future so please vote no and SB two eighty nine thank you so much thank you for your comments Janet Dixon to speak for the bill. Janet Dixon euros the speak for the bill. Hi thank you get Mr service the. You're recognized thank you my name is Janet Dixon and I live in baton I'm a board certified women's health nurse practitioner and my husband's a general surgeon and we have been hello I mean were lifelong residents of Arkansas but we've been practicing I've been practicing for thirty years and he's been practicing thirty two anyway I think that you've heard a lot of really good things and the one thing I thought I could maybe bring that's a little different is just the human aspect of being a nurse and in being a wife of a physician we all have free will and it's a really great thing that we have we're faced with numerous decisions every day that require or hot conscience our values and our beliefs and I mean just every decision even what to eat but when we act against our conscience fear and anxiety or the consequences and this is exactly one of the reasons that I do what I do I'm the director of new beginnings pregnancy center and Benton and one of our main goals is to empower young families to make good decisions about their pregnancies and I take pride in the fact that we do not co workers we do not manipulate we do not push our beliefs on them I want to empower them to do something that they will be proud of that they can not regret later on I want them to make a good decision for themselves based on their conscience so again we as nurses and health care providers we want that for our clients we want that for ourselves and I would think that you would want that in your life as well is the free will to exercise your conscience and so this is yes it is kind of one sided fifteen six okay thank you knowing the psychological impact to I just want to say that it is hard to be in health care now and we have three children no. None of them have chosen to go into healthcare and so I just want to say that if we want and I love this letter from the medical student if we want our young people to go into medicine we do not need to make it harder than it already is and we can go for days talking about that thank you for your comments thank you very much. Of. Mr. Rebbe Kamar miss revenue more sorry. You're recognized please notice yourself. Thank you Mr Tran committee members my name is pretty per of each mark I make current medical student and am here today on behalf of over two hundred of future health care providers and students in the state of Arkansas we're not here as a part of organization or institution but we would like to express our To speak against this bill so we understand that as future healthcare providers of Arkansas for where of some of the complex involved in conversations around medical ethics and are sympathetic to concerns of legitimate conscience of objections however some regarding this bill we have a few of the points that we would like to make this bill goes against the ethical guidelines and principles that were instilled with throughout our education and all the respective code of ethics for healthcare professionals there are provisions that state but the well being of our patients is at the center of our professional practice and that we are to provide care equitably and without judgment we're taught that if we truly believe we can't provide care to a patient without compromising our own conscience then it's our responsibility as future healthcare providers to be able to refer that patient to another provider or at least offer impartial guidance to help the patients educate themselves on how to get access to the services they need yeah under this bill a healthcare provider can refuse to refer a patient to another provider and can even refused to provide a diagnosis or an initial examination and as someone else mentioned this is concerns for areas of rule Arkansas where patients may not have another option or may not have the resources to be able to figure out where else they may. Get a service and our main job is to provide care regardless for these patients. And also with the reported intent of this bill is to protect the conscious of health care providers but some of these already exists under the healthcare. Just act in section twenty six one oh nine which states that healthcare provider institution may decline to comply with an individual instruction or help your decision for reasons of cost for reasons of conscience so we strongly urge you to vote no on this bill as medical students and pharmacy students and social work students and as other healthcare a future providers of Arkansas thank you. Thank you. Kevin McLean to speak for the bill. You're recognized represented Payton. I'd like to move for media consideration we have members that need to vote and they're going to have other obligations so I moved for immediate consideration. A. Hi motion is for immediate consideration we still have a long list of people that would like to speak that's that's the motion on the floor in discussion. Represented Payton did you make a motion I make a motion for whatever is the proper term to have immediate consideration. The move meeting I moved to pass an immediate consideration thank you. Thank you represented. I have a motion to pass in an immediate consideration is no discussion on the motion. I understand the motion. There. Consider. Okay to be. Yes thank you Committee okay the vote is for immediate there is two motions one is do pass the next motion is immediate consideration we're voting on immediate consideration. All in favor signify by saying aye. All opposed nay. No seven. We still have a motion of do pass. We can discuss that. No no no no there's a motion on the floor to do pass there is discussion. Mr eyeing withdraw my motion do pass for but he wants to hear. All right thank you. Okay Kevin McLean. To speak for the bill. Kevin McLean. Given a clean. Yes you have a sea to table my name yes the queen so when it's on the river thank you mask of policing. My name's on the river. Established walking in the room either in person what is your name again you'll River. Are you are you signed up to speak for the bill or gas bill for the go ahead yes. Lose yourself yes Sir members of the committee and my name's Linda rivers and I am a medical student in between my first and second years of medical school here in the state of Arkansas and I'm also working on my master's in public health which is a lot of education to speak to say that I don't know very much but I I don't think we have to go very far in medical history to realize that medicine sometimes get things wrong and physicians need I need the The Legislative maybe a power button legislative backing to know they can make the best decisions ranges of the