Public Health, Welfare and Labor Committee - Senate

About that basically turning around fairly dysfunctional emergency departments and was helping run those emergency departments within the governor called and so at the end of two thousand sixteen was appointed Surgeon General was sworn in in January two thousand fifteen and he came back home it's been really the honor of my entire career to be the Surgeon General for the state and and they come back and be close to friends and family and then people always ask me they say well what do you do a Surgeon General. past using. So the surgeon general position a lot of people don't realize it's a part time position it kind of feels full time these days but it's technically a part time job I'm not an employee of the state I don't get healthcare benefits retirement benefits from the state I get paid on a ten ninety nine from the department of health as an independent contractor and it's always been this way so it's going back to the first Surgeon General that our state had in the private sector I continue to work clinically I do a handful of ships every month as the medical director of the emergency department in Russellville St merry's and I've had a private sector role that's kinda change from year to year just as opportunities opened up but I've really enjoyed working at Saint Mary's over the last year I and I do some advising to some venture capital groups in the state and continue to work with some small innovative start ups and you know the other thing that's kinda going on that's been in the background that started because of it but it's been able to continue is finished my MBA it and a program it'll end in may yes specifically what I'm doing right now I'm on five code committees so I'm on the physician pandemic group which is the group of physicians at the health department that manages and and talks about Covin tries to figure out solutions to what we're doing on the the cares Committee distributes the the charismatic that the federal government gave for pandemic relief I'm on the governor's medical advisory committee so he selected a group of physicians most in the health department but also some from other places to serve on his medical advisory committee that the vice chair of the cares Committee on the chair of the high school sports committee which is looking at how we safely open up high school sports in our state and then the most recent committee was the winner task force which the governor put together for covert response from the vice chair of that committee which started in December so it's a busy time the Surgeon General job you sort of adjust to the season and what the topics are that the governor wanted to focus on. I see my role is advising elected officials on health care policy and advocating for healthcare providers and for patients around the state as need be on the the various issues that we have so appreciate the opportunity to come and speak to you guys and happy to answer any questions if you have any. Senator. Thank you thank you measure the I just want to get your opinion if you don't wanna answer I'm okay with that jut select my wife have code test and when she talked to our primary care physician he said we're not going to treat it if you have trouble breathing go to the ER which seems somewhat contrary to some of what we heard through the public testimony. And I'm wondering how much of the overload to the medical system has been created by not treating in the medical offices and as a result pushing to the hospitals to the R. once the disease has progressed so far that you're having breathing problems that's that's a great question senator and the answer is I don't know the exact percentage but the the the recommendations for treatment have changed over the course of the last few months and so initially we did we had no treatment if you go back to the very beginning we really had nothing that we feel confident about now what we do if I see a patient that's tested positive because of it but they're not very severely ill they don't need to be an impatient I treat them as that term action Dr drawn usually which is an anti inflammatory steroid and insert the Max's an antibiotic which can help prevent secondary bacterial pneumonia I know that there are physicians who are using other types of treatments but you know the other thing that we have now that we didn't have that I can I'm happy to speak in more detail about this but the other thing that we've been using is the monoclonal antibodies at which is an injectable treatment but it's private predominantly for people who look like they might tip over into the inpatient setting but they're not quite there yet and sometimes those antibodies can be I can be helpful in preventing admission I do think that you there there has been a time when we were seeing a lot of patience is showing up for mild disease because they didn't know what to do it seems like the patients who are showing up now or or less that and more of the more sick people so I don't have an exact percentage for you and I know that the you know the kind of shutting people to the emergency department has played a role but it seems like that's getting a little bit better these days okay VOL manager yes thank you so. and I understand if I was a physician I might be a little apprehensive to about you know what to prescribe what not prescribed because so many different opinions coming down from the top all week filtering through. What. And and I understand now that even and and I. The fact checked yes but I think there's about four governors now that are participating with their deterrent surgeon general's as far as things that were once taboo as far as treatment are now recognized as yes it does work and we need to be aggressive about doing this what is the official position or is this a health department. Question what is the official position that physicians ought to look to as far as what's acceptable treatment should they