Public Health, Welfare and Labor Committee- House

the 2nd bill, correct? Thank you. Chairman and committee, can you guys hear me OK? Alright, thank you so much and with Chairman, with your permission, I'd like to have a little uh lady here at the beginning of this and just have a little history on this bill because maternal health is such a huge topic in our state, and this bill discusses that so far. Our new members of this committee, I'm going to give a real quick, quick, uh, history on what we've done to where we get to this point today with this bill. So House Bill 1181 is going to amend a bill this committee passed in 20 2021 to give full scope practices certified nurse midwives in a state. A group of people that has been shown across the nation to improve maternal health and so this bill, this committee was gracious enough to be the first ones to pass that bill, but I'm going to go back just real quick for this committee to hear and for those around us that in 20 2019, we had a bipartisan bill passed in this committee and in the Senate to establish the maternal mortality Review Committee and in infant quality review committee and if you guys have not on this committee read this here this review from the maternal mortality Review Committee, get with Laura Shu in the Department of Health and she can get a copy of that bill for you and there. It shows why women in this state are dying from maternal health. We can't fix the problem if we don't know why, and that's why we established that committee. So the number one cause of death of women in our state maternal wise as older women that have hypertension, diabetes, and those comorbidities that make uh being a mom, a little, a little more difficult, and those are the women that we are losing in our state. So I think it's really important for you guys to read that bill and understand what people are saying what in the world are you doing for maternal mortality in Arkansas. We're doing a lot of things, but we had to start and find out why it's happening, so. This committee has steadily done done things to improve what's happening in our state, and I know it looks, it looks bad, but we're heading in a good direction. I really feel confident that Arkansas is moving in the right direction. So, um, a number of the members of this committee have been with NCSL with the maternal Health and Child Fellowship to learning what other states are doing across the nation. What are other states that have great maternal outcomes and infant mortality. What are they doing? So we found that one of the biggest things they're doing to decrease the maternal deserts that we have is to bring certified nurse midwives and real quickly, a certified nurse midwife is much different than a midwife that we have. We have what we call lay midwives or certified midwives that just received training to be a midwife, a certified nurse midwife is someone who gets a bachelor. degree in nursing, she gets over 840 hours and then then she goes in for her uh 2.5 years to completed her master's and then her doctorate. So a certified nurse midwife is much more trained, um, and she mostly operates in the hospital, so real quickly, I probably the only one in this committee that's had, I've delivered two babies with a certified nurse and midwife and 22 babies with a physician, and I found the certified nurse and midwife to be much better, but she left after my first two, and so there was none left in the state. As a mom at 30, I had no idea why, but Arkansas has been the most restrictive state in the nation when it comes to certified nurse midwives. We have the most regulations, made it nearly impossible for them to practice here in the state. That's why when the certified nurse midwife that I had left, there was no more to be found in the state, so I went to the hospital and delivered there. So what we're trying to do here today is to uh to rectify what I didn't do when we passed that bill, when we passed that bill, I did not put admitting a discharge privileges in there for the midwives. I just assumed that was part of giving them full scope of practice. It was not. So today's bill is a very simple thing. All for the certified nur nurse midwives in our state that are doing it. We need them again this committee passed a bill to allow to establish a nurse midwife program at UMMS that'll start next year. So when we get done paying for these nurses to get trained. We don't want them leaving into another state. We want them to practice right here. So everything that we can do to make their practice possible will be will be helpful and so we can decrease the maternal mortality in our state, and that's the whole goal of this bill and my efforts on this committee. So if you guys will look at the bill, all it does is add to allow these um hospitals. where they are privileged to get that right from the hospital to be able to admit and discharge and to work on the birth and death certificates, um, which I regret from the hospital administration to be sure we added that. So with that committee, I'll take any questions that we've got. Any questions from the committee on the presentation. Representative and you recognize and Representative Rose, I have your motion at the proper time. Thank