Public Health, Welfare and Labor Committee- House
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Transcript
4 documents
Bills discussed (5)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
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HB1107
Act 62
· 2 mentions in agenda, chapter
Matched: “…TY IN BATTLING THE ABUSE OF PRESCRIPTION DRUGS IN ARKANSAS. HB1107 Boyd TO AMEND THE PRESCRIPTION DRUG MONITORING PROGRAM ACT.…”
|
TO AMEND THE PRESCRIPTION DRUG MONITORING PROGRAM ACT. | Boyd | Notification that HB1107 is now Act 62 |
|
HB1154
Act 268
· 2 mentions in agenda, chapter
Matched: “…NAGEMENT CREDENTIAL. DEFERRED ITEMS Number Sponsor Subtitle HB1154 Ladyman TO AMEND AND UPDATE THE ARKANSAS CODE REGARDING REG…”
|
TO AMEND AND UPDATE THE ARKANSAS CODE REGARDING REGULATION OF IONIZING RADIATION TO COMPLY WITH … | Ladyman | Notification that HB1154 is now Act 268 |
|
HB1155
Act 345
· 2 mentions in agenda, chapter
Matched: “…ENDA *Bills in Red added 01-19-2021 Number Sponsor Subtitle HB1155 Ladyman TO REMOVE BARRIERS TO THE RELEASE OF DATA IN THE AR…”
|
TO REMOVE BARRIERS TO THE RELEASE OF DATA IN THE ARKANSAS CENTRAL CANCER REGISTRY TO … | Ladyman | Notification that HB1155 is now Act 345 |
|
HCR1002
· 2 mentions in chapter, agenda
Matched: “HCR1002 Boyd TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE…”
|
TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE PROVIDERS, LAW ENFORCEMENT, EDUCATORS, PUBLIC OFFICIALS, AND THE ARKANSAS … | Boyd | Approved by the Governor |
|
HB1174
Act 63
· 1 mention in chapter
Matched: “HB1174 Boyd TO ELIMINATE THE NURSING HOME CONSULTANT PHARMACIST PE…”
|
TO ELIMINATE THE NURSING HOME CONSULTANT PHARMACIST PERMIT AND THE DISEASE STATE MANAGEMENT CREDENTIAL. | Boyd | Notification that HB1174 is now Act 63 |
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- October 7, 2026
here at the front table so um jeff you have anything okay all right so we'll get right into it um first on the agenda is the department of energy and environment so if y'all would come forward to the front table
Secretary Keough, if you would, please introduce yourself and the other members of your team that are here. Well,
Speaker 7
0:43
good morning. Can you hear me through my mask or do I need to
remove it? If you'd like to take it off, you should be spaced there,
Speaker 7
0:52
so you're welcome to do that. Well, if it would be clear. Good morning. I'm Secretary Becky Keough. I serve as director of DEQ as well, Division of Environmental Quality, but in my capacity
as secretary over the Department of Energy and Environment. And I've got with me our chief counsel for the department, who also serves two jobs. He is Shane Curry. He is the assistant director of the Arkansas Oil and Gas Commission, but is serving at the department level as chief counsel. And then we have Michael Grape, who's sitting behind me, who is in our director's office or in the, I'm sorry, the department's office serving as a direct contact for you as legislators.
And he would be your first point of contact on any issues that you might have during this session. But also in the interim periods between sessions, we're happy to work with you on constituent issues or things that come up. So and we were happy and he will make sure that it comes to my attention as well as the appropriate parties in the department to get you a timely response or support. So the department was formed really brought together several entities that have some regulatory function, but also are comprised of what I call a strong scientific group as well.
So there's a good alignment when you look at the entities that were brought together under the Department of Energy and Environment. I just wanted to mention those entities briefly, as I mentioned, the Division of Environmental Quality, which is formerly the Department of Environmental Quality, where I continue to direct. We also have the Pollution Control and Ecology Commission entity, which is a separate body who manages rulemaking and poor environmental issues as well as handles
administrative appeals of director decisions. We have the oil and gas commission led by Larry Bingle, Director Larry Bingle, who you know, he also is now serving at the department level as well in a second job as our chief technical officer for the department. And that's, he's been very a strong asset for us in the department. We have the Arkansas Geological Survey if you're familiar with them. It's an entity that does a lot of geological research in the state but also
manages a risk around earthquakes as well as other supporting other departments in terms of the geological sciences and resource development in the state. We have the liquefied petroleum gas Board, which is basically, in layman's term, propane, servicing that regulatory gas board who assures the safety of the propane installations in the rural parts of our site and in the urban parts as well. A small entity, but a very active entity, especially this time of year.
