Call to Order and Roll Call
Theeighth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, December 14, 2016, at 10:00 a.m., in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 10:07 a.m., and the secretary called the roll.
Members:Senator Julie Raque Adams, Co-Chair; Representative Tom Burch, Co-Chair; Senators Ralph Alvarado, Tom Buford, Danny Carroll, Julian M. Carroll, Denise Harper Angel, Jimmy Higdon, Alice Forgy Kerr, and Reginald Thomas; Representatives Robert Benvenuti III, George Brown Jr., Joni L. Jenkins, Reginald Meeks, Phil Moffett, Tim Moore, Ruth Ann Palumbo, David Watkins, Russell Webber, Susan Westrom, and Addia Wuchner.
Guests: Allison Ball, Kentucky State Treasurer; Kevin T. Kavanagh, MD, MS, Board Chairman, Health Watch USA; Mary Kathryn DeLodder, Kentucky Home Birth Coalition; Cherie Sibley, CEO, Clark Regional Medical Center; Lynne M. Saddler, MD, MPH, District Director of Health, Northern Kentucky Independent District Health Department; Tyler Radford, Co-founder, and Hassan Latifilia, Co-founder, Dreamsetters United; Sara Ann Selm, Recipient, Union, Boone County; Matt Holder, MD, MBA, Chief Executive Officer, Henry Hood, DMD, Chief Clinical Officer, and Kristin Compton, DMD, Dental Director, Lee Specialty Clinic; Mimi Kramer; Gisela D. Nelson, Cofounder and Executive Director, Courtney Lamont Phelps, JD, President, The Christopher Wade Phelps Foundation and Volunteer, Government Affairs Department, Bill Huston, Cofounder and CEO, Our Crowd Rocks, Paul E. Nelson, Sr., Cofounder, Legacy Reentry Corp; Amanda Harding, Jessica Williams, and Paul Daniels, Kentucky Board of Pharmacy; Jennifer Hicks and Stephanie Sharp, Commonwealth Council on Developmental Disabilities; David Wheeler, ResCare; Kelli Williams and Patrick Rork, Accenture; Sarah Nicholson, Kentucky Hospital Association; and Joy Hoskins, Department for Public Health, Cabinet for Health and Family Services.
Approval of the Minutes from the November 16, 2016 Meeting
A motion to approve the minutes of the November 16, 2016 meeting was made by Senator Julian Carroll, seconded by Senator Harper Angel, and approved by voice vote.
Consideration of Referred Administrative Regulations
The following administrative regulations were referred to the committee for consideration: 201 KAR 2:045 – establishes the qualifications required for a pharmacy technician to practice under the general supervision of a pharmacist, and establishes the scope of practice for a pharmacy technician; 201 KAR 2:050 – establishes reasonable fees for the Board of Pharmacy to perform all the functions for which it is responsible; 201 KAR 2:351 – repeals 201 KAR 2:350 that regulated home medical equipment providers because it is obsolete; and 921 KAR 1:410 – establishes procedures for collection and enforcement of child support. A motion to accept the administrative regulations was made by Senator Julian Carroll, seconded by Senator Alvarado, and accepted by voice vote.
Kentucky STABLE Program
Allison Ball, Kentucky State Treasurer, stated that STABLE accounts are made possible by the federal Achieving a Better Life Experience (ABLE) accounts. STABLE accounts allow individuals with disabilities to save and invest money without losing eligibility for certain public benefits program like Medicaid, SSI, or SSDI. Earnings in a STABLE Account are not subject to federal income tax, so long as it is spent on qualified disability expenses. STABLE accounts are investment accounts and invested in different options. While money can still be withdrawn whenever it is needed, a STABLE account allows money to grow to save on long-term disability expenses. Although ABLE accounts are available nationwide, STABLE Kentucky is only available to Kentucky residents and are opened at discounted rates. In order to open a STABLE account, a person has to be disabled before 26 years of age. Recipients can deposit between $14,000 and $100,000 per year without losing benefits with a lifetime total of $426,000 without it affecting taxes. More information about STABLE Kentucky accounts can be found at stablekentucky.com.