you, Mr. Chair. I have one question, uh, Representative Bentley. Can you provide evidence that CNNMs have shown to be effective in spotting the signs of emerging postpartum emergencies and have demonstrated knowledge of when it's when it may be necessary to hold a mother for continued observation. Sure, that's part of their training and their, I mean, they have their nationally board certified uh to be able to recognize that. I've got some documentation here if I can show you after the committee if you'd like to see it. Happy to do that. Thank you. And there again we'll say the uh March of Dimes is hugely in favor of this, so I think that's a group that would definitely not support what we're doing with certified nurse midwives at the March of Dimes would not support what we're doing today. Any other questions from the committee? See another questions. Is there anyone in the crowd to speak for or against the bill? Seeing no one, what's the pleasure of the committee. I have a motion from Representative Rose for DuP pass, I presume. All those any discussion on the motion? All those in favor, say ah. I'll opposed. I have it. Congratulations, your bill had passed, and we'll move on to 1183, and that's the bill that has a amendment. So if you would, let's take up the amendment prior to the bill, sir. Thank you. um, staff's gonna pan out the amendment to to you colleagues on this bill, so I want you to know that I have uh worked on this bill digitally with the medical society with so many people, I think I have amended this bill more than any other bill I have ever worked on because I want everybody to be on the same page. I do not want this to be controversial. I'm a person that wants to be transparent to make sure that we're taking care of the patients in Arkansas and the whole purpose of this bill is to get good patient care. At the end of the day, we want our patients taken care of also everybody in here knows that we have a huge nursing shortage, so we want to make sure the nurses in that building are being used to the best of potential and that they're taking care of things that only they can take. here. So, um, what we have here is an amendment is a talk about as everybody got the amendment before I, OK, it's a simple change that hospital society and the medical society asked that we make a change to make this registered, and that's really all this amendment does is to change the wording there to add registered on this bill, so. plenty questions on the amendment, and then I'll go into the full bill after the amendments passed. This is on, this is on another bill for next week, sorry. Any questions on, on the amendment. I have a motion to adopt amendment. All those in favor say aye. All opposed. I have it with that, you're now recognized to present your bill as amended. OK. Thank you, thank you, colleagues. Thank you, Chairman, I appreciate that. So Arkansas has 2500 residents right now that are in kidney failure and receive dialysis treatment daily. And if you guys have not, not daily, some weekly, but if you've not had an opportunity to go and see those Dallas, I would recommend that you go. It's really amazing what they're doing and it'll also give you a quick reminder of why you don't need to be eating sugar. I can tell you that after you get done with there. So right now, um in Arkansas, the Um, patient care takes are highly trained. They get 18 months training. They're trained by that facility to do specifically what a physician has designated for them to be have done each day so the safety protocols set up a, uh, again to make sure they're doing exactly what's designed at that particular place where they work to get the dialysis treatment done each day. These PCT takes uh a really amazed me that I want to watch them when they were putting the candles and they're taking care of and they're knowledge of the dialysis machine and everything that happens a very highly trained folks to take care of these patients all. time. So what we've seen in Arkansas is that um unlike other states, unlike 34 other states, they're not allowed to use heparin and if you would think about motor oil and engines, heparin is to dialysis machine. If you have no motor oil, the engine is going to seize up. If we don't have heparin in that dialysis machine, the same thing's going to happen. The blood's going to clot, so it's very important. So again, I would just think of it heparins just like motor oil and engine heparin is to the dialysis machine to make sure. So these people are specific things that look at the blood pressure and what's going on to make sure the heparin is given correctly and. Ebolas given, so right now what they have to do is stop and find an RN there's only 4 RNs to 12 patients there, so they have to find an orange to come over there and give that bowl of other states are allowed to do it right there for the patient care it takes to give it. So this will allow them for the RN to delegate. Yes, you can do that. They're right there on the premises if there's an issue, there's some of that immediately take care of this will lie what they're doing in 34 other states to get the heparin as needed as set out in policy and for them to be designated to do that, so it's really a simple bill. It