And then we have a few, several licensing and advisory committees that serve under those those various entities, but those are the the official part of the Department of Energy and Environment. We have, we'll have this session, we anticipate about six pieces of legislation, which we can explain or not explain. I just wanted to bring you an explanation of what we're doing. The legislation is designed around aligning our programs more effectively, looking at how we can
implement the programs in a more cost-effective, but also a timely and with the focus on providing better service to those that depend on our services. But we also have a number of just some cleanup legislation that will bring us in compliance with various statutes that were adopted. So I wanted to make sure that we identify those. But Shane, did you want to elaborate on those at all? We're welcome to, or I would be happy
Speaker 13
4:55
committee is, or otherwise we can do that when we present the
Speaker 7
4:59
bill. Yeah, you may proceed. Go ahead. Okay. Well, I'll mention the first one, and then I'll pass it on, because some of you may know there's a Clean Water Act, Section 404, which has traditionally been implemented by the U.S. Corps of Engineers and the U.S. EPA. This program was adopted at the federal level with the intent that it become a state primacy program, and that's been slow to happen. So there's been several states now that have been able to work with the Corps
and EPA, and they have expressed an intent to delegate this program to states. And so this bill will take the first step in order for Arkansas to receive delegation of this 404 Clean Water Act permitting program. And that shift will be important to Arkansas. It will create some efficiencies for both agriculture and your county operations, but it will also provide more certainty and consistency statewide, as right now our state is split among three U.S. district core offices, so we will have a single type permitting program, which would apply to all
of Arkansas if the state has primacy. So at that point, I'm going to shift over to Shane and let him explain
Speaker 18
6:09
the other five pieces. Thank you. Our second piece of legislation, a proposed legislation deals with the Arkansas mining program, and our proposal is to shift the administration of the mining program from what has been a DEQ-administered program to an oil and gas-administered program. We think that will be a better alignment and create efficiencies within the Department of Energy and Environment, both of them being a resource
extraction and management program. So that proposal would shift that over to the oil gas commission to be administered by Larry Bingle as director primarily and the oil and gas commission. We'll also have a few cleanup pieces codifying some special language. There's a piece of special language currently in the division environmental qualities appropriation that gives an exemption to certain public facilities. And we want to basically codify that, get it out of the appropriation bill and put it in the statute so that everybody
knows where it is and basically maintain the status quo but put it correctly where it should be. Last session, you all, members, you all remember there was this piece of legislation that said agencies were supposed to change the term from regulation to rule. And there was a simplified process for most agencies that said if you filed a letter with I think the State Library and the Secretary of State's office by the end of the year, you could just file a new copy of your rules and changing the term regulation of rule. The only issue is that that did not apply to
agencies that are not subject to the Administrative Procedures Act. So while most of the entities within E&E were able to do that, specifically Oil and Gas Commission, LP Gas Board, they were able to do that, the Division of Environmental Quality was not. So it's basically a mirror image of that piece of legislation that allowed a quick, easy way to change the term regulation to rule in accordance with the act from 2019. We also have a proposed amendment dealing with our environmental officer program. We're trying to clarify some existing
statutory language to limit the authority of environmental officers. This was passed two years ago during the last session and there's some question and maybe some need for clarity in what the actual powers and duties of an environmental officer are and actually some limitations to when they can come on public land. So we're actually trying to clarify that to make sure that we're not empowering these environmental officers to go on private lands when they shouldn't be there. So we're actually trying to clarify that. And our last piece deals with the Solid Waste Licensing Committee. We're going to be reducing the number of members on
that committee. I think this is a universal recommendation from that committee as well as secretary keogh and also easing the burden of these operators we're going to go to instead of paying having to register and pay a fee every year they'll be basically doing that every two years so the fee will stay the same they'll just be doing it two years at a time so those operators don't have to do it every year they'll be able to do it every other year and i think that wraps up the six department proposals we have i assume most of them maybe all of them there might be one or two that don't come specifically this committee the the ones not dealing with deq but
I would assume you're going to see some version of these in this committee at some point.
Representative Mary Bentley
Unverified
9:32
Thank you. All right. Thank you very much. Members, do you have
any questions? For those of you that are new to the committee, you may not have thought we would hear ADEQ bills in here, but most of your bills will come to this committee, so we will see some of those air, water, waste related bills.
Thank you all very much. John, do you have a
Representative John Payton
Unverified
10:00
question? Representative Payton. Yes. Thank you, Mr. Chair. The legislation that you just mentioned, are any of
Speaker 26
10:07
those drafted or filed or could you forward us what information or brief points on
Speaker 27
10:11
that that you have? Yes, sir. Okay, there
Speaker 18
10:22
we go. Yes, some, they're in the process of being drafted.
Some of them have been filed, but we'll make sure, I'll have Mr. Grafay make sure he distributes a copy to all of you members of those six pieces as they're, once they're drafted and filed, or would you like the previewed ones, or just once they're going to be filed? Yeah, I mean,
Speaker 26
10:39
right now, early in the session, we have a little more time to concentrate on that. So if you could forward some points or whatever on that, it'd be great. All right, thank
you. We'll make sure we do that. All right, thank you. All right, next on the agenda, we have the Arkansas Center for Health Improvement, ACHI.
So if y'all would come forward. And Dr. Thompson, if you would introduce yourself and your team
Speaker 36
11:13
there. Good morning, Mr. Chair, members of the committee. I'm Joe Thompson, the director of the Center for Health Improvement and a professor in the College of Medicine at UAMS. With me is Michelle Kitchens, who you will see and be available for you when I'm not, and you can get to me that way anytime. Glad to have Michelle on the team with us now.
You've got a handout, I think, or there is one that we'll get out to you. I'll be very brief. Our center has been around. We're in our third decade. It's hard to believe we've been around this long, but I've not been the director the entire time. We are administratively housed in the chancellor's office at UAMS, but our physical office is over here in the Victory Building. where Channel 4 is, so if you ever want to come visit us, feel free to. Our goal is to be a catalyst to improve the health of Arkansans, and we have worked closely with members of the executive teams,
as well as many of you and your predecessors, to achieve some pretty big accomplishments in the state as a collaborator. You've got several things on here. The Tobacco Settlement Act is how we got started, the clean indoor air bill, the obesity efforts that we've had underway, the private option, now Arkansas works on the Medicaid expansion. One of the biggest issues that you have is the Transparency Initiative Act that the legislature passed in 2015 that puts all of the paid claims
from Medicare, Medicaid, commercial, plus linked to the health department's data to actually be able to provide you information to make informed choices on your Bureau of Legislative Research can access that data and we'll be glad to work with them or with you directly as questions come up. About 20% of every dollar that is exchanges hands in the state of Arkansas is in health care so that's why this piece is going to be in front of you people are going to want part of that 20% we tend not to get into the scope of practice issues or things like that
We try to stay on more of the substantive issues going forward. We have been providing some analytic surge capacity to the health department, putting out both school district and zip code level information of the number of COVID cases that are active and so forth. We work closely with the Municipal League and the State Chamber to try to inform those audiences. One of the things that we have seen is the explosion of telemedicine. I mean, if we just look at the state and public school employees before March, they had fewer than 200 telemedicine visits each month.
And in last spring, they got up to 20,000. In fact, some counties, 25% of all the visits were done by telemedicine. And the public health emergency rule kind of threw that wide open, and we anticipate that we're going to have to narrow it down. We don't want to go back to where we were before, very restrictive, but I think we're going to need to find some ways to fine-tune the telemedicine payments and so forth going forward there. The other thing that you have on your agenda this year is the reauthorization and reappropriation of the Arkansas Works Initiative.
That bill has a sunset of December 31st, 2021, so you will need a reauthorization for the Department of Human Services to continue that program. We will be a strong advocate for that. We have seen in the states around us just in the last eight years since your passage, 57 rural hospitals close in states around us that did not expand Medicaid to offer a mechanism for low-income, uninsured individuals to get care. We've only had one hospital close, and that was in Dequeen, which was really not because of uninsured issues.
