Call to Order and Roll Call
The fourth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 17, 2012, at 1:00 PM, in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 1:10 p.m., and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Joe Bowen, Tom Buford, David Givens, Denise Harper Angel, Alice Forgy Kerr, Dennis Parrett, Joey Pendleton, Katie Stine, and Jack Westwood; Representatives Julie Raque Adams, Bob M. DeWeese, Kelly Flood, Brent Housman, Joni L. Jenkins, Mary Lou Marzian, Darryl T. Owens, Susan Westrom, and Addia Wuchner.
Guest Legislator: Representative Jimmie Lee.
Guests: Cindy Heine, Associate Executive Director, Prichard Committee; Libby Doggett (on video), Director, Pew Home Visiting Campaign, Pew Center on the States; Jeff Dean, Pendleton County Attorney, and Yancy Edwards, Fight Crime: Invest in Kids; Ruth Ann Shepherd, M.D., Office of Early Childhood Development, Department for Public Health, Cabinet for Health and Family Services; Lynn Bennett, HANDS Family Support Worker, Family and Children’s Place, Edwina Hazel and Monique Lewis, HANDS participants; William Bryant, MD, Patient Safety Officer, Owensboro Medical Health System; Mike Rodman and Preston Nunnelley, M.D., Kentucky Board of Medical Licensure; Bill Doll, Jackson and Kelly, representing the Kentucky Medical Association; Kate Wood Foster, Legislative Liaison, and Hollie Hopkins, General Counsel, Office of the Governor; Andrew Wood, Emergency Medical Training Professionals; Jim Cecil, Kentucky Youth Advocates; Pam Duncan, Legal Counsel, Bill Young, Director of Educational Licensure, and Mike Poynter, Kentucky Board of Emergency Medical Services; Steve Veno, Child Support Enforcement, Cabinet for Health and Family Services; Darla Bailey, President, Kaleidoscope, Inc., Younger Adult Day Health Center; Carol Borden and Paula Schenk, Kentucky Board of Nursing; Sarah S. Nicolson, Kentucky Hospital Association; Gary Blalack, GlaxoSmithKlein; Liz Ferguson, Family and Children’s Place; Stephanie Brammer-Barnes, Office of Inspector General, Cabinet for Health and Family Services; and Karen Chrisman and Ken Mitchell, Governor’s Office of Electronic Health Information, Cabinet for Health and Family Services.
LRC Staff: DeeAnn Mansfield, Jonathan Scott, Sarah Kidder, and Gina Rigsby.
Approval of the Minutes
A motion to approve the minutes of the September 19, 2012 meeting was made by Senator Bowens, seconded by Senator Givens, and approved by voice vote.
Report of Subcommittee Meeting
Senator Stine, Co-Chair of the Families and Children Subcommittee, reported that the subcommittee heard testimony about the Kentucky Foster Care System and the Strategic Planning Committee for Children in Placement from Teresa James, Commissioner, Department for Community Based Services, Cabinet for Health and Family Services, and Michelle Sanborn, President, Children’s Alliance. The subcommittee also heard testimony about school required immunizations for children from Kraig E. Humbaugh, M.D., M.P.H., State Epidemiologist, Director, Division of Epidemiology and Health Planning, Department for Public Health, Cabinet for Health and Family Services, and Kay Kennedy, Director, Division of District Support, Office of Administration and Support, Kentucky Department of Education. Testimony on Executive Order 2012-585 relating to the Child Fatality and Near Fatality External Review Panel was given by Sara Osborne, Legislative Liaison, and Tom Cannady, Staff Assistant, Justice and Public Safety Cabinet. A motion to accept the Families and Children Subcommittee report was made by Senator Stine, seconded by Senator Givens, and approved by voice vote.
Consideration of Referred Administrative Regulations
201 KAR 20:230 – establishes requirements and procedures for the renewal of a nursing license; 201 KAR 20:370 – establishes requirements and procedures for licensure for nurses; 201 KAR 20:411 – establishes the requirements relating to a sexual assault nurse examiner course and the credentials of a sexual assault nurse examiner; 202 KAR 7:601 – establishes requirements for an organization to be approved by the Kentucky Board of Emergency Medical Services as an Emergency Medical Service Training and Education Institute (EMS-TEI) and also establishes standards for the certification and recertification of EMS educators; 900 KAR 9:010 – establishes the procedures for participation by health care providers in the Kentucky Health Information Exchange (KHIE); 906 KAR 1:160 & E – establishes the Kentucky Electronic Methamphetamine Precursor Tracking (KEMPT) system; 921 KAR 1:001 – establishes definitions of terms used by the cabinet in administrative regulations pertaining to the Child Support Enforcement Program; 921 KAR 1:380 – specifies the process by which an individual may apply for child support services, the scope of services available, and the process for an intergovernmental case; 921 KAR 1:400 – establishes the requirements for the establishment, review, and modification of child support and medical support orders; and 921 KAR 1:410 – establishes procedures for collection and enforcement of child support.
