2021-09-21 00:00:00 - Joint Committee on Ways and Means
2021-09-21 00:00:00 - Joint Committee on Ways and Means
(Part 4 of 4)
[PART 4]
SHOW NON-ESSENTIAL DIALOGUE
Mhm thomas king and Hema Sarang Sieminski. Hi, how are you? Hi, well how are you? Thank you for hearing all of us today.
[HEMA SARANG-SIEMINSKI (JANE DOE INC):] Sure, I'll begin. Um So good afternoon chair. My name is Hema Sarang-Sieminski and I'm the30 policy directorate, Jane Doe Inc. JDI is a State Coalition and Sexual assault and Domestic violence. And you know, I really want to reiterate much of what Lee and shared today. But41 from the perspective of programs that directly work with survivors of sexual assault and domestic violence as a coalition and I am our programs are very concerned and we are very hopeful that you will consider allocating funding from the American rescue plan to MOBA to continue to support survivors of sexual assault of domestic violence and all crimes as Liam laid out for us.
This additional funding will close this temporary and critical gap in funding for victim services created by this decline in VOCA funding and it really makes sure that life giving services continue but they're not interrupted. It also provides this unique opportunity to deepen the culturally responsive services, two survivors who are most impacted by so many of the racial disparities that came to light through the pandemic. Okay, um from from a JDI perspective, you know,101 victims and survivors across the commonwealth rely on programs and services that are106 made possible, in part through vocal funding the vast majority of JDI member111 programs are funded in part through VOCA dollars and deliver services to survivors.
So this means court advocacy, housing support in the aftermath of a sexual assault, a range of types of advocacy that are important for survivors to really navigate the day to day realities and and the and the double impact of COVID. Um we want to note that 72% of VOCA funding is used for staffing and personnel costs.140 And, you know, the prospect of an impact of a reduction in funding is profound.145 Um and, you know, I think we are coming, we're so grateful to the Legislature for the deep investment in sexual assault and domestic violence services in the commonwealth through the DPH funding and really feel that the Legislature has responded to the emerging needs of survivors, especially through the pandemic by funding these increased opportunities for advocacy and outreach and specifically around culturally and linguistically specific services, housing advocacy and and really addressing the most vulnerable survivors during this time.
Despite these victories, JDI programs are very worried. They're concerned about these unprecedented gaps in funding with some programs, you know, wondering how to navigate deep cuts. 35% and above as Liam laid out. And, you know, we're we were so thrilled to see the vocal fix passed. Um that said, you know, that doesn't solve our problems immediately. And this is really an opportunity for this bridge funding. And um we really hope that this this bridge funding will allow programs to fully realise of the intent of the Legislature and funding services. Um and I will wrap up with that and leave time for questions. But we really hope that this $70 million dollars of231 ARPA funding can be used to b this bridge.
SHOW NON-ESSENTIAL DIALOGUE
Tom Do you want to?
[TOM KING (MASSACHUSETTS CHILDREN'S ALLIANCE):] Yes, absolutely. Good to see you. Dykema I'm sorry, it's been so long. Um Good afternoon Chair Friedman Chair Hunt and members of the Joint Committee on Ways and means my name is Tom King and I'm the executive director of the Massachusetts Children's Alliance, the Coalition254 of the State's 12 Children's Advocacy centres. Thank you for this opportunity to provide testimony as others have said, it's been a long Day thank you for doing this for us and I really am here like Hema to talk about using ARPA funds to bridge the 35% reduction in federal victims273 of crime act money that we are facing in addition to the potential cuts and victim service staff at our278 CACs which I will outline in written280 testimony.
We, would like to speak to you about our VOCA funded statewide Commercial Sexual Exploitation of Children or otherwise referred to as CSEC service project That ensures trauma informed victim centred service provision to children 18 and under who have been or297 at risk of commercial sexual exploitation. I really would like to give voice to this victim population today, Sexual exploitation of children as a form of violence which includes sexual abuse in exchange for money goods or services on average children first fall victim to CSEC between ages 12 and 14 and studies have found 70-90% of these children have a prior history of sexual abuse.
Victims of CSEC are often at risk youth suffering from complex trauma in presenting many challenges to child abuse professionals and service providers. children who run away are at high risk of sexual exploitation due to their mental, physical and financial vulnerability. Moreover, LGBTQIA Youth are disproportionately represented in the CSEC population. A recent survey reported that 40% of homeless youth identify as LGBTQIA. And they are homeless, mostly due to family rejection based on their sexual orientation or gender identity. Many homeless youth engage in survival sex, which is exchanging sex for food, shelter, clothing, basic needs.
The pandemic is only worsen the scenario for these youth Moreover, cases of online enticement and exploitation have skyrocketed over the last 18 months. With our unique intervention, CSEC victims in the commonwealth have access to streamline trauma informed response to child advocacy center. Our project funds case managers for each of the CACs. They are solely dedicated to responding to this victim cohort, ensuring specialist in tailored service responses to these children's unique needs. The coordinated collaborative approach towards better investigative outcomes and offers children a critical connection too much needed services, including evidence based mental health interventions and connection with survivor mentors so that they can begin to recover and heal.
Additionally, CFCs, the multidisciplinary team approach offer high level review in quality assurance of the cases presenting to DCF in law enforcement. I would urge you to support the use of ARPA money to bridge this temporary cut VOCA funds to prevent the disruption of lifesaving interventions and care to a truly vulnerable victim cohort. Thank you for your time to be most happy to answer any questions that you would have also want to thank Decker for her leadership during the pandemic and sharing that special committee listening to all of437 us about how victims of were affected during the pandemic. So thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Thank you very much. Thanks to both of you for your testimony. Great follow up to liam. So thank you. Thank you all. Okay lisa McKechnie lisa. Okay Peter Evers. Yeah peter are you with us? Okay. Okay. Deborah Deb Wilson Hi good afternoon. Hi, thank good, how are you?
487 [DEBORAH WILSON (LAWRENCE GENERAL HOSPITAL):] Thank you, chairs, Friedman and rep hunt and committee members for inviting testimony today. My name is Deb Wilson and I am the president and CEO of Lawrence General Hospital In March of 2020 when the pandemic struck, none of us knew our hospital would be called upon to manage what turned out to be the508 highest impact of COVID in any community, no other city comes close in terms of impact in numbers One of four people in Lawrence over 21,400 people and many more in surrounding surrounding communities have had COVID. At one point nearly 80% of our hospital beds were dedicated to caring for COVID. We were financially weak before COVID. But due to do the structural reimbursement issues as a safety net hospital and then COVID hit our workforce.
The community and our hospital finances have not recovered. Lawrence General did receive crucial emergency financing in august that stopped us from having to close maternity pediatrics and other services. We are very grateful for that funding in our community will continue to have access to those key services. We truly appreciate the amazing support from the570 state, the Legislature and mass hospital Association and we hope MHH’s request for 500 million towards hospitals is funded like many hospitals. We are not out of the woods due to the high COVID impact in Lawrence patient volume for non-emergency services has not returned to pre pandemic levels. We are still dealing with workforce shortages, that impact cost to deliver care to the community. And as a high Medicaid hospital with substantial shortfalls and reimbursement and lo commercial rates.
We will have fiscal challenges. But the COVID impact in our community has only made us more financially vulnerable. Like most Medicaid hospitals, we are not part of a large health system and that means that we stand alone serving our community with whatever revenue are hospital receives and it means we count on support like these ARPA funds. I hope very much that among the other worthy purposes, the Legislature will prioritize getting hospitals and especially ones like Lawrence general back on their feet647 now while the state has the capacity to help and ARPA funds are available in our case. It will save services and build back capacity as one of the vital community assets in the Merrimack valley and the largest employer in Lawrence. It will also help the commonwealth largest community of color that was the most impacted by COVID. Thank you very much.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. So you're you're testifying on behalf of the a request that is that correct? 500 yes, thank you. Thank you, Bruce Moore Yeah. Hi Bruce, uh you are694 you are a696 muted. Sorry,
[BRUCE MOORE (NATIONAL CENTER FOR CHILDREN'S VISION AND EYE HEALTH):] Thank you madam chairman. And uh like to thank the committee for the opportunity of speaking today. Uh my name is Bruce Moore I'm a professor emeritus at the new England College of Optometry in Boston. Also a co-chair of Children's Vision Massachusetts and the National Center for Children's Vision and eye health. I'm going to speak on a request for one time only ARPA funds to improve the Massachusetts system of vision screening by school nurses across the commonwealth. The legislature established the Massachusetts Special Commission on children's vision and eye health four years ago to better understand the status of children's vision in Massachusetts and how to improve on it.
I served on that commission. The final report has been held up by COVID but is said to be released shortly. Vision problems and children are the most common disabling condition of childhood according to the CDC. Vision isn't often ignored vastly misunderstood and fundamental emperor of trial development and learning finding and fixing vision774 problems early in a776 child's life and development is a simple cost effective public health intervention that spares some significant percentage of children from the adverse effects on their learning and reducing the need for additional costly educational interventions in some of those children, children's vision can change quickly as a result of COVID, major effects on children's vision have occurred.
For one. children's vision have not children have not had school-based vision screening for the last 2-3 years. There was a tremendous backlog of children needing to be screened and assistant to receive the vision care that can make a big difference in the classroom. children in low income and minority communities are inequitably affected by this lack of screening. These being the same children who are known to be at significantly higher risk of vision disorders. In addition, increased screen time during COVID along with reduced outdoor time has led to a dramatic and now well documented increase in both the prevalence and rate of increase in myopia around the world.