It was a management issue there in Dequeen, and they're rebuilding that hospital back, or a new hospital back. So our health care infrastructure has been relatively steady. We do think you're going to have several legislative issues that we can just identify for you. Obviously, the COVID-19 mitigation, vaccination, we're still in the middle of that. The Arkansas Works reauthorization that I mentioned, we've been doing evaluations of the crisis stabilization units. These are units in four cities, Fort Smith, Fayetteville, Jonesboro, and here in Little Rock,
where an individual that's in a mental health crisis and comes into contact with law enforcement, they can be taken to a stabilization unit as opposed to jail. Jail is probably the worst place for somebody in a mental health crisis to get, and that will need to have your support to be able to continue those entities. Last month, in the congressional bill, the COVID relief bill, there were two things that may come up in front of you. One was a limit on surprise billing. This is when individuals, you know, go to an in-network hospital, and then they get a surprise bill because a physician
or something was not in-network, and they get that. It's not as big an issue here in the state because we haven't any willing provider law, but there is a piece of, a new piece of congressional action that may need the insurance department support to oversee. Also in that piece of congressional action was a new designation, the Rural Emergency Hospital designation that allows rural hospitals to convert from critical access hospitals, which they can do now, to a new model that has a more stable long-term funding mechanism.
We think there may be half a dozen Arkansas hospitals that would benefit from that designation. And finally, on the policy objectives that we have, I mentioned the telemedicine issue. We anticipate pharmacy benefit managers will still be in the news because of the 8-0 Supreme Court decision supporting your piece of legislation two years ago. And then finally, we'll always be trying to add vaping to the clean indoor air bill to make sure that that's not an exposure that happens inside of closed airspace.
So we'll be glad to help you with anything that comes along. Our goal here is the same as yours, I think, to have the healthiest, most productive state that we can. And as I mentioned, with 20 percent of every dollar exchanging hands in the health care system, there's lots of interest in the health care financing and delivery within our state.
Thank you, sir. Be glad to take questions. Well, I have a question. I know the new waiver that we have to apply for, there's a lot of discussion about measuring outcomes
because even though Arkansas Works, Private Option, Affordable Care Act has been in effect for many years, our outcomes in the state of Arkansas has not improved, and in many other states it hasn't improved. So many of the proposals are outcome-based, which I think is good. Is that something that you all will be able to help us to measure? You know, what are the outcomes, not just how many cases we have, but, you know, do we have a goal?
Speaker 38
17:55
Are we hitting that goal? Are we approaching that goal? Is that something
Speaker 36
17:59
you can help us with? I think it is something that we'd be glad to help with. Also, we're engaged with Dennis Smith and the team at DHS to help develop some of those indicators. I do think it's important that the financing of when people are sick and need care is one piece of the puzzle. The other piece is how we keep people healthy on the front end, and that's with tobacco control and obesity management, having people be a little more physically active. If we don't deal with the front end, we're going to continue to have a challenge in paying for and delivering care
when people become sick and need that level of service. So I think it's a whole package, but we'll be glad to help you on measuring those outcomes. I would just encourage, let's look at the upstream outcomes
Representative Carlton Wing
Unverified
18:41
as well as the delivery system outcomes on the
downstream. Okay, I agree. Members, any questions? Representative Wing, you're recognized. Thank you, Mr. Chair. Just a couple of quick clarifications. I wanted to make sure I got the notes right. As you were talking about telemedicine, you gave two examples of where we were,
and then you said $20,000. I just missed that first figure. If you could talk just
a little bit about where we were and where we are now. So, and I trust you'll be able
Speaker 36
19:12
to get this out. There's a slide on the fifth page here. of the telemedicine provided to the Arkansas State employees and public school employees plan. Those two plans are the largest plans that we have in the state, so we kind of use that as a window into what's going on. October, November, December of 19, January, February of 19, fewer than 200
telemedicine visits as we shut down and went into the public health emergency and had the rules around what could restrict telemedicine opened up. In March, we had 4,300 telemedicine visits for state and public school employees. In April, 21,000, so we went from fewer than 200 to 21,000 in two months. And obviously, I think many patients have welcomed not sitting in a doctor's waiting room for an hour while they wait on the doctor, and they can just call up and have that taken
care of. But I think we're going to need to move to where we come back to, okay, we've accelerated telemedicine probably by a decade. Let's get it right
Representative Carlton Wing
Unverified
20:11
on when and how and where it's delivered. Great. Thank you for that. Thank you, Mr. Chair.
Representative Joe Cloud
Unverified
20:22
Representative Cloud, you're recognized. Thank you, Mr. Chairman. Dr. Thompson, would you or Ms. Kitchens just provide your contact number? You might want to do that offline. I'd be glad to give you my cell phone number.
Chair
Unverified
20:35
One, six, zero, seven, four, three, eight, nine. Representative Bentley, you're recognized. Thank you, Chairman.
Representative Mary Bentley
Unverified
20:55
Dr. Thompson, thanks for coming today. As I look at that report that we were just talking about, the last reported number you have is for July of 2020. Do we have anything since then that you could share with us? Because it looks like it's leveled off quite a bit, so it's down to $54,000.
Representative Fred Allen
Unverified
21:09
As our physician offices open back up, people have started going back to the office, although still we were at $5,000. We can look for subsequent
Speaker 58
21:16
information. We usually have about a three-month lag, so we should be able to get you information
Representative Mary Bentley
Unverified
21:22
after July. I'd just like to know if it hasn't leveled off to that number.
Representative Fred Allen
Unverified
21:30
Thank you, sir. Appreciate your help. Representative Allen, you're recognized. Thank you, Mr. Chairman. My question has been partially answered. But I was going to ask Dr. Thompson, with the increase of telemedicine, was that driven by COVID-19?