Pam Duncan, Legal Counsel, stated that the administrative regulation was amended to comply with current medical practices.
Andrew Wood, Lexington paramedic and educator, stated that the administrative regulation require schools to have a 30 percent pass rate to continue operating. In 2010, Kentucky tied for last place for first-time pass rate for EMTs with national registry. The KBEMS passed a resolution to make the pass rate 68 percent for 2012. He questioned why the administrative regulation states a 30 percent pass rate is acceptable. Ms. Duncan stated that KBEMS went through the public comment period, and no one commented on the 30 percent pass rate.
In response to questions by Senator Denton, Bill Young, Director of Education Licensure, Kentucky Board of Emergency Medical Services, said that the administrative regulation specifically states that identification of competency of EMS professionals will not be solely by the pass rate. One of the administrative regulations states that a new student has the right to ask for and receive the institution’s pass rate. The 30 percent pass rate was a compromise. The administrative regulation will hold the Training and Education Institutes (TEIs) to a greater accountability than in the past. Taken as a whole, the administrative regulation tightens the standards. All TEIs that offer paramedic training will be required to be accredited by a national agency. Requirements have been tightened up for anyone who wishes to become an EMS educator. An EMS educator has to have a Bachelor of Science degree in education or complete 40 hours of the national Association of EMS education instructor’s course. Kentucky is on target to finish with a 66 percent pass rate. The KBEMS will now conduct announced site visits to see if there are any problems and offer assistance to TEIs. Ms. Duncan stated that the 30 percent pass rate is to pass the National Registry exam not the course itself. A student has six opportunities to pass the exam over a two-year period before having to repeat the course and begin the testing process again.
A motion to amend 202 KAR 7:601 by stating on page 4, Section 5 (16), by deleting thirty (30) and inserting fifty (50) in lieu thereof, was made by Senator Buford, seconded by Senator Denton, and approved by voice vote. The KBEMS agreed to the amendment. A motion to accept the referred administrative regulations as amended was made by Senator Buford, seconded by Senator Denton, and approved by voice vote.
In response to questions by Representative Owens, Mr. Young stated that if the 50 percent pass rate is not attained, a plan of corrective action would be implemented to correct the problems. The TEIs will be required to advise students that they have the right to ask for and receive the pass rate. Ms. Duncan stated that until all students in a course finish the six attempts to pass the exam, there is no way to know the ultimate passage rate.
In response to questions by Senator Stine, Mr. Young stated that if a student does not pass the exam, there is a two-week waiting period before being able to take the exam again. If a student fails the exam three times, the student is required to take a refresher course. The National Registry exam is computer adapted and is either a pass or fail. At a certain point the software is able to calculate if the candidate is or is not minimally competent and will shut itself off. Scores are received within 24 hours.
In response to a question by Representative Wuchner, Mr. Young stated that if there is no prior certification, the student is not allowed to function as a provider on the ambulance until the exam is passed and the student is licensed by KBEMS.
Health Access Nurturing Development Services (HANDS)
Cindy Heine, Associate Executive Director, Prichard Committee, stated that quality early childhood programs like HANDS are critical to reach education goals of college and career readiness for all students. The Pew Center on the States is a division of the Pew Charitable Trust that identifies and advances effective solutions to critical solutions facing states.
Libby Doggett, Director, Pew Home Visiting Campaign, Pew Center on the States, stated that Kentucky has identified home visiting as one of the smartest strategies a state can use to produce measurable improvement for at-risk families and produce meaningful savings for tax payers. Quality home visiting helps address some of the nation’s costliest problems like child abuse and neglect, low birth weight, school failure, poverty, unemployment, and crime. Kentucky stands out as a national home visiting leader because services are integrated within a comprehensive system of care helping families in all 120 counties. Kentucky will face increasing funding challenges if the Tobacco Settlement funds continue to decline. To maintain and grow the HANDS program, Kentucky will need to replace tobacco funds with a more sustainable funding source.