Uh The State Department of Public Health school Health division has engaged with a variety of consultants myself included, recently revised the Massachusetts vision screening protocol guidelines. These new streamlined evidence based guidelines will soon be disseminated with new training. Women are webinars filmed just yesterday for implementation over the next year. Many existing vision screening tools and schools, will by the fall of 2022 become obsolete. Our ask is to fund a onetime purchase of about 2500 updated screening kiss for every public school building in the state. To equalize the best current evidence based systems and tools. Provisions screening across all schools in the commonwealth.
Funding will also provide training and resources assistance in communities most affected by COVID and facilitation of eye care for the child funding. This will enable every child in the community regardless of their zip code or the schools district ability916 to buy kits to avail themselves of these evidence based techniques for detecting vision problems. This is a onetime expenditure to ensure the health equity of all students in Massachusetts929 public schools Total cost is under $1.7 million. I'd just like to add one thing. And935 that is the deficits that were discussed about oral health care out in the Berkshire County are duplicated almost completely in terms of deficits of vision care. They're in Western Mass and also approved communities across the state. So thank you.
[SEN FRIEDMAN:] And uh and you know, you have written testimony for us, did you?
[MOORE:] Yes I do.
[FRIEDMAN:] Okay, great. All right, thank you so much for your time. Thank you for joining us and972 testifying. Mhm.
SHOW NON-ESSENTIAL DIALOGUE
Mhm Okay. Are next testifier is lily Sue.
[LILY HSU (LABOURÉ COLLEGE OF HEALTHCARE):] Good afternoon. Committee chairs. Vice chairs and members of the committee. Uh My name is Lily Hsu and I am the president987 of Labouré College of Healthcare Milton Mass. Each year the Labouré College graduates the largest, most diverse class of nurses in Massachusetts. About 400 nurses. Each year. Over 50% of our students are at or below the poverty line and 65% of them are people of color and 100% are residents of Massachusetts. Our graduates begin rewarding careers with family sustaining wages. They are nurses who are increasing the ethnic representation and delivering compassionate, culturally competent care to Massachusetts residents.
The continued retirement of the baby boomer generation will result in an additional loss of one million us nurses by 2030. The state of nursing in Massachusetts survey revealed that the pandemic has exacerbated existing problems within health care, particularly nurse burnout and turnover. The pandemic also brought health inequity and racial disparity to the forefront. Labouré’s nursing graduates can play a central role in addressing these health inequities. We must invest in our nurses and in nursing education. Labouré has more nursing applicants than we can admit into the associate level program. The biggest factors limiting our growth are a lack of nursing faculty, particularly diverse faculty and a lack of clinical affiliation.
Perhaps these challenges could be addressed by expanding the1085 composition of the healthcare team to meet the needs of tomorrow. We may need to think differently to innovate examples for your consideration are to create recognize specialties within the BSN degree that support1100 nurse practitioners as part of the healthcare team, increase compensation rate for certified nursing and medical assistance so that they can earn a family living wage to find new and intermediate positions in health care like the patient care technicians. I believe these strategies will redefine and strengthen the health care team in various settings that will result in better health outcomes. As stated earlier.
The nursing shortage means addressing the barriers to nursing education and the shortage of nursing educators, strategies to consider to1139 increase the continued use of BSN nurses with clinical experience to teach in the associate level programs, increased professional development opportunities and increased nursing scholarships, direct tuition support and loan forgiveness programs across the health career path raise. Keeping our children and families healthy and safe and meant containing medical costs depends on having a well-educated and trained nurses and other healthcare professionals. We need to implement new strategies to address the nursing shortage. The health and well-being of our families depends on it. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Thanks so much for your testimony. Yeah, Cheryl Ryan Chan But are you here with us Sheryl. Okay, chris hope uh
[CHRIS HOEH (DIGNITY ALLIANCE MASSACHUSETTS):] Good afternoon. I thank you for being here and sharing this for all this time. And I have to say I've learned a great deal about um what's uh the needs of the commonwealth and much of what I will say overlaps with others who testified on Chris Hoeh. I'm a quadriplegic who is fortunate to be1224 speaking to you from the home that I share with my family, where I am able to participate fully in my community.1232 And this is largely due to the services and policies that advocates fought for and that have been enacted by the legislature. I thank you all. And um today I'm representing the Dignity Alliance Massachusetts.
I appreciate the opportunity to offer six uses of ARPA funds for your consideration that respond to issues or needs that have arisen or been exasperated due to the pandemic. They focus on specific populations and do not require ongoing funding. One established an initiative to connect the SAP network with the administrative, I'm sorry the Admissions Discharge Transfer Notification Systems that are used by acute care hospitals to improve care, coordination between home and community based service1289 providers in the health care system in order to facilitate more in home care provision.
Two acquire electronic communication devices that agencies can make available for homebound consumers so they can access telehealth and similar online communications services. Three conduct a two-year demonstration regarding the advocacy of employing spouses of a disabled partner for parents of disabled minor children as personal care attendants or home health aides. Four mount an initiative to fund one-time home modifications consistent with money follows the person waiver service plans as well as one1338 time purchases of durable medical equipment for persons currently in or at risk of being admitted admitted to nursing facilities.
Five Fund a study to analyse the state's long term care system and its reliance on nursing facilities and to identify ways to eliminate barriers to community living for persons who are at risk of admission to nursing facilities. Similar studies have sucked1370 successfully been conducted in New Jersey and in California. Finally, six provide one time grants and technical assistance to nursing facility providers who are committed to transforming their business model so they can operate residential settings for individuals with disabilities or older adults who do not need ongoing who do need ongoing personal1396 care services but not significant nursing care. We will be providing more detailed written testimony and welcome questions to expand1407 on any of them following the hearing.
[FRIEDMAN:] Thank you Chris thanks um for our outlining that for us. I'm glad that testimony, the written testimony is coming and we can take a look and I I appreciate you hanging hanging on this long to testify and well uh as I said be taking a look at what you all sent, appreciate your testimony.
[HOEH:] It's nothing compared to how the time you spent and the decisions that are before you. Thank you.
[FRIEDMAN:] Very kind. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Um Okay. Uh Deborah but solely.
[DEBORAH BITSOLI (MERCY MEDICAL CENTER):] Good afternoon thank you Senator Friedman You've had a very very long day and thanks for giving me a few minutes and also thank you for the opportunity to testify. So I am one of those hospital CEOs. My name is Debbie Bitsoli and I run Mercy Medical Center in Springfield and prior to that I'll let you know I did work at Cambridge health alliance which was also a safety net hospital. I've only worked in Massachusetts and I have a little bit of a unique background so I come with a little bit of a1485 different perspective and I will be brief. I early on in my career I did get an accounting degree. I'm actually a certified public accountant so I can look at a hospital portfolio financially.
But then I'm also a hospital operator and I ran medical groups in downtown Boston. So Mercy Hospital quickly is about it says about 80,000 ED. Visits per year and it's about 182 beds. We run a census of about 145. We also do serve the financially challenged most of our pair mix about 30% of Medicaid and only about 25% is commercial. I just wanted to share with you the financial impact of COVID. Um specifically with the COVID relief funding that we did get we still lost 16.3 million at the end of June 2020 and then in 2021 with the COVID funding we still lost 19.5 million. If we didn't have that funding the losses would have been 63 million and 31 building
And I think that many of you have heard about the hospitals, the incremental staffing, the premium dollars. We still have tempt checkers here at our front doors, the PPE etcetera. And also the loss of volume. What I would say is this fiscal year, although the volume has returned for July and August were still running a loss of $7 million. So in closing, what I would like to say is the hospital businesses, a thriving business in Massachusetts.1582 We take care of many of the under served as a safety net hospital. The ARPA funding would be very, very helpful to us, especially with the pandemics that we have and I would finally like to say you guys are very nice to do this all day and if you could help us out this1601 is not really sustainable in the1602 long term the staggering losses. So thanks again and thank you for your time today. I appreciate it.1612
[FRIEDMAN:] Sure. Thank you for your time and thank you for all the work you've done. Um keeping people keeping people safe in keeping people healthy and we take all the issues around our hospitals very seriously as you know and we will be looking at how we can address this. The really daunting financial um issues before you. So thank you and thanks for waiting so long to.
[BITSOLI:] Thank you very much.
SHOW NON-ESSENTIAL DIALOGUE
Okay. Okay that was different. Lynn Hancock if you can see and hear me okay I can high.
[LYNNE HANCOCK (AMERICAN NURSES ASSOCIATION MASSACHUSETTS):] Good to see you again so soon. So good afternoon, thank you for allowing me to present testimony on behalf of the American Nurses Association of Massachusetts. ANAMASS is the premier professional organization representing the interests of the Commonwealth. plus, licensed registered nurses. My name is Lynn Hancock and I'm a registered nurse and the president of ANAMASS. In addition to being the magnet program director for Boston children's Hospital, you will be receiving extensive written testimony from ANAMASS as well.