Without question, the increase in telemedicine
Speaker 36
21:46
was as we went into the kind of shutdown mode that we're in March, April of last year. People still needed to get care. People had conditions and they needed to get care. And so our physician and clinician workforce started using telemedicine in a more robust way. So I think without question, it was driven by COVID-19, and we probably jumped forward five to 10 years on what we can do. We now need to figure out how we optimize that, particularly in rural parts of the state,
to be able to try to get specialty access out so that people don't have to drive 100 miles to come in to get specialty access when we can do it through telemedicine,
Representative Fred Allen
Unverified
22:25
televideo contact. Follow-up. Yes, please. Do you see this as part of a new norm in our society today? I
Speaker 36
22:32
think it's clearly going to be a part of the new delivery system. I think we will have many physicians that see this as a way to extend their clinic. Obviously, there are many conditions that have to be taken care of in person.
You can't really have surgery via telemedicine. But I think hypertensive management, diabetic management, HIV management, things where it's more of a conversation, counseling, those type of sessions, telemedicine could really open up specialty access across the state and so that we could really improve rural access
Speaker 58
23:00
to specialists for those individuals that need it. Thank you. All right, seeing no further questions. Thank
you for the opportunity. Look forward to work with you this year.
Okay, next item on the agenda is Dr. Budso, Arkansas Surgeon General, if you would come forward. And Dr. Bledsoe, please
introduce yourself. Thank you. Excuse me. Thank you, Mr. Chairman. I
Speaker 69
23:38
appreciate the committee allowing me to come to introduce myself today. And what I thought I'd use my time to do is answer a couple of questions that I get asked all the time. And the first one is, what's your background? And the second one is, what do you do?
And so I'm an emergency physician by background. I grew up in Rogers, Arkansas. I did med school and residency at UAMS. My specialty training, obviously, is emergency medicine. I started my career doing global health, and so I went out of state to complete my training. I did a two-year fellowship in international emergency medicine, got a public health degree at Johns Hopkins, stayed on faculty there a couple of years and did research and teaching. And then they sent me all over the world. So I've been to almost 60 countries, mostly doing medical care.
I worked with the Secret Service as a consultant, put together a textbook on expedition and wilderness medicine and then was hired away from Hopkins by the University of Pittsburgh where I did a consulting contract in the Middle East in the country of Qatar and my wife and I moved there when she was six months pregnant and not an easy sell to tell the in-laws you're taking their their daughter to the Middle East to have their first grandchild but they were very supportive and we went to Qatar and spent 14 months in Qatar working on an emergency medicine program there
with the University of Pittsburgh. My first daughter was born there. When we finished the contract, we came back to the States. We lived in Georgia for a little bit. I put together a small medical education company, basically teaching what I'd learned at Hopkins in doing global health, teaching American physicians and nurses how to do global health. And that small company is still going on. It's called ExpedMed. And we have had a couple of conferences here in Little Rock in the last couple of years, bringing physicians from all over the country to teach them global health. And then was managing emergency departments in Alabama while I was doing
these other things when the governor called and asked that I come back home, which was an incredible opportunity to come back and be close to family and friends and then also work in Governor Hutchinson's administration. So what I do now, the interesting thing about the surgeon general position is it's not full-time. I'm not a state employee. So I get a stipend from the state. I don't get health care benefits. I don't get retirement from the state. I work predominantly out of my home office at this point, like many folks with COVID. But I'm an advisor to
the governor and to our elected officials. And so I interact between the health care community and patients and those who serve in elected office as an advisor. And in addition to those duties, I'm expected to have a private sector job. And so I run the medical department, or excuse me, the emergency medicine department at St. Mary's in Russellville. So I'm the medical director there. and continue to do work in the private sector as well as advising and being involved as Surgeon General. And specifically what I'm doing these days, it's everything COVID, as you can imagine.
So I've been involved in a lot of different things. As per my title, I'm a member of the Board of Health. I'm a member of the Health Day Act of Arkansas Board. I'm a member of the board that oversees the all-payers claims database that the state set up a few years ago. But regarding COVID, I'm on five committees. I'm a member of the physician pandemic group at the Department of Health, the governor's medical advisory group. I'm vice chair of the CARES committee that distributed the CARES money over the last few months. I'm the chair of the high school sports
committee regarding COVID and the opening or not of various sports. And then I'm the vice chair of the winter task force that the governor put together just recently with a lot of hospital executives from around the state. So it's a busy time to be Surgeon General, but it's an incredible honor, and I look forward to working with all of you on health care issues. And the best way to interact with me, you're welcome to text or call me anytime. You can email me. But I take a lot of texts and calls from people who just want a physician's perspective on various legislation,
and that's kind of where I feel like I can give my most valuable advice to the folks who are making decisions. So thank you for having me. I'm open to any questions. Representative Bentley, you're recognized
Representative Mary Bentley
Unverified
27:50
for a question. Thank you, Chairman. Dr. Bledsoe,
thank you so much for being here today. And just can you give us, what are you
seeing now as the best therapeutic therapeutics for COVID? Because I think I get that question asked most. I know, unfortunately, too many folks are sitting at home and getting sick before they get treatment. So can you give us what you think are some of the best outcomes that you're seeing for therapeutics now that
folks can be going to get, so they're not sitting at home getting real sick
Speaker 69
28:17
before they get treated. Yes, ma'am. That's a great question. And I have the real privilege of having a foot as Surgeon General in the policy side, but also having another foot in the clinical side. And I worked a shift, a 12-hour shift yesterday. I work a 12-hour shift tomorrow. And there's a lot of COVID patients. And one of the things that worries me is that you're absolutely right. People get sick, and they stay at home, and they stay too long at home, and they come in,
some of them crashing. The good news about COVID amidst all the bad news that we've had over the last six months is that, you know, the virus is spreading. It's mutating a little bit. You know, we've got the new variant strains that are going around, but we're learning too. And so when this started in March, we had no idea how to treat this. There was a high mortality rate. If you got it. People do not do well. That's changed. There are still people who are dying of COVID. Our ICUs have a lot of COVID patients. Our hospitals have a lot of COVID patients. I've lost count of
the number of people I've intubated personally who've had COVID and have watched die of COVID. But the good news is, is that we have therapies. So we have the antiviral medicine remdesivir, which was developed during this crisis. And if you're admitted to the hospital and you're sick, your oxygen levels are low, we can give you remdesivir, which is a five-day treatment. And that's been shown to really, it seems to really help. There's another therapy called convalescent plasma, which is survivors who have gone through a COVID infection can donate blood.