Jeff Dean, Pendleton County Attorney stated that Fight Crime: Invest in Kids is a national organization consisting of approximately 5,000 law enforcement and prosecutors. Experience shows that Kentucky needs to invest in programs such as HANDS to get early intervention in homes. There are approximately 700,000 child abuse or neglect cases reported nationally. In 2010, there were 17,000 reported cases in Kentucky and over 30 deaths. The youngest children are the most vulnerable victims often ending in death. Approximately 30 percent of child abuse victims grow up to be abusers or grow up and become victims of crime. Research shows that early intervention will prevent repeat offenders. Without programs like HANDS, there will be a continual downward cycle.
Ruth Ann Shepherd, M.D., Office of Early Childhood Development, Department for Public Health, Cabinet for Health and Family Services, HANDS is a voluntary, intensive weekly home visitation for first time moms and dads regardless of income from prenatal care until a child is two years of age, and is designed to improve both health and social outcomes. The goals of the program are for moms to have positive pregnancy outcomes, optimal child growth and development, health and safe homes for children, and family self-sufficiency. Brain, cognitive, and behavioral development are linked to both educational and health outcomes later in life. The HANDS program serves approximately 10,000 to 11,000 families annually in all 120 counties. Case workers conduct over 700 home visitation services on a daily basis and over 14,000 on a monthly basis. The Maternal, Infant, and Early Childhood Home Visiting Program administered by the Health Resources and Services Administration, Administration for Child and Families, U.S. Department of Health and Human Services will allocate $1.5 billion over five years. To be eligible, states are required to maintain current funding for existing home visiting programs as of March 2010. Kentucky’s maintenance of effort (MOE) is $8.3 million. The purpose of the legislation is to strengthen and improve the programs and activities carried out under Title V, to improve coordination of services for at-risk communities, and to identify and provide comprehensive home visiting services to improve outcomes for families in at-risk communities. The Home Visiting Grant will expand the HANDS to all at-risk moms, add mental health brief interventions, and improve systems of care and referral for at-risk families with children birth to three years of age. In 2010, Kentucky’s formula grant was $1.4 million and implemented in Owsley, Lee, Wolfe, Leslie, Letcher, Knott, Perry, Breathitt, and Lawrence Counties. In 2011, Kentucky used the $1.9 million grant allocation to implement programs in Floyd, Johnson, Magoffin, Martin, and Pike Counties. In 2012, Kentucky received $6.8 million competitive grant.
Lynn Bennett, Family Support Worker, Family and Children’s Place, stated that she conducts weekly visits with first-time moms and dads. She works with the parents to make sure the child’s shot records are up-to-date, works with the child to help developmental growth, and helps parents set goals. Over her fifteen years working with children and parents, she has seen very positive outcomes. A nurse conducts visits with the families every three months.
Edwina Hazel stated that she has been a HANDS participant since December 2011. The HANDS program has helped her learn how to become a good mother.
Monique Lewis, HANDS participants, stated that she has been a HANDS participant since October 2010. Since being in the program, she has become more independent and has learned how to take care of her child. She urged members to continue to fund the program to help future participants learn to become a better parent and give children a chance to be healthy and productive adults.
In response to questions by Senator Westwood, Ms. Bennett stated that all protocols are followed if there is any suspicion of neglect or abuse, and DCBS is called immediately. Dr. Shepherd stated that the grant money was distributed according to risk factors per county. The grant is written that the funds will be used in the higher at-risk counties first.
Kentucky Spirit
Audrey Tayse Haynes, Secretary, Cabinet for Health and Family Services, stated that the cabinet has had daily conversations with Kentucky Spirit over the past several weeks about its MCO contract. Kentucky Spirit experienced more losses in Kentucky than estimated. Kentucky Spirit sent a letter to the cabinet on the morning of October 17 stating that it would terminate its contract as of July 5, 2013. The cabinet will take the necessary steps to ensure that the 125,000 to 140,000 Medicaid participants covered by Kentucky Spirit will be transitioned into CoventryCares and Wellcare. Kentucky Spirit is in breach of contract by leaving Kentucky one year early, and the cabinet will pursue damages for any expenses and money incurred because of the departure.