I am testing fighting today to urge robust and immediate action to use ARPA funds to address the needs of1696 nurses who cared for the citizens of the commonwealth. During the COVID 19 pandemic nurses have remained steadfast on the front line since the beginning of the pandemic while overcoming challenges, risked their personal health and safety and the physical emotional and mental health burden of the COVID1713 19 virus nurses across settings have contributed and volunteered their time to support the Commonwealth's COVID-19 response ANAMASS is deeply concerned that there is a national and state level severe shortage of registered nurses, especially in long1726 term care and mental health facilities and in acute care specialties such as the operating room emergency departments and intensive care units.
These shortages will have long term repercussions for the profession, the healthcare delivery system and ultimately on the health of the commonwealth first. I would like to review current concerns related to the iron workforce in Massachusetts. One of the largest barriers is the inability to successfully gather and report data on this. The state's nursing workforce for the last statewide workforce survey was conducted in 12 2014. There are educational challenges related to limited clinical placement sites, which is a critical element of nursing education.1765 Currently 44% of the R and workforce in Massachusetts is over the age of 50, compared to only 35% nationally.
Close to a quarter of all new registered nurses leave1778 within a year of employment. There is pay inequity between health care settings. Currently nurses are leaving their communities for higher compensation, furthering local staffing strains, often an underserved communities I would now like to share ANAMASS’s top three recommendations for your consideration for use of the funds. Additional recommendations will be provided in our written testimony, recommendation Number one is to charge the Massachusetts Health policy Commission with the creation of a blueprint to develop, implement and source ongoing funding of a nursing workforce center.
35 states including Vermont Connecticut, New Jersey, New Hampshire in New York belong to the national form of state nursing workforce centers and regularly examine educational capacity, workforce, demographics and forecast need. These centres assure an adequate supply of qualified nurses to meet their population health needs. Recommendation number two is to invest in a pipeline of diverse nurses and nurse leaders for the commonwealth and a strategic use of the ARPA funds are both short and long term dividends. This can be accomplished through scholarships, for example, the foundation of nursing advancement in Massachusetts recently announced its first $2500 scholarship1848 to advance diversity in nursing.
There are over 30 qualified applicants for a single scholarship with more funding as 501(c)(3) organization could grow this scholarship program and clearly facilitate the education of a larger number of racial and ethnically diverse nursing students in the commonwealth recommendation number three is to address the bottlenecks and challenges in the nursing workforce pipelines such as bypassing the nursing licensure compact act, established loan repayment programs for those specialty areas in which the commonwealth has the most needs behavioral health, substance abuse disorders, long term care and community health provide funding to support the use of nurse residency programs to facilitate the transition to practice of newly licensed nurses. Thank you for allowing me to testify today and I'm happy to answer any questions you might have.
[FRIEDMAN:] Okay, thank you, Lynne. Um so I know we talked very recently so um you know we're aware of um what you're asking and the committee members will get to look at the testimony as well. So that will be um that will be really useful for all of us. So I appreciate all the work you and the ANA have done to present these proposals.
[HANCOCK:] Thank you very much for your time. I appreciate it.
SHOW NON-ESSENTIAL DIALOGUE
Okay, take care. Um Candy New Isaiah tomorrow Candido, are you with us? Okay, Bluefin for blue. Mhm Katie Murphy Thank you. Chair of Friedman I admire your stamina. My name coming from a nurse. That's a compliment I think.
[KATIE MURPHY (MASSACHUSETTS NURSES ASSOCIATION):] Thank you very much. Chair Friedman and Chair Hunt. I'm Katie Murphy I'm an intensive care unit nurse who spent1978 the majority of the pandemic working on a COVID. I see you. I'm also president of the Massachusetts Nurses Association, representing over 23,000 members who have been on the front lines of the pandemic for over a year and a half. I'm here today to identify issues we would like to see prioritized for ARPA funding. It's important to remember that each of these issues for each of these issues. The pandemic served to highlight and exacerbate existing problems.
The preservation of essential health services is crucial to improving the health of residents in the commonwealth. Unfortunately, the elimination2014 of dozens of facilities, units and services has left communities without access to essential health services specifically. We have seen a reduction in the availability of inpatient behavioral health services2025 as well as maternity and birth related services. We've seen that we've seen firsthand the detrimental effects of these service closures and reductions, the lack of behavioral health beds has led to increased wait times to access clinically appropriate treatment.
The reduction in maternity beds and units has led to the emergence of maternity desserts, causing pregnant women to travel much farther and longer, a costly burden. As the factors that contribute to deaths and complications in maternal child health include limited access to transportation, lack of continuity of care and reduced access of care. This problem is particularly acute in lower income communities and2068 communities of color. We propose funding to be allocated to increase reimbursement rates for behavioral health and maternal child health services. If that is the barrier identified to maintaining the services and the facilities that accept increased funding be required to maintain these services.
We further propose allocating direct grants to organizations dedicated to addressing the crises created by the closure of essential maternal child and behavioral health services, school nurses and in school mental health counselors are being asked to do more, but they don't have all the resources they need safely reopening schools has been identified as critical to reopening our economy. COVID precautions such as physical distancing, masking, testing, sanitizing and contact tracing or mandated. All evidence based in most cases, if not all districts. In not all districts, the full time job of swapping testing, data entry, follow up and phone calls has been dedicated to the staff member who already has a full time job.
The school nurse, we propose that ARPA funding allocated to municipalities and school districts be used to hire increased staff to perform the second job rather than a sign the second job to a professional who already has a full time job. These increases should be maintained for the duration of the pandemic. And we are also including in our testimony that we're submitting um we are advocating Arpa funding to continue to diversify the nursing workforce and address violence in the healthcare workplace and I'm available for any questions.
[FRIEDMAN:] Thank you. Thank you so much. We will look at the testimony, follow up with any questions um that that we haven't and thank you for understanding that we may be out of questions that this book.
[MURPHY:] I get it shame so much.
[FRIEDMAN:] Okay. All right, thank you.
SHOW NON-ESSENTIAL DIALOGUE
Mhm. Okay. The next group is a panel maddie Ribble Cheryl's Barra Eileen McEneny and uh Mayor Ari joe. Mhm.2219 Okay. I see. Cheryl. Yes, I see Maddie, you know I know who maddie is um and oh I see. Uh Senator italian is their high. Okay, so I guess there's been some swapping, so just I'm gonna go go ahead and um
[CHERYL SBARRA (MASSACHUSETTS ASSOCIATION OF HEALTH BOARDS):] thank you very much. Chair Friedman2244 and um hello to chair Hunt. My name is Cheryl Sbarra and I am the2250 executive director and senior staff attorney for the Massachusetts Association of Health boards. We are the membership association for the 351 local boards of health in Massachusetts and um the statutory and regulatory obligations of local public health are too numerous to list just a few I'll mention2271 here, um assure safe drinking water, monitor infectious diseases, inspect homes for lead and housing code violations, inspect camps, test beach water, inspecting, hotels, issue isolation and quarantine orders, address public health nuisances and the list just goes on and on and on.
And as chair Garlick mentioned this morning, this pandemic revealed the fact that where you live largely determines the public health services available to you. If you live in a wealthy white privilege city or town, your beaches, restaurants, multi-unit dwellings and school cafeterias are likely to be inspected regularly by trained and educated public2310 health staff, but this is the exception, not the rule, even though public health legal authority is embedded in the power to protect the health safety and welfare of the residents of the commonwealth, just like police and fire funding for local public health has historically come only from what a city town decides to spend on it, what they decided to spend on.
It determines the2339 services and also the training and educational level of public health staff to make matters even more inequitable. There are absolutely no work for standards for local public health staff. Tree wardens need to be qualified as do library employees, but not public health staff. Something is the matter with that picture, no wonder there's such a disparity in the way public health services are delivered in our state and as always, those who need public health services the most get hurt the hardest. In order to fix this system. We need two things. We need a plan and we need a way to pay for that plan.
We have both our legislature as you heard this morning, created a special commission on local and regional public health a few years ago and the commission2391 drafted a blueprint. The blueprint includes recommendations for improved effectiveness, efficiency and equity for our public health system. It also includes workforce requirements. That's the plan. Now, how do we pay for this plan? Well, since the priority of the American Rescue Plan Act is to invest in state and local public health systems. I would respectfully suggest that ARPA can give us that second thing the way to pay for that plan. Thank you.
[MADDIE RIBBLE (MASSACHUSETTS PUBLIC HEALTH ASSOCIATION):] Okay, Hello, Good afternoon. Hello, Good afternoon. My name is Maddie Ribble. I'm the policy Director for the Massachusetts2431 Public Health Association. I always think the sixth hour overhearing is always when the fun starts. Thank you all for sticking in today. Sure. Friedman uh Chair Hunt and Chair Decker as well for being here. I've thrown away my prepared remarks after the sixth hour, so I just want to add a few things to what my colleagues have shared previously as well as to mention a few of our colleagues who had hoped to share some local experiences but had to step away2464 to attend to other responsibilities.
They include uh Deputy Health and Human Services Commissioner. Soloe Dennis from Springfield. Health Director Damon Chaplin from New Bedford. Mayor Arrigo from Revere who had to step away. Uh as as well as Eileen2481 McAnneny from the Mass Taxpayers Foundation and Barry Keppard from the Metropolitan Area Planning Council. They'll all be submitting written testimony for your consideration. So let me just say uh2491 you know, to the issues of local public health, we've been talking about this issue has been effectively studied. We have effectively developed consensus solutions from all partners in state and municipal government as well as the public and nonprofit sector.