have somebody that has tested positive for coke. The health department has some guidelines the CDC has some guidelines for that and most physicians I know we're responding to those guidelines I do know some physicians who have used things like to drop the Cork winner after Mactan or things of that nature I don't personally use those because I think the the benefit of those is fairly limited but I I certainly wouldn't criticize a physician who felt like that was worth the try and there's no bans on those the health department hasn't banned that that's that kind of rumor that's going around that they there was some regulatory requirement that wasn't allowed the prescribing of those nets and and that's not the case but you know the official guidelines that you can see on the CDC and the Arkansas department health websites or the or the recommendations of those positions I know or falling okay thank you thank measure yes. All rights are there any of the questions of doctor blade so I do have one we've been reading about a new strain. Of the code that can you speak to that please yes ma'am you're supposed to give me the the heads up your **** or questions. so there's actually three strains three variants that are coming out there's one from Brazil one from South Africa and one from the U. K. and you know I haven't seen this morning's news but I know that that some of these are actually in the United States and are actually starting to spread the word the worry about these variants is not there more with more lethal it's that there are more easily transmitted so if you think about what's been going on in the last six or eight months and how all transmissible virus already is a lot of people are saying that these new variants are fifty percent or more more transmissible which means that they're getting but there's more more research people to catch these there is also some concern that they might be a little less effective vaccine might be a little less affected these variants and then also some of the other therapies might be a little less affected as well the you know what I tell people there are people who obviously for good reason concerned about this and but I always tell people is that there's two things that are going on simultaneously and sometimes it equal speed and sometimes it at different speeds but you have two things number one it with every moment in time as this progresses the viruses learning and changing it's mutating and so you have these variants that are starting to come out and so that's a big problem but on the on the flip side of that is that we're learning more to serve every day that goes by we get a little bit smarter we get a little little bit better at treating these patients and coming up with therapies that are preventing the spread and preventing the deaths from these if you will back eight to ten months ago if you got Covin you had significant comorbidities and you were older you it was almost a death sentence and so we had a high mortality rate in the very beginning but over the course of the last few months what's happened is is that we've gotten better at treating and so you have people who are entering the hospital and getting significantly ill but are recovering and and going back to full function so that's that's an example of how things were learning to sew the variants are. A problem there they're concerning into something we need to keep our eyes on but you know the good news is that there are a lot of smart people out there who are also working on this and and they're getting smarter and boarding more as well. All right thank you any other questions. All right seeing none thank you so much for visiting with us today and we know we'll see you at other times thank you for calling him out of jail. All right ladies and gentleman we are going to now here from the Senator Teague and Senate bill one eighty nine. All right when you're ready Senator Teague you're recognized. I was really appreciate calling baby what Sir No. Hi my notes here so I think it was four years ago maybe. I've been to I think it was four years ago we passed a legislation that we created upper payment limit for ambulance providers a very similar to what the hospitals do with their upper payment limit. this bill simply adds nonemergency runs may by emergency ambulance providers that program and A most folks have been working with digestion you'll notice in the bill there's expressing Simpson for DHS is a contracted non emergency transport providers or providers. Hello anybody as against this bill madam chair and I would appreciate a good vote I just I have a question please Sir So it's necessary because why was distracted so so this is you remember when we did this this was to allow. The aim which providers access up to the upper payment on the Medicare that the band would pay and but I think they actually will match the money their staff to get up to that up for payment so it's just what we do with the hospitals and their upper payment limit to this just gets more revenue to Amos Services I think it's been eighteen or twenty years since Jamison had an increase in Arkansas. And this is a way to get them for them to help get their self more money and any questions from the committee. All right does anyone in the audience want to speak for the bill. Is anyone want to speak against the bill. Seeing none heavy clothes for your bill yes ma'am thank you all right what's the pleasure of the Committee. Alright have a motion and a second all those in favor say aye. All those opposed congratulations to paste your bill thank you guys. Right Senator hammer. Yes. Three two. Senator hammer when you are ready you're recognized thank you ma'am chair last session around a bill that establish the pain pandas Advisory Council it had a sunset clause on it because we anticipated that we can get our work done before the sunset which was December thirty first of this year however due to some interruptions by a code to committee was