patients that's why I'm spending twelve years to go into medicine and supplies used in higher education hundreds of thousand dollars of in student loans but we'll have to go that far back in medical history from nineteen twenty seven the case with but the billing for sterilizations of sixty thousand Americans or when my colleagues aforementioned Tuskegee study of syphilis when what that wasn't even terminated until nineteen seventy two but if I could kind of speak on maybe an unintended consequence as I think one of the your colleagues mentioned previously is that Arkansas is hurting on a chronic disease level and this is actually an area passion of mine right now presently of the State of Arkansas is third in heart disease rate in the country and the diabetes upgrades there the country rates of obesity third in the country cancer death rates seventh in the country I am concerned for the state on a. Chronic disease and public health level that we make as many provisions as possible to keep physicians in our state from packing their bags and going to bigger cities are beaches keep positions in our state that to go to rural areas to go to areas that are underserved fifteen seconds and my concern in this is from Dr Bala of the Arkansas department of health that Arkansas has a hundred twenty point nine primary care physicians per hundred thousand population was the U. S. average of one fifty six so care about Arkansas about position staying in Arkansas and I think this bill as we take those positions I want to do the best things for their patience a long term without political pressure anyway that's all I have thank you thank you. Tomblin hook. Senator so. You have two minutes. Thank you Sir my name's Tom then how come here on behalf of the Arkansas chapter American college of emergency physicians. want to try to get I think the questions want to try to bring up things that have not been brought up before I particularly appreciate represent Dotson's comments on the fact that the time to get the law right is now before it's written and not to throw a law that's vague to the courts to get straight later. I would point out that it's highly arguable an argument in law is bad it's highly arguable that when you're talking about health care service as defined by this law that it means a specific procedure for every patient everywhere. if you read the definition of health care service in the law in the bill sorry in the bill itself it says initial examination how can you possibly refuse an initial examination without discriminating and somebody you can't if you're trying to give somebody the right to decline to participate in the procedure say that but that's not what it says it says service and service is incredibly broad. And I would I would point out that that is that the land mine field you probably don't want to wait into other comments were made in tala was brought up which is a federal statute I should point out that impala only applies to hospitals. It does not apply to anywhere else this law applies everywhere else and it kind of the whole purpose of this law I think the intent of this law is to get people that you do the agree with you to not do things that you don't want them to do the problem is this law also allows people who don't agree with you to not do things that you would want them to do so this will allow a nurse in a nursing home who does not want to refer somebody to the hospital at the end of their life to die for instance it would allow a paramedic to not transport somebody in and none of these circumstances does impala apply fifty second those those are my big concerns. I'd I'd I think the law needs fleshing out I don't think it's ready for prime time thank you. Marshall boss to speak for the bill. Your dish self please yes I Marshall boss I'm a pharmacist I've been interested in conscience cost for a long time I published an article in hospital pharmacy back in two thousand and eight call the. The pharmacist right to refuse to dispense medications based on moral grounds and what it did it took all fifty states back in two thousand and eight and put what the laws were in each state and they were really quite different I'm not going to go on about the bill itself but I would give you two examples that I know of one for myself and one for my friend where I used conscience objection in my practice the first one with myself I was working in a hospital and I was asked to draw up a chemo drug in a small dose to be given to a pregnant women a woman to kill her unborn baby and of course I objected to that and so I said to I found somebody else who was working and they came down and they took care of it and so the patient got the drug as ordered on time it had nothing to do my objection did not in anyway prevent that patient from getting her dress I also have a doctor friend who's a GI doctor so he didn't think he'd have much use for birth control pills and he was against using birth control pills he had a patient that had a condition that needed possibly birth control pills so he gave her a referral to another physician who he knew. Beyond a doubt would give her birth control pills he told the patient Hey this is one of your options I'm not okay doing it you should have all your options here's go to this doctor and I'm giving you a for referral right now to this doctor. So that talks about. The important thing is the patient is not going to not get a service or a drug because we object I mean fifteen seconds okay so I'm gonna in with if we depend on the federal government to take care of things here we've got some problems especially with the. hobby year the Serra coming in as the new health and Human Services director nominee if he gets in we're all in big trouble he He loves abortion that's just one thing so I'm saying let's. Comments your time is up thank you. willow Bashir's to speak against the bill. You. Okay of Randy Zook to speak against the bill. Please enter this yourself X. or whatever else. Thank you your rate is a Arkansas state chamber of commerce in the books. The roof Rennie's Arkansas state chamber of commerce speaking against the bill on three basic points a lot of what I would head to head plan to say is already been covered several times three points number one there is a high degree of concern about this bill that's growing by the hour literally for many of our most successful employers across the state. They say the bill undermines the mission and purpose of their organization these are health care executives they've also been told directly that the state's largest employers specifically Walmart in Tyson's are adamantly opposed to the bill because it signals that Arkansas would put in question the ability of some of their employees and potential employees to get needed medical attention that is