Call to Order and Roll Call
Thefourth meeting of the Interim Joint Committee on Licensing, Occupations, and Administrative Regulations was held on Friday, September 8, 2017, at 10:00 AM, at Buffalo Trace Distillery Distribution Center, Frankfort, Kentucky. Senator John Schickel, Chair, called the meeting to order, and the secretary called the roll.
Members:Senator John Schickel, Co-Chair; Senators Joe Bowen, Tom Buford, Denise Harper Angel, Jimmy Higdon, Paul Hornback, Dan "Malano" Seum, and Damon Thayer; Representatives Al Gentry, Dennis Keene, Chad McCoy, Jerry T. Miller, C. Wesley Morgan, Kimberly Poore Moser, David Osborne, Ruth Ann Palumbo, Phillip Pratt, Sal Santoro, Walker Thomas, and Susan Westrom.
Guests: Representative Kim King; Mark Brown, President, CEO, Buffalo Trace Distillery; Kevin Corman, Jessamine County Sherriff, President, Kentucky Sherriff’s Association (KSA); Ernie Keltie, Mercer County Sheriff’s Office; Barrett Block, Vice President, The Castle; Jessica Estes, DNP, APRN, President, Beth Partin, DNP, APRN, FAANP, Legislative Chair, Catherine Waits, and Sheila Schuster, PhD, Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM); Cannon Armstrong, Commissioner, Department of Charitable Gaming; Catherin Waits, Kentucky Coalition of Nurse Practitioners & Nurse Midwives; Sandra Thomas, KLOAR; Kelli Neafus, Pawnbrokers; Nancy C. Swikert, MD, Past President, and Don Swikert, MD, President, Kentucky Medical Association (KMA); Ron Waldridge, Kentucky Association of Private Providers (KAPP); Trina Summers, Kentucky Department of Alcoholic Beverage Control (ABC); Brian Houillion, MD, Kentucky Public Protection Cabinet (PPC); Oliver Barber Jr., Barber, Banaszynski and Hiatt, PSC; Morgan Ransdell, Attorney, Pam Hagan, APRN and Nursing Practice Consultant, Paula Schenk, Executive Director, and Ann Tino, RN, BSN, Kentucky Board of Nursing (KBN); Judy Taylor, Keeneland; Carl Breeding, Kentucky League of Cities (KLC); Wendell Strode, Corvette Museum; Melinda Hill, Chief of Staff, Kentucky Finance and Administration Cabinet (FAC); and Don McLachlan, Dixie Pawn Shop.
The minutes from the August 18, 2017 meeting were approved without objection.
Senator Seum was recognized and stated that Senator Higdon had been elected to replace Senator Givens as President Pro Tempore who has stepped down from that position.
Senator Higdon was recognized and asked committee members to keep the family of Senator Paul Hornback in their prayers for the loss of Senator Hornback’s father-in-law.
Welcome to Buffalo Trace Distillery
Mark Brown, President and CEO of Buffalo Trace, welcomed the committee and said that this distillery opened in 1773. The distillery is making a $1.2 billion investment in the buildings on campus. The meeting for this committee will be converted to a state-of-the-art bottling facility. Approximately $25 million will be invested every four months for the next 10 years to build new warehouses. All cookers will be replaced to allow the distillery to work at capacity. During the excavation of an old warehouse, workers discovered the original 1873 O. F. C. distillery; this has been named Bourbon Pompeii. A tour will be offered of Bourbon Pompeii after the meeting. Mr. Brown said prohibition is not a solution to alcohol problems. The three-tier system effectively minimizes the effect of alcohol in society. It is the foundation for an orderly, regulated market place. Buffalo Trace has no interest in direct shipment, either in-state or out-of-state.
Kevin Corman, Jessamine County Sheriff and President of the Kentucky Sheriff’s Association, said not all pawn shops operate the same way. New legislation would bring consistency by requiring all pawn shops to maintain a data base of those who pawn items, and who sells items. The drug epidemic is increasing stolen items being pawned or sold. With a suspect’s name and description of an item, it is possible to quickly locate an item that has been stolen. Changing the hold period for items that are purchased versus pawned from 10 to 12 days gives law enforcement time to investigate a stolen item. If an item is sold on the same day it has been purchased by the pawn shop, the item is gone before law enforcement can investigate.
Sheriff Corman said most pawn shops are operating using a transaction recording service that is accessible to law enforcement agencies. People who are selling stolen items know which shops use the database and sell to others, making it harder to recover stolen property.