In response to a question by Senator Danny Carroll, Treasurer Ball stated that Vanguard was chosen to manage the STABLE account and is the same company used by Ohio for its STABLE accounts. Senator Carroll stated that STABLE Kentucky accounts will give parents and families a peace of mind knowing their child will be taken care of after a parent is gone.
Representative Wuchner stated individuals need to be able to have money set aside for expenses.
Multi-Resistant Drug Organisms: The Importance of Reporting
Kevin T. Kavanagh, MD, MS, Board Chairman, Health Watch USA, stated that control of the infection is key. According to the 2010-2011 baseline, the United States is not on track of a 50 percent MRSA bloodstream infection reduction by 2020. There are no firm protocols. Disparity rate should be 20 percent or less. Reporting to the health department is essential for public safety. Patients should know when outbreaks of dangerous pathogens occur in healthcare facilities. Reporting by facility is preferable, but at least regional reporting should be done. Overall days of therapy with antibiotics among hospitalized patients in the United States has not changed significantly between the years of 2006 to 2012. Drug resistant bacteria is a huge problem. Current data sheds doubt that the epidemic is being controlled. More comprehensive and timely data is needed.
Representative Burch stated that there are no drugs to cure MRSA.
In response to questions by Senator Alvarado, Dr. Kavanagh stated that MRSA is not strictly a hospital problem. Antibiotic utilization needs to be curtailed.
Midwifery Draft Legislation – 2017 Regular Session
Representative Russell Webber stated that the bill would establish a Kentucky Board of Midwifery. The goal is to provide a safer environment for mothers and children through the licensure of certified professional midwives. The bill could also provide a cost savings in Kentucky, because home births cost significantly less than other options.
Mary Kathryn DeLodder, Kentucky Home Birth Coalition, stated that in Kentucky, 600 babies are born at home yearly. The bill pertains to certified professional midwives (CPMs) and not to APRN nurse midwives who practice almost exclusively in hospitals. The bill requires specific education requirements at a specific type of school and is not a self study process. CPMs do not prescribe medication and would have the same statutory requirements for malpractice insurance coverage as physicians do in Kentucky. The American Congress of Obstetricians and Gynecologists (ACOG) wants CPMs to be prohibited from performing twin births, breech births, or a birth to a woman who has had a prior C-section. Home birth is not a safe option for every woman because of preexisting medical or other circumstances that do not make them a good candidate. Midwives need to be trained to be able to screen candidates to see if the woman is a good candidate for a home birth. Administrative regulations could be created to say that specific education is required above and beyond the basic education in order for a midwife to attend high-risk births. Administrative regulations could also have clinical requirements on who is a good candidate to have high-risk births at home.
Senator Buford stated that a lot of women are opting to have a home birth. Home births encourage breastfeeding. Whether the legislation is passed or not, home births will continue.
Cherie Sibley, CEO, Clark Regional Medical Center, stated that home births have been around as long as babies have been born. Many have gone well, many have not and the proposed midwifery legislation does not assure the women of Kentucky the quality and safety they strongly deserve for home births. The bill only addresses women who are 100 percent healty and are guaranteed no complications. In 2015, national vital statistics reveal per 100,000 births, 6.3 have a ruptured uterus, 11.9 have to have unplanned hysterectomies, 6.6 are admitted to ICU, and 167 need blood transfusions. Kentucky’s infant mortality rate is 6.7 percent and 33rd nationally. How does a home birth accommodate mothers and babies when immediate care is needed to save their lives? The bill does not have provisions for transfer agreements with hospitals for mothers and/or babies. Mothers and babies who need immediate care in specialized areas require specialized teams of people to be on sight to provide the care. If a required transfer agreement is not included, patients would simply be sent by ambulance and taken to an emergency room without all the information needed to care for the patient.