The blood is purified, the plasma that the blood cells are in is purified. And then the antibodies from those patients are then injected like a blood transfusion into a patient that has active COVID, and that seemed to help. And then there's another therapy called monoclonal anti-antibodies, which is a synthetic version, kind of like the convalescent plasma, but it's made in a lab. It has antibodies. And we just started giving this out of my emergency department in Russellville and around the state. They're giving it. And that's for people who aren't quite needing a
hospital bed, but it looks like they have risk factors for potentially bad disease. They're kind of on the edge, but they can get monoclonal antibodies and hopefully keep them out of the hospital. And so that's been a really great thing. And I was on a call this morning, Governor Hutchinson had his winter task force, and we were talking to hospital executives around the state, and many of them said that the monoclonal antibodies seem to be helping. It's keeping patients out of the emergency departments and out of the hospital beds, which is a great thing. And then, of course, the ultimate preventative therapy is the vaccine.
And just, I don't want to take up a lot of time, but I will say this about the vaccine. The vaccine technology is really unbelievable. I mean, to me, as someone who, you know, I was at Hopkins 15 years ago. I studied vaccines as part of my public health training, and I'm a believer in vaccines. But the technology that is being used in the Pfizer vaccine and the Moderna vaccine is, it's the difference between a Volkswagen bug and a Tesla. What they're doing with these vaccines is something that was almost science fiction a few years ago. So if you look at a cell, you have the DNA in the nucleus of the cell.
When the cell wants to create a protein based on that DNA, a messenger RNA strand is formed, and that messenger RNA goes out into the cell protoplasm, links up with a ribosome, which is another organelle of the cell, and then the ribosome reads that messenger RNA and produces a protein. What scientists have theorized is that maybe we could develop our own messenger RNA and inject that into a patient and turn the patient's cells into a production factory of whatever protein or therapy that we need. And so it's been theorized that you could use this
instead of taking a pill, taking a drug, you could do an injection like this, and the body's own cells would develop proteins to fight against whatever the patient has, whether it's a genetic disease or cancer or even infectious diseases, and then ultimately, of course, vaccines. And so what the Pfizer team and the Moderna team did was they did that very thing. They developed The DNA of the COVID virus was sequenced. They read the DNA. They developed their own synthetic messenger RNAs that would code for the spike proteins on the outside of the COVID virus.
And now they're injecting that into patients. And what happens is the messenger RNA gets absorbed into cells, linked up with ribosomes. The proteins, the spike proteins of the COVID virus are made. There's no danger to the patient. The messenger RNA dissolves. It doesn't go into the DNA. It doesn't alter the cells in any way, but what it does is it allows the cell's body to quickly form antibodies without exposing patients to the COVID virus. It's an amazing technology, and it's one of those things that when I was reading about this, I really couldn't believe we were actually doing it,
and so I'm really excited about the vaccine, but those are the overall therapies that have been developed in the last six months. One quick
Representative Mary Bentley
Unverified
33:11
follow-up. That's okay, just real fast. Yes. I know that your boots on the ground are in the ER and not in the physician's office, and I'm hoping to keep folks out of the ER, period. So are you hearing any other therapeutics like ivermectin or some other meds that are keeping folks from even having to get to the ER? I know that's really a primary care med that's being used out there. Are you hearing anything about that or any other primary care meds even keep them out of the
Speaker 69
33:33
ER? Yes, ma'am. Great question. So the two things I've heard that
people are using that have seemed to help. Some patients are taking Zithromax, like a Z-Pak, and that has not really helped as an antiviral, but it has helped with developing secondary bacterial pneumonia while they're struggling with COVID. And the other thing that some people are taking is Decadron, which is an anti-inflammatory steroid that I've seen patients go on. When I got COVID in October, I wasn't admitted to the hospital, but I got a pretty bad case and I was having a lot of coughing and shortness of breath. The Decadron seemed to really help me, help me get
rest and also recover. The other treatments, I've heard some of them, but I haven't personally used them, and the physicians I've interacted with in the community are using mainly the Decadron and the Zithromax and not the other treatments.
Yeah. Dr. Bluntzel, I may be getting too deep in the weeds here. If
I am, I apologize, but I've read that there's some research going on to develop like a boiler
plate for different types of viruses or bacteria. And one of the things that I've read is that we were able to develop a vaccine quicker because we already were very familiar with coronaviruses like the flu and the common cold and others. So there was discussion about can we develop, I call it a boilerplate, but basic things about a certain virus group and then that would get us to a virus quicker because that work's already done. Is that what was done with COVID-19 and
is that something that you see going forward other groups doing? That's a great question.
Speaker 69
35:20
I've been asked a lot about the timetable for how quickly we develop these vaccines and a lot of people worried that maybe politics was injected and that's how we sped things up. To answer your question. I do think we benefited from the prior research on the COVID, you know, the coronaviruses and some of these other viruses. The big thing that sped these vaccines up was that when you
develop most vaccines, you have to actually grow the viruses and grow the bacteria. And so you're taking bacteria and viruses, and then you're doing something to them to keep them from being infectious, and you're injecting either part of the virus or part of the bacteria or some antigen of those entities into a patient to develop the immune response. And that is obviously something that can be risky. And so it takes years of research and years of growing and making sure that you've got the right types of viruses because you're dealing with a live entity.
The biggest thing that happened with the COVID viruses is that the mRNA that was developed was synthetic. And I think that is the game changer as far as the speed. It's not just the research that was done on the coronaviruses, but it's also the research that was done previously on the mRNA technology. And so, whereas normally what would have happened is you would have labs around the world growing these viruses and trying to figure out, you know, how to safely change them, that they could form an immune response without infecting patients. Instead of that, you had
instantly, digitally, all over the world, people had access to the sequence genome of the virus. and then you had scientists who were already doing mRNA research starting to figure out what part of the DNA coded for the spike proteins, developing messenger RNA from it, and then accelerating the process of the research on testing to make sure it was safe. And so I think your overall perspective is accurate. We need to have active research going on on these viruses because I don't think that COVID is, I mean, I think COVID will die down and we'll get better
at controlling this and things are going to get better. But the risk of having pandemics in the future is going to continue. When 20 years ago, again, when I was at Hopkins, it wasn't COVID, it was SARS and swine flu and all that. I remember I was on the committee for our department looking at how Hopkins would respond to a pandemic outbreak. And we had people who came in who did models and infectious disease experts. And it was very alarming what would happen if we had
especially a virus that had a high fatality rate. And so, you know, this work needs to continue. We've benefited from the work of people who were doing this sort of in the shadows, so to speak, you know, in the laboratory. And I think the technology that has been applied to this situation through these mRNA vaccines is really game-changing, and we need to support that. Yes, sir.