sounds like a lot, but again, I want to make sure that is. And important the wording is correct. It's important that the Board of Nursing can have a register these people so we know who is actually operating in the state of Arkansas's an issue that can be reprimanded if needed to be. So it puts them under the board of nursing. It gives a safety protocols like they have in other states and I do talk quick, so I will take questions if anybody in this committee has some questions as we go along. If y'all got all that, you're way better than this old dumb ploughboy up here. Any questions from the committee? She know anyone in the crowd to speak for or against the bill. See you now, what's a pleasure to the committee. A do pass Representative Gramlich. Any discussion on the motion. All those in favor, say ah I'll pose. I have it. Congratulations, your bill passed. We'll move on and as amended, correct? Representative Greenwich. We'll move on to House Bill 1214. Representative Bentley, you're recognized. And that's the bill that has a handout, correct? Sorry for the confusion that handout is for next week, but it's a really important bill so whenever we have a scope scope week, so the handouts for Scope Week. This is informational packet for our new colleagues to hear about that program. So that's just for their information for another meeting. Do you want it handed out today, or do you want to hold it to scope? I think it'd be great for us to hand it out when this meeting's over, if that's OK, Chairman's fine with me. Thank you, sir. I appreciate it immensely. So this last one is very important bill. As I was in nurses training in 1980, I had the pleasure of working at a nursing home and so when I got I was the director of nursing there, so taking care of the clients and nursing home are very important to me. They're very, uh, patients that need to be taken care of well. There are our moms and our grandmas, and we want those patients taken care of very well, so I put a pretty restrictive bill in in place to make sure that our CNA instructors knew what they were doing, and it was every 5 years they had to have worked a year and a long term care facility to make sure that they knew the up and coming things that were going on to make sure we had good instructors. That's the only way we're going to get good CNAs if we had good instructors. Well, maybe I want A little bit too tight on that bill, so we've expanded to go that the CNA instructor must have had one year of experience in long term care setting within 10 years, so some of my colleagues have asked to expand that a little bit, so on behalf of Representative Robin Lundstrom, I'm presenting this bill today to make sure we go to 10 years and also In place of that, it will require 8 years, 88 years, 8 hours of continuing education that's performed by the Arkansas Health Care Association, so they are getting online 8 hours continuing education to know what's going on, to make sure that our patients are being well taken care of because again our elderly are very vulnerable, and I'll make sure they're well taken care of and CNA is a very important to be trained correctly, so this instructor bill gives a little bit of leniency, but in return it requires them to do 8 hours every year of continuing education that we freed them online that they can take to make sure they're up and coming. What's going on and the state to make sure our vulnerable patients are being taken care of. So with that I have to take any questions on the CNA instructor bill. Seeing no questions. Is anyone in the crowd to speak for or against the bill? What's the pleasure of the committee and do pass Representative Allen, any discussion on the motion? Seeing none. All those in favor, say ah. All opposed. I have it. Congratulations, you have passed your 3 bills today. Thank you, Chairman. Thank you committee. I'll try to slow down next committee. Members kind of go over the agenda real quick, um. Shanice and I worked on this a lot this last weekend, uh, the reason we set this agenda up this way so everyone is aware of what's coming and when it's coming, we will absolutely only hear scope bills on February 13th, and we will hear those first. If you do not present your bill on February 13th and it's in that box. That is the first strike. You will get another strike the following Tuesday and another strike that Thursday, and it goes on deferred. So we will take those bills up first and those following 3 meetings. before we move to the regular agenda, um, it's the way I've done it, I guess it's about 10 years ago when I sat in the seat and we just keep that same uh method going forward. So with that, any questions on the way the agenda is set up. Yes, sir. You want to hit your mic? Thank you, Mr. Chairman. What's the process of getting it off the ferry. The process notifying uh Shanice with an email, and I think the rules say we were just talking about that a few minutes ago. I think it says it has to have 2 days' notice. So if you ask for it to be off today, it could be off for Thursday. Um, and we were gonna look at the rule book and make sure that was correct, but we think it's 2 days. Any other questions? See you're not, no, no further business, we stand adjourned. that's