In response to questions by Senator Denton, Secretary Haynes stated that the costs are outlined in the MCO contract as being legitimate costs that should an MCO exit the state early the cabinet would pursue. An official dispute was sent to the cabinet on October 12, 2012 by Kentucky Spirit and a cabinet hearing will have to be conducted and resolved within 30 days. The dispute is the cabinet would not agree to Kentucky Spirit’s request to add more money to its contract. When all three MCOs signed a contract with the cabinet, they had built in rates. Kentucky Spirit contracted and received a one percent rate increase in July. Wellcare and CoventryCares received a three to five percent rate increases in October. When a risk adjustment is done, the MCO with the highest number of members and the highest acuity rates will receive the largest increase in rates, and Kentucky Spirit has maintained a healthier population. The cabinet agreed to the negotiated rate in the contract as well as the one percent increase. As of end of October, Kentucky Spirit’s rate per member per month is approximately $310, and CoventryCares and Wellcare’s is approximately $400.
In response to questions by Senator Kerr, Secretary Haynes stated that Kentucky Spirit is responsible for the damages and costs to Kentucky. The company is in breach of contract by leaving the state early, and the cabinet did not give permission to leave before the contract ends. Centene, the parent company of Kentucky Spirit, is a $6 billion company that operates in 19 other states. Kentucky Spirit will be liable if there are any costs to the state because of its breach of contract. The cabinet asked that the MCOs agree that all of them would either have or not have co-pays, so each MCO agreed to have co-pays. Kentucky Spirit has a healthier population, and therefore when a risk adjustment was done, CoventryCares and Wellcare received more money because of their higher acute population.
In response to questions by Representative Owens, Secretary Haynes stated that the current MCO contracts will end in June 2014, and there is no plan to rebid Kentucky Spirit’s contract to another entity. The cabinet will work with CoventryCares and Wellcare on how to transition the Kentucky Spirit membership to them over a period of time. The MCO contracts in place have four one-year extensions, but the cabinet has the option to rebid the entire state in 2014. Of the 550,000 Medicaid members, CoventryCares started with 212,000 members and as of September had 230,000 members; Wellcare started with 121,000 members and ended with 150,000 members; and Kentucky Spirit started with 219,000 and ended with 137,000 members.
In response to questions by Senator Givens, Secretary Haynes stated that Price, Waterhouse, Coopers found the data book to be actuarially sound. Each MCO had the same data and opportunity to question the information in the data book. If the data book is wrong, the cabinet has an obligation to take a look at it and be able to reconcile it with the companies. It is important to that note that there have been no attempts by the MCOs to work with the cabinet on incorrect data. Kentucky Spirit bid a rate that was substantially lower than the other two MCOs, and even went back and lowered the rate again. Each MCO was allowed to determine when there would be a rate increase and the amount of the increase. It is important that CoventryCares, Wellcare, Passport, and Humana remain successful companies in Kentucky so citizens can become healthier. The rate increases were factored into the budget for fiscal year 2014.
In response to questions by Senator Stine, Secretary Haynes stated that there are negotiated rates within the contracts of the MCOs. There are provisions in the contract for damages due to breach of contract. The weighted rate that includes acuity for Wellcare is $360, $341 for CoventryCares, and $311 for Kentucky Spirit.
In response to questions by Representative Housman, Secretary Haynes stated that each MCO has new members every month due to various reasons, and the other two MCOs have the capacity and willingness to accept Kentucky Spirit’s population. Kentucky Spirit wanted to do business with Kentucky and made an aggressively low bid. The company projected substantial losses in the first two years doing business in Kentucky. It is not necessarily Kentucky’s fault for accepting the lowest bid.
In response to questions by Senator Bowen, Secretary Haynes stated that she did not know if it is a pattern for Kentucky Spirit to pull out of any state before the contract ended.
In response to questions by Representative Marzian, Secretary Haynes stated that she would have to ask DMS to provide the information on how much Kentucky Spirit was paid for members and how much was paid out on members for healthcare. When corporations file quarterly earnings reports, researchers on Wall Street estimate losses based on contracted rates and number of members. All three companies have lost money in Kentucky to date.
Representative Flood asked that the cabinet provide information on whether Kentucky Spirit had left any other state, and if so, the circumstances and reasons of the departure.