The bill gives broad authority for lay midwives to order diagnostic tests, and does not limit testing to only laboratory tests and ultrasounds, as in other states’ laws. Secondly, there is no specified training in the interpretation of laboratory results. The bill asks a certified midwife to interpret ultrasound results that sometimes only a radiologist can interpret. The bill does not contain any requirement for midwives to carry medical liability insurance. If it is not required, the mother has no protection for the cost of potential injury or death to a newborn or the mother caused by a midwife’s care. The bill does not set out the circumstances when a patient must be transferred to a hospital or when to consult with a physician. Nurses, anesthetists, doctors, nurse practitioners, respiratory therapists, physical therapists, and audiologists are required to pass a certification test and work under the guidance of a physician and so should certified midwives.
In response to questions by Senator Higdon, Ms. DeLodder stated that 30 other states recognize certified midwives. Kentucky’s legislation takes specific parts of Maine’s legislation. Currently, there is not a board certified midwives can be placed under.
Senator Alvarado stated that he is not opposed to home delivery, but there are some types of deliveries that carry higher risks. The American Congress of Obstetricians and Gynecologists, the Kentucky Medical Association, the Kentucky Hospital Association, and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives oppose the bill. There should be consensus from all groups. High-risk deliveries such as breech, twins, and vaginal birth after C-section (VBAC) can be very dangerous for the mother and child. Educational requirements should not allow home studies. A low-risk delivery can turn into a high-risk delivery in minutes. Rural settings do not have obstetricians at hospitals ready to handle emergencies and puts the mother’s and/or baby’s life at risk. Ms. DeLodder stated that the National College of Nurse Midwives are supportive of the bill.
Representative Benvenuti stated that an adult can sacrifice themselves based on their own beliefs about their healthcare, but cannot sacrifice a child’s healthcare because of those beliefs. In response to a question by Representative Benvenuti, Ms. DeLodder stated that there are schools accredited by Midwifery Education and Accreditation Council (MEAC) that offers training. The training takes three to five years to finish.
In response to a question by Senator Adams, Ms. DeLodder stated that currently there is not a Board of Midwifery. The Kentucky Board of Nursing licenses APRN midwives.
In response to a question by Senator Thomas, Ms. DeLodder stated that the Kentucky Board of Midwifery is needed to ensure the health and safety of unborn babies.
Representative Burch stated that a woman who knows she will have a high-risk delivery will be under the care of an obstetrician. Unfortunately, not all women have access to healthcare prior to birth.
Senator Alvarado stated that hospitals require doctors to carry medical liability insurance.
Northern Kentucky Health Department - 2015 SB 107
Lynne M. Saddler, MD, MPH, District Director of Health, Northern Kentucky Independent District Health Department, stated that 2015 Senate Bill 107 reduced the independent district board of health from 32 members to 21 and are filled based on population.
Tyler Radford, Co-founder, and Hassan Latifilia, Co-founder, stated that Dreamsetters United was found on October 20, 2016 with a goal to empower youth to be the best possible people they can be by identifying and capitalizing on their abilities and talents. The organization wants to clean up the streets by giving youth visions of change in themselves, guide and show them who they truly are, help them fulfill their dreams, and treat all races, genders, religions, and individuals with disabilities as equals. Children need good role models to look up to and relate with their situations. A lot of people feel powerless about their situations. The organization gives clothes and toys to children in need.
Representative Meeks stated that he would like to partner with them.
Senator Julian Carroll commended Tyler and Hassan to being committed to make a change and told them not to give up until they win.
Representative Benvenuti stated that there is a need for more men to mentor and guide young boys in positive directions, because it will affect the boys the rest of their lives.
Lee Specialty Clinic – 2016 HCR 174
Matt Holder, MD, MBA, Chief Executive Officer, stated that the clinic was named after former State Representative Jimmie Lee of Elizabethtown, a tireless advocate and leading legislative voice for Kentuckians with intellectual disabilities. The clinic serves half of Kentucky’s counties and has 1,200 patients. A huge problem with patients is they do not always know what is wrong with them and are misdiagnosed. Funding for the clinic is provided by the federal Centers for Medicare and Medicaid Services (CMS) and the Kentucky Cabinet for Health and Family Services, Department for Behavioral Health, Developmental and Intellectual Disabilities.