And thanks to the foresight of the legislature and governor Baker over the last two years, especially we have invested in some pilots and incremental reforms through the public health excellence grants that have made some important changes at the local level as well as taught us lessons and I want to say2523 thank you to all of our legislators for voting for that funding over the last couple years into Governor baker for signing it. Um we have also seen the devastation of a public health pandemic now that we have not seen when we started this work and we understand intimately what that looks like.
Um we now have the opportunity after2548 decades of discussion about this issue to truly transform the system for generations to come. And the proposal we've made, which represents just 5% of ARPA funds controlled by the legislature is the kind of investment that can make a generational transformation, leaving fully 95% of those opera funds for the many very worthy and impactful proposals that you've heard today. So we ask for your support to make that investment. Um I2582 wanted to briefly just mentioned those numbers which will be providing additional written testimony about our proposal is for 250.9 million over five years.
That includes 118.4 million to establish integrated 21st century data systems. 37.5 million to invest in workforce development to ensure that every resident benefits from trained public health professionals and 95 million to support a 5-year program of investment to address health disparities in the communities that are farthest behind for meeting basic standards as well as those communities that have the deepest and most persistent health inequities. So we ask for your support and we thank you very much for your time. Um and we're going to substitute if you don't mind Barbara italian to pinch hit for some members of our panel who left. All right, thank you.
[BARBARA L'ITALIEN (PARTNERS IN HEALTH):] Thank you Maddie were in the interest of time we are consolidating two panels into one. So good afternoon to chair Friedman chair Hunt, Chair Becker and representative Balser thank you for hanging in and for your time and attention2642 as you way the very real decisions around the investment of ARPA funds as you know, I'm Barbara L'Italien senior government affairs adviser for Partners in Health. It's a social justice organisation striving to make health care a human rights, starting with those who need it most. And PIH has been engaged in battling COVID 19 in Massachusetts throughout the United States and abroad.
Over the past 18 months, I have been working on COVID 19 response and I've joined with the Coalition for Public Health and the Mass Public Health Association to improve our state public health system. I learned firsthand and as a g attorney general Healy mentioned earlier, Massachusetts is an outlier in operating a system that is decentralized. A patchwork quilt of 351 individual systems which range from some well-funded staff and executed communities, to systems with little funding, few if any public health professionals.
The system lacks a functioning data system, proper training, staffing and credentialing a baseline of uniform standards and operates at the ability and interest of local government for funding. Since there is no dedicated state funding formula for local public health. Cities and towns alike have struggled. And health equity issues have are abundant during this pandemic. We can and must do better. As was mentioned, there is a local Public Health Commission report and with thanks to the legislative support, particularly by reps, Kane and Garlick and senator Comerford, there are the public health excellence grants to regional sharing of services which has been a great collaboration between legislators, public public health experts and others.
It's a great down payment and bridge to what's needed. But the pending safe legislation is the blueprint to the ARPA funds requests that we are outlining here this afternoon investing that $251 million as was mentioned, it's a 5% of the total of ARPA funds directly received by the state. And this is for five years can transform our public health system to a well-trained and staffed system with a functioning data system to address many requirements required of2776 local boards uh, well before COVID from food and water quality issues to Mosquito Borne illness and to be prepared to face future pandemic challenges beyond the run of COVID-19.
This fits within the concept of using ARPA funds2790 as a bridge to stabilize mitigate and recreate the public system is mentioned by health and Human Services Secretary uh, this earlier today. Um, and this would address issues of workforce access and technology. Lastly, I'd just like to say that pH has been doing contact tracing work here in Massachusetts. And the connection has been strong during this pandemic, but I prefer to live in a place with a fully functioning health system which does not need to rely on a nonprofit to help manage public health. We need to invest in our public health system here in Massachusetts. I'd love to put myself out of a job and these wonderful professionals are really have done a lot of work to set the stage for this to happen. So I request that you fully endorsed the ARPA asked before you and I think all of us are happy to answer any questions that you may have.
[FRIEDMAN:] Great, thank you. Thank you very much2866 for your testimony. I think we've heard a lot of compelling testimony around our need to strengthen our public health system so, so thank you. Um Mhm.
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Okay, um I'm going to move on um with Elaine Korea rashida, um Ahmad Camilla Sharif and Sara Black. Me. Good and baby Hunt Okay, how sad?
[ELAINE CORREIA (MASS SENIOR ACTION COUNCIL):] Okay, good afternoon. Chairs Chairman Friedman Chairman Hunt in the committee. I thank you for hearing so many voices today. I'll be brief because it's been a long day. The disproportionate impact of COVID-19 on seniors, particularly on seniors of colour has exposed longstanding economic and health inequities. We know the access to affordable care is essential2926 if we are going to address these disparities, harper in fact, deepen subsidies for those covered through the exchange. Seniors however, were left behind Lower income seniors continue to lack access to affordable insurance, paying more than 20 for premiums alone.
This group of seniors is distraught. Disproportionately women, particularly women of color, we urged the Legislature to right this wrong and invest ARPA funds and expanding Medicare savings program. An investment of 17 million can extend a lifeline 2 50,000 seniors and serve as a stimulus By bringing over 200 million in federal benefits back to the state. In fact, we estimate the first year impact Would be less than eight million With a federal return of approximately 100 million. We urge you to leave no seniors out of the rescue. I speak today as a surrogate for egg for our president Edna, whom I'm sure you know and have been familiar with who has done such good work in Massachusetts. Thank you for listening And there will be a written testimony and Rashidah I think is ready.
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Thank you rashida. Can you hear me? Yes, I can.
[RASHIDAH AHMAD (MASS SENIOR ACTION COUNCIL):] Okay, good afternoon madam chair Friedman and the rest of the committee. Thank you for giving me this time to speak. My name is Rashidah Ahmad. I'm 74 years old. I am the eldest of 11 children growing up. We always had to take care of each other and keep the families supported. It is a natural transition to them. Working almost half of my lifetime in the health care field, Durbin and caring for others. I spent over 30 some years helping men and women reach optimal health through quality care at the Montigny hospital. Until the day that my world turned upside down when my husband was diagnosed with progressive Alzheimer’s disease.
I eventually had to retire fully to support my husband here first at home and then later I had to place them, which was not safe. So I had to place them in a nursing home. I went to the nursing home to care for him each and every day for 10 years and then COVID hit the staff was great, but it was so hard to be a part I call and I use space time. But really couldn't only but really couldn't only talk. Mhm. Through the stair because he did not understand. On April 20th 2020 I lost my husband to Colbert. No one should have to wonder how they will make right while dealing with the loss like the. But that was my reality. Mhm. We have all experienced hardship during the pandemic.
But it is more common for seniors to3141 experience these kinds of life events as you heard from others. Health care is one expensive that I was not prepared for. I never imagined that Medicare will cause so much My income is under $2,000 a month. I paid over $400 a month in Medicare for me. And I know it will go up. I don't know how much yet, but I know it will be more. And that is the fact Social Security goes up. But Medicare goes up two. So we just don't get it. I struggled to cover necessity of when food and utility and find myself relying on my limited retirement savings come back and be.
But at this rate I won't have it alone. Now more than ever with the extreme circumstances of this pandemic, we need the expansion of the Medicaid savings program. This would help seniors like myself and others by covering a much needed Medicare part b premium. And having the Medicare savings Program increased to 200% of the federal poverty level,3231 eliminating this assets limits. This is a crisis that is if it's not a trick. Well, this place, most seniors at the most vulnerable stages of their life. The time is now for better health care policy that protect and care for us. And3253 thank you for listening to me. SHOW NON-ESSENTIAL DIALOGUE
Thank you rashida. Sarah, are you going to speak or? Hello, you are muted. Sarah.
[SARAH BLAKENEY (MASS SENIOR ACTION COUNCIL):] Good afternoon. My name is Sarah Blakeney I'm a resident of Milton Mass. This year I celebrated my 94th birthday two years ago. I came before you to tell you about my challenge I've faced because of the high cost of Medicare at the time. I paid $400 for each premiums and prescription. And my income was less was on the 14,000 dollars. Thank you. In 2020 I was able to get Medicare savings program for the first time. It helped me a lot. I don't have to pay the premium anymore. And it really has paid my medication.
I used to pay $10-$15 for each prescription. But now I don't have to pay for $3.60. I can't begin to tell you what a difference that made. I am here because I know there's so many seniors that is struggling with the high cost of uh cost of Medicare and that's not right. We're asking you to just use a little of the federal money to help3359 seniors like me to avoid their health care, please expand the Medicare saving program. The 200% of federal poverty level. Thank you so much for listening.
[FRIEDMAN:] Thank you so much testifying. Uh, that's it on the panel. Right, Blame. Okay, so thank you. Thanks to the three of you. Excellent, excellent testimony. As usual from the mass Senior action council and have come to not expect anything less. Please please send our very best wishes to Edna. Um, and we will very we will take a look at this and um, and see where it's at and see what if anything we can do with ARPA money. But again, thank you so much for your testimony and thanks for hanging in there, ladies that it's a long day for you. So um take care.
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Thank you. Okay, Thank you. You're an amazing woman. I've come to you today, having been with you since 11:00 this morning in your face. Uh, run a trooper. Okay, um, Lynne Parker, Elizabeth Soul. We own a nelson Davies. Hello, good morning or Good afternoon, Mrs Lynne Parker. You how are you? Just fine.