profoundly disturbing to these business leaders and I'm hopeful that that falls into that big circle of unintended consequences secondly the bill would fundamentally alter the relationship between employers and employees in medical care settings the prospect that an individual member of a complex team could choose to opt out of their responsibilities at a moment's notice because of a patient's characteristic is frightening employees are hired and paid to provide defined services and support not to evaluate the merits of a patient's worthiness of treatment and finally as many have said the bill is too broad I wish we could have I could have given about two minutes to the doctor that was just her minute ago. If in the there's anywhere in the bill the issue the bill addresses it deserves a full review with adequate time to evaluate the narrowest possible application of state law to clearly define the consequences of such a bill June closing to reject the bill in its current form and send a clear signal that Arkansas remains a fifty second open and welcoming to people of good will thank you very much thank you for your comments. gravy Crossman. To speak for the bill. Still. Dr Grady crossing of a licensed physician for forty six years of been board certified in five different specialties was an associate professor UAMS in anesthesiology pediatrics of emergency medicine for nearly twenty years I do not represent you a mess I practice was of a CH and I do not represent a CH I am the campus adviser for the Christian medical and dental association at UAMS. I want to say that When Dr Bledsoe was talking about the gender for transition surgeries that I would before I involved are being asked to be involved to provide the anesthesia for that case I would have to decline and if I lose my academic position if I lose my hospital licenses if I lose that I financial situation so be it as Martin Luther said it is to go against conscience is neither right nor safe I Mark Twain who is not a theologian said It is never wrong to do the right thing the first of that is it is never right to do the wrong thing in the case of which doctor Bledsoe alluded. My calculation is that there's really no informed consent that any child can provide and even legally consent is a much later age and the second thing is Dr for Bledsoe uses kind language I abuse that surgery has just figure ment and other parts physicians have referred to it as mutilation so please do not ask me to do that. Your comment to your constituents have empowered you to may fifteen seconds every day based on the right of conscience do not deny me my right of conscience do the right thing thank you. Thank you for your comments Maurice Rigsby to speak against the bill. Thank you Mr restricts B. vice chancellor UAMS I wanted to briefly speak on some of the unintended consequences and the broadness of the language that we see I've worked closely with senator hammer and talk with doctor Bledsoe and have a great deal for all all of them and represent Smith before this meeting I presented several questions to senator hammer and some of those questions are does this bill target specific procedures of our services can a provider invoke conscious doing a routine cancer health and or or orthopedic procedure what language at the language in the bill prevents a provider institution from invoking conscious based on race gender national origin et cetera is there a duty to refer a cancer or other patient to another provider if conscious is involved S. B. of two eighty nine as language is broader than the language in Illinois and Mississippi and seems to cover all medical procedures help me clarify the anger of the ambiguity in the language can conscious be invoked in the middle are doing a procedure what protocols are in place to protect the health and safety of patients was conscious is involved that that those are my overarching issues in our questions and I've talked with Senator hammer but I really want to hone in on something I represent Dotson race also the doctor raise at the end I think Randy just alluded to it if you look at the services if you go to page four of the bill section five warehouse outlined services and compare that to what illinois' has Illinois has with a defined what medical care is is say is healthcare means any phase of patient care including but not limited to testing diagnosis prognosis and ancillary service research institution of family planning counseling referrals or any. In connection with the procurement of contraceptives sterilizations abortions medication surgeries are any of the carrier as relate or abortion as defined by the reproductive health at the law needs to be narrow that is a significant flaw there represent Dotson raised and has been highlighted by others I think we should not do that it cause confusion for thank you for your comments your time as a thank you. Can never make a motion please chairman. Yes you're recognized I'd like to make a motion infirmity consideration we've got to leave and I want to make a motion to do pass American I'd like to make a motion to pass at this point thank you. Right we have a motion of do pass for and we have a motion of me consideration. Can I just remove my many considerations about if I need it whatever but I need to make about me to consideration for do pass please. So do you make in a motion of immediate consideration would do pass. Okay we have to vote on immediate consideration first there's a motion of immediate consideration on the floor all in favor signify by saying aye. All opposed nay. Eisenman. Motion is do pass. All in favor signify this. You can't it's meetings duration. Your managed in me exhilaration means no discussion and motions do pass. All in favor signify by saying aye. All opposed nay. Is haven't. No call. Okay since this is our first roll call I was going to just remind people remind all the members of all call your name twice then I'm going to repeat back what I heard you say. For or against so. Representative Wardlaw. Representative Wardlaw. No. Represented Eubanks. No. Representative McGee. A Representative gave votes now. Percent of Johnson. Representative Johnson. Representative Miller. Yes. Represented Payton. Represented Bentley yes. RIP center of gray. Represented Gonzales. Yes. RIP center Boyd. Representative Allen. Retentive Coleman. Representative Pilkington. Representative Pilkington yeah. No yes yes I'm sorry okay. Represented wing yes yes. Represented Penzo yes. RIP center pairing. Resulted yes no I know. Represent of Davis. No. Representative clown yes. Vice chair Ferguson. Sure Lehtinen's. Ten. What the. Ten dollars right there. One nine. Sir. Eight. One on the. This. Sign. Representative Smith your bill is fails. Thank you committee I know you have things to go to so we are adjourned.