Henry Hood, DMD, Chief Clinical Officer, and Kristin Compton, DMD, Dental Director, stated that stated that the clinic’s patients are medically complex. Some patients have not seen a dentist in years and some never have. Many patients are behaviorally complex and cannot verbally communicate pain, engage in self-injurious behaviors, and lash out at loved ones and care givers with aggressive behaviors. Aggressive behaviors can cause social isolation, complicate residential placement, and cause physicians and dentists to refuse to treat patients. The outpatient center the clinic has used in the past has started to refuse to accept behaviorally challenged patients into its operating room. There are currently 80 patients waiting for services but nowhere to take them.
Mimi Kramer’s 35-year old son, Trey, has severe behavioral and intellectual problems. He receives services at the clinic. She has nowhere to take her son for his yearly examination, because no hospital will admit him because of his behavioral and intellectual problems.
In response to questions by Senator Buford, Dr. Holder stated that the General Assembly could enact legislation that would urge the Governor to request the Secretary of the United States Department of Health and Human Services to designate people with intellectual and developmental disabilities as a medically underserved population in the Commonwealth of Kentucky. This designation would help recruit and train providers to serve this population.
In response to a question by Senator Danny Carroll, Dr. Hood stated most dentists have not had any experience with the disabled population.
Michelle P. Waiver Challenges
Sara Ann Selm, Recipient, Union, Boone County, stated that she is a 32-year old spastic quadriplegic with cerebral palsy and scoliosis. She is opposed to the 40 hours per week limit across the board. She uses 60 hours per week and would essentially have to be institutionalized without the extra hours. Her father and aunt help her, but she has been on her own for the most part for approximately 12 years. She has 3 college degrees, but it has been unable to obtain full-time employment.
Senator Danny Carroll stated that the state needs to make sure services are available. The waiting list for the waiver is very long, so if services are discontinued, it would be difficult to get them back quickly. He commended her for her efforts. The focus is to keep people out of institutions and in the community.
Representative Burch stated that the need for services is great for Kentuckians and hoped that her needs can be met.
New Legacy Reentry Corp
Gisela D. Nelson, Cofounder and Executive Director, Courtney Lamont Phelps, JD, President, The Christopher Wade Phelps Foundation and Volunteer, Government Affairs Department, Bill Huston, Cofounder and CEO, Our Crowd Rocks, Paul E. Nelson, Sr., Cofounder, stated that New Legacy is a faith-based community organization that is committed to breaking the cycle of chronic recidivism for male ex-offenders who were previous incarcerated for nonviolent, nonsexual crimes. In addition, New Legacy provides a separate program which attends to the needs of veterans who may face joblessness, homelessness, and medical issues. Currently, the organization offers a 12- to 24-month residential program in a 9,000 square foot facility that addresses the societal stigma and challenges that veteran and non-veteran ex-offenders face as they find substantive ways to integrate successfully back into mainstream society. Spalding University provides forensic psychology, social work, case management, and occupational therapy. Utilizing resources and existing business entities, New Legacy aims to build income and careers for its residents by partnering with local employers, and to provide job skills training and supportive services. The Soft Skills program offers entrepreneur training to residents as well as those in the community who have a desire to become entrepreneurs. The curriculum of the academy includes business plan writing, training in market analysis and business development, and basic leadership skills. The Jeremiah Project provides short-term job skills training and practical, hands on, work experience in the construction industry for male ex-offenders and veterans. The New Legacy Market is a non-profit corporation launched by two experienced local food and produce distributors after an offseason planning process undertaken by several organizations active in the local food movement in Metro Louisville.
In response to a question by Representative Brown, Ms. Nelson stated that funding for New Legacy comes from income from properties owned by her and her husband and donations. Representative Brown stated that recidivism is a huge problem, and the Department of Corrections might be able to provide some financial help for the organization.
There being no further business, the meeting was adjourned at 12:45 p.m.