[LYNNE PARKER (MASSACHUSETTS LEGAL ASSISTANCE CORPORATION):] Um, so thank you for your time. Thank you for the immense investment you've you've afforded us all today. Thank you. Chair Friedman and chair Hunt in the honourable members of the3459 joint committee for your leadership and for affording me the opportunity to speak today. You may see that I'm named on two panels. but my testimony here is3469 will be addressing issues raised by both panels. My name is Lynn Parker. I'm the executive director of the Massachusetts Legal Assistance Corporation. MLAC is the largest funder of civil legal aid programs throughout the commonwealth. These programs provide vital services to low income people and have been providing essential services to people in need throughout the pandemic.
With the availability of American rescue plan funds, it provides a unique and important opportunity to put critically needed programs in place to expand services to low income and vulnerable people served by legal aid providers across the state. I'm here today to voice support and to urge the use of ARPA3510 funds for two specific proposals which you'll hear more about in more specific terms from my colleagues who will follow me here. The proposals are the expansion of medical legal partnerships with legal aid programs in a pilot family preservation project. In brief medical legal partnerships between health care providers and legal advocates developed across the country as an efficient and effective method to identify legal issues connected to urgent health problems.
Partnerships between health care providers and legal aid providers who understand the particular challenges that low income people face work well as they enable health care providers to leverage the resources and legal expertise available at legal aid programs to best meet patients needs with the ongoing and persistent impact of COVID 19 on the health of low income and vulnerable communities. I urge the use of ARPA funds to expand funding for MLPS as a very cost effective and successful model to meet the increasing health related legal needs of vulnerable populations across the state. I also want to speak to and support funding for family preservation project.
This project would stabilize at risk families and avoid foster care placements by providing needed legal aid and supportive services to at risk families living in communities with substantial low income minority populations. children often end up in the foster care system because of underlying poverty related issues that have legal solutions, modelling other successful programs across the state legal aid programs in Massachusetts envision a family preservation pilot project to provide needed civil legal aid and related supportive services to enable families to remain intact. Additionally, designating MLAC to administer the ARPA funds necessary to support the legal aid, medical legal partnerships and a family preservation project makes good sense.
As many of you know, as with the state3626 appropriation funding that hemlock receives for civil legal aid and funding for several other projects from various other funding sources. MLAC skilfully manages applications for funding, requires regular reporting from the programs and funds, tracks data reports and outcomes and engages in program monitoring and evaluation. MLAC has a longstanding and proven track record of having the ability the capacity and the infrastructure to manage and oversee complex projects for civil legal aid. So when I thank you for your strong support of legal aid and thank you so much for this opportunity today, I really, really appreciate the significant time you're investing in this immensely challenging effort. Thank you.
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Thank you very much Elizabeth, are you next or I am?3641 Okay.
[ELIZABETH SAULE (METROWEST LEGAL SERVICES, FRAMINGHAM):] Thank you. Um thank you to the committee chairs for holding this very important hearing and allowing me to testify. My name is Beth A. Saule. I'm the executive director of Metrowest Legal Services in Framingham uh, for those of you who may not be totally familiar with the concept of medical legal partnership is a health care delivery model that formally includes lawyers on a health care team to address legal issues that drive poor health and contribute to population health inequities.
The MLP approach combines the expertise of health and legal professionals to help3676 identify address and prevent health harming legal needs, health harming, legal needs, being social problems that adversely affect a person's health or access to health care and is better remedied through the joint legal and health care system than through health care services alone. MlPs have existed for several decades and currently there are 17 operating in Massachusetts. This holistic approach to delivering legal services and medical settings such as community health centers, hospitals and clinics maximizes the ability of the client to solve multiple legal problems and be connected with wrap around services. MLPs, improve health outcomes, increased patient engagement and lower health care costs.
Families often ask health care providers for help with issues that cannot be resolved in an exam room or with a prescription. Oftentimes, low income patients need to extend well beyond the scope of traditional medical or behavioral health care and there are substantial environmental, physical and emotional3735 risks that correlate with living nearer below the poverty level. The MLP model makes attorneys as a member of the health care team where they are available on site to address unmet social and legal needs of patients that directly impact health outcomes. The COVID pandemic has both exposed and exacerbated the existing health disparities in Massachusetts, it's brought to light the critical importance of health equity on our vulnerable communities, whether they be low income communities of color, immigrant communities, those with disabilities and seniors as patients, health harming legal needs continue3770 to grow
As a result of COVID legal3774 advocacy is an increasingly important component of patient care and the medical setting.3778 Existing MLPSs have been able to efficiently evolved3781 to be responsive to patients increasing needs. But it has become very clear that more communities would benefit from having MLPS to meet the increasing3790 health Markey legal needs of the vulnerable population. So, unlocking in the regional legal aid programs who currently operate them see the use of ARPA funding to meet three goals. To stabilize the funding for existing ARPA funding for existing MLPS. To bring back dormant MLPs that ended due to a lack of funding and to expand the number of MLPs throughout the commonwealth targeting underserved populations. Funding is sought for work over a three-year period in the amount of 6.8 million. And with that I will turn it over to my colleague Weayonnoh Thank you.
[WEAYONNOH NELSON-DAVIES (COMMUNITY LEGAL AID):] Thank you, thank you so much for the Co-chairs and the joint committee for the opportunity to speak here today3830 and for hanging in3832 there with us. My name is Weayonnoh Nelson-Davies and I am the management attorney at Community Legal Aid in central and Western, Mass. As someone who has spent most of her legal aid career as a medical Legal partnership Attorney and currently as a supervising attorney of Community Legal Aid's medical legal partnerships with you Master Moral Healthcare. The impact of MLP is near and dear to my heart .
So I'll use my time to talk about how MLP have had3862 impacts with the patients who have served in the past year. The COVID 19 pandemic has made it clear the health care assistance benefit from having MLPs to address social determinants of health and many other health harming legal needs in order to promote health equity and access to justice in the vulnerable communities. We serve. For example, in the last year, community legal aid's medical legal partnership attorney received an average of 15 referrals a month and provided at least 20 consultations per month to medical providers.
40% of those cases referred with housing issues followed by 30% of unemployment and public benefits cases. MLP Are often able to uncover additional legal barriers harming the overall health of patients or referral for an unemployment matter leads to discovery that that mother doesn't have enough money to pay for rent, food or healthcare needs. She will then reveal when she speak with her attorney that she is a victim of domestic violence wanting a divorce from her abuser. She lets her attorney know that she is in an overcrowded home where her autistic child is included in her bedroom for many months during the epidemic while her other child is sleeping in the dining room. T
his is an actual referral we recently received from a medical provider. Yeah. Yeah. Other words of one of our young MLP client mothers who have tried for months to get him special education services after we represented him and he received the services he needed. She stayed at it is almost like I had a megaphone. The lawyer was my megaphone and they were able to hear, I did not feel like a whisper screaming out of people. It really helped me. Through. MLPs more and more medical providers recognize that achieving optimal health for the patients involved addressing health, health harming legal stressors and barriers in their life.
Medical providers have referred to MLP as the lifeline for them and their patients and I will end with this. These words of my care manager at U Mass Memorial that captures the essence of medical legal partnership. And I read I think we have had a true awakening and a real broadening of the understanding of how people live and how that affects our health care and how together with care management, health care and legal aid we can better address some of the barriers our patients experience. Thank you so much for your time.
[FRIEDMAN:] Thank you so much. That was really really compelling testimony. Thank you. Thank you all. Um we will take a look at this. Absolutely learned something today. I've learned a lot of things today but this is another thing that I've learned. So thank you.4047
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Um is there another um group that's testifying Lynn you said that you were part of another panel? Is that panel or people on that panel? Still here? Yes they are. Okay. Thank you. Thank you very much. And now I will ask um laura gal and Susan nelson. Okay thank you. I'll let citizen go first if she's is available. I'm here. Senator nelson. Okay you see me here. Yes. Take a Yes.
[SUSAN ELSEN (MASS LAW4092 REFORM INSTITUTE):] Good afternoon chairs and members of the committee and thank you for your endurance. A statewide support center for the Massachusetts legal services programs. Thank you for the opportunity to talk to you about the family preservation project which would provide civil4116 legal services to address the issues that put low income children at risk of entering the Massachusetts foster care system so that they can instead stay safely at home. Too often, low income children and particularly children of color enter foster care because of unaddressed issues of homelessness, domestic violence or their families, inability to access services and supports their eligible for these issues have have of course intensified during the pandemic with many families losing income, housing and childcare.
Each of these losses impacted communities of color. Color the hardest, putting them at greater risk of losing their children to foster care. Even before the pandemic children of color entered foster care at over 2.5 times the rate of white children and these disparities will only increase4169 as children return to school and back into the public eye. This project will target the crises that poverty and the pandemic have created and exacerbated for families rather than allowing them to mushroom into family separations following successful models. And at least eight programs around the country in the family preservation project.
Teams of of civil legal aid attorneys, social workers and parent advocates with lived experience in the child welfare system will work with families to address the issues but put their children at risk and we'll avoid the child trauma, family disruption and tremendous cost to the commonwealth of a foster care placement, A relatively modest investment of 1.6 million per year for three years as a bridge to sustainable long term funding compared to the 608 million that Massachusetts spends each year on foster care Would provide these multidisciplinary teams in five legal aid programs across the Commonwealth.