One other question. The therapies that have been developed and used in different hospitals and emergency rooms,
is that used in all hospitals? Is that the decision by the hospital management board? I mean, I've heard people say, well, I could go to this hospital and get this therapy, but I go to this hospital and they're not doing that. So is that a local decision, and if so, how could we as users of that know
Speaker 69
38:52
that? That's a great question. So, you know, a hospital, I think there's a couple of things.
Hospitals, there are different types of hospitals and different levels of care you can get at hospitals. If you have what we call a tertiary hospital, that's, you know, the kind of the top of the line as far as they have a lot of expertise, a lot of access to technology and support. And, you know, in Arkansas, that would be a place like UAMS or Big Baptist here in Little Rock or Mercy Hospital in Northwest or St. Bernard's in Northeast. So those are big tertiary care centers. Big hospitals have a lot of different specialists, a lot of different technological support.
And based on the capabilities of those hospitals, the hospital boards and the medical officers there make decisions about what they can and can't do. So there are some hospitals in our state that do a great job with primary care and even emergency medicine, but they don't have ICU beds, for instance. And so they don't feel like they can be doing some of the more cutting-edge stuff because if the patient continues to spiral down, they don't have a place for them. And so they recommend when a patient comes in who's a little bit more sick to go to a more, you know, a hospital that has more depth, so to speak.
I don't know of how the average citizen can figure out, you know, other than just speaking to hospital representatives and ask the therapies that are being done, but that is, that's what's going on. And I, I think it, you know, one, one thing I would say that has been really encouraging dealing with this pandemic in Arkansas for the last, you know, eight, 10 months, you know, Arkansas is not a big state. We only have 3 million people, but it's amazing to me how well we work together when, things are important and I know that you guys in the legislature sometimes see the the cantankerous
back and forth on issues but from my perspective over the last 10 months has been really inspiring so in the last in the first two months of this pandemic I reached out on private cell phones to hospital CEOs the CEO of Blue Cross and other insurance companies the the the heads of large organizations and industries, physicians, nurses, and without exception, people said, you know, we're here to help. How can we help? And I think part of the success that we've had
in our state in dealing with this has been because of the team effort that has been made by leaders all over the state and working together. So, you know, we need to support our tertiary care centers that have the ability to do these more in-depth therapies, but we also need to make sure that our rural hospitals have the funding they need to support their communities, especially in the critical access areas. It's very important for the state. Thank
Chair
Unverified
41:36
you for those answers. Representative Allen, you're recognized.
Representative Fred Allen
Unverified
41:41
Thank you, Mr. Chairman. Dr. Blesow, I want to sincerely thank you for coming this morning. You have been very inspirational. You've been very knowledgeable. And I want to thank you for all the wonderful things that you're doing in the state of Arkansas. As a matter of fact, if I was chair, I would adjourn right now. So again, thank you. Representative Allen, you're not chair, so we'll move on.
Thank you for those comments. Representative Payton, recognized.
Representative John Payton
Unverified
42:17
Thank you, Mr. Chair. So in regards to the convalescent plasma,
Speaker 26
42:20
what's the time frame like you just came through it you're taking antibiotics you you have other medicines that you're taking to get over it what's the time frame on donating and who do you contact that's that's
Speaker 69
42:34
a great question to be honest I'm not sure the exact time frame on that but you know you would contact your local hospital and where you would give a
blood transfusion and what I'll do is I'll try to figure out the exact time frame and get that back to you, but
that's a great question. I'm not sure. Okay. Thank
Chair
Unverified
42:56
you. Thank you, Mr. Chair. Representative Gonzalez, you're recognized. Thank you, Mr. Chair. Is it important for someone who has just recently recovered from the virus to go ahead and get vaccinated or, and how long do the antibodies last from an active
Speaker 69
43:10
infection versus the vaccine? Yeah. Another great question. I get asked this all the time. So yes, you do need the vaccine and the very short answer about the,
immunity is no one knows. So we're hoping that the vaccine will provide months or maybe over a year or who knows, maybe even longer of immune response and antibodies. But it really depends on a couple of things. It depends on the patient's immune response. It also depends on what happens with the virus. So one of the reasons why we recommend flu virus vaccines every year is because the flu virus is very active and changing. And so every time we get a flu season, it's a different strain
of flu. And so you have experts who are monitoring this and they're putting into the flu vaccine what they think is going to be the flu virus of that next season. But that's why you have to get it every year. We're hoping that's not what happens with COVID, but it might. And no one really knows how long the vaccine antibody response works. And no one really knows also, you know, if you have a a case of COVID, how long the immune response lasts for an active case, we think, we're confident that it lasts at least 90 days. And so most recommendations are that if you've had COVID,
you don't need the vaccine for the first 90 days, so let it go to other people, unless you're a frontline worker and you're being exposed constantly and they just wanted to get those people vaccinated. But the general recommendation is that if you can pick and choose your time when you get the vaccine and you've had COVID, wait 90 days and get the COVID vaccine after 90 days and that it's for extra protection. But yes, we do recommend the vaccine even if you've had COVID. Representative Cloud, you're recognized. Thank you, Mr. Chairman. I just
Representative Joe Cloud
Unverified
44:57
want to piggyback off of Representative Allen. Having the unfortunate experience of finding myself in Dr. Bledsoe's emergency room and then being one of those that was hospitalized with the COVID pneumonia and in the intensive care for five days. Thank you on a personal level. Thank you. Thank you, staff, St. Mary's Hospital. And I would like to extend that to all of our health care workers who are working tirelessly under adverse situations. You heard Dr. Bledsoe say
he'd lost count of how many patients he had had to intubate, how many patients he'd seen die. So just my heartfelt thanks. Thank you, Dr. Cloud.
Speaker 69
45:37
And I just want to say one thing in response to that. I appreciate the kind words of Representative Allen and Representative Cloud, but I also want to turn the spotlight onto those colleagues of mine that aren't here today. You have nurses. I have two nurse practitioners that work with me in the emergency department who are six months pregnant, who are working 12-hour shifts because we need them, and they They volunteered to do that, taking care of COVID patients and other sick people that come in.