In response to a question by Senator Westwood, Secretary Haynes disagreed with the statement by Kentucky Spirit that there is not a viable path to a sustainable Medicaid managed care program in Kentucky, and stated that Kentucky can have a successful MCO program. Kentucky Spirit believes it can get out of its contract with only a six-month notice which is untrue.
In response to questions by Senator Kerr, Secretary Haynes stated that the anticipated savings from having Medicaid managed care in Kentucky was never added to the budget, so the cabinet fully anticipates meeting its budget. Based on practices in other states, the MCOs have a model that looks at utilization rates, cutting down ER visits, and control pharmacy costs. Kentucky has been more difficult than the MCOs anticipated.
In response to questions by Senator Denton, Secretary Hanes stated that Kentucky Spirit’s contract states it will continue to make payments owed to providers. Centene has a subsidiary incorporated in each of the states it resides.
Senator Parrett stated that Kentucky Spirit signed a contract for a one percent rate increase.
Prescription Pain Management (2012 HB 1)
William Bryant, MD, Patient Safety Officer, Owensboro Medical Health System, testified that everyone agrees that controlled prescription drug misuse and diversion is a significant growing problem in Kentucky. While agreeing with the intent of the law, the unintended consequences include patient safety concerns, access to care, and barriers to safe and appropriate pain management. Physicians now have two laws to comply with the statutory prescribing standards in 2012 House Bill 1, and the Kentucky Board of Medical Licensure (KBML) regulations. Each law has different requirements that must be met prior to prescribing a controlled substance. The legal ramifications and punitive tone intertwined with the complexity of the laws renders a physician reluctant to ever prescribe controlled medications for pain. Failure to fulfill every requirement of the law has significant personal and professional consequences including medical licensure board review and medical license restrictions. Restrictions can means the loss of board and professional certifications, removal from insurance provider lists, and loss of hospital privileges. The stress plus the law’s complexity interferes with the ability to think thus increasing the chances of medical error. Concerns include increased emergency room visits, hospital admissions, and nursing home admissions due to inadequate pain control and adverse effect of alternative medications. All patients with pain should receive optimal, safe, and respectful care, particularly the most vulnerable patients in long-term care and hospitals. Dr. Bryant recommended the following: (1) repeal KRS 218A.205 mandating to the licensing boards to create prescribing standards for Kentucky physicians; (2) amend KRS 218A.205 mandating that licensing boards issue prescribing standards for controlled substance used to treat long-term pain, rather than all controlled substances; and (3) eliminate the hospital reporting requirement in KRS 218A.202.
In response to questions by Senator Denton, Dr. Bryant stated that the Kentucky Board of Medical Licensure (KBML) emergency administrative regulations include Ambien and testosterone. Ambien is potentially habit forming, but he did not know why testosterone would be regulated.
Senator Bowen stated that the legislation and supporting administrative regulations encumbers physicians and deterring the practice of good medicine. House Bill 1 makes Kentucky unattractive for future physicians.
In response to Representative Burch, Dr. Bryant stated that as he understands, individuals already on medications will be grandfathered in and a doctor would have to document a patient is stable on the current dose and run a KASPER report every three months. House Bill 1 is very challenging to understand.
In response to questions by Senator Pendleton, Dr. Bryant stated that it is unclear who pays for a drug test. KASPER is a great tool for law enforcement. The original statute that applies to hydrocodone, hydrocodone controlling medicines, contained medicines, and other Schedule III drugs applies in the hospitals and nursing homes. KBML emergency regulations that apply to other medicines such as Ambien and testosterone, do not apply in hospitals and nursing homes. Pain management is an integral part of hospitals and long-term care settings.
In response to a question by Representative Owens, Dr. Bryant stated that if the prescribing standards in KRS 218A.172 are repealed and the KBML develops some workable controlled medicine regulations, it would be a win/win for everybody. Physicians are on board with improving the process to have a better outcome.
Representative Westrom expressed concern that doctors were not involved in the process before the bill passed.
In response to questions by Senator Parrett, Dr. Bryant stated that he is not an expert on House Bill 1, but if the prescribing part was removed and KBML had workable administrative regulations everyone could live with that would cut down drug misuse and diversion in the state, it would probably be a workable bill. KASPER needs to be more voluntary and be more flexible.