Imagine, for example, a victim of domestic violence whose children are at risk of foster care placement. The children could remain with a parent if the abuser were kept out of the home and supervised when with the children. Additionally, the parent needs access to domestic violence counseling, therapy for the children, Mass health and cash assistance and may also be facing eviction. The project team drawing on the resources of their legal services office and its deep ties in the community could address all these issues, stabilize a crisis and keep the children out of foster care.
This model has an impressive track record of avoiding foster care and has also reduced the need for children to change school districts, thereby increasing their chance of graduating from high school reduced racial disparities and foster care and save states the enormous cost of foster care and court proceedings. We4289 urge this committee to invest a total of $4.9 million dollars over three years for in bridge funding in the family preservation project. We'll have more information in our written testimony and we're happy to answer any questions. Thank you so much for your time.
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Thank you and girl
[LAURA GAL (GREATER BOSTON LEGAL SERVICES):] Yes, thank you. Good afternoon Senator Friedman and representative hunt and committee members and thank you for taking time to hear about this much needed statewide project to address the health and well-being of children. My name is Laura Gal. I'm the managing attorney for family law at greater Boston legal services. And I see4336 firsthand the benefits of coordinated advocacy between legal services and the Department of4343 children and Families. We know that COVID-19 has had a disproportionate impact on black and brown communities in Massachusetts.
DCFs 2020. Annual report also tells us that Hispanic and black families continue to be disproportionately represented in the DCF Caseload. We anticipate that more families in need will be identified by DCF in the coming year. As children return to school, survivors of domestic violence can more safely seek out help an eviction moratoriums and enhanced unemployment benefits. End for some, the difference between family preservation and family separation will depend on successful navigation of our district Probate and family and housing courts when families are referred to legal services.
Foster care often can be avoided. The use of ARPA to to support families that are capable of caring for their children but who need help navigating legal and administrative systems in order to secure financial support protection from physical violence housing and SNAP and other4410 public benefits would meet the needs of our communities and would also meet the4415 criteria for appropriate allocation of ARPA funds. The majority of greater Boston legal services.4421 Family law clients are survivors of domestic violence with minor children and most live at or on either side of the poverty threshold.
As a result, many are financially dependent on their abusers leaving the home can mean losing housing and needed financial support. We help clients obtain abuse prevention, custody and child support orders. We helped secure housing and public benefits were appropriate and we work closely with social service providers to make sure families collateral needs are4455 met. So this is work that we are already trying very hard to do. Um and in addition we are trying to target DCF. DCF involved cases. Greater Boston Legal Services currently has a pilot project with funding for a single lawyer acting under a two-year fellowship to try to get this going during the pandemic.
Similarly, community legal aid is pursuing funding to pilot a multi professional project as we recover from this pandemic, we must help all families and especially low income black and Hispanic families to stabilize so the children can be spared the additional trauma of family separation. The family preservation project would allow the Department of children and Families to direct appropriate families toward legal services in away from the foster care system. Leaving DCF more resources for the families that remain in a better chance of stabilization for all families. Thank you for your time.
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Thank you very much. Thanks for your testimony. Um Okay and4525 uh lin you already went. So I'm gonna move on to the next panel. Um Okay, uh the next panel I believe is linda Kenney and Liz Friedman Betsy Lehman Center, are you here? Okay. Um, is Gail Forbes here. Okay, um Alexandra Cherry Daniel Bennett and Rachel Rodrigues Rodrigues Yes, yes, we are here. Okay, play right.
[RACHEL RODRIGUES (LOUIS D BROWN PEACE INSTITUTE):] Hi, good afternoon. Um, my name is Rachel Rodrigues I am one of the co-directors of the Louis D Brown Peace Institute. I'm also a survivor of a homicide victim. Senators and representatives. It's a privilege to testify before you today on behalf of the Louis D Brown Peace Institute. We are respectfully asking the legislature to stabilize victim service programming in Massachusetts as organizations grapple with the devastating impacts of COVID-19 on victims of crime as well as survivors and underserved and disproportionately impacted communities.
Funding through the American Rescue plan Act can provide a unique opportunity to innovatively support all crime victims services in Massachusetts. We are also asking for an investment of 3.5 million. Specifically for the Louis D Brown Peace Institute for the sustainability and growth of our services to communities impacted by violence in the commonwealth. The Louis D Brown Peace Institute is currently a recipient of Ocha front funding excuse me administered by the Massachusetts office for victims assistance. VOCA funds make up about half of our budget for direct service work to survivors of homicide victims in the state of Massachusetts.
Primarily our survivor outreach services which assists families within 24 to 72 hours after homicide. Our specialized4678 staff walk families through their immediate next steps after death notification. They address practical needs and they ensure connection to all the resources that are available to them regardless of the circumstances surrounding the homicide funding available for VOCA grants is historically low as you've heard today and any decrease in the funds available for disparate. We're just distribution results in a decrease in the number of victims and survivors that are served as well as potential loss of essential staff for victim service programs like ours.
So a state investment through ARPA will allow MOPA a to work with culturally specific programs like ours to provide technical assistance and ensure success without the administrative barriers required by federal funding. Every year, whether or not homicide rates increase or decrease, the survivor rate continues to rise. Our services to survivors of homicide victims. It doesn't end after the funeral and we continue to serve families in the months and the years after. Since the start of the pandemic, the demand for our services has only increased the demand far exceeds the support we can provide via our VOCA funding alone in order to adequately serve families and do even more to transform societies response to homicide and gun violence, which we desperately need right now.
We're advocating4764 for increased investment from the commonwealth. 3.5 million over three years would allow us to continue to be the leading survivor lead and community-based service provider focused on supporting the communities most impacted by trauma and gun violence in the commonwealth. We need to both sustain and grow our staff team provide4782 them with training benefits and invest in their growth. The majority of our staff and leadership are also survivors of violence. My4791 colleagues on the panel, we'll go into more detail about the needs, best practices services and advocacy we are providing. We respectfully ask for your support of movies, request for an investment from the commonwealth to medicate the declining VOCA funding and to also prioritize funding to the Louis D Brown Peace Institute, which again, we are survivor lead and community based organizations. Thank you for your time and I'll turn it over to Alexandra.
[ALEXANDRA CHERY (LOUIS D BROWN PEACE INSTITUTE):] Thank you Rachel. I'm Alexandra, co-director of the Louis D Brown Peace Institute on behalf of the Peace Institute. We are respectfully asking the Legislature to make an investment and survivor lead and community based support to survivors of homicide victims in the commonwealth. Funding the Peace Institute from the ARPA provides a unique opportunity to address short and long term needs of communities most impacted by gun violence. We want to thank our legislators for the current $200,000 line item already allocated to the Peace Institute.
The Peace Institutes model is in line with the CDC social ecological framework that states in order to interrupt cycles of violent interventions must happen at multiple levels. We do this work through our services, advocacy and training are consistent, coordinated services meet families in the initial stages after a homicide and walks them through step by step what to do until funeral and burial using are survivors burial and resource guide. We guide families through the many systems they must now interact with, including the many layers of the criminal justice system. We support returning citizen’s reentry and work with families of incarcerated loved ones to promote a healthy collaborative reentry and support plan .
Simultaneously, We support families with their ongoing healing through our grief support group workshops and while we're able to meet their practical and emotional needs, we also assist with financial needs to our rest in Peace Fund so families can bury their loved ones with dignity and our live In Peace Fund that provides emergency financial assistance such as rent, mortgage utilities. Um and that also includes4916 safety relocation.4917 Our advocacy includes the coordination of two statewide networks of providers network and the survivors of homicide victims network.
Our training equips providers, healthcare workers, educators, legislators, law enforcement, gun violence prevention coalitions, trauma responders and trauma teams with best practices to equitably serve survivors of homicide victims.4936 Our training offers consultations to survival at organizations as they build their own programming. The Peace Institute has developed and continues to coordinate the city of Boston homicide response protocol. Throughout our 27 years, we've identified a consistent emergent need for survivors of homicide victims and surviving victims of violent crime, which is immediate access to emergency housing relocation.
By allocating 3.5 to the Louis D Brown Peace Institute. $3.5 million. Excuse me to the Louis D Brown Peace Institute. We will continue to provide consistent coordinated4970 services and meaningful emergency housing support which includes safety accommodations in undisclosed4974 locations, travel to and from that location first and last month's rent brokers, fees and4977 moving expenses. We respectfully ask for your support to prioritize funding to the Peace Institute, the leading community based4989 homicide response agency and the commonwealth. Thank you for your time and I'll turn it over to my colleague Danielle.
[DANIELLE BENNETT (LOUIS D BROWN PEACE INSTITUTE):] Thank you Alexandra. Thank alexander dignity, respect, equality, equitable and effective response to homicide victims, families5000 and victims of violent crime. These are just a few things that we talk about here. I have had a front row seat in this community of survivorship from the devastating loss of my cousin Sherrice and having to pick up pieces and help my family move forward as an advocate. I sat across the table from too many families to offer some sort of assurance that their loved one will be laid to rest with the utmost respect regardless of circumstances.
I sat in the front line with our survivors of homicide victims network and our serving survivors of homicide. The riders network to advocate for the change to amend the victims conversation language to be able to dismiss the shame that is once caused the to families being denied funeral. Very assistance. I sat5039 at tables offering my ear and hand to support families who have returned to the pieces to with the need to add creative spaces, killing workshops, educational programs, driving classes. This is in a few two, keep your love with memory alive, not only in their world, but lots of others.