Barrett Block, The Castle, said he agrees with Sheriff Corman. Passage of the bill is important to the pawn broking industry in Kentucky. It will enhance the pawn broker’s reputation and level the playing field of pawn brokers who care about helping law enforcement catch criminals. Pawn brokers provide a service to members of the community, lending to people who are not able to get money in more conventional ways. They are lenders of last resort and take care of people in financial need.
Ernie Kelty, Sheriff of Mercer County, said he agrees with Sheriff Corman and appreciates the cooperation law enforcement has received from The Castle for years. All involved would like to level the playing field.
Jerry Wagner, retired sheriff, Executive Director Kentucky Sheriff’s Boys and Girls Ranch, said he appreciates the cooperation getting this legislation ready for the 2018 General Assembly.
In response to a question from Representative Miller, Representative King said recording serial numbers from items pawned or sold has been discussed. Mr. Block added that secondhand merchandise is defined as an item that is sold by a member of the public. Some pawn brokers sell new jewelry or new guns bought from a wholesaler.
Kellie Neafus, on behalf of the Kentucky State Pawn Brokers Association, said she has concern for some bill specifics. Pawn shops fall under seven federal laws, like banks, because they loan money. In order to pawn in Kentucky, a person must provide a valid driver’s license. A Social Security number is not necessary to track stolen merchandise. The association believes this is a privacy issue. Also, the hold period, in Jefferson County, has changed over the years. The number of days held is not relevant. Documentation from law enforcement that there is an investigation regarding a particular item would be helpful. The shop could then hold that item but no other items not under investigation.
Ms. Neafus stated it is important for the pawn brokers to be part of the process for contracting with a company that will maintain an online data base for pawned or sold items.
Don McLachlan, owner of Dixie Pawn Shop in Elizabethtown, said there is a concern regarding the holding period. Pawn shops keep records of who purchases items; 12 days could interfere with some sales.
In response to a question from Senator Seum, Ms. Neafus said the hold time is different across that state. The association agrees that is should be the same statewide.
In response to a question from Representative Morgan, Ms. Neafus said there is no requirement to photograph customers making a pawn or a sale. Pictures must be taken of items pawned or purchased. With regard to looking for stolen property, a photo of the person making the pawn or sale is not useful.
Senator Hornback commented that he did not agree with taking Social Security numbers during a pawn transaction but agrees that a holding period and taking photos should be mandatory.
Senator Buford said that, when Kentucky changes the driver’s license to Real ID, Social Security numbers will be encoded in the license.
Representative King responded that the driver’s license or Social Security number is in place in the bill to cover when a person either does not have a license or the license has been revoked. Also, Leads on Line is a proprietary company. To date, no specific company has been named for a contract. The holding period for guns and trailers is not negotiable. Those items are two of the most stolen properties. Regarding photos, not every item must be documented with a photo. However, if law enforcement requests a photo, the shop must comply.
Sheriff Corman said recent experience proves that using only the driver’s license makes it easier for law enforcement to track stolen property.
Enhanced prescriptive authority for APRNs
Senator Paul Hornback said he had met with all interested parties in May to discuss issues concerning APRNs. The opioid issue is serious. Over-prescribing is a big problem. Yet, there is a crucial need for nurse practitioners and nurse midwives in underserved areas on Kentucky. All parties agree that nurse practitioners provide a valuable service.
Jessica Estes, Family Psychiatric Mental Health Nurse Practitioner, President of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM), said all APRNs have a masters degrees and some hold doctoral degrees. Nurse practitioners are typically individuals working in primary care settings. APRNs practice in all 120 counties. In 2014 legislation allowed APRNs to prescribe non-scheduled drugs without a Collaborative Agreement Prescriptive Authority (CAPA) signed by a physician in the same specialty. This has allowed APRNs to further their practice in rural areas.
Under Kentucky law, APRNs are not required to be supervised. The CAPA is for prescriptive authority only. KCNPNM has 50 years of data that demonstrate safe and effective prescribers providing quality care. APRNs focus on health promotion, health education looking at disease prevention, and make educated decisions regarding patient care.
The Collaborative Agreement Prescriptive Authority for Controlled Substances CAPA-CS will allow APRNs to prescribe controlled substances. This is not new authority. Currently APRNs have their own DEA number identifying the prescriptions they write. There is also a statutory restriction regarding the amount of controlled substances APRNs can prescribe. The coalition is asking to change the way the CAPA is administered.