Bill Doll, lawyer at Jackson and Kelly, on behalf of the Kentucky Medical Association (KMA), stated that if KASPER could function in real time and make other improvements, it becomes a valuable tool to law enforcement and as a treatment mechanism in terms of the physician enjoying the benefit of a clear awareness of knowing exactly what medications a patient takes. House Bill 1 has some unintended consequences. There are codified standards that are part of the law, not part of the administrative regulation, that dictate what someone has to do when involved in prescribing or dispensing a Schedule II or Schedule III with hydrocodone. The law states that KBML shall promulgate regulations relative to the prescription and dispensing of controlled substances. Emergency administrative regulations have the force of law and penalties. Under the law itself, there is potential for some criminal violations as well as some potential civil liability on the basis of either prescribing too much or prescribing too little.
Dr. Preston Nunnelley, Kentucky Board of Medical Licensure, stated that KBML is listening to groups around the state and getting suggestions. The emergency regulations will be revised in November 2012 to correct many of the problems. Problems that doctors are having are due to either misinterpretation of the statute or the administrative regulations. KMBL is posting clarifications on its web site. KBML wants to change the regulations to be more specialty-specific. What cannot be changed in the emergency regulations hopefully can be changed in the statute.
In response to questions by Senator Denton, Dr. Nunnelley stated that KBML met with multiple committees and did not agree that the administrative regulations are as egregious as people think. Urine screens are inappropriate for everyone and have been changed in the draft administrative regulation. The bill does not keep anyone from getting pain medications. KBML has met with different stakeholders on a regular basis to get their input. Approximately ten pill mills have been shut down. There is no physician in Kentucky that will get in trouble when it is referred to KBML as practicing quality medicine. There are elements of the bill that need to be changed, but overall the bill is working.
Kate Wood Foster, Legislative Services, Office of the Governor, stated that the Governor supported the passage of House Bill 1, and he thinks the successful implementation of the bill is critical and important to the families and communities throughout the state. KASPER is being utilized more robustly. Comments received by the Governor’s Office have been discussed with stakeholders and try to look, along with KBML, at what can be changed and adapted to make sure the administrative regulations go along with the intent of House Bill 1, to address the issue of abuse and diversion of prescription drugs in the state.
Representative Wuchner expressed concerns about individuals that have to sign a document to agree to waive their applicable privilege and right to privacy and confidentiality.
In response to questions by Senator Bowen, Dr. Nunnelley stated that a solution is to amend the emergency regulations to rectify the problems. Hollie Hopkins, General Counsel, Office of the Governor, stated that everyone is aware of the provisions of Chapter 13A and recognizes that there are some issues with what can or cannot be done with respect to amending emergency regulations verses filing new emergency regulations. The end goal of all licensure boards is to navigate the statutory mandates to get clarity to provider and patient communities in the most effective and efficient way possible.
In response to a question by Representative Burch, Mr. Doll stated that as the KMBL moves closer to a practical regulatory framework that would allow people to know what the rules are and address some of the problems, the more likely they are to offend the statute.
In response to questions by Senator Denton, Ms. Wood Foster stated that the Governor sees the successful implementation of House Bill 1 as critical. Several stakeholders approached the Governor’s Office to help facilitate. The Governor’s Office sees itself as a facilitator not an expert opinion. The intention of the Governor’s Office is to develop regulations that are both reasonable and practical. Mr. Doll stated that the American Medical Association has provided, typically specialty groups, clinical guidelines that try to help doctors in their practices. When these guidelines become regulations overnight, it does not work. Dr. Nunnelley stated that doctors learn what to prescribe in medical school, residency, fellowship, post-graduate education, and continued medical education. Ms. Hopkins stated that the Governor’s Office is exploring all options available as the regulation is developed. The KBML will make the decision to either amend the emergency regulations or withdraw the emergency regulations and file new emergency regulations. Any emergency regulation has to be signed by the Governor, so any change to an emergency regulation would have to be made with the consultation and cooperation of the Governor’s Office. Dr. Nunnelley stated that KBML will make recommendations to the Governor that will correct the problems as quickly as possible.
Senator Pendleton stated that it is very, very important to get the public to show up at public hearings to voice opinions and concerns. The board has responded to his requests made at a public hearing.
In response to concerns by Dr. Bryant, Dr. Nunnelley stated a doctor who is practicing quality medicine will not get in trouble with the KBML.
Senator Pendleton wanted the minutes to reflect that he was present until the end of the meeting.
There being no further business, the meeting was adjourned at 4:58 p.m.