limited on meeting however we did achieve a lot of good work and what I'm asking for is to continue that Advisory Council and it does have a it is going up and whenever legislative action would end it and I'd like to about some of the good work that we've been able to achieve to kind of help establish why we need to continue especially one key factor of first of all once we file the billing got started there's an organization out of Arizona called the pace foundation it was started by a Mr Mrs page because our grandson was diagnosed with the disease of panda pandas and as a result of that they started a foundation and out of that five major universities that all have experience or exponential medical research involved were added into a consortium a couple is being UCLA university Wisconsin and then university of UAMS was added as one of those And so as of right now we are kind of the the the go to place in the central U. S. for clients to cover patients to come in order to be treated also as a result of this advisory council's work there was establish the center of excellence over children's through you M. S. a partnership with you And missing children's and I want to publicly thank each of those institutions as they work together to collaborate that and bring that into existence and the third thing is that as of today because of anonymous donation that was made to you M. S. they were able to. You're a nurse or a I think that the nurse secured that works with two of the doctors over a children's and they see of patients who are referred from primary care physicians for further examination also official diagnosis that the client has pain and pandas and so because of that we we are able to have that inner staff over there but the handout that you had maybe one of the biggest things that has occurred as a result of the partnerships we have formed with the other research institutions and with the patient Dacian and that is at octapharma has set aside a thirty million dollar phase three study of which they are going to select ninety four adolescents from around the country some might even be able to be able to participate from around the world and in Arkansas now is has a seat at the table in that and so those had been diagnosed with that through the center of excellence will have an opportunity if selected kiss paid in that and adventure will happen is it will it'll hopefully lead to FDA approval of the drug in order to be able to treat those they're diagnosed with pandas pandas and with that being said manager the reason we need to continue the work of the Advisory Council is because we still have work to do we want to follow through is what we started with and would appreciate a good vote so that we can allow this you committee and all the members of the committee or voluntary to if appointed back are willing to serve on the committee so won't be like we got a search for much new people they want to continue to work but we need this in order for the work to continue. I'll be glad to answer any questions any questions from the committee. All right seeing none is there anyone in the audience that would like to speak for or against this bill. All right. Seeing none heavy clothes for your bill yes ma'am I make a motion appropriate time do pass all right all right this is the the time we have a motion to pass to have a second all right all those in favor say aye. All those opposed congratulations you passed your bill thank members or members of committee. All right the K.. All right Senator Bledsoe you're recognized for Centerville. All right I think my Senate bill ninety nine is the next one on the list bill ninety nine a all right ladies and gentleman you heard this bill it went out of the committee unanimously and then we have put a three amendments on it the first amendment we withdrew and incorporated that information on that amendment into the second one and so today I just wanted to run to the engrossed bill which you have. Of at your at your seats in a tell you what those things are. And by the way before I get started I want to tell you that to. That we have met with everyone I did get a call today about someone else but to we're moving on. And the we have meant without the concerns of DHS with the concerns of just about to. Everyone and this is the bill that to has been amended in we believe it's a good bill and remember what stepped therapy is it also has the name Phil first initial know that when you go to the doctor he A prescribe some medicine for you go the pharmacist and the pharmacist says well your insurance is not going to pay for this and then you start the procedure of to try to get your insurance company to pay for that medicine and I will tell you again before I start then I had an email from someone that I've looked around look at the committee that you would all know he's the middle forties he goes to work every day has a lovely family and he said you can use my case but don't use money so I'm going to under that of course but I want to tell you that he was diagnosed with Psoriasis. A. Matar the service right so let us authorized and the wind he. Was given the first medicine. that was when the. Insurance company said I'm sorry we're not going paper that into you to this medicine and you try this medicine what we tried it and it made as joint so well and it was very very painful for him. So now fast forward eighteen months and he was still trying to get his insurance company to pay for the medicine that would relieving the pain that we keep this joint from swelling. So that he could be of a very productive citizen eighteen months committee and the thank given up. And he says I guess I'm just going to have to take this other medicine. For the rest of my life so with that lists the talk about the amendments. Arkansas is currently Arkansas currently has laws pertaining to stepped therapy. And you can see the current law on page nine of the bill most of the current law will be stricken you will