APRNs are aware that there is a problem in the Commonwealth and want to take appropriate steps to solve the pain pill addiction issue. This fall the coalition is going to offer three, five hour sessions related to HB 1 requirements. In the spring there will be 10 sessions, offered at their annual conference, related to addiction and or pain management. The coalition publishes an APRN prescribing guide, used by both pharmacists and other health care providers.
The CAPA is a challenge for APRNs because there is a lack of primary care providers as well as mental health care providers in the state. The CAPA does not change what they can prescribe, just how they are able to prescribe it. As a mental health prescriber, Ms. Estes’ patients are mostly in managed care and half of those patients are on Medicaid. In 2016, a managed care organization refused to credential her because the physician who signed her CAPA only accepted cash from his patients. In western Kentucky, it is impossible to send 4,200 patients to another provider. These patients will be forced to seek care in an emergency room, which is more costly than seeing an APRN in an outpatient setting.
Beth Partin, Family Nurse Practitioner, Legislative Chair for the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, said it is difficult for some nurse practitioners to find a physician who will sign the CAPA-CS. Some insurance companies are requiring the physician signing also be participating with that insurance company. This is a problem for the nurse practitioner who is opening a practice. In order to prescribe suboxone that assists people addicted to medication, the physician signing the CAPA also has to be approved in the waiver program. There are only a few of these physicians, and they are refusing to sign a CAPA. This creates a barrier to treating patients with opioid addiction.
Ron Waldridge, MD., Family Physician, President of Kentucky Medical Association (KMA), said great strides have been made in medicine. Pain management should be considered in a holistic manner using not only prescriptions but massage therapy and counseling. Regarding the legislation proposed, however, the request to remove the collaborative agreement seems reckless. While it is not a supervision, it is a collaboration. KMA is interested in seeing data from the KBN to measure how the APRN prescribing authority is working. KMA is committed to working with all colleagues to look at proactive ways to change the climate in Kentucky. KMA feels that this legislation does not address the current addiction crisis. If it is found that there are patients who are in need and cannot get prescriptions, KMA wants to be part of the solution.
Nancy Swikert, MD., Family Physician, said KMA has seven thousand members who are concerned about the opioid issue and against the increase to access by allowing APRNs to prescribe. It is the general feeling that there are too many prescribers now and that increasing prescription authority will mean additional drugs on the street. KMA wants to work with all parties to find a solution; however, increasing access to prescriptions is not an answer.
In response to a question from Representative Moser, Dr. Estes said APRNs practice in 87 professional shortage counties. There is no full-time physician in Hancock County. One physician works one day a week, and she is the only prescribing mental health provider in the county.
In response to a question from Representative Miller, Dr. Swikert said from the physician’s side, even down-grading the requirement for schedule III and IV drugs, there is still the potential for abuse. Dr. Partin replied APRNs are already limited to a three day supply of schedule II drugs and are not asking to change that language.
Senator Schickel commented that he disagrees with the sentiment that doctors have caused the addiction crisis. He feels that rather than an addiction crisis there is a crime wave because people will used the excuse that a doctor over-prescribed, making them addicted to drugs.
Cannon Armstrong, Commissioner of the Department of Charitable Gaming, said charitable gaming in Kentucky is a $370 million industry. Speaking as a regulatory agency, there are a lot of good things done through charities. However, there are also a lot of bad actors using the money for other purposes. Kentucky does not extend charitable gaming privileges to 501(c)(7) organizations. Typically these organizations are social or recreational clubs such as a country club, fraternity, sorority, dinner clubs, hunting-fishing clubs, home owner associations etc. None of these organizations currently game. They cannot hold raffles, special limited including poker tournaments, electric pull tabs, or bingos. The agency is not against extending gaming status to 501(c)(7) organizations; however, there are issues. A 501(c)(3) that does too much gaming risks losing exempt status. Regardless of status, every charity that submits an application must meet criteria set in statute. The applicant must provide its charitable purpose that must relate to relief of poverty, advancement of education, protection of health, relief of disease, relief of distress, protection of environment, conservation of wildlife, advancement of civic, governmental or municipal purposes. A 501(c)(7) exemption would allow a non-charitable recreational organization to engage in charitable gaming.
Senator Higdon commented that Commissioner Armstrong is very accessible and is doing a good job at the agency.
In response to a question from Representative Gentry, Mr. Armstrong said there is a fee when applying for a gaming license. An exempt organization that does not collect $25,000 in gaming revenue is charged no fee. There is a gaming fee based on gross receipts. This is collected when charities submit their monthly financial statements. The agency is a restricted fund agency.
There being no further business, the meeting was adjourned at 11:30 AM.