And we have intensivists around the state and nurses around the state and family practitioners and pediatricians around the state who are working very long hours to keep Arkansans healthy and safe. And I feel a duty to make sure that they're recognized as well because they've been working incredibly hard at great personal sacrifice for themselves and their family through this pandemic. And they've been doing a great job. Thank you, guys. All right.
Thank you, Dr. Bledsoe. And I, you know, I want to add to Representative Allen and
Cloud, you know, your answers have been clear. They've been where we can understand them. So you've done a very good job presenting this morning. And also the frontline workers have done a great job. So thank you very much. Thank you, Mr. Chairman. All right. Moving on down the agenda, we'll move into the consent agenda. uh the first bill that's listed there hb 1155 which is my bill uh i won't be able to run that today we have a members i have a members only amendment that is over in the house so i won't
be able to run that until our next meeting so we'll skip over that one uh so we'll go to Representative Boyd's resolution, HCR 10-02. Representative Boyd,
you're recognized to present your resolution.
Representative Justin Boyd
Unverified
47:41
Thank you, Mr. Chair. And I have an amendment right here that everybody should have a copy of. The amendment, just in short, so can I present the amendment? Yes. Okay, so the amendment, in short, just updates the statistics and makes them the most current statistics. Representative Ward-Long, do you have a
Representative Mary Bentley
Unverified
48:06
motion? Move forward to adoption of the amendment.
I have a motion and a second move for the adoption of the amendment. Any discussion? Hearing none, all in favor signify by saying aye. Aye. All opposed, nay. Motion carries.
Representative Justin Boyd
Unverified
48:26
Your amendment is approved. Proceed with your resolution. Okay, so I'm proceeding with the resolution as amended with the updated statistics here. And so I just want to point out that since 1999, the misuse of prescription drugs or the overdose deaths in Arkansas has more than tripled since 1999.
And right now we hear a whole lot about COVID, and rightly so, it's an important issue. But the opioid epidemic that we were hearing about prior to COVID didn't suddenly go away. It's still happening. And so since I was elected in 2015 or since I was in legislature in 2015, I ran a House resolution like this and then beginning in 2019, a House concurrent resolution. So this resolution does two things. One, it just presents to the House and Senate where we are in the opioid epidemic or specifically relating to prescription drug abuse.
I mean, so when we look at the opioid epidemic, there are actually two prongs. One prong is the non-prescription side, and then the other side is, you know, prescription opioids. But this looks at all, you know, prescription drugs or controlled substances, brings them together, says here are some facts that we all should know, and then secondly, encourages everybody to work together to stem the tide of prescription drug abuse. So that's really all I have to say.
our drug czars here if if you have more questions i mean i don't want to speak for him but my gut tells me he'd be happy to come up here and tell you some more if you want to hear that if you would have him if you would come
up to the table and just introduce yourself so the committee knows who you are if they have any questions you can be able to
answer those hi good morning i'm kirk lane state drug director thank you
Speaker 100
50:19
mr lane um all right committee do we have any questions
seeing none do you have a motion representative boy sorry
Representative Justin Boyd
Unverified
50:38
you're recognized representative on the front row there i can't see your name i like to see your back i'm sorry oh representative
Representative Marsh Davis
Unverified
50:52
davis sorry yes sir thank you mr chairman i'd like to make a motion do pass as amended i have
motion do pass as amended or a second
i have a motion and a second any discussion seeing none all in favor signify by saying aye Aye. All opposed, nay. Motion carries. Congratulations, Representative. Your resolution is passed. Thank you. Thank you, Mr. Lane. All right, let's move on to HB 1107. Representative Boyd, you're recognized to present your bill.
Speaker 93
51:34
Thank you, Mr. Chair. House Bill 1107 is an update to the Prescription Drug Monitoring
Representative Justin Boyd
Unverified
51:39
Program. You might or might not know this state and legislatures prior to my ever being here adopted what's called a prescription drug monitoring program. So if you go to a pharmacy or anywhere in the state of Arkansas where a prescription is filled, if it's for a controlled substance, so this isn't your amoxicillin, this isn't your blood pressure medicine, this is only things that are scheduled and controlled either by the state of Arkansas or the federal government.
the federal government. So hydrocodone, Xanax, those are a couple, you know, examples of controlled substances. So when that prescription is filled, that information is sent to the state and housed there in what's called the prescription drug monitoring program. So the prescriber is supposed to check the prescription drug monitoring program prior to writing a prescription, and then it's the the duty of the dispenser, which in most cases is the pharmacy, uh, to, to, um, you know, make sure
that those, that information is reported to the prescription drug monitoring program. So the challenge is, is that right now there's, uh, there's the possibility, you know, if information is in there, there's not necessarily a way to audit that information and make sure it's correct or audit it by the department of health. And so what this does is it makes clear that the Department of Health can go to whoever is dispensing the controlled substance and request copies of the prescription. Whether they're hard copies, phone
orders, or electronic prescriptions, they'd have the ability to do that and audit. Because otherwise it's just somebody's calling in and saying, you know, you'll have a prescriber call in Department of Health saying, hey this this isn't right, and they don't have a way to audit it and verify this. So this will go through and give the Department of Health the authority they need to do that. Department of Health is here if you need me to bring them to the table to answer any questions that are over my head.
Okay we do have two people that have signed in on this bill. Maybe they're
just here for questions but Jamie Turpin with Department of Health. Did you want to speak on the bill. And then also, Laura Hsu, if y'all will take turns or come together, it's your option there. Go ahead and introduce yourself. Hi, I'm Jamie
Chair
Unverified
54:06
Turpin. I'm the Prescription Drug Monitoring Program Administrator at the Department of Health. This bill will really help us out in
trying to make sure that the data we get is accurate and being able to audit and evaluate that um at the program typically when i get an error like um representative boyd had said i usually tell the the doctor to call the pharmacy and have them look at the prescription and that just kind of makes it a little difficult to to decide what's correct what's not following up and making sure if it is incorrect to that it is updated in our system do you all have any questions are there
any questions representative davis you recognized thank you mr chairman
Representative Marsh Davis
Unverified
54:48
A question for you, Representative Boyd. I know in the past as we stood in the pharmacy filling prescriptions, I'm just curious. I remember one of the things I used to have to battle was how quick this updated. You know, as names came in and new information, and there was a lag. I think that got better over time. Can you speak to me just a second about if it did get better? It did get better.