see that it was focused mainly on providers and insurance companies it is my hope that the changes proof of proposed in this bill should they become law will focus on the patient and their care. Since my bill was filed on January the twelfth three amendments have been passed and like I said we took the first one and we. Withdrew it and incorporate that into two and three. I have worked with groups associated with both sides of this issue and feel the amendments improve the bill and it is my hope again that we cannot all now support the bill the first amendments like I said simply simply change simply changed rulemaking authority from the Department of Human Services to the insurance department of. That is on the bottom of the page ten I'm gonna quit holding this thing up so if you can't hear me. Raise your hand and I just. Talk louder. so that's on the bottom of page ten. The second amendment that was engrossed. and made in an engrossed the first changes simply amended the legislative funding for that support and I want to focus on of the most important things. Of the next changes ensure that dental or vision care only benefit benefit plans are as specifically exempt from insert from a of ensuring that they are excluded from the from the health benefit plan along with Medicaid being sent and that is so Page three day see Roman numeral nine. And then the kid to be. Line twenty nine. And then the next change of was made to better defined utilization review organizations and that will be included that would include those that perform stepped therapy for for healthcare insurers and others but excluded. An insurer of automobile homeowners in casualty and commercial liability insurance so you can look on page four line twelve and then page four again line twenty three. So this does limit the bill to the entities providing certain health care insurance plans finally the last change in the second amendment ensures that M. multi disciplinary panel of export experts create clinical review criteria and that Page four line thirty the third amendment has also been engrossed in the bill before you is the current bill again hi I really believe that this does make a a much better bill in the first change better defines clinical practice guidelines to ensure that guidelines are derived from peer reviewed published medical literature evidence based research and widely accepted medical practice the last change allows peer reviewed published medical literature to be used to be used to establish clinical review criteria in lieu of guidelines however the litter to should be developed in a manner to ensure conflicts of interest are managed if possible. And that is the the the first change that mention defines clinical practice guidelines it's page two lines sixteen through eighteen the next one is page four lines twenty seven through thirty and then page five line one. Now I have agreed to all three amendments to this bill after working with groups on all sides of this issue and I believe that to add just like I said today spoke with someone I don't know what their issue is but of the ones that I have worked with us now there were three amendments from a large insurance company which will remain anonymous that didn't accept of but we felt like that it changed the bill to the extent that we didn't we didn't have a bill but these are the The Amendment sent to that is one here today it's the the engrossed bill in a good to be glad to answer any questions. Our members are there any questions by the committee senator hammer you're recognized for a question. Thank you Mr and thank you Senator Bledsoe just a couple quick questions. As far as like large employers who are self insured. Does this bill applied to them as well. It does not apply to a recess plans okay Senate Walmart okay The second thing is on page four when it talks about the multiple multi disciplinary panel. Who selects that panel or who's going to determine who serves on that panel what what line did you say Page four line point I'm sure it's page four I think it's when you're members page four line thirty and thirty. Well and stepped therapy it's all about information and I'm assuming I don't know per se but I'm assuming it's a some of the stakeholders involved coming up with the and and hopefully medical a part of people in in those that are involved in the treatment. Of some of these illnesses that are under that stepped therapy. So. I'm not positive but I will find out the answer before I take it to the floor okay thank you because the following Mr for follow up thank you because in doing another subject matter were you know multiple disciplinary panel the server that was established. If. Penzo which which means if the insurance companies they don't stand a chance but if if it's made up of the medical profession sought I would just ask maybe if we could define before gets the floor who that's going to be make sure that the the the citizens are represented in that okay with a sense so as not to citizens but those who I'm that medical knowledge right. Okay thank you. All right members are there any other questions. C. nine is there anybody in the audience to speak for or against. C. nine center but so you're recognized close your bill I am. I think I've said everything that I need to say so I am close from a bill all right or the wish of the committee. The motion by Senator Hester second by Senator Gilmore all in favor signify by saying aye. Post resolution senator Blitzer your bill passes thank you. And then you have another bill and that is Senate bill eighty five. A we won't pass today okay I need an amendment on them correct another amendment that should set okay. This is do you have another one I have two others it's under represented Boyd's name and okay thank you so you Mr with house bill eleven oh seven nine. I have someone here to help me with the Levin of seven. If you're recognized herself hi I'm Jamie turbine the PDMP administrator from the Arkansas department