We have been able to provide these through the many dozens of other families twice a year with the exception of 2020, where we were able to provides services as mentioned to the rent and mortgage, things like that. Basic needs to meet family’s needs. So now getting referrals from the agencies who trust that we will find a way when we really don't have one like this need for emergency housing, specifically for survivors of homicide victims that is beyond emerged at this point, the bills are being displaced due to crimes committed by others against them in their families.
As I mentioned, eyewitness families go from the first day of this trauma and life changed to no longer feeling safe in the neighborhood that they grew up with. So after finding a sense of5091 safety and security and the courage to get up and get out and advocate on behalf of others who are facing similar accusations. Unfortunately, what I've also witnessed is that for those who do not have the means to pick up their lives and find safety tragedy may strike as they become victims when they were seeking support from system and was not a part of the guidelines by being physically homeless or fleeing from domestic violence partners.
Just the mother was asking for system to recognize the child is potentially going to end up on the other side of the yellow tape and then she might become eligible to receive services. Point in case in real time A family of five single mom who fled fled to Massachusetts from a domestic violence partner. Her 20 year old, 22 year old son was survived his multiple gunshot injuries from being shot in front of her home, natural fear, stress and anger sudden she no longer feel safe having to live in fear that they will return in this time, possibly commit murder on her son or one of the other four children.
The business too has spent in excess of $12,000 on this family alone for a small hotel room 30 miles away from their from their home just to provide some sort of safety and security. I'm still on the phone as we speak, emailing zoom calls, advocating for this is exactly how we interrupt the cycles of violence when a family who has not yet experienced loss due to turn her5170 away and she becomes a headline. The ARPA5172 funding would be a beneficial in providing not only a sustainability but the equitable and effective change that is very much needed. Thank you for your time.5189
[FRIEDMAN:] Thank you. Thank you very much for your testimony. Um, we appreciate it, appreciate you taking the time to come and speak with us.
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Okay, Mark Hughes does here. Can you see me? Okay.
[MAURA HUGHES (BOSTON MED FLIGHTS):] Yes, great. Um, so my name is Mark Hughes, I'm the CEOof Boston MedFlight and Boston MedFlight is a nonprofit organization. We reform 36 years ago and our mission is to care for the region's most critically ill and injured patients whether it's a trauma patient, um, you know, from a car accident side of the road um or taking a a patient from a community hospital into one of our world renowned teaching hospitals with four bases. Um in Lawrence, Bedford, Mansfield and Plymouth We care for over 5000 patients every year and we have cared for over 85,000 patients. Um since our inception and we do this with our fleet of helicopters, are ground critical care ambulances and our airplane, all of which are outfitted with state of the art medical equipment and basically serve as mobile. I see us.
So critical can't transport is an essential part of the commonwealth health care delivery system. No, not all hospitals can be everything to every patient, but there needs to be a way of transporting these patients throughout the health care system um, in a safe and efficient manner and that's Boston MedFlight inefficient During the COVID-19 pandemic Boston Med flight has played a critical role in5290 health care systems. Response to date. We have cared over for over 1650 critically ill. COVID patients moving them throughout the health care system, ensuring that no hospital5304 or no I see you is overwhelmed with patients with the availability of ARPA funding.
We have identified two potential spending areas um in line with our mission number one infrastructure to support helicopter air ambulance operation with GPS approaches and FAA certified Automated Weather Reporting Stations and number two Critical Care Transport. So GPS approaches are basically instrument procedures serving as electronic roadmaps in the sky to safely guide helicopter pilots, two helipads using satellite technology and include inclement and marginal weather. While5348 there are some GPS approaches being utilized in Massachusetts, we have identified approximately two dozen hospitals and communities in the commonwealth where GPS approaches are lacking.
Also needed to support helicopter ambulance infrastructure are several additional FAA certified automated weather reporting stations needed to5366 plan safe helicopter operations in remote locations in the commonwealth. Similar to what you find at major airports. These weather stations provide real time conditions to pop pilots and will be accessible to all aviation users, um improving patient safety. And secondly, we ask consideration for critical care, transported5417 Massachusetts, funding equipment, aviation equipment, vehicles and simulation um equipment. We must be considered and we will provide more detail in written testimony. Thanks very much.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Uh Chessie Petrus Chelsea. Okay, Samantha lifton Samantha, are you here? Okay. Peter Macy and heather. Connors, we're here. Thank you. Just waiting for Peter to start, I will start instead. Okay,
[HEATHER CONNORS (CENTER FOR GUARDIANSHIP EXCELLENCE):] Thank you. Chair Friedman and Chair Hunt for5449 the opportunity to speak today. My name is heather Connors and I'm the executive director of the Center for Guardianship Excellence. I have a PhD in gerontology and I direct and conduct research on social, medical and financial aspects of guardianship. I've also had the opportunity to manage one of the elder affairs state guardianship contracts. Today I'd like to speak to you about the need for better monitoring and training of guardians for adults.
I recall once being in court5473 waiting for a hearing on one of the cases that I managed in watching a nervous middle aged woman standing in front of the judge. She agreed to be named as5483 her elderly aunts guardian. Despite the fact that protective service had testified that elder non cooperative would not deal, would not accept services. Excuse me from home care providers and was non-compliant with medications. There were no requirements that the niece received training on how to be a guardian or what services were available to her aunt? The judge simply appointed the woman as guardian. Thank her for her service and dismissed her. I remember wondering what it was like to be that nice.
Did she have children of her own at home? Did you wear full time? How is she supposed to make this guardianship work on top of all of her other responsibilities.5518 It seems scary and overwhelming. COVID really highlighted the need for better support for guardians Court service centres were not readily available and some of the services that families relied on, like ARPA grants for disabled adults were not running uh resources that they could access from home on their own schedule. While the Center for Guardianship Excellence has begun building an online on demand curriculum for guardianship education.
We wish to expand our offerings5542 and make them available in Spanish as well. ARPA funds would cover the creation of materials that could be housed in our learning management system and accessed by learners for free. This onetime expense would have long lasting benefits, especially the low income families were unable to pay privately for a lawyer or case manager. The National Probate Court standards recommend that courts monitor the well-being of a person under guardianship in the status of the person's estate on an ongoing basis.
A report based on a survey of judges and court administrators found that in5574 many cases guardianship monitoring is being neglected as a result of shortage of staff and resources. Unfortunately, Massachusetts is no exception. The commonwealth does not collect data on the individuals under guardianship, those serving as guardians or the outcomes of such arrangements. Nor are there any requirements for training experience or clinical supervision for court appointed guardians and conservators. The Massachusetts Guardianship Policy Institute held a colloquium on guardianship oversight in December 2020.
Representatives from Pennsylvania New Mexico Minnesota Idaho and Utah presented on their courts on how the courts monitor guardians. The presentation shared a common theme. The need for data collection, participants from Minnesota and Pennsylvania shared information on the court software systems. They collect data from the time of the guardianship petition and are able to assign flags when issues of concerns occur similarly, Idaho uses a differentiated case management system where the system assigns different interventions such as a status hearing or court monitoring visit depending on what the Guardian reports.
As we consider the components for monitoring system for Massachusetts were able to build upon the systems created by our colleagues in other jurisdictions. COVID highlighted the probate and family courts need for improved technology. Many forms are still submitted on paper with original signatures. It takes time for humans to process the paperwork for from a hearing and get the guardian assigned decree by mail. While the court has risen to the occasion by using zoom and updating some processes. News technology would certainly improve things monitoring guardians is not an academic exercise. Its aims to protect those under guardianship.
People under guardianship are some of the most vulnerable in our society and it is the responsibility of the court and all of us to make sure that the people assigned to oversee their wellbeing are keeping them to bargain is need to be trained, supported and monitored on behalf of the Massachusetts guardianship policy institute. I respectfully ask you to approve ARPA funds to pay for upgrades and technology and training to support those under guardianship. Our panel will be submitting written testimony as well as a fact sheet detailing our request. Thank you for your time and consideration.
SHOW NON-ESSENTIAL DIALOGUE
Okay, peter. Yes, thank you. I'm sorry, I was on mute when I was called.
[PETER MACY (PUBLIC GUARDIAN SERVICES):] Good afternoon chairs. Thank you Committee. A moment of silence for seven hours of testimony that you have handled masterfully. You look just as attentive now as you did seven hours ago. Um I'm executive director of a company, a nonprofit that sponsors public guardian uh services. Heather is also an affiliated organization, the Center for Guardianship Excellence. Thank you Heather for those words and I'm we're going to hark back to Scott Harshberger, former Attorney General Scott Harshberger testimony uh no five hours ago.
Um and we're supporting what he mentioned uh which is to request funds for the guardianship oversight that Heather just described. I want to point out that our request echoes the request of a number of other prior witnesses were looking for ARPA funds for software development. I think like us, they recognize that this is an appropriate use for non-recurring budget allocations in our case. We’re requesting 5.2 million to design, build and operate a statewide IT system for guardianship case management and oversight which would to mention some of the things Heather had mentioned, begin tracking how many cases there are and where they are located, create searchable databases.