Representative Justin Boyd
Unverified
55:18
It is better. Now it's within 24 hours. And in my professional opinion, that's adequate. It would be extremely hard to have some kind of conspiracy where we just mass, you know, put information or had prescriptions going everywhere in under a 24-hour period.
Speaker 93
55:36
Thank you. Representative Payton did you have
Speaker 113
55:43
a question? All right. Okay. All right.
Representative Mary Bentley
Unverified
55:56
Thank you, Ms. Turpin. Your comments. Thank
you. Laura Hsu and Matt Gilmore are listed. Would you like to come forward? Okay. Does anyone have any questions for Department of Health? Okay, seeing none. Representative Payton, you're recognized. I'd like to make a motion do pass. Okay, have a motion do pass. Any discussion? No discussion. All in favor signify by saying aye. All opposed nay.
Motion carries. Congratulations Representative Boyd, your bill has passed. You're now recognized to represent Bill HB 1174. Thank you,
Speaker 93
56:46
Mr. Chair. So House Bill 1174 is actually a bill to kind of clean up the pharmacy permitting, or
Representative Justin Boyd
Unverified
56:53
I should say pharmacist permitting process, because within a pharmacy, the pharmacy is permitted, the pharmacist is permitted, the pharmacy technician is permitted as well and so on the pharmacist so now I'm specifically
talking about the pharmacist permit or the pharmacist license there can be certain credentials so as of today or in the past few days there were 132 pharmacists that had what is called a nursing home consultant permit or credential that was on the license this strikes to to remove that permit it doesn't remove the need for nursing homes to have a consultant. So this makes it easier for pharmacists. It makes it less confusing. It opens up the market for more pharmacists to be able to
be nursing home consultants. So on a high level, that's what it does. If there are more specific questions, the
Speaker 96
57:49
Board of Pharmacy is here to help me answer those. Representative Gonzales, you're recognized
Representative Justin Gonzales
Unverified
58:06
for a question. Thank you, Mr. Chair. I see it eliminates where it says a maximum fee for that could be $35.
Chair
Unverified
58:14
Is that opening it up for the fee to be higher? It's
Representative Justin Boyd
Unverified
58:20
eliminating the credential, so it's eliminating the fee. And so it's only 132 licenses, so it will have a minimal revenue impact on the Board of Pharmacy. And they are okay with that. I mean, they're, you know, it's reducing government. Okay.
Okay, we do have one person that signed up to support the bill, speak for the bill. So, Mr. John Clay Kirtley, if you would, please come forward and introduce yourself for the record.
Speaker 117
58:51
Thank you, Mr. Chair. I'm John Clay Kirtley. I'm the director of the Board of Pharmacy. I'm just here for any questions
the members may have. All right. All right. Any further questions? Seeing none, Representative Wardlow, you're recognized. Motion to pass. Have a motion. Sorry. Okay, have a motion and a second. Do pass. Any discussion on the motion? Seeing none, all in favor signify by saying aye. Aye. All opposed, nay.
Motion carries. Congratulations, Representative Boyd. Your bill has passed. Thank you. Thank you, Mr. Curley. All right. So that is all we have on the agenda for today. Members, we will not meet on Thursday. It's my understanding that the B committees will be meeting on Thursday. So our next meeting will be next Tuesday. And I want to remind you, if you have a bill that you want to run in this committee,
you need to text me the information on that bill. What day you want to run, how many people you're going to have as a witness, whether it's controversial or non-controversial so text me that information you have to do that before we can get you on the agenda even though you see it on the web page it's not on the agenda until you contact me so thank
you all for your attention we are adjourned
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1:00:30
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Agenda
CONSENT AGENDA *Bills in Red added 01-19-2021 Number Sponsor Subtitle
HB1155 Ladyman TO REMOVE BARRIERS TO THE RELEASE OF DATA IN THE ARKANSAS CENTRAL CANCER REGISTRY TO QUALIFIED CANCER RESEARCHERS.
HCR1002 Boyd TO ENCOURAGE CONTINUED COLLABORATION AMONG HEALTHCARE PROVIDERS, LAW ENFORCEMENT, EDUCATORS, PUBLIC OFFICIALS, AND THE ARKANSAS COMMUNITY IN BATTLING THE ABUSE OF PRESCRIPTION DRUGS IN ARKANSAS.
HB1107 Boyd TO AMEND THE PRESCRIPTION DRUG MONITORING PROGRAM ACT.
HB1174 Boyd TO ELIMINATE THE NURSING HOME CONSULTANT PHARMACIST PERMIT AND THE DISEASE STATE MANAGEMENT CREDENTIAL.
DEFERRED ITEMS Number Sponsor Subtitle
HB1154 Ladyman TO AMEND AND UPDATE THE ARKANSAS CODE REGARDING REGULATION OF
IONIZING RADIATION TO COMPLY WITH FEDERAL LAWS AND REGULATIONS.
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH, WELFARE AND LABOR COMMITTEE- HOUSE, Jan 19, 2021 | Agenda | 1 | Official source ↗ |
| HCR1002 Amendment- JMB149 | Exhibit | 2 | Official source ↗ |
| Handout 1- Energy and Environment | Exhibit | 1 | Official source ↗ |
| Handout 2- Arkansas Center for Health Improvement | Exhibit | 8 | Official source ↗ |
Speakers
Representative Jack Ladyman Chair
Unverified
Speaker 7
Speaker 11
Speaker 13
Speaker 18
Representative Mary Bentley
Unverified
Representative John Payton
Unverified
Speaker 26
Speaker 27
Speaker 36
Speaker 38
Representative Carlton Wing
Unverified
Representative Joe Cloud
Unverified
Chair
Unverified
Representative Fred Allen
Unverified
Speaker 58
Speaker 69
Representative Justin Boyd
Unverified
Speaker 100
Representative Marsh Davis
Unverified
Speaker 93
Speaker 113
Speaker 96
Representative Justin Gonzales
Unverified
Speaker 117