of health great thank you welcome to public health center but so you're recognized receive your bill all right thank you so much the purpose of this bill is to allow the PDMP to request copies of original prescriptions or electronic prescriptions in order to audit and evaluate the controlled substance dispensation data reported to the program but dispensers which in essence would be pharmacies the bill also includes language for the PDMP to request copies of original prescriptions or electronic prescriptions from describers in the case of a prescriber this dispensing a controlled substance from his or her office at this time we are unaware of the any prescribers were being told that there are no of describers dispensing controlled substances from their offices but date S. that we include this language just in case that changes in the PDMP is an important tool used by health care providers for improving patient care professional license boards law enforcement and investigations into create reports of that are published for the public can for providers for these reasons it's important that the date of the complete and accurate and that the program have the authority to audit the date of receipt all right of. Currently the only way the P. D. empty is made aware of an era if a provider calls in indicates that there is missing data like to Klay prescriptions on a patient or if there are Heironeous prescriptions to treat it to him or her this bill would allow for thorough audit. And the the Arkansas board of pharmacy currently has the authority to request this type of documentation from their licensed pharmacies and when possible of they will coordinate with the pharmacy board in the requested this information so that efforts are not duplicated. And a number of states have this sort of authority to request this information and to they would like for Arkansas to join that group. All right. Right members he per an explanation of the bill are there any questions Senator hammer you're recognized for a question Sir thank thank you in any the Senator Bledsoe or I'm sorry I didn't get the name of your Jamie tarpon Mr bin. So what's the necessity that we're having to ask for physical copies because I would think that the electronic. Would be sufficient but who are we and I'm opposed I'm just trying to say why we haven't asked for physical copies also. Some prescriptions are actual paper okay that makes sense is that what you're asking yeah I'm just trying to live without the ones that were sent in okay all right thank you. Fazer amor. Three more questions members. All right say no more questions and we've got Mr been you've signed up to speak for the bill you wanna go ahead and yes please you're recognized to speak for the bill. I just really appreciate this up already in order to audit the data when we do get heirs called in all I can really do is ask a provider to call the pharmacy and have them look at the hard copy and then go from there this would just help alleviate having the provider to to call the pharmacy the pharmacist had to look at it and then go back and forth knowing their schedules that just might make it a little easier for us to handle that in house. Thank members have any questions for Mr Cohen. Thank you very much we also have Mr Kirk lane signed up to speak for the bill. Thank you please identify yourself for the record I'm Kerr claimed state drug director I want to speak for this bill the the prescription drug monitoring program as Senator Bledsoe said was is it is one of our most effective tools especially in a lot of the opioid epidemic. even though we have the second highest prescribing rate in the United States still today we're at the lowest prescribing rate that our state has been in fifteen years giving good data and it's so important that we have accurate data to prescribers helps them make good prescribing decisions so I would hope and encourage you to pass this bill because it would help us greatly thank you Sir members are there any questions. All right see none Mr lane thank you for your testimony. And we also have Mr John Kirkley. The House gave me your on the next bill all right is there anyone else that like to speak for or against. I seen under center but so you're recognized to close your bill. Thank you but I am clear closed all right or the wishes of the committee. Got a motion by Senator Gilmore second by Senator hammer all in favor signify signify by saying aye. Opposed regulations senator bill passes thank you and then we'll proceed on to House Bill O. Levin seventy four yes and I would like Mr Kirkland to come up and sit with me. Bill this is really just some clean up language it just removes unnecessary costs and various for fun of pharmacists wishing to practice in nursing homes and then as a nursing home consulting consultant. Of and this bill removes of those two things by a statue and by rule also the bill would eliminate and unnecessary and confusing additional license endorsement to practice in Arkansas for something that it's been standard pharmacy education for decades and the maybe Mr Kirkland would like to add to that but I think it's just to Just cleanup language. China to go ahead and just identify yourself for the record thank you Mr chairman name is John currently on the director the board of pharmacy I'm here to answer any questions but in brief this I just would delete two endorsement processes where farm sister in a paper chase to have an extra line on their license to show that they have something is an endorsement that's been in our education for thirty or forty years at this point but answer any questions you have. Members are there any questions. See non what's the pleasure of the Committee. We got a motion to pass by Senator hammer a second by Senator Gilmore all in favor please signify by saying aye. Opposed graduation center your bill passes. Alright ladies and gentleman the. I don't. Know of any other business and because of that we are now adjourned.