So we would know, courts will be able to look up, for example how old guardian people under guardianship are,5794 where the cases are located. The reasons for guardianship, how much property is managed by conservators. The states that have these kinds of systems, Pennsylvania Minnesota can tell you $1.2 billion dollars is under conservatorship, being managed by conservators who are court appointed. And that's really important information to have. Um, reports would be reviewed electronically and artificial intelligence would be applied to pick up red flags as heather mentioned. COVID-19 exposed the inadequacies of the paper system.
We, there are no hard numbers, but we estimate about 30,000 guardianships in the state. Uh, that's all being all the reports and oversight are self-Filled reports that are filed in paper stuck in five miles. And the only way to access them is to open the file and read them. Uh, so when COVID hit the volunteers who read these reports couldn't get in to open them. So nobody's read them. We don't actually know if there have been abuses in the last 18 months for many, many cases because no one's been able to read the reports. Uh, Kind of, it's not the courts fault.5859
We're not in any of the probate court has been a marvelous partner in creating Public Guardian services 100% behind it. They just don't have any money and we want to try to get them some of that money. Um, we uh, I want to mention finally that this is a leveraged request In order to do manually with 30,000 cases. What this software would do would cost, we have to staff dozens of people for every year, Millions of dollars a year. So $5 million dollars here. We'll get us $30 million 10 years. Um, and finally,5895 I guess my last point is that we've been lucky so far in Massachusetts.
No scandals, California has not been lucky. North Florida or Nevada or some other states. Um General Harshbarger mentioned our reputation as a5907 state that takes care of its own and does things right. This is the way to do this, right. It's a hard time to bring this up. Might I have been moved to tears by so many prior speakers? Not just because they're great speakers because their issues are so vital. Uh, but this is serious and this is a real opportunity. I hope you'll take it seriously. I do think it's tied to COVID. Uh, and we we do have the written testimony to back that up and thank you for your time and God bless you all for being here.
[FRIEDMAN:] Thank you. Thank you. Peter. Yes, we are taking seriously.
[MACY:] Thank you. I have closed bars in my day,5949 but they were never this much work. Yeah. Uh any questions. I'm happy to answer them if you have questions.
[FRIEDMAN:] I think we understand it and I think we'll look forward to the testimony.5962 So thank you.
SHOW NON-ESSENTIAL DIALOGUE
I feel like I've watched um rep Hunter's baby for5970 the day. Like I feel like I was there when he woke up. I feel like I already have blood, looks like he's ready for bed. So great to see him and you uh I have to say your hair lines are exactly the same. We get that a lot is working on the UKulele skills. Excellent. Could use some music right now. Um I'm gonna circle back to uh luh in for lou. You're muted.
[LEW FINFER (MASSACHUSETTS COMMUNITY ACTION6014 NETWORK):] Thank you. Vice Chair Senator Friedman Thank you. Chair hunt. And also for allowing me to come back. I'm going to testify on three issues reentry, one Job Training to and Affordable Housing.6030 three. Um After a death. I think reentry could be the biggest tragedy of for people to experience for the person with their family, for the community um for the victim and then the costs to the courts, the police and the prisons when when someone recidivism happens and there's a very high rate in Massachusetts.
Um there's a very uneven system of little to middle amount done for people before they get out more on the little side. So we're proposing a system of case managers assigned to people as they're getting out to start to work with them on state IDs Mass health application, birth certificate, social security cards that they need to go forward and to help them with the process of applying for benefits that they might qualify for ESSI, EBT, etcetera and most important housing. Um Finding housing and and cannot be better than a shelter or a temporary place in a sober house. Obviously it's very hard with the housing situation but it has to be worked on.
Um The second area is a building acquisition fund that could help there are opportunities to sometimes acquire hotels, motels, um that could be housing for chronically homeless or for residents, additional residential reentry sites. Um There's a good model that just happened recently with the father builds place, acquiring a former motel in Brockton. Um so act with those kind of acquisition6130 have to be worked on and this6133 kind of money is fitting for this. The, the best, best model of this is the Hampton County uh post supporting center that was started by6144 Sheriff Michael Ashe 25 years ago and has an is employing 21 people at 1.7 million out of the Sheriff's own budget.
To do all kinds of support on housing job training um and uh substance substance use, support, all those kind of things and we need that kind of center really in all the different areas of the state. Um moving the job training. Um There's an incredible job, the job training system in Massachusetts. It's is training, I don't know, several 1000 people a year, but with so many tens of thousands6182 of jobs not coming back because of the pandemic and the turnover the economy in areas, you know, like restaurants and hospitality um just to name the top to, we need to train a system that's going to train many, many tens of thousands, so we need a much6201 huger system.
[FRIEDMAN:] Excuse me. Mhm. I'm sorry, these are really important, but could you kind of make the nexus to health care, because this is this hearing is specifically around health care and the health care system. And I want to make sure that the housing people get housing and economic development, get your stuff for job training, but can we just focus on the health care? We feel it's a big enough bucket that, you know, we're going to focus on.
[FINFER:] Yes, okay, so I'll stop, I won't talk on that and um and just on the reentry, it's just the um uh it's just such an you know, some places have virtually nothing for people coming back coming out um and some people have some things and then once they get out, there is a question of where you go, like, you might be able to go to your family's home when you get out, but they may not want you there forever and you may, and that person may not want to be there forever, so then you run into the housing thing, if you don't read run into it the day, people get out, you run into it um soon and obviously, you know, the health connections to homelessness if people are going to shelters. So you've been very patient so I'll just leave it at that and I'm glad he could testify in that. And then the other things to the other hearings and thank you again. Vice chair, Friedman and chair hunt for your patience and letting6294 me come back.
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Thank you. Um lose Friedman You are our last testifier.
[LIZ FRIEDMAN (GPS GROUP PEER SUPPORT):] All right, well let's make it good. Good evening chairs. Friedman and Hunt and distinguished committee members. It's been lovely to hang out in your homes with you all day. And I'm happy to give you your homes back in a second6314 on behalf of6315 GPS Group Peer Support and the Betsy Lehman Center for Patient Safety. Thank you for your stamina to hear all of us all day. Um when COVID 19 took hold in our communities, my husband was seeing patients in an urgent in an addiction clinic. My brother in law at an urgent care centre. My nephew at BMC’s ICU. Dear friend, a nursery assigned to a COVID floor. My staff members, Mother and Soldiers Home. They did what they needed to do.
They never questioned their responsibility, but they suffered from relentless exposure to illness here. Good grief, isolation and and so much death. My brother6356 in law retired early. My nurse friend quit her job. I begged my husband to take a leave of absence. He wouldn't the consequences to health care workers, Mental health has been overwhelming and needs our immediate attention. We are having a workforce crisis that will only get worse if our mental health crisis is not addressed. Depression, anxiety and suicide rates are up for front line health care providers with 49% experiencing anxiety, 87% increased stress, 16%, increased alcohol and drug use 25% with probable PTSD and 37% wanting to retire within a year.
50% could be at risk for6399 one or more mental health problem, including acute traumatic stress, depression, anxiety, problematic alcohol use and insomnia, with the rates comparable to those from 911 and Hurricane Katrina. But nearly 50% report not feeling comfortable seeking mental health treatment. Not only is addressing health care providers mental health the morally right thing to do. It's the prudent thing to do. When we let health care providers suffer from mental health issues, we threaten the ability of our health care system to deliver high quality healthcare, retain employees and address the workforce crisis, which has been an overwhelming part of today's testimony from so many.
Thus we6436 increase our medical costs, diminish our ability to be responsive in the next emergency and jeopardize our workforce. For all these reasons. We firmly believe that four million in ARPA funds should be allocated specifically to support the mental health of these essential workers who have held up our health care system over the last 186457 months. We request this money be allocated to support The Mass Strong Proposal, a discrete three-year program that will be run in collaboration between the Betsy Lehman Center for Patient Safety. and GPS Group Peer Support. Eligible healthcare workers would include medical providers, but just as importantly nursing home staff, long term care and home care workers and all hospital staff, including those who clean up after the ill fed them and cared for them after they died.
This includes a large number of people of color, recent immigrants and lower wage workers. The Mass Strong Proposal6494 would consist of online group mental health care utilizing the GPS group Peer support evidence based in trauma informed model, which has been successfully implemented at DPH Bureau of Substance and Addiction services to since 2019. This proposal includes payment of clinician’s technology to support an online mental health group infrastructure as well as participation stipends and employer incentives, both of which increase engagement.
Not only is this the morally right thing to do, but it's a critical investment in emergency preparedness, our efforts to retain the health care workforce and the long term well being of those who cared for us during the hardest days of COVID and continue to this day. Thank you for your attention. Uh, my co panel member needed to leave. I'm happy to answer6538 any questions, but I'm also happy to go woo you guys did it. You listen to6545 all of us and I wanted to be really early, but I'm glad that I was the last because I got to hear everybody. And it was it was quite a powerful day. So thank you so much.
[FRIEDMAN:] Thank you. Think it was very fitting that we ended health care um with focusing on the needs of our health care providers. So it worked out for everybody. So thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you very much. Uh we have now come to the end of the registered testifier as6587 I do not believe that there is anybody else out there who has signed up um6595 that we missed. If we if you have uh speak now or forever, hold your peace. Great. I asked for a motion to adjourn this hearing, motion to adjourn. So I hear a 2nd 2nd. All right, this hearing. Thank you everybody. Thank you to my great, great co chair and to everybody. Um oh my um uh colleagues who were here today. Thank you all for your time and your energy. And um this hearing is adjourned